Introduction:Discussion of bad news and resuscitation in terminal cancer is an important but difficult and often neglected issue in day-to-day oncology practice.Materials and Methods:We interviewed 35 radiation oncologists using an indigenous 15-item questionnaire on their beliefs about breaking bad news and resuscitation to terminal cancer patients.Results:Most responders had an oncology experience of three to seven years (20/35). Thirty-two were comfortable discussing cancer diagnosis, prognosis and life expectancy-related issues. A similar number believed all cancer-related information should be disclosed, while only four believed in imparting all information in one visit. All agreed that disclosing sensitive information did not affect survival. When requested by relatives to withhold truth from patients, 11 said they would not comply, 22 agreed to tell the truth only if asked and two agreed to avoid difficult questions. Twenty responders denied having been adequately trained in breaking bad news and were keen on dedicated classes or sessions in this area of practice. Most (33/35) believed that Indian patients were keen on knowing their diagnosis and prognosis. Although all agreed to the importance of discussing resuscitation, only 17 believed patients should be involved. Majority (20/35) agreed that the issue needs to be discussed while the patient was conscious. Patients with unsalvageable disease were deemed unsuitable for aggressive resuscitation by 30 responders while the rest believed it should be offered to all. Most (21/35) admitted to feeling depressed after breaking bad news though only seven felt disclosure was more stressful than untruthful statements. Only four knew of a law regarding resuscitation in cancer.Conclusion:Observing the widely varied beliefs and practices for disclosing bad news, it is recommended that such training be a regular part of medicine curriculum, especially in the Oncology setting.
CT-guided HDRIBT is a safe and feasible non-surgical treatment option for patients with MLL. It provides effective tumor control and needs to be studied further.
Re-irradiation of second primaries or recurrences of head and neck cancers with moderate radiation doses yields acceptable progression-free survival and morbidity rates.
In clinical practice, evaluation of clinical efficacy of treatment planning stems from the radiation oncologist's experience in accurately targeting tumors, while keeping minimal toxicity to various organs at risk (OAR) involved. A more objective, quantitative method may be raised by using radiobiological models. The purpose of this work is to evaluate the potential correlation of OAR-related toxicities to its radiobiologically estimated parameters in simultaneously integrated boost (SIB) intensity modulated radiation therapy (IMRT) plans of patients with head and neck tumors at two institutions. Lyman model for normal tissue complication probability (NTCP) and the Poisson model for tumor control probability (TCP) models were used in the Histogram Analysis in Radiation Therapy (HART) analysis. In this study, 33 patients with oropharyngeal primaries in the head and neck region were used to establish the correlation between NTCP values of (a) bilateral parotids with clinically observed rates of xerostomia, (b) esophagus with dysphagia, and (c) larynx with dysphagia. The results of the study indicated a strong correlation between the severity of xerostomia and dysphagia with Lyman NTCP of bilateral parotids and esophagus, respectively, but not with the larynx. In patients without complications, NTCP values of these organs were negligible. Using appropriate radiobiological models, the presence of a moderate to strong correlation between the severities of complications with NTCP of selected OARs suggested that the clinical outcome could be estimated prior to treatment.
Background:Phyllodes tumor (PT) of the breast can be categorized into benign, borderline and malignant subgroups depending on various histopathological factors. Although malignant PTs may be indolent and controlled by local excision, they frequently show local and distant relapses. Literature reveals local recurrence to be the predominant pattern of failure and thus emphasizes the importance of adjuvant radiation in these tumors. The role of systemic chemotherapy has remained doubtful.Materials and Methods:We have analyzed details of all patients of PT (n = 33) treated with adjuvant multi-modality approach in our institute since 1994–2009. The demographic data, treatment details, recurrence patterns and salvage treatment options were documented.Results:All patients received adjuvant radiation. Seven patients received adjuvant chemotherapy. The mean survival of the entire cohort was 150.618 months. There was a trend for better overall survival with borderline grade (193.6 vs. 160.2 months; P = 0.08, log rank). The disease free survival (DFS) favored borderline grade (193.6 months vs. 82.9 months for high grade; P = 0.02, log rank). The DFS was significantly better in tumors having negative margins on postoperative histopathological examination (DFS rate at 5 years being 100% vs. 69.2% for positive or close margins; P = 0.015). The mode of surgery did not have any impact on survival.Conclusion:Adjuvant Radiation should be discussed taking into account surgical margins, size and various pathological factors of the primary. Adjuvant radiation may be utilized in high risk patients to enhance loco-regional control. Systemic chemotherapy is an option, worth exploring, in cases of systemic failure.
Background: With the pandemic gaining a firm foothold globally, various governments world-wide are trying hard to halt its unprecedented spread. The pandemic is challenging the healthcare professionals in unique ways and forcing the frontline fighters to come up with dynamic changes in almost all disciplines of medical science. This article is aimed at a detailed review of the exist-ing guidelines for radiotherapy practice during this pandemic from across the world. Methods: This review has been organised under specific subheadings that pertains to the functioning of a Radiation Oncology facility in South Asian countries like India. After a detailed Zoom video conference between the authors, it was decided to focus the review under the following sub-headings: staff allocation, staff education, screening of patients, patient waiting area modifica-tion, patient selection, radiotherapy planning and execution, review of patients on radiotherapy, brachytherapy, inpatient admissions, follow up, resident training and treatment of suspected or positive COVID 19 patients.Results: After discussion among the authors, a consensus working suggestion during the COVID-19 pandemic has been proposed for a radiotherapy center in a South Asian country like India. All the authors worked simultaneously on a Google doc docu-ment to develop this manuscript. Conclusions: This paper can be a reference document for the functioning of a radiotherapy facility during the COVID19 pandemic. As the infrastructure of different institutes vary and so does each patient, the importance of fine tuning and tailoring our final decisions before treating a patient in this unprecedented crisis cannot be undermined.
with areas of metaplastic carcinoma-osteoclastic giant cell rich variant hence we present this rare entity. Osteoclastic giant cells are seen in 2% of breast cancers, including infiltrating ductal carcinoma, invasive lobular carcinoma, sarcomas and metaplastic carcinomas. [4] Osteoclastic giant cells are usually seen in approximation to thin walled blood vessels giving it a gland like appearance and show an association with chondroid/osseous differentiation. Our case showed similar appearance. Osteoclastic giant cells are cytokeratin negative and vimentin positive. Nodal metastasis is less in metaplastic carcinomas (6-26%) than infiltrating duct carcinoma but distant metastasis to lung is frequent. This variant tends to be hormone receptor negative (ER, PR negative), an attribute typically associated with worse outcome. Survival of metaplastic carcinomas-osteoclastic giant cell rich variant is better-68% as compared to carcinosarcoma 49%. [2-5] In our case with a clinical diagnosis of PT, lumpectomy was done, she needs a further axillary clearance in view of metaplastic carcinoma. However patient did not return for follow-up since one year.
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