Radiotherapy Institutions Research Articles

Association of Menopausal Status with Pathological Features of Tumor in Stage I to III A Breast Cancer Patients Treated With Upfront Modified Radical Mastectomy

Introduction: Breast cancer is the commonest malignancy diagnosed among women worldwide. In Pakistan around 90,000 women are diagnosed with breast cancer every year. Lymphnode involvement, tumor size, receptor status, tumor grade, presence of LVI, age and ethnicity are well recognized prognostic factors for breast cancer. The aim of this study was to evaluate the relationship of menopausal status with pathological and prognostic features of tumor in patients with stage I to III A breast cancer treated upfront with modified radical mastectomy. Material and Methods: This was a single institute observational retrospective study conducted at Nuclear Medicine Oncology and Radiotherapy Institute (NORI) Islamabad. A total of 381 patients with histopathologically proven diagnosis of Invasive ductal carcinoma after modified radical mastectomy were included from January 2009 to December 2013. Age, menopausal status, tumor site, tumor size, grade, lymphnode involvement, receptor status and presence of LVI were recorded on a particularly composed proforma. Statistical analysis for determining the association between menopausal status and pathologic features of tumor was performed using Chi-square test. P value < 0.05 was considered significant. Results: The minimum age of study population was 24 years and maximum age was 80 years with a mean age +/- SD of 48.5 +/- 11.1 years. There was a statistically significant association between menopausal status and grade of tumor, lymphovascular invasion and HER2/neuoverexpression (p < 0.05). Conclusion: Grade of tumor, lymphovascular invasion and HER2/neu over expression in stage I to IIIA breast cancer has statistically significant association with menopausal status.

HBV Genotyping and Phylogenetic Analysis through Multiplex PCR Using Type Specific Primer Pairs in Pakistani Population

Background: Hepatitis B virus causing acute and chronic hepatocellular carcinoma relics a serious health issue affecting more than 350 million people worldwide. Geographically, nine genotypes of HBV have been identified so far. Four open reading frames named (ORF P, S, F and X) renders it to specifically targets hepatocyte cells. Additionally, reverse transcription process present in the life cycle of HBV caused four order higher mutation rates as compared to adenovirus. The structural and functional differences between HBV genotypes are the mainstay to severity, complications, treatment and possibly vaccination against the virus. Hepatitis B genotyping is important for assessing its clinical implications and geographical distribution, but the sub-genotypes have been found useful for determination of specific genomic markers related to hepatocarcinogenesis and medical therapies. In Pakistan, there is no reported data available on molecular evolutionary analysis of HBV. A study was, therefore, much needed to evaluate the spectra of dominant strains prevalent here. Objectives: This study was aimed to figure out the prevalence of HBV genotypes among population in Pakistan. In this research, we focused to find out the new strains and sub genotypes of HBV. Pakistan is one of the HBV endemic countries but there is no data on subgenotypes and their recombination or the phylogenetic relatedness of the virus endemic in the country. The present study was carried out in this perspective. This study will help future researcher to study some other aspects of HBV related strains in Pakistan and also about its medical therapies. Place and duration of study: The present study was carried out at Polymerase Chain Reaction (PCR) lab, Nuclear Medicine, Oncology and Radiotherapy Institute [NORI], Islamabad, and the samples were collected between September 2012 to February 2014. Study design: A total of 450 Hepatitis B surface antigen HBsAg and HBV DNA positive samples were collected in the first step during the period of September 2012 to February 2014 and sent to Nuclear Medicine Oncology and Radiotherapy Institute [NORI], for further analysis. All the samples were genotyped by type specific nested PCR primer pair method for 8 HBV genotypes from A through H. The patients were randomly selected irrespective of their age and gender and a written consent (parental consent in case of less than 18 years of age) was obtained. The study was approved by ethical review committee. In our research, we have used the type specific primer technique to find out the dominant strain in Pakistani populations and furthermore its phylogenetic analysis with reference sequences retrieved from NCBI databases. Results: Our results showed a direct relationship between viral load and identified genotypes and pinpointed that genotype D is the most pre-dominant genotype and prevailing in high proportions among all genotypes in Pakistani population. Mix HBV genotype infections of genotype A with B & C, D with B and C constitute about 17 percent of all the samples. Subgenotypes of different HBV strains have been identified on the basis of differences in the complete nucleotide sequences. Positive PCR results were repeated twice for confirmation. Furthermore, phylogenetic analysis revealed a homology between our reported sequences and reference sequences. The phylogenetic method showed that genotypes/sub-genotypes varies in the geographical areas and correlate strongly with ethnicity. Conclusion: Genotype D was identified and come out to be the most dominant genotype in Pakistani community showing sub-genotypes of D1 & D3 in our study. Genotype A and D are present as co-infection with each other and contributed as the second prevailing genotypic group. Additionally, phylogenetic analysis revealed that genotypes varies in the geographical areas and correlate strongly with reference sequences from NCBI.

