BACKGROUNDRadiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional twodimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. Intensity-Modulated Radiotherapy (IMRT) can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This study reveals the role of IMRT in head and neck cancer in view of normal tissue sparing with good tumour control. MATERIALS AND METHODSRadical radiotherapy was given using linear accelerator up to a dose of 66 to 70 gray in 30 to 33 fractions (intensity-modulated radiotherapy with simultaneous integrated boost) over 6 to 7 weeks to 56 eligible patients. Concurrent cisplatin was given to patients with locally-advanced disease up to a dose of 40 mg/m 2 weekly once along with radiation. The patients were monitored weekly once during the treatment for acute skin and mucosal toxicities using the RTOG scoring criteria. After the treatment, locoregional response was assessed and recorded at 6 weeks, 3 months and 6 months intervals. RESULTSSevere skin toxicity (grade III or more) was seen in approximately 7% patients. Severe mucosal toxicity (grade III or more) was seen in approximately 80% of patients. IMRT technique showed better skin sparing compared to 3D conformal radiotherapy. Severe mucosal toxicity was slightly higher in this study due to the simultaneous integrated boost technique used for dose intensification to the mucosa, which results in better primary tumour control. At the end of 6 months, 75% patients achieved locoregional control and residual/recurrent disease was seen in 25% of patients. IMRT offered good locoregional control with less skin toxicity and acceptable mucosal toxicity. The results were similar to the previous study reports using IMRT. CONCLUSIONIMRT is a better treatment option in locally-advanced head and neck malignancies providing good locoregional control with acceptable toxicities.
Purpose/Objective(s): Craniospinal Irradiation (CSI) is standard of care in the treatment of primary CNS tumors with the propensity to seed through the cerebrospinal fluid. Survival rates of patients with these tumors have increased dramatically since the early 1960s because of the advances in treatment and reduction in treatment toxicity experienced. Low/middle-income countries, like Nigeria, continue to experience several barriers to treatment including unavailability of modern radiation treatment facilities. Improved radiation therapy techniques in pediatric CSI aim to improve accurate treatment delivery and reduce acute and long-term toxicity and sequelae. Volumetric Modulated Arc Therapy (VMAT) is a new treatment technique in Nigeria. Although pediatric CSI has been practiced in Nigeria for many years, the use of the VMAT to deliver this treatment is significantly new. We reviewed the first set of patients to undergo CSI at a one-year old cancer center in Nigeria. This series reviews the treatment technique, the progress experienced, dose statistics achieved, treatment toxicities, and current status of the treated patients. Materials/Methods: Five children with histologically diagnosed cancers requiring craniospinal irradiation whose parents consented to the study were recruited and followed through the process of their therapy. All patients had undergone prior surgical resection. Information regarding their clinical history and therapy was noted and analyzed. Doses to the lenses, eyes, optic nerves and chiasm, pituitary gland, brainstem, cochleae, thyroid gland, heart, lungs, liver, kidneys, bowel, and gonads were measured. Results: Diagnoses include intracranial germ cell tumor in 2 patients, medulloblastoma in 1 patient, Pineoblastoma in 1 patient and ependymoma in 1 patient. A dose of 36.0Gy in 1.8Gy daily fractions was prescribed to the entire neuraxis, with a subsequent boost of 18Gy in 10 daily fractions to the primary tumor bed (or posterior fossa) was delivered. Concurrent weekly vincristine was administered when indicated. Toxicity was monitored at weekly review appointments using the CTCAE version 5.0. Acute side effects included: alopecia (100%), hyperpigmentation (80%), nausea and vomiting (60%), headache (80%), leukopenia (100%), neutropenia (100%), and sore throat in 1 patient (20%). All toxicities were grade 1 or 2. No acute grade 3 toxicity occurred in this cohort. At the time of this review, all of the patients are alive and all acute side effects have since resolved completely. Conclusion: Great progress has been made in delivery of CSI in Nigeria demonstrating tolerable acute side effects using VMAT. This series suggests that developing countries, like Nigeria, can safely implement advanced technologies. Additional follow-up will be needed to determine if survival rates and chronic toxicity rates are similar to those of other countries globally.
A 21-year-old male underwent screening for a positive family history of colloid cyst with an MRI scan. This suggested a lesion in the region of the roof of his 3 rd ventricle which was confirmed on a computerized tomography (CT) scan as a colloid cyst measuring 6 mm. Seven-years before his evaluation, the patient's father was found to have an approximately 20 mm colloid cyst with acute hydrocephalus for which he underwent excision. His sister suffered a sudden death at the age of 25. The cause of death was confirmed on autopsy as a colloid cyst which was undiagnosed and associated with acute hydrocephalus. At the time of evaluation, the patient was asymptomatic. On serial imaging in 1-year, there was a definite increase in size of the colloid cyst which now measured 8 mm along its maximum dimension. The colloid cyst also changed in signal intensity appearing more hyperintense on T2-weighted images and fluid-attenuated inversion recovery (FLAIR) sequence. A serial magnetic resonance imaging (MRI) was performed in 18-months as a part of ongoing surveillance with neuroimaging following the first presentation. This demonstrated a decrease in size and change in the shape of the colloid cyst, measuring 5 mm in maximum dimension, with associated decrease in ventricular size and resolution of hydrocephalus suggesting some spontaneous rupture of the colloid cyst. A CT head with unenhanced volume acquisition of the head demonstrated residual partially international organization for standardization (ISO), partially hyperdense colloid cyst seen at the foramen of Monro. This confirmed the findings of MRI with a decrease in size of residual colloid cyst measuring approximately 5 mm in maximal diameter with no residual hydrocephalus.
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