NOV 2023 ONCOLOGY CARTOONS

1. DR KANHU CHARAN PATRO
M.D, D.N.B[RT], MBA, FICRO, FAROI, PDCR,
CEPC
NOVEMBER 2023 ISSUE/92nd VOLUME
www.facebook.com/oncologycartoons/photos_albums
www.slideshare.net/search/slideshow?searchfrom=header&q=oncology+cartoons

4. 16th OCT 2023/STAGING
PECULIARITY ABOUT VARIOUS STAGINGS
AJCC
PECULIARITY ORGAN
 Changes according to histology
 Changes according to level
 Esophagus
 No stage IV
 Serum marker staging
 Testicular tumor
 Different staging systems for NSCLC and SCLC  LUNG
 No stage I,II.III in anaplastic thyroid  Thyroid
 Stage V is there
 FNAC/BIOPSY changes the stage
 Weight of the tumor changes the stage
 Wilms
 Changes according to infection e.g HPV  Head and neck
 Changes according to some biochemical level  Myeloma
 Changes according to molecular study  Endometrium
 Different nodal staging than other head and neck cancer  Nasopharynx
 LVI and PNI changes the stage
 Cellular differentiation changes the stage
 Penis
 AGE changes the stage  Thyroid [FOL/PAP]

5. 17th OCT 2023/BMT
DENNIS STANLEY/CUREUS/2021
TBI VS TMI

6. DENNIS STANLEY/CUREUS/2021
TMLI VS TMI
1. Total marrow irradiation (TMI) and total marrow
and lymphoid irradiation (TMLI) are methods to
deliver organ sparing targeted radiotherapy using
intensity modulated radiation therapy (IMRT).
2. This approach offers radiation oncologists,
hematologists and the bone marrow transplant
team the ability to reduce dose to critical organs
or any other anatomic region, while increasing
dose to user-defined targets depending on the
clinical situation.
3. TMI and TMLI represent a departure from total
body irradiation (TBI) and a paradigm shift in the
use of radiotherapy as part of the conditioning
regimen in hematopoietic cell transplantation
(HCT)
4. The term TMI is used if the target is bone and
was used in a tandem autologous HCT multiple
myeloma trial. TMLI adds the major lymph
node chains and spleen as target regions and is
used in allogeneic HCT regimens.
5. In some studies, TMLI also includes the liver
and brain to 12 Gy while other target regions
(bone, lymph nodes and spleen) are escalated
to 20 Gy
18th OCT 2023/BMT

7. Pocket Guide to Oncologic
Emergencies
HEART FAILURE AS A SIDE-EFFECT OF ANTICANCER
TREATMENT
19th OCT 2023/BSC

8. Pocket Guide to Oncologic
Emergencies
RAISED ICP/HERNIATAION AND
MANAGEMENT
20th OCT 2023/BSC

9. Abdul Hussain Azizi/JACC/2020
SVCO CAUSES AND GRADING ACCORDING
SITE
21st OCT 2023/BSC

10. https://www.emnote.org/
SVCO AND PEMBERTON'S SIGN
22nd OCT 2023/BSC
1. Pemberton's sign, also known as Pemberton's maneuver, is a clinical test used to assess
for SVC syndrome.
2. During the test, the patient raises both arms above their head for one minute. If this
maneuver leads to facial flushing, bluish skin discoloration, or difficulty breathing, it may
indicate obstruction of the superior vena cava

11. DIFFERENTIATION SYNDROME IN ACUTE
LEUKEMIAS
23rd OCT 2023/BSC
Pocket Guide to Oncologic
Emergencies

12. DIFFERENTIATION SYNDROME IN ACUTE
LEUKEMIAS
24th OCT 2023/BSC
Pocket Guide to Oncologic
Emergencies
[URINE CULTURE]

13. Syndrome of Inappropriate Antidiuretic Hormone Secretion
(SIADH)
25th OCT 2023/BSC
www.chop.edu/conditions
1. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which
the body makes too much antidiuretic hormone (ADH). ADH is also called vasopressin.
This hormone helps the kidneys control the amount of water your body loses through the
urine. SIADH causes your body to retain too much water
2. Approximately 67% of SIADH cases are reported to be caused by cancer, the
majority of which (70%) are linked to small cell carcinoma of the lung . Head and
neck cancers are responsible for only 1.5% of SIADH cases; however, most of
these cases have the histology of small cell carcinoma
3. In the acute setting (ie, < 48 h since onset) with moderate symptoms such as
confusion, delirium, disorientation, nausea, and vomiting, the treatment options for
the hyponatremia include 3% hypertonic saline (513 mEq/L), loop diuretics with
saline, vasopressin-2 receptor antagonists (aquaretics), and water restriction

