FEB 2024 ONCOLOGY CARTOON /95TH VOLUME

1. DR KANHU CHARAN PATRO
M.D, D.N.B[RT], MBA, FICRO, FAROI, PDCR,
CEPC
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95th volume/February 2024

4. PORTEC 4a design in endometrial cancer
ANNIE SHOPHIE/IJGC/2020 16th JAN 2024/ENDOMETRIUM

5. Diagnostic algorithm for the integrated molecular EC classification
ESMO GUIDELINE 17th JAN 2024/ENDOMETRIUM

6. Selected ongoing studies of liver SBRT
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
18th JAN 2024/STEREOTAXY

7. Statistical Data Measurements And Types
Dr Kanhu Charan Patro 19th JAN 2024/STAT
Let’s discuss the statistical data.
Qualitative and Quantitative data.
Qualitative is non numerical.
Quantitative is numerical.
It is the measurement of observations.
Extract to make some decisions.
Original data is called primary data.
Secondary data extracted from primary data.
Collected data can be represented on graph.
Bar chart, pie chart and many more graph
Quantitative is discrete or continuous.
Discrete is number and measurements are continuous.
Ordinal data is result with order.
Nominal data is named data without order.
Having two values are called binary data.
Like true or false and yes or no in your data

8. Understanding the p value
Dr Kanhu Charan Patro 20th JAN 2024/STAT
p-value is a statistical measurement.
Used to validate your experiment.
Results of your hypothesis test
P value determines the significance of test
The opposite of significant is non-significant.
A value less than point zero five is significant.
Significant P value supports alternative hypothesis.
Non-significant P value supports null hypothesis.
If in study p value is less than .05(five)
Means in hundred results by chance is less than five.
p-value, or probability value, is a number.
Its value never be a unity number.
Write the p value in small letter.
And write in italic letter.
Never use zero before decimal
Use space both side of sign equal.
P = .05

9. Understanding the Metanalysis
Dr Kanhu Charan Patro 21st JAN 2024/STAT
Analysis of many similar studies
Either systematic review or metaanalysis.
Systematic review analyses qualitatively
Metanalysis analyses quantitatively.
Metaanalysis are based on systematic (review) analysis.
But all systematic reviews are not metaanalysis.
Interested in analysis of metanalysis.
You have Forest plot for analysis.
Forest plot is the graphical representation.
All studies are given in that presentation.
Effect size is in horizontal axis.
Null effect line in vertical axis
Effect size may be odds ratio.
Relative risk to hazard ratio.
Number of samples indicated by black box size.
All studies conclusive analysis given in diamond size.
Horizontal lines are confidence interval.
Tip of the diamond is the overall confidence interval.
In left the events, author column, sample size.
Confidence interval indicated by width size.
The more width confidence interval is less precision.
The less width confidence interval is more precision.
Combined CI is the width of diamond.
Combined rate ratio is the height of diamond.
Diamond presence is very important.
Its left right position is very relevant.
If it is in left experimental arm is better
The right position means control arm is better.
If diamond touches the null line
Indicates both arms are fine.
Heterogeneity assessed by the chi square test.
You can also be assessed by I square test
Z denotes the overall effect
p value determines the significant
The heterogeneity of eyeball test
Determined by the line of overall effect.
If it passes through all horizontal lines
Means more homogeneity in the analysis.
Publication bias in the forest plot
Must analyze through funnel plot

10. Censoring in survival analysis
Dr Kanhu Charan Patro 22nd JAN 2024/STAT
In statistics censoring is a condition
Whose observation is partially known.
Or time to event not known.
In survival analysis censoring leads to bias
Care must be taken to prevent this bias.
There are three types of censoring.
Left, right and interval censoring.
In the study if it uncensored.
Means observation has completed.
Event occurred before the enrolling.
It is known as left censoring.
It is called right censor.
lost to follow up in the center.
or event happens after tenure.
Interval censoring is the event.
You do not the period of relevant.
Means happens in between follow up event.
Non-informative censoring is unrelated to the study.
Informative censoring is related to the study.
To prevent censor bias in analysis
Please consider sensitive analysis