Prevalence of Depression and Anxiety amongst Cancer Patients in a Hospital Setting: A Cross-Sectional Study.

Background. The biomedical care for cancer has not been complemented by psychosocial progressions in cancer care. Objectives. To find the prevalence of anxiety and depression amongst cancer patients in a hospital setting. Design and Setting. This cross-sectional study was conducted at the tertiary care hospitals Shifa International Hospital Islamabad and Nuclear Medicine, Oncology, and Radiotherapy Institute [NORI]. Patients and Methods. 300 patients were interviewed from both the outpatient and inpatient department using The Aga Khan University Anxiety and Depression Scale (AKUADS). Main Outcome Measures. Using a score of 20 and above on the AKUADS, 146 (48.7%) patients were suffering from anxiety and depression. Results. When cross tabulation was done between different factors and the cancer patients with anxiety and depression, the following factors were found out to be significant with associated p value < 0.05: education of the patient, presence of cancer in the family, the severity of pain, and the patient's awareness of his anxiety and depression. Out of 143 (47.7%) uneducated patients, 85 (59.4%) were depressed, hence making it the highest educational category suffering from depression and anxiety. Conclusion. The prevalence of anxiety and depression amongst cancer patients was high showing that importance should be given to screening and counseling cancer patients for anxiety and depression, to help them cope with cancer as a disease and its impact on their mental wellbeing. Limitations. The frequency of female patients in our research was higher than those of male patients.

To Investigate Prevalence of Diabetes Type 1 and Type 2 in HCV Infected Individuals

This study was aimed to investigate the prevalence of diabetes mellitus type 1 and 2 in patients infected with hepatitis C virus. This study was conducted in blood collection Centre at Nuclear Medicine Oncology and Radiotherapy Institute (NORI) situated in Islamabad, Pakistan. The duration of study was from March 2014 to June 2014 twice a week. Randomly selected 112 HCV infected patients were included in this study. Patient information form was used to collect information from patients. In addition to this, about 51 patients were tested for random blood glucose levels, by strip based glucose testing method. Our control group consisted of 80 non HCV infected individuals of same age group. The results of the present study showed 7/112 (6.25%) diabetic patients in HCV infected group and 9/80 (11%) in non-infected. Statistical analysis does not support association of diabetes type 2 with HCV infection (OR=0.5926, 95% of CI=0.2116 to 1.6594, P=0.3193). Similarly, when we analyzed diabetes type 1 separately, 3.57% were suffering from type 1 in HCV infected patients, contrary to that there was not a single person was suffering from type 1 diabetes. Statistically, it is insignificant with p value 0.2050. Although insulin resistance is often reported in HCV infection, however, association of diabetes type 2 with HCV seems rare event. Type 1 Diabetes mellitus is reported to be linked with antiviral therapy, but our results show insignificant association.

TU‐G‐BRD‐06: The Imaging and Radiation Oncology Core Houston (IROC Houston) QA Center International Activities Outside North America