14. Procedural details, how to do the SBRT in HCC/PVTT with
ascites?
26th OCT 2023/SBRT
CLINICAL EXIPERIENCE
1. Doable
2. Check PT/INR
3. Use pigtail
4. Do not do continuous drainage
5. Drain 2-3hrs before simulation /treatment
6. Clamp after treatment
7. Check input-output regularly
8. Try for positive balance
9. Can be replaced by IV infusion
10. Watch renal and electrolyte chart
11. Albumin infusion if needed
12. Watch for infection. abdominal rigidity/TLC
Treatment with ABC
Perfect matching CBCT
PIG TAIL

15. SIADH is a paraneoplastic condition
Mostly small cell carcinoma is the situation
Excess ADH secretion
Causes more water retention
Follow Batter’s criteria
Normal create and urea
Decrease in serum osmolality
Increase in urine osmolality
Hyponatremia , delirium and confusion
Treat with Loop diuretics with hypertonic solution
Add ADH antagonist with water restriction
Syndrome of Inappropriate Antidiuretic Hormone Secretion
(SIADH)
27th OCT 2023/BSC
www.chop.edu/conditions

16. ONCOLOGY EDUCATION RESOURCE LINKS
28th OCT 2023/LINKS
DR KANHU CHARAN PATRO
1 Radiation examination hub https://t.me/+u2aps8N3pjY1NjI1
2 PPT hub https://chat.whatsapp.com/GASsIIHLx1Q6xNkLA5Y9jk
3 ONCO books https://t.me/+ZCzx75Kx1j9lZDdl
4 Lung SBRT task force https://chat.whatsapp.com/ELbuwcc25KzCZEZwbV6M4L
5 Liver SBRT task force https://chat.whatsapp.com/IncGhTnCWaXFv2LRTVfdY1
6 Prostate SBRT task force https://chat.whatsapp.com/I5mEiCM3s3KDwZpb0R9TqT
7 Spine SBRT task force https://chat.whatsapp.com/CMRKgUHrqyaKY6lmYymeIw
8 Pancreas SBRT task force https://chat.whatsapp.com/JaRUzVvyahN9g9lD7A7EHq
9 Cranial SRS task force https://chat.whatsapp.com/FoXLDlKnqxu6pmskcpJ5ul
10 Oncology resource links https://drkanhupatro.com/
11 Brachytherapy task force https://chat.whatsapp.com/IY7osGGXaH9GWuPV9IXXHn
12 Oncology Guideline hub https://t.me/+6f5pn1MMAX5jNzZl
13 Radiation target delineation https://t.me/+JL4CmKAW3cliOGU1
14 Oncology education videos https://www.youtube.com/@DrKanhuCharanPatro/videos
15 Scihub https://t.me/scihubot

17. RADICALS RT FINAL RESULTS - 10
YEARS UPDATE
29th OCT 2023/PROSTATE
Noel Clarke/ESMO/2023

18. SIB IN POST BCS BREAST- IMRT-MC2
Trial
30th OCT 2023/BREAST
Juliane Hörner-Rieber
/ijrobp/2020
To our knowledge, this is the first
prospective trial reporting the
noninferiority of IMRT-SIB versus 3-D-
CRT-seqB with respect to cosmesis and
LC at 2 years of follow-up. This
treatment regimen considerably
shortens adjuvant radiation therapy
times without compromising clinical
outcomes.

19. 10-DAY RULE PRINCIPLES PREGNANCY
31st OCT 2023/GENERAL
https://inis.iaea.org/search/search.aspx?orig_q=RN:104
45306
When should I call a lady patient
for a follow up?
With in 10 days of
menstruation, as if needed to
do the radiological
investigation?

20. NRG RTOG 1005 BREAST SEQUENTIAL VS CONC.
1st NOV 2023/BREAST
F A VICINI/IJROBP/2022
50 Gy in 25 F or 42.7 Gy in 16 F plus sequential boost of 12 Gy in 6 F or 14 Gy in 7 F (Arm I)
or H-WBI 40 Gy in 15 F plus concomitant boost of 8 Gy in 15 F of 0.53 Gy per day (Arm II).

21. ICORG 10-14 Neo–AEGIS TRIAL -ESOPHAGUS
2nd NOV 2023/ESOPHAGUS
John V Reynolds /Lancet Oncology/2023
Although underpowered and incomplete, Neo-AEGIS provides the largest comprehensive randomised dataset for patients with
adenocarcinoma of the oesophagus and oesophagogastric junction treated with perioperative chemotherapy (predominantly the modified
MAGIC regimen), and CROSS trimodality therapy, and reports similar 3-year survival and no major differences in operative and health-related
quality of life outcomes. We suggest that these data support continued clinical equipoise

22. A summary of key trials of total neoadjuvant therapy in
rectal cancer
HOLLIE A.
CLEMENTS/BJC/2023
3rd NOV 2023/RECTUM

