Objectives: Small field dosimetry plays a critical role in modern radiotherapy techniques such as IMRT, IGRT, VMAT, SRS, SRT, SBRT, and Tomotherapy, where the goal is to deliver a highly conformal dose to the tumour while minimizing exposure to surrounding healthy tissues. Accurate dosimetric measurements are essential to ensure treatment efficacy and patient safety. While TRS-398 serves as the Code of Practice (CoP) for dosimetry in conventional large field radiotherapy. The objective of the study was to evaluate the performance of these detectors and identify the most suitable one by comparing the measured output factors with reference data. Material and Methods: In this study, various detectors available in our department were employed to measure output factors for different small field sizes. The measurements were performed according to TRS-483 guidelines, and the obtained output factors were compared against reference data from standardized studies. Results: Differences in measured output factors were observed among the detectors, particularly in the smallest field sizes. From the comparison keeping Gafchromic film data as the standard it was seen that CC01 is more suitable for 6 MV-FF beam measurement whereas EPD gives least percentage deviation for the output factors of 6 MV-FFF beams. Conclusion: The results emphasize the importance of choosing an appropriate detector for small field measurements and adhering to TRS-483 recommendations to ensure accurate and reliable dosimetry in advanced radiotherapy applications.

Primary squamous cell carcinoma (SCC) of the external auditory canal (EAC) is an exceptionally rare malignancy with limited literature on optimal management and outcomes. This case series details the multimodality management of three patients with SCC of the EAC treated at a single institution. The treatment approach for all patients involved surgical intervention followed by adjuvant radiotherapy using intensity-modulated radiation therapy (IMRT), with one patient also receiving concurrent chemotherapy. At a follow-up of up to 28 months, all three patients achieved locoregional control of their disease. Both acute and late treatment-related toxicities were manageable and favorable, with all patients maintaining a good quality of life post-treatment. This series reinforces that a combination of surgical resection and adjuvant IMRT is an effective standard of care for locally advanced EAC tumors, providing excellent locoregional control with an acceptable toxicity profile. Further studies are warranted to optimize long-term outcomes.

Objectives Traditionally, oral health maintenance of patients diagnosed with a cancerous condition relied mainly on the patients themselves and the bedside nurses. Limited overlap of medical and dental expertise and curbed dental resources in typical oncology units baffles access to optimal dental care for children with cancer. Here, we outline the creation of a novel pediatric oncodental team to address this predicament by furnishing primary prevention strategies for high-risk patients in a multispecialty center. To form an interdisciplinary team and implement a novel system aimed at optimizing oral health care for inpatient pediatric oncology patients in a hospital setting, and to study the effect of primary prevention on pediatric oncology patients after primary health education and oral hygiene demonstration by a pediatric dentist. Material and Methods After the genesis of a novel pediatric oncodental team, this prospective longitudinal one-group (pre- and post) study assessed fifty-three 3-13-year-old inpatients undergoing treatment at a cancer super specialty institution. Primary health education was imparted to the participants, their caretaker, nurses, and the paramedical staff, along with giving case-specific oral hygiene maintenance modification measures. Oral hygiene status was recorded at baseline and 1, 3, and 6-month follow-up. Results The results demonstrated a significant plummeting in the OHIS score at 1, 3, and 6 months as compared to baseline, proving evidently that oncodental role can potentially be an emerging arm of pediatric dentistry. Conclusion Conceding the importance of oral health for pediatric oncology patients and restraints in the traditional approaches, the role of the pediatric dentist in the oncodental team represents an innovative solution. By integrating oncology and dental specialties, the team aims to improve oral health outcomes, reduce the risk of infection, and provide better support and education for patients and caregivers

Objectives Chemotherapy-induced peripheral neuropathy (CIPN) is a significant adverse effect of neurotoxic chemotherapeutic agents such as paclitaxel, carboplatin, and cisplatin. CIPN can impair sensory, motor, and autonomic functions, severely reducing patients’ quality of life. This study aimed to assess the prevalence of CIPN in cancer patients undergoing chemotherapy, focusing on its relationship with chemotherapy regimens, onset timing, and patient characteristics. Material and Methods This cross-sectional observational study included 218 cancer patients at Shree Krishna Hospital, Gujarat. Patients were assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 questionnaire in three phases: pre-chemotherapy, mid-therapy, and post-treatment. Descriptive and inferential statistics were used to assess CIPN prevalence by chemotherapy drug, cancer type, and treatment cycle. Results The overall CIPN prevalence was 19.1%. Paclitaxel-treated patients had the highest prevalence at 34.6%. CIPN was more common in females (25%) than males (13.33%). Breast cancer patients had the highest CIPN prevalence at 34.6%, followed by esophageal cancer patients (21.4%), and oral cavity cancer patients (13.3%). CIPN symptoms often began mid-therapy (14.6%) and persisted post-treatment (15.7%). Paclitaxel was significantly associated with a higher risk of CIPN. Conclusion CIPN is prevalent among patients treated with neurotoxic chemotherapy agents, particularly paclitaxel. Early detection and management strategies are critical to prevent chronic neuropathy and improve quality of life. Future studies should explore interventions to reduce CIPN without compromising chemotherapy efficacy, with significant implications for physiotherapy rehabilitation.