Purpose:To describe the extent of IROC Houston's (formerly the RPC) QA activities and audit results for radiotherapy institutions outside of North America (NA).Methods:The IROC Houston's QA program components were designed to audit the radiation dose calculation chain from the NIST traceable reference beam calibration, to inclusion of dosimetry parameters used to calculate tumor doses, to the delivery of the radiation dose. The QA program provided to international institutions includes: 1) remote TLD/OSLD audit of machine output, 2) credentialing for advanced technologies, and 3) review of patient treatment records. IROC Houston uses the same standards and acceptance criteria for all of its audits whether for North American or international sites.Results:IROC Houston's QA program has reached out to radiotherapy sites in 43 different countries since 2013 through their participation in clinical trials. In the past two years, 2,778 international megavoltage beam outputs were audited with OSLD/TLD. While the average IROC/Inst ratio is near unity for all sites monitored, there are international regions whose results are significantly different from the NA region. In the past 2 years, 477 and 87 IMRT H&amp;N phantoms were irradiated at NA and international sites, respectively. Regardless of the OSLD beam audit results, the overall pass rate (87 percent) for all international sites (no region separation) is equal to the NA sites. Of the 182 international patient charts reviewed, 10.7 percent of the dose calculation points did not meet our acceptance criterion as compared to 13.6 percent for NA sites. The lower pass rate for NA sites results from a much larger brachytherapy component which has been shown to be more error prone.Conclusion:IROC Houston has expanded its QA services worldwide and continues a long history of improving radiotherapy dose delivery in many countries.Funding received for QA audit services from the Korean GOG, DAHANCA, EORTC, ICON and CMIC Group

Imaging Radiation Doses and Associated Risks and Benefits in Subjects Participating in Breast Cancer Clinical Trials.

Medical imaging is commonly required in breast cancer (BC) clinical trials to assess the efficacy and/or safety of study interventions. Despite the lack of definitive epidemiological data linking imaging radiation with cancer development in adults, concerns exist about the risks of imaging radiation-induced malignancies (IRIMs) in subjects exposed to repetitive imaging. We estimated the imaging radiation dose and IRIM risk in subjects participating in BC trials. The imaging protocol requirements in 10 phase III trials in the adjuvant and advanced settings were assessed to estimate the effective radiation dose received by a typical and fully compliant subject in each trial. For each study, the excess lifetime attributable cancer risk (LAR) was calculated using the National Cancer Institute's Radiation Risk Assessment Tool, version 3.7.1. Dose and risk calculations were performed for both imaging intensive and nonintensive approaches to reflect the variability in imaging performed within the studies. The total effective imaging radiation dose was 0.4-262.2 mSv in adjuvant trials and 26-241.3 mSv in metastatic studies. The dose variability resulted from differing protocol requirements and imaging intensity approaches, with computed tomography, multigated acquisition scans, and bone scans as the major contributors. The mean LAR was 1.87-2,410/100,000 in adjuvant trials (IRIM: 0.0002%-2.41% of randomized subjects) and 6.9-67.3/100,000 in metastatic studies (IRIM: 0.007%-0.067% of subjects). IRIMs are infrequent events. In adjuvant trials, aligning the protocol requirements with the clinical guidelines' surveillance recommendations and substituting radiating procedures with equivalent nonradiating ones would reduce IRIM risk. No significant risk has been observed in metastatic trials, and potential concerns on IRIMs are not justified. Medical imaging is key in breast cancer (BC) clinical trials. Most of these procedures expose patients to ionizing radiation, and the risk of second cancer development after imaging has prompted recent concerns and controversy. Using accepted calculation models, the number of malignancies were estimated that were potentially attributable to the imaging procedures performed during a patient's participation in BC clinical trials. The results show that for patients participating in metastatic trials, the risk of imaging radiation-induced malignancies is negligible. In adjuvant trials, some second cancers due to imaging could be expected, and measures can be taken to reduce their risk.

Impact of age, tumor size, lymph node metastasis, stage, receptor status and menopausal status on overall survival of breast cancer patients in Pakistan.

Survival of breast cancer patients depends on a number of factors which are not only prognostic but are also predictive. A number of studies have been carried out worldwide to find out prognostic and predictive significance of different clinicopathological and molecular variables in breast cancer. This study was carried out at Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, to find out the impact of different factors on overall survival of breast cancer patients coming from Northern Pakistan. This observational retrospective study was carried out in the Oncology Department of NORI Hospital. A total of 2,666 patients were included. Data were entered into SPSS 20. Multinomial logistic regression analysis was performed to determine associations of different variables with overall survival. P values <0.05 were considered significant. The mean age of the patients was 47.6 years, 49.5% being postmenopausal. Some 1,708 were ER positive and 1,615 were PR positive, while Her 2 neu oncogene positivity was found in 683. A total of 1,237 presented with skin involvement and 426 had chest wall involvement. Some 1,663 had > 5cm tumors. Lymph node involvement was detected in 2,131. Overall survival was less than 5 years in 669 patients, only 324 surviving for more than 10 years, and in the remainder overall survival was in the range of 5-10 years. Tumor size, lymph node metastases, receptor status, her 2 neu positivity, skin involvement, and chest wall involvement have significant effects whereas age and menopausal status have no significant effect on overall survival of breast cancer patients in Pakistan.

