PurposeBrachytherapy in the oral cavity is an important alternative to conventional treatment, and provides a high localized dose and short overall treatment time. A rapid fall of dose beyond radioactive source makes it possible for increased tumour control and sparing surrounding tissue, while short overall treatment duration reduces risk of tumour repopulation. Moulds are fabricated to hold the catheters in position as closely as possible to tumour surface to provide adequate dose coverage of tumour volume and increase distance to other normal surrounding structures. Image based planning and dose optimisation help in better defining target volume and dose coverage.Material and methodsA retrospective analysis of patients of early squamous cell carcinomas of lip and buccal mucosa from September 2011 to June 2014 to study response to mould brachytherapy. Double plane moulds were prepared for all lip cancer cases and single plane for buccal mucosa cases. Patients are being followed up till disease recurrence. In this study evaluation was done of the technique used, planning details, response to therapy, and reactions encountered.ResultsNine patients treated by mould therapy were reviewed; seven cases were of lip and two of buccal mucosal cancers. Dose delivered ranged from 12.5-48 Gy in fraction sizes of 2.5-3.5 Gy. Equivalent dose in 2 Gy fractions (EQD2) ranged from 18-64 Gy. Maximum dose to organs at risk (OAR) was 91% of prescribed dose. Local mucositis was only reaction in all cases, which resolved in 3-6 weeks. Median follow-up was 19 months. Eight out of nine patients are in remission at a minimum of 7 months (1 case, rest over 14 months) post therapy and only patient had nodal recurrence at 18 months.ConclusionsMould therapy is an effective treatment method for selected early and superficial squamous cell carcinomas of the oral cavity, although indications are limited.

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ACC has locally aggressive behavior. Radiotherapy adjuvant to surgery improves local control in locally advanced disease. Longer follow-up is mandatory in view of incidence of late metastasis.

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Purpose Brachytherapy (BT) forms major treatment modality in squamous cell carcinoma of head and neck cancers (HNC). However, there is a dearth of literature and guidelines for the use in various indications. High-dose-rate brachytherapy (HDR-BT) in Indian scenario is an important treatment modality, and the recommendations in this guidelines aim to provide the necessary recommendations for the use of HDR-BT for uniform application across the country in patients with HNC. Material and methods A panel consisting of members of the Indian Brachytherapy Society (IBS), based on their clinical experience was invited. The process involved defining important steps, precautions, target volumes and indications, thorough literature review, and discussion with fellow members. The guidelines were established and formulated the recommendations for HDR-BT based on available evidences and individual experience for sites, relevant to Indian settings. Results The IBS recommends the use of HDR brachytherapy as a part of treatment of head and neck tumors. The scope of these guidelines and recommendations included practical suggestions, ensuring efficient use of brachytherapy treatment as radical with external beam radiotherapy (EBRT) boost, palliative and adjuvant as definitive, or re-radiation as salvage for HNC in India. The IBS has made specific site-wise recommendations for previously untreated and recurrent HNC patients on their selection criteria, implant techniques, target volume definition, and HDR treatment parameters, such as time, dose rate, total dose, and fractionation schedules. Limited experience exists with HDR-BT in patients with head and neck cancers in India and across the globe. Conclusions IBS provided a consensus statement and guidelines for the head and neck brachytherapy and believed that these recommendations will overcome the fear of practicing radiation oncologists. This should generate interest amongst students and will help radiation oncologists all across the country to use the art of brachytherapy carefully in HNC patients, with better curative and salvage options.

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PurposeSoft tissue sarcomas of the extremities account for half of all soft tissue sarcomas. Radiotherapy and surgery have been the standard modalities in the treatment of this type of cancer. Brachytherapy can be used as the sole therapy, if the target volume is localized and easily accessible. This work reports three cases of shoulder soft tissue sarcomas with positive deep resected margins, treated with a combination of external beam radiotherapy and surface mould brachytherapy boost technique.Material and methodsBetween January and June 2014, three patients received brachytherapy with sites close to the shoulder, and post-surgery involved deep resected margins. Each mould was made on a base of thermoplastic, over which dental wax was coated and catheters implanted. The target volume was defined as the tissue covering the tumor bed with lateral margins of 2-2.5 cm and depth of 1-1.5 cm. Treatment planning was computed tomography-based and dose prescribed was 85-100% isodose. Treatments has been delivered twice daily, six hours interval, and a review of reactions evaluated.ResultsVolume receiving more than 150% of the prescribed dose has been limited to less than 2%, and that above 200% to be inside the mould. Brachytherapy equivalent dose at 2 Gy per fraction (EQD2) of these patients was 24 and 28.6 Gy. Maximum dose to organ at risk (OAR) (2 cc of OAR) ranged between 55-87% of prescribed dose, with a median dose being 80%. All cases had only grade 1 post-radiotherapy skin immediate reactions, which resolved within four weeks. In all patients, no treatment failures were noted at nearly 2-years post-irradiation.ConclusionsSurface mould brachytherapy in soft tissue sarcomas could be a useful alternative to interstitial brachytherapy, especially where the target volume is superficially extensive with underlying critical structures, and where catheter placement may be difficult, such as the shoulder.

Background: Primary gastric adenocarcinoma commonly occurs in the elderly in the sixth to seventh decade of life but is exceedingly rare in children and adolescents, accounting for only 0.05% of pediatric gastrointestinal malignancies. Because of the nonspecific clinical presentation, gastric adenocarcinomas in children and adolescents are often metastatic when they are discovered. Case Report: We describe a case of gastric adenocarcinoma in a 16-year-old female who was diagnosed early and successfully treated with surgery and chemoradiation by volumetric modulated arc technique. Conclusion:The possibility of gastric adenocarcinoma should be considered in children and adolescents with persistent nonspecific symptoms of vomiting and upper abdominal pain so that the diagnosis can be made at early stages and radical treatment can be offered.