23. Ongoing trials of total neoadjuvant therapy in ca oesophageal or
gastroesophageal junction
HOLLIE A.
CLEMENTS/BJC/2023
4th NOV 2023/ESOPHAGUS

24. Mousa Reza Anbarloui/Indian Journal Of Neurology/2015 5th NOV 2023/BRAIN
BRAIN –TUMOR RECURRENCE VS RADIATION
NECROSIS

25. 1. CCA- Contrast clearance analysis
2. This is based on the concept that active tumor tissue is characterized
by the effective clearance of the contrast agent, whereas in necrotic
tissue the contrast agent accumulates over time, which can be
visually observed and manually measured.
3. This methodology thus promises better differentiation of treatment-
induced effects versus real tumor progression.
4. A diagnostic sensitivity of 100% and a positive predictive value of
92% have been reported,
5. To perform delayed contrast extravasation MRI, an additional short
MRI scan is added >1 h after a standard contrast enhanced MRI scan.
6. For the analysis subtraction, maps are obtained in which T1-MR
images acquired 5 min postcontrast are subtracted from T1-MR
images acquired 80 min postcontrast.
7. T1-MRI of the second time point are therefore registered to the
location of the first time point. Finally, subtraction maps are
calculated by voxel-by-voxel subtraction of the early images from the
late images.
CCA –TUMOR RECURRENCE VS RADIATION
NECROSIS
6th NOV 2023/BRAIN
Julian Mangesius/Cancers /2022

26. R. Bodensohn/ESMO OPEN/2022 7th NOV 2023/BRAIN
Contrast Clearance Analysis
1. The images show four different patients (A-D), each
with a regular contrast-enhanced T1-MRI
sequence, a late phase T1-sequence w1 h after
contrast media application, and their CCA (from left
to right).
2. Tumor tissue is depicted as blue in the CCA, while
reactive tissue is depicted as red.
3. (A) Glioblastoma (WHO 2016 grade IV) IDH wt: a
frontoparietal lesion showing tumor tissue in a
circular formation with reactive components
centrally and at the lesional border (Patient ID 17).
4. (B) Lung adenocarcinoma with brain metastases: a
right cerebellar lesion showing tumor tissue with
reactive components in the surrounding area
(Patient ID 03).
5. (C) Glioblastoma (WHO 2016 grade IV) IDH wt: a
periventricular lesion showing spotted areas with
reactive tissue (Patient ID 20).
6. (D) Maxillary squamous cell cancer with brain
infiltration: a lesion in the right temporal lobe
consisting nearly entirely of reactive tissue (Patient
ID 25). IDH, isocitrate dehydrogenase; MRI,
magnetic resonance imaging; WHO, World Health
Organization; wt, wild type

27. Contrast Clearance Analysis – Radiation Necrosis
Julian Mangesius/Cancers /2022 8th NOV 2023/BRAIN
1. A,B-The mean ADC in radionecrosis is not
significantly different between the enhancing
area and the neighboring area.
2. C-Non-correlation between the boundaries of
the lesion seen on enhanced T1-weighted and
T2-weighted imaging (“T1/T2 mismatch”)
3. D-Non-specific morphological appearances of
contrast enhancement in post-contrast T1-
weighted images.
4. E-Which increases diffusely after 80 min in the
delayed contrast extravasation MRI.
5. F-As the contrast agent accumulates over time
in necrotic tissue, color-coded in red in the
treatment response assessment map (TRAM)
6. G-Decreased rCBV as a result of occlusive
vasculopathy leading to ischemia
7. H-Low tracer uptake in in the 18F-FET-PET
examination.
8. I-The lesion is located within the high dose
area of the radiation therapy.

28. Treatment algorithm–tumor necrosis and tumor
recurrence
Julian Mangesius/Cancers /2022 9th NOV 2023/BRAIN

29. Mechanism Of Radiation Induced Brain Necrosis
Xiaojing Yang/Oxidative Medicine and Cellular Longevity/2021 10th NOV 2023/BRAIN

30. Agents helping in Radiation Induced Brain Necrosis
Xiaojing Yang/Oxidative Medicine and Cellular Longevity/2021 11th NOV 2023/BRAIN

31. Mechanism of Bevacizumab in Radiation Induced Brain
Necrosis
Zhuang et al. Molecular Cancer (2019) 12th NOV 2023/BRAIN

32. Management of primary and recurrent GBM
Kathryn M. Field et, al/Cancer/2015 13th NOV 2023/BRAIN
IF ReRT or SURGERY IS NOT feasible

33. Studies of Bevacizumab in Radiation Induced Brain
Necrosis
Zhuang et al. Molecular Cancer (2019) 14th NOV 2023/BRAIN

34. NEVER START, IF STARTED STOP NOW
Google 15th NOV 2023/PUBLIC