Implementation of a software for REmote COMparison of PARticlE and photon treatment plans: ReCompare

PurposeTo guarantee equal access to optimal radiotherapy, a concept of patient assignment to photon or particle radiotherapy using remote treatment plan exchange and comparison – ReCompare – was proposed. We demonstrate the implementation of this concept and present its clinical applicability. Materials and methodsThe ReCompare concept was implemented using a client-server based software solution. A clinical workflow for the remote treatment plan exchange and comparison was defined. The steps required by the user and performed by the software for a complete plan transfer were described and an additional module for dose-response modeling was added. ResultsThe ReCompare software was successfully tested in cooperation with three external partner clinics and worked meeting all required specifications. It was compatible with several standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. ConclusionThe ReCompare software can be applied to support non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by remote treatment plan exchange and comparison.

Workshops as a useful tool to better understand care professionals' views of a lean change program.

For change programs to succeed, it is vital to have a detailed understanding of employees' views regarding the program, especially when the proposed changes are potentially contested. Gaining insight into employee perceptions helps managers to decide how to proceed. The authors conducted two workshops in a radiotherapy institute to assess the benefits and drawbacks, as well as their underlying causes, of a proposed Lean change program. Managers' views on the workshops' usefulness were charted. The paper aims to discuss these issues. Two workshops were organized in which employees predicted positive and negative effects of a Lean program. The workshops combined a structured brainstorm (KJ-technique) and an evaluation of the expected effects. Eight top managers judged the workshops' value on supporting decision making. In total, 15 employees participated in the workshops. Participants from workshop 2 reported more expected effects (27 effects; 18 positive) than from workshop 1 (14 effects; six positive). However, when effects were categorized, similar results were shown. Three from eight managers scored the results relevant for decision making and four neutral. Seven managers recommended future use of the instrument. Increased employee involvement and bottom-up thinking combined with relatively low costs were appreciated most. The workshop could serve as a simple instrument to improve decision making and enhance successful implementation of change programs, as it was expected to enhance employees' involvement and was relatively easy to conduct and cheap. The workshop increased insight into employee views, facilitating adaptive actions by healthcare organization managers.

A novel simple phantom for verifying the dose of radiation therapy.

A standard protocol of dosimetric measurements is used by the organizations responsible for verifying that the doses delivered in radiation-therapy institutions are within authorized limits. This study evaluated a self-designed simple auditing phantom for use in verifying the dose of radiation therapy; the phantom design, dose audit system, and clinical tests are described. Thermoluminescent dosimeters (TLDs) were used as postal dosimeters, and mailable phantoms were produced for use in postal audits. Correction factors are important for converting TLD readout values from phantoms into the absorbed dose in water. The phantom scatter correction factor was used to quantify the difference in the scattered dose between a solid water phantom and homemade phantoms; its value ranged from 1.084 to 1.031. The energy-dependence correction factor was used to compare the TLD readout of the unit dose irradiated by audit beam energies with 60Co in the solid water phantom; its value was 0.99 to 1.01. The setup-condition factor was used to correct for differences in dose-output calibration conditions. Clinical tests of the device calibrating the dose output revealed that the dose deviation was within 3%. Therefore, our homemade phantoms and dosimetric system can be applied for accurately verifying the doses applied in radiation-therapy institutions.

Clinical Study of a Fibrocystic Breast Patient Presented in Dhq Hospital Sialkot, Pakistan.

