Purpose:The aim of this case report is to present a case of orbital mesenchymal chondrosarcoma sarcoma with multiple recurrences, and to report technical details of a contemporary approach for orbital brachytherapy that can be used in low-resource settings.Material and methods: A 46-year-old female diagnosed with recurrent orbital mesenchymal chondrosarcoma of the left orbit presented with her third local recurrence. The patient proceeded with conservative surgery with planned adjuvant high-dose-rate brachytherapy 2 weeks post-surgery. Brachytherapy mold applicator was fabricated using thermoplastic mask, ProGuide catheter needles, catheter fixation buttons, and a strip of gauze. Ideal catheter placement was done with CT simulation planning.Results: High-risk clinical target volume (HR-CTV) corresponded to gross tumor residual, and intermediate-risk clinical target volume (IR-CTV) corresponded to the whole orbit. Flexitron iridium-192 high-dose-rate (HDR) brachytherapy plan was generated using Oncentra brachytherapy planning system. The treatment plan had HR-CTV total dose of 55.6 Gy and equivalent dose in 2 Gray fractions (EQD 2 ) of 96 Gy. IR-CTV total dose was 45.5 Gy and EQD 2 of 70 Gy. The plan was evaluated using dose-volume histogram and dosimetric parameters, which showed adequate irradiation of tumor volume and at-risk areas. The patient underwent orbital brachytherapy without any adverse events, except for mild skin erythema. One-year post-treatment showed no local recurrence and no soft tissue necrosis or swelling.Conclusions: In the previously irradiated orbital sarcoma patient, adjuvant brachytherapy is an effective and safe modality for the delivery of sufficient radiation dose to the target, as presented in the current case report. The materials used in the brachytherapy applicator are easily available in majority of radiation therapy centers and can be manufactured even in low-resource settings.
Background: The COVID-19 pandemic has caused a global public health emergency. High levels of fear and limited access to cancer treatment may jeopardize the delivery of optimal oncologic care, potentially influencing treatment outcomes. This study aimed to identify patients’ and their caregivers’ perception of safety and accessibility of cancer care during the COVID-19 pandemic. Methods: A cross-sectional survey of patients and caregivers at the Benavides Cancer Institute, University of Santo Tomas Hospital was performed from August to October 2020 using a 20-item investigator-developed questionnaire. Results: A total of 207 participants answered the survey. Frequency of hospital visits varied from none to more than ten times in the previous month; but having multiple postponements were uncommon. Eighty-two percent, 77%, 62%, and 55% of participants reported being afraid of contracting COVID-19 from other patients, hospital surroundings, hospital staff, and doctors, respectively. Twenty-six percent and 12% had difficulty finding transportation and passing through checkpoints, respectively. Twenty-eight percent strongly expressed financial limitations in prioritizing cancer care. Participants were amenable to the use of telemedicine and stringent protocols to reduce in-hospital transmission risk, but had some reluctance to spend out of their pockets for screening tests. Conclusion: The perceived safety of cancer care was influenced by fears of contracting COVID-19; and accessibility was influenced by limited transportation and financial constraints. Despite these, multiple postponements and cancelled hospital visits were uncommon. Institutional approaches targeting these concerns will be crucial to ensure safe and timely delivery of cancer care during the COVID-19 pandemic and further mitigate its impact on oncologic outcomes. Key words: cancer care, COVID-19 pandemic, safety, accessibility
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