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Radical chemo irradiation with IMRT in elderly patients is a feasible option. Long term local control and overall survival benefits needs to be followed up.

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Background: Aim of the study was to compare the response of altered fractionation schedule with concurrent chemo-radiation in patients with primary and the nodal disease.Methods: Total of 40 patients (20 in each arm) with stage 1- 4 squamous cell carcinoma of the head and neck with a performance status of 0-2 (ECOG) were included in the study. Arm A was altered fractionation schedule where in patients received 6 fractions per week to a total dose of 6600 cGy in 33 fractions. In Arm B, patients received conventional radiotherapy with concurrent chemotherapy three weekly Inj. of cisplatin (100 mg/m2). Patients were evaluated for acute toxicity every week using the Acute Radiation Morbidity Scoring Criteria. The response was assessed after 6 weeks and 12 weeks post treatment using the RECIST criteria. Data was statistically analyzed.Results: Seventeen patients in Arm A and 18 patients in Arm B completed the treatment. At the end of three months, In Arm A, 7 patients had complete response and in Arm B, 9 patients had complete response of the primary (p>0.05).  When the complete nodal response was compared in both the arms, there was no difference (2 vs 4 in Arm A vs Arm B resp.). But there were more partial nodal responders in Arm B (p = 0.016). The acute toxicities were comparable in both the arms.Conclusions: Altered fraction radiotherapy can be used in early lesions with minimal nodal burden but with locally advanced disease or large nodal burden addition of chemotherapy should not be avoided.

Three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are the three main radiotherapy treatment techniques for cervical cancer. Whether either technique significantly reduces the radiation exposure to organs at risk remains unclear. We dosimetrically compared the irradiated volumes of bone marrow, bladder and rectum in cervical cancer patients using 3DCRT, IMRT and VMAT techniques in those patients with FIGO stage IIIB cervical cancer, receiving chemo irradiation at our institute.  A total of 10 patients were dosimetrically compared. Significant reduction in V10, V20, V30, V40, V50 Gy of bone marrow was observed with IMRT and VMAT when compared to 3DCRT. Similar results were seen with V20, V30, V40, V50 Gy of bladder, and V40, V50 Gy of rectum. While comparing IMRT and VMAT, statistically significant dose reduction was noted in V20 Gy of bone marrow and V20 and V30 Gy of bladder with VMAT. When compared with 3DCRT the use of IMRT and/or VMAT reduced the radiation exposure to bone marrow, bladder, and rectum volumes at various radiation dose levels. VMAT can further reduce the radiation exposure to bone marrow and bladder when compared with IMRT. Thus, we propose the use of VMAT in cervical cancer to reduce the OAR toxicities.

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Background: Malignancies form one of the important causes of pediatric morbidity as well as mortality. These malignancies are increasingly becoming more important causes of pediatric mortality as deaths from other causes such as infections, malnutrition, and heart diseases are decreasing due to advances in field of pediatric medicine. Urogenital tumors form one of the important causes of pediatric urology consultations. This study was done to describe the spectrum and clinicopathologic features of childhood tumors of the urogenital tract in our institution. Aims and Objectives: The aims of this study were as follows: (1) To study the histopathology of childhood tumors of the urogenital system. (2) To describe the clinical, gross, and microscopic features of these tumors. Materials and Methods: This was a retrospective study conducted in the Department of Pathology of Christian Medical College, Vellore, in which children below 18 years of age, in whom biopsies or resections of tumors of the urogenital system was done, were included on the basis of a predefined inclusion and exclusion criteria. Slides of all such specimens were retrieved from the archives of General Pathology. The clinical features were recorded from cases papers. Microscopic and immunohistochemistry findings were studied. Data analysis was done using SPSS 16.0. Descriptive data were reported and compared. Categorical variables were reported using frequency and percentage. Continuous variables were reported using mean ± standard deviation or median (interquartile range) as appropriate. Results: In our study of 100 pediatric patients with urogenital tumors, there were 55 boys (55%) and 45 girls (45%) amongst the studied cases with a M: F ratio of 1:0.81. The most common type of urogenital neoplasm in pediatric age group was found to be Wilms tumor which was seen in 55 (55%) patients. The other common histopathological findings were mature cystic teratoma (13%), mixed germ cell tumor (7%), yolk sac tumor (6%), and rhabdomyosarcoma (6%). Sertoli cell tumor, Sertoli-Leydig cell tumor, and clear cell renal carcinoma were less common and were seen in one patient (1%) each. Conclusion: Urogenital tumors in pediatric age groups form one of the important causes for pediatric urology consultation. In our study Wilms tumor was most common urogenital tumors followed by mature cystic teratoma, mixed germ cell tumor, yolk sac tumor, rhabdomyosarcoma, and immature teratoma.

Introduction: High expression of Human Epidermal growth factor Receptor 2 (HER2) is a predictive biomarker for the treatment of gastric carcinomas with targeted agents. Targeted therapy could improve the outcome of patients with gastric carcinoma overexpressing HER2. There is limited information on mucosal biopsies to characterise the HER2 expression status of a tumour. Aim: To study HER2 expression by Immunohistochemistry (IHC) in matched mucosal biopsies and surgical specimens in patients with gastric adenocarcinoma and to discover the level of concordance. Materials and Methods: This was a prospective observational study conducted in the Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India, for one year (1st July 2016 to 30th June 2017). The IHC for HER2 was performed on matched mucosal biopsies and corresponding gastrectomy specimens of 72 patients. The HER2 overexpression (HER2+) was defined by a score 3+ on IHC. The results were analysed using Statistical Package for the Social Sciences (SPSS) software and Chi-square test was done for statistical significance. Results: The overall HER2 positivity rate was 11.11% (8/72). The HER2 positive rates (score 3+) were 9.72% on biopsy (7/72) and 8.33% on resection (6/72). Five cases showed concordance of HER2 between mucosal biopsies and resection specimens, however the other three cases showed a discordance i.e., two mucosal biopsies showed HER2 positivity and one resection showed HER2 positivity. The concordance rate in this study was 95.83% between resection and mucosal biopsies. Among the eight HER2 positive cases, five cases showed good concordance. One case showed positive shift: HER2 score was 0 on the mucosal biopsy and HER2 score was 3+ on the resection. Two cases showed a negative shift: mucosal biopsy showed HER2 score 3+ and the resection HER2 score 0. All the three discordant cases had received Neoadjuvant Chemotherapy (NACT) and showed heterogeneous staining on the resection specimen. None of the five concordant cases had received NACT and three of the five resections showed heterogeneous staining pattern. Conclusion: To the best of the authors’ knowledge, this was the first study to compare HER2 expression in gastric adenocarcinoma in matched biopsies and the corresponding resections in India. There was concordance of HER2 expression in 69 cases and discordance in three. Differences between biopsy and resection HER2 expression could be explained by intra-tumoural heterogeneity and possibly by decreased HER2 expression after NACT. The HER2 analysis by IHC on both mucosal biopsy and resections could optimise the selection of trastuzumab-eligible patients in case of gastric adenocarcinoma.