This case report was designed to report an incident of benign breast tissue with fibrocystic change in a 50 years old woman brought to Gujranwala Institute of Nuclear Medicine and Radiotherapy (GINUM) and having 2-3 months of disease history with serious symptoms. With mammography she was diagnosed fibrocystic breast changes and later on fine needle aspiration cytology (FNAC) of the breast was performed. Hence, surgical removal of benign mass was recommended by the consultant oncologist . In DHQ Hospital Sialkot, she undergone a successful surgery. Chemotherapy was suggested for two weeks and she was cured.The effective care of fibrocystic breast change may potentially needs comprehensive assessment for appropriate differential diagnosis. However, the rational therapy and scientific drug monitoring can help to control the fibrocystic breast change. Moreover, consultant oncologists should be careful to detect the exact neoplasm and initiate the treatment to avoid morbidities and mortalitiesss

Quantifying the contribution of pathology to patient management: a review of pathology cases presented at a head and neck multidisciplinary meeting

Background Multidisciplinary meetings (MDMs) are widely established in oncology. Studies into the effectiveness of MDMs have principally focused on patient outcomes and management changes, without specific reference to the impact of pathology on decision-making. Aims To determine the influence of pathology on patient management discussed at a head and neck MDM, and the factors leading to change. Methods We reviewed anatomical pathology cases discussed at the head and neck MDM between January and September 2014. The surgical team prospectively recorded pre- and post-MDM management plans. Results Of 129 patients, pathology led to management change in 26 patients (20.2%). Factors included involved margins (14/26, 53.8%), adverse prognostic factors (9/26, 34.6%), unexpected second pathology (5/26, 19.2%), unexpected disease extent (3/26, 11.5%), unexpected primary diagnosis (2/26, 7.7%), diagnosis change on review (1/26, 3.8%), and unexpected differential diagnosis (1/26, 3.8%). Two factors were present in 9 cases (34.6%). Changes included institution of radiotherapy, chemotherapy, or radioactive iodine (16/26, 61.5%), further surgical or investigative procedures (8/26, 30.8%), and palliation (2/26, 7.7%). Discussion The input of pathologists at MDMs of a complex discipline can be instrumental in determining appropriate management, mitigating patient risk and improving the quality of care, and provides quality assurance for the unit.

Immunohistochemical expression of CD-10, BCL-6 and MUM-1 antibodies and immediate clinical response in patients of diffuse large B-cell lymphomas after six cycles of chemotherapy.

To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymphoma (DLBCL) and its association with immediate clinical response after six cycles of CHOP chemotherapy. Analytical study. Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Nuclear medicine, Oncology and Radiotherapy Institute (NORI), Islamabad from September 2010 to September 2011. CD-10, BCL-6 and MUM-1 antibodies were applied on cases diagnosed as DLBCL. Immediate clinical response was noted after 6 cycles of chemotherapy with the help of oncologist and divided into complete response, partial response, stable disease and relapse/ progression. Patient's age, results of expression of CD-10, BCL-6 and MUM-1 and results of immediate clinical response to chemotherapy were noted. Regarding analysis of prognostic markers (CD-10, BCL-6 and MUM-1), chi-square test was used for immediate clinical response to chemotherapy in DLBCL. CD-10 was positive in 40% cases, BCL-6 in 58.7% cases and MUM-1 was positive in 46.7% cases. About 41.3% of patients showed complete response, 10.6% partial response, 17.3% stable disease and 30.8% showed relapse/progression. CD-10 expression in DLBCL was associated with better immediate clinical response (p=0.011) whereas MUM-1 expression in DLBCL was associated with poor immediate clinical response (p<0.0001). However, there was no statistically significant association of BCL-6 with immediate clinical response (p=0.22). DLBCL shows expression of CD-10, BCL-6 and MUM-1 in nearly fifty percent of the cases. CD-10 is associated with good whereas MUM is associated with poor response. However, there was no association of BCL-6 with immediate clinical response.

JS5-1 - Present Status of the Particle Beam Therapy in Cancer Radiotherapy

Eleven particle radiotherapy facilities (heavy ion; 4 institutions, proton; 8 institutions) are located as of 2013 in Japan. Several other institutions are planning to install an instrument of particle therapy in the near future.Japan is one of the countries with having the most particle radiotherapy institutions in the world.Particle therapy including proton and heavy ion have physical and biological advantage outstanding compared with X-rays. Critics of particle radiotherapy have noted the relative lack of prospective data from clinical trials showing a benefit for particle radiotherapy despite its theoretical advantages.At the symposium, we will discuss present status of the particle beam therapy in cancer radiotherapy based on the review of clinical trials of particle radiotherapy.