Phosphaturic mesenchymal tumors (PMTs) are rare neoplasms often associated with tumor-induced osteomalacia (TIO). They present diagnostic challenges due to their rarity and nonspecific symptoms. A 44-year-old male presented with a one-year history of back pain, eight-month history of difficulty walking, and swelling over the right upper thigh. MRI of the dorsolumbar spine revealed subtle disc bulges and mild vertebral hypodensity. A bone scan suggested seronegative spondyloarthropathy. Positron emission tomography - Computer tomography (PET-CT) showed a somatostatin receptor-expressing lesion in the right proximal thigh. MRI confirmed a soft tissue lesion. Surgical excision and histopathology confirmed PMT. Preoperative serum phosphorus was low (1.6 mg/dL), and fibroblast growth factor 23 (FGF23) was elevated (352.4 pg/mL). Postoperative serum phosphorus normalized, and the patient received denosumab treatment. Follow-up over one year showed the patient remained asymptomatic with normal serum markers. This case highlights the importance of considering PMT in patients with persistent musculoskeletal pain and hypophosphatemia. Complete surgical excision is curative, and adjunct therapies like denosumab can be beneficial.

Thyroid carcinosarcoma (TC) is an aggressive biphasic malignancy. It has a high mortality rate even after the application of a Multi-disciplinary therapeutic approach. We studied a 63-year-old lady with neck swelling for 4 years with a rapid increase in size in 2 months. Fine Needle Aspiration Cytology (FNAC) of the thyroid nodule was reported as papillary thyroid carcinoma. Positron Emission Tomography and Computed Tomography (PETCT) showed a hypermetabolic lesion in the thyroid with a hypermetabolic lytic lesion in the 4th rib, suggestive of metastasis. Subsequently, patients underwent total thyroidectomy with central compartment clearance and left selective neck dissection. Histopathological evaluation and immunohistochemistry showed that spindle cells were positive for smooth muscle actin (SMA) and negative for Pan Cytokeratin (Pan CK), Carcinoembryonic Antigen (CEA), Paired-box-gene (PAX8), SRY-related HMG-box 10 (SOX10) and Desmin. Thyroid transcription factor 1 (TTF-1) was positive in follicular cells and Cytokeratin 19 (CK19) was focal positive. Hence, a diagnosis of Sarcoma with myoid differentiation and Follicular Carcinoma (carcinosarcoma) was made. Treatment of this disease remains not very clear. The method of management in is still Surgical removal of primary tumor.

Objectives This study explores variations in hormone receptor (HR) status between biopsy and post-operative reports, as well as changes following neoadjuvant chemotherapy (NACT). The correlation between HR status alterations and patient survival outcomes is the key focus of this investigation. Material and Methods This retrospective study conducted at a tertiary care center in Kolkata, Eastern India, from 2013 to 2018. Results The parameters of 482 breast cancer patients meeting inclusion criteria were studied. The majority were >40 years (68.2%), with 300 receiving NACT. Clinical staging distribution was I (2.9%), IIA (10.4%), IIB (22.2%), IIIA (34.3%), IIIB (28.6%), and IIIC (1.6%). Preoperative and postoperative staging changes occurred in 47.7%, with 38.8% downstaging and 13.5% upstaging. Estrogen receptor (ER), progesterone receptor (PR), and Her2neu positivity at diagnosis were observed in 46.3%, 41.9%, and 36.9% of patients, respectively. Postoperative ER, PR, and Her2neu positivity were 46.1%, 40%, and 37.3%, respectively. Recurrence in 33.6% of patients correlated with factors like age, tumor grade, lymphovascular invasion (LVI), Perineural invasion (PNI), postoperative stage, ER, PR, and their changes. Multivariate analysis identified age, PNI, postoperative stage, stage change, ER, and PR changes as independent factors for recurrence. The correlation study demonstrated a significant association between NACT and changes in PR status (χ2 = 16.56; p = 0.001), while no significant associations were found for ER and Her2neu changes. Analysis of variance (ANOVA) revealed a substantial association between NACT and PR status changes (p = 0.001). Post Hoc tests indicated significant differences in PR status changes related to NACT. Kaplan-Meier survival analysis revealed a significant difference in disease-free survival (DFS) based on changes in ER and PR status, with ER-positive patients having a median DFS of 76 months and PR-positive patients showing a median DFS of 47 months. No significant DFS difference was observed for changes in Her2neu status. Conclusion Changes in hormone receptor status, particularly ER and PR, significantly impacted recurrence and DFS. The study highlights the importance of personalized management strategies, with age, tumor grade, lymphovascular invasion (LVI), and changes in ER and PR status identified as key factors influencing prognosis.

