Case PresentationA hypertensive middle-aged female presented to our center for persistent palpitation. She had dual chamber pacemaker pacing 3 years ago for symptomatic sick sinus syndrome and was taken up for electrophysiological study. Surface ECG showed typical counterclockwise (CCW) flutter-like ECG with positive flutter waves in V1 and negative waves in leads II, III, and aVF. Intracardiac tracing showed an atypical flutter pattern with activation from superior (Halo 10) and inferior (Halo 1) tricuspid annu-
Background: External Beam Radiotherapy is the treatment of choice of locally advanced carcinoma cervix (LACC). The two techniques, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), have been compared previously in terms of outcomes and toxicities. IMRT has still not shown any benefit over 3DCRT in terms of local control and survival. Hence, the present study was conducted to compare local control and toxicities among both techniques.Material & Methods: Fifty-four patients of LACC (FIGO IB2-IVA) were randomized to receive 50 Gray in 25 fractions by either 3DCRT or IMRT with concurrent cisplatin-based chemotherapy followed by brachytherapy. Plans were compared for planning target volume (PTV) coverage, dose to organs at risk (OAR), homogeneity index (HI), and conformity index (CI). Patients were assessed for acute toxicity and local control for three months.Results: Out of 54 patients, 27 received treatment by 3DCRT and 27 by IMRT technique. Dosimetric evaluation for PTV coverage was similar in both arms. D15, D35, and D50 (dose to 15%, 35%, and 50% volume, respectively) for bladder were significantly reduced in the IMRT arm. Dosimetry for rectum and bowel bag was similar in both. There was a significantly decreased dose to femoral heads in the IMRT arm. Patients in the 3DCRT arm had significant grade 1 and 2 anemia and neutropenia compared to the IMRT arm. Local control for three months was similar in both the arms. Conclusion: IMRT is associated with decreased acute hematological toxicity compared to 3DCRT with similar local control. Long-term follow-up is needed to assess any difference in long-term toxicity and survival between the two arms.
Background
Despite the high prevalence of locally advanced head and neck cancer, treatment failure in the form of a cutaneous deposit in the treatment field during radiation is not common. There has never been a cytology-proven published case of marginal treatment failure in the cutaneous region during radiotherapy.
Case presentation
A 51-year-old male patient was diagnosed with squamous cell carcinoma of the left tonsillar fossa. After a partial response to induction chemotherapy, the patient was treated with definitive chemo-radiotherapy. After the 23rd fractionation of radiotherapy, there was a clinical progression in the form of a solitary skin nodule within the treatment field, which was further treated with an electron boost to a total dose of 70 Gy followed by palliative chemotherapy.
Conclusion
During definitive chemoradiotherapy, failure outside the high-dose radiation field is not common, and a skin nodule during treatment had never been described. Our case demonstrates the importance of performing thorough clinical examinations on a weekly basis, not only for toxicity assessment but also for treatment response.
Hypercalcemia occurs in 30% of patients of cancer at either as apart of paraneoplastic process or due to bone metastases. It is an uncommon finding in gynecological cancers. Most common in ovarian cancers and till date very few cancer cervix with hypercalcemia have been reported. We, hereby, report patient of carcinoma cervix who was found to have incidental hypercalcemia without any associated clinical symptoms.
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