Does lean management improve patient safety culture? An extensive evaluation of safety culture in a radiotherapy institute

PurposeThe importance of a safety culture to maximize safety is no longer questioned. However, achieving sustainable culture improvements are less evident. Evidence is growing for a multifaceted approach, where multiple safety interventions are combined. Lean management is such an integral approach to improve safety, quality and efficiency and therefore, could be expected to improve the safety culture. This paper presents the effects of lean management activities on the patient safety culture in a radiotherapy institute. MethodsPatient safety culture was evaluated over a three year period using triangulation of methodologies. Two surveys were distributed three times, workshops were performed twice, data from an incident reporting system (IRS) was monitored and results were explored using structured interviews with professionals. Averages, chi-square, logistical and multi-level regression were used for analysis. ResultsThe workshops showed no changes in safety culture, whereas the surveys showed improvements on six out of twelve dimensions of safety climate. The intention to report incidents not reaching patient-level decreased in accordance with the decreasing number of reports in the IRS. However, the intention to take action in order to prevent future incidents improved (factorial survey presented β: 1.19 with p: 0.01). ConclusionsDue to increased problem solving and improvements in equipment, the number of incidents decreased. Although the intention to report incidents not reaching patient-level decreased, employees experienced sustained safety awareness and an increased intention to structurally improve. The patient safety culture improved due to the lean activities combined with an organizational restructure, and actual patient safety outcomes might have improved as well.

Survey of stereotactic ablative body radiotherapy in the UK by the QA group on behalf of the UK SABR Consortium

To ascertain the progress being made towards the implementation of stereotactic ablative body radiotherapy (SABR) treatment in the UK, to obtain details of current practice in centres with an active treatment programme and to assess the projected future provision. In August 2012, an online questionnaire was sent to all 65 UK radiotherapy institutions. The included questions covered the current number of patients being treated and the intended number of patients for each clinical site; immobilization and motion management methods; CT scanning protocols; target and organ-at-risk delineation; treatment planning; image-guidance and treatment protocols; and quality assurance methods. 48/65 (74%) institutions responded by the end of November 2012, with 15 indicating an active SABR programme. A further four centres indicated that a SABR protocol had been established but was not yet in clinical use. 14 of the 29 remaining responses stated an intention to develop a SABR programme in the next 2 years. The survey responses confirm that SABR provision in the UK is increasing and that this should be expected to continue in the next 2 years. A projection of the future uptake would suggest that by the end of 2014, UK SABR provision will be broadly in line with international practice.

Public exposure from I-131 hospitalized isolated patients in NIMRA Jamshoro Pakistan

Purpose/ Background: To treat the cancerous tissues the unsealed radioisotopes are being in clinical practice since 7 decades. From these unsealed sources, I-131 is the choice of treatment for the treating thyroid cancers. Orally administered I-131 patients are to be kept isolated in hospital for some period until captured activity in the body reaches to national and international limits for the avoidance of unacceptably high radiation exposures to patients' family members and the general public to keep ALARA (as low as reasonably achievable) principal in mind. The main rationale of this study was to calculate the exposure/dose of the general public. Material and Methods : This work presents the exposure rate and dose to the general public in the corridor and the non-radioactive patients admitted in adjacent room from I-131 administered isolated patients treated at NIMRA (Nuclear Institute of Medicine and Radiotherapy) Jamshoro Pakistan. In this study exposure from 23 thyroid cancer patients treated with different activities of I-131 (50 to 200 mCi) from January 2011 to December 2012 were included. Results: The average exposure rate in the corridor was about 5.17 µSv/hr (2.14 µSv/hr to 8.15 µSv/hr) and the cumulative dose to nonradioactive patients residing in an adjacent room was 0.647 mSv (0.192 mSv to 1.664 mSv). Conclusion : This study concludes that the exposure rate to the general public especially the admitted non-radioactive patient in the adjacent room is almost within the limits of 1 mSv as specified in national and international standards. ----------------------------------------- Cite this article as : Memon SA, Laghari NA, Qureshi ST, Ahmad A, Khan AA, Hussain MM. Public exposure from I-131 hospitalized isolated patients in NIMRA Jamshoro Pakistan. Int J Cancer Ther Oncol 2014; 2(2):020214. DOI: 10.14319/ijcto.0202.14

Concept for individualized patient allocation: ReCompare—remote comparison of particle and photon treatment plans