Objectives This study aimed to investigate the expression of key genes (Notch-1, Notch-2, Notch-3, Notch-4, DLL1, DLL3, and NPR3) in the Notch signaling pathway in medulloblastoma tumors, and explore their correlation with clinicopathological features, including patient survival outcomes. Material & Methods A total of 103 histologically confirmed medulloblastoma tumor samples were analyzed using quantitative Real-time polymerase chain rection (qPCR) to assess the expression levels of the seven Notch pathway genes. The relationship between gene expression and various clinicopathological parameters, including tumor location, patient age, gender, and risk group classification, was examined. Statistical analyses were performed using SPSS software, with p-values ≤ 0.05 considered statistically significant. Progression-free survival (PFS) and overall survival (OS) were also analyzed to determine the clinical impact of gene expression levels. Results The study revealed varying levels of upregulation for the Notch pathway genes in medulloblastoma tumors: Notch-1 (38%), Notch-2 (58%), Notch-3 (82%), Notch-4 (33%), DLL1 (69%), DLL3 (71%), and NPR3 (57%). Notably, Notch-3 expression was significantly associated with tumors located in the occipital region (p=0.04). A significant inverse correlation was found between high-risk patients and Notch-4 upregulation (p=0.05). DLL3 expression showed significant inverse correlations with gender (p=0.03) and risk group classification (p=0.04), but a positive correlation with the primary tumor site (p=0.003). NPR3 expression was inversely correlated with patient age (p=0.01). Furthermore, all Notch receptors and ligands demonstrated positive intercorrelations, suggesting a coordinated role in tumor biology. Survival analysis showed that patients in the average-risk group had significantly higher recurrence rates at both 12 and 24 months compared to high-risk patients (p<0.01). Notably, patients who received only radiotherapy post-surgery had lower recurrence rates and better survival outcomes, with significantly lower incidences of death at 12 months (p=0.005) and 24 months (p=0.03). Conclusion The findings highlight the potential clinical significance of Notch-3, Notch-4 receptors, and DLL3 as key biomarkers in medulloblastoma. These genes offer promising targets for developing more personalized and effective treatment strategies. Further research into their precise role in tumor progression and response to therapy is warranted.

Objectives To assess the clinicopathological parameters in colorectal cancer. To determine the proportion of BRAFV600E mutations among colorectal cancer (CRC) patients. Material and Methods The cross-sectional study was conducted in 85 consecutive samples of histologically confirmed colon/rectal adenocarcinoma cases from a Tertiary Care Hospital, Thrissur, for eighteen months. Informed consent was obtained from patients whose specimens were collected, and the tests were performed after approval from the Institutional Ethics Committee. All the gross findings were recorded, including the size of the specimen, the tumor site, and the gross appearance. Histological sections were studied under a light microscope. Further deoxyribonucleic acid (DNA) isolation and amplification refractory mutation system- polymerase chain reaction (ARMS PCR) were carried out to confirm the BRAF mutation status. Data were entered into MS Excel and analyzed using IBM-SPSS software version 25. Results 55.3% (47 cases) of CRC were above 65 years, 63.5% (54 cases) were males and 36.5% were females (M: F 3:1). Majority of tumors were located in the sigmoid colon (31.8%) followed by rectum (16.5%), ascending colon (14.1%), hepatic flexure (10.6%), caecum (7.1%), transverse colon (5.9%), descending colon (4.7%), and splenic flexure (1.2%). 91.8% of cases were low grade, and 8.2% were high grade. 50.6% of tumors were pT3, and the least were T4 (2.4%). Out of 85 study participants, BRAF was positive in 2(2.4%) patients and negative in 83(97.6%) patients, respectively. Conclusion This is the first such South Indian study. The small sample size, demographic disparities in the study population, and pre-analytical factors could explain the low positivity number. In the future, routine molecular testing for various biomarkers including BRAF may become inevitable in targeted therapy of CRC for practicing precision medicine.