BackgroundIdentifying those patients who have a higher chance to be cured with fewer side effects by particle beam therapy than by state-of-the-art photon therapy is essential to guarantee a fair and sufficient access to specialized radiotherapy. The individualized identification requires initiatives by particle as well as non-particle radiotherapy centers to form networks, to establish procedures for the decision process, and to implement means for the remote exchange of relevant patient information. In this work, we want to contribute a practical concept that addresses these requirements.MethodsWe proposed a concept for individualized patient allocation to photon or particle beam therapy at a non-particle radiotherapy institution that bases on remote treatment plan comparison. We translated this concept into the web-based software tool ReCompare (REmote COMparison of PARticlE and photon treatment plans).ResultsWe substantiated the feasibility of the proposed concept by demonstrating remote exchange of treatment plans between radiotherapy institutions and the direct comparison of photon and particle treatment plans in photon treatment planning systems. ReCompare worked with several tested standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow.ConclusionsOur concept supports non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by providing expertise from a particle therapy center. The software tool ReCompare may help to improve and standardize this personalized treatment decision. It will be available from our website when proton therapy is operational at our facility.

Re-irradiation for painful heel spur syndrome

Painful heel spur syndrome is a common disease with a lifetime prevalence of approximately 10 %. One of the most effective treatment options is radiotherapy. Many authors recommend a second or third series of radiation for recurrent pain and partial or no response to the initial treatment. As the results of re-irradiation have not been systematically analyzed the aim of this study was to document the results of repeated radiation treatment and to identify patients who could benefit from this treatment. The analysis was performed on patients from 2 German radiotherapy institutions and included 101 re-irradiated heels. Pain was documented with the numeric rating scale (NRS) and carried out before and directly after each radiation therapy as well as for the follow-up period of 24 months. The median age of the patients was 56 years with 30.1 % male and 69.9 % female patients. Pain was caused by plantar fasciitis in 72.3 %, Haglund's exostosis in 15.8 % and Achilles tendinitis in 11.9 %. Repeated radiation was indicated because the initial radiotherapy resulted in no response in 35.6 % of patients, partial response in 39.6 % and recurrent pain in 24.8 %. A significant response to re-irradiation could be found. For the whole sample the median NRS pain score was 6 before re-irradiation, 2 after 6 weeks and 0 after 12 and 24 months. Of the patients 73.6 % were free of pain 24 months after re-irradiation. All subgroups, notably those with no response, partial response and recurrent pain had a significant reduction of pain. Re-irradiation of painful heel spur syndrome is an effective and safe treatment. All subgroups showed a good response to re-irradiation for at least 24 months.

GYNAECOLOGICAL MALIGNANCIES

Objectives: To determine the frequency of different Gynecological Malignancies and outcome following primary treatment.Study Design: Cross sectional Descriptive Study. Place and Duration of study: In a tertiary care hospital; Bolan Medical ComplexHospital Quetta Baluchistan from Feb 2006 to Nov 2009. Methodology: All the women presenting with genital tract cancer during thestudy period were included. Their age, parity, mode of presentation, anatomic area involved, and investigations performed were noted.Stage of disease (according to FIGO staging), surgical procedures performed, and operative finding were recorded. Specimens weresubjected to histopathological examination. Post operative chemo or radiotherapy was given according to stage and histopathologyreports. Patients were followed up by telephonic appointments for growth recurrence, disease free interval and mortality. Follow uprecords were also obtained from Oncology Department &amp; CINAR (Cancer Institute of Nuclear Medicine and Radiotherapy) HospitalQuetta. Results: Amongst the 93 cases of gynecological cancer ovarian cancer was the commonest (45%), cervical and uterine cancerswere equal in frequency (17.2%), and Choriocarcinoma was seen in (9.3%) cases while vaginal cancer was rarest (1.83%). Epithelialovarian tumors were the commonest (71%) and 67% patients presented in stage III &amp;IV. During the median follow up period of 25 months44% patients are alive without recurrence. 27% lost to follow up, 18% developed recurrence, 11% died with disease, 50% cancer deathswere due to ovarian cancer. Conclusions: Ovarian cancer is the commonest genital tract cancer and accounted for half of all genital tractcancer deaths. Early diagnosis and treatment can improve prognosis. Well established screening program and public awareness isimportant for early diagnosis and to decrease mortality.