11. Survival Analysis
Dr Kanhu Charan Patro 23rd JAN 2024/STAT
Let’s discus Survival analysis.
It is time to event analysis.
It is not only survival.
It is any event including survival.
This word is a misnomer.
Survival is not only whistle blower.
Time interval in x axis
Survival fraction in y axis
It may be an actuarial life table approach.
Or Kaplan Meier approach
In actuarial life table approach
At fixed time interval
In Kaplan Meier approach
At every event interval
Many curves for analysis of event or survival
Kaplan Meier or log rank or cox proportional
Kaplan Meier used for single outcome.
Log rank used for more than one outcome.
Cox hazard is influence of variable in outcome.
Influence of age
Dental filling comparison

12. Hazard Ratio
Dr Kanhu Charan Patro 24th JAN 2024/STAT
Hazard ratio is commonly reported in randomized trials.
It is the ratio of events to two arms in those trials.
Hazard ratio is reported in time to event data.
It is the ratio of outcomes of test and control data.
If it is one event rates are same in both arm
More than one is event rates are more in test arm.
Less than one is event rates are more in test arm.
If p value is less than .05 means data is significant
If confidence interval having one it is insignificant
Risk ratio (Relative risk) and hazard ratio are not same
Contrast to risk ratio, hazard ratio calculated in time frame.
It is a relative efficacy measure.
It summarizes Kaplan Meier.
Either superiority or inferiority measure
Trial designed based on this measure.

13. Cancers with bimodal distribution
SHREYA DESAI/WORLD J ONCOL/2022 25th JAN 2024/GENERAL

14. ANDREW GEORGE/CUREUS/2020 26th JAN 2024/BIOSTAT
Relative risk (RR) vs. Odds Ratio (OR) vs. Hazard Ratio (HR)

15. Colette J. Shen/Advances in Radiation Oncology (2018) 27th JAN 2024/BRAIN
Optimal radiation dose for recurrent GLIOMA- ReRT settings
1. Reirradiation dose >41.4 Gy (HR: 0.6; 95% CI, 0.4-
0.9; P Z .03)
2. Salvage reirradiation, even at doses >41.4 Gy in
conventional fractionation, along with
chemotherapy, was safe and well tolerated with
meaningful survival duration.
3. These data provide information that may be useful
in implementing safe reirradiation treatments for
appropriately selected patients and guiding future
studies to define optimal reirradiation doses,
maximal safe doses to critical structures, and the
role of systemic therapy
4. Repeat radiation using conventional fractionation
up to a dose of 45 Gy with concurrent TMZ is a
safe and potentially effective therapy for recurrent
high-grade glioma. More information is needed
about the tolerance of critical structures, which
may limit the safe administration of 45 Gy in many
circumstances but also allow for dose escalation
when not at risk

16. Andre Tsin
Chih Chen/IJROBP/2024
28th JAN 2024/BRAIN
Optimal hypo RT dose for recurrent GLIOMA- ReRT settings
1. Recurrent GBM is rapidly progressive,
and its overall prognosis remains
dismal.
2. Within this context, our prospective
phase 2 randomized screening trial
showed no signal that 35Gy in 5
fractions (BEDGy10 59.5; EQD2
49.6Gy) improves PFS compared to
25Gy in 5fx (BEDGy10 37.5; EQD2
31.3Gy)
3. Hypofractionated Stereotactic
Radiotherapy alone with 35Gy/5fx was
not superior to 25Gy/5fx in terms of
PFS or OS.
4. Due to a potential increase in the rate
of clinically meaningful treatment-
related necrosis, we suggest 25Gy/5fx
as the standard dose in HSRT alone.
5. During follow-up, attention should be
given to differentiate tumor progression
from potentially manageable
complications

17. Gregory Bruce
Mann/LANCET/2024
29th JAN 2024/BREAST
CAN I OMIT RADIATHERAPY IN POST BCS BREAST CANCER?
PROSPECT suggests that women
with unifocal breast cancer on pre-
op MRI and favourable pathology
can safely omit radiotherapy.
1. Between May 17, 2011, and May 6, 2019, 443 patients with
breast cancer underwent MRI.
2. Median age was 63·0 years. MRI detected 61 malignant occult
lesions separate from the index cancer in 48 patients (11%).
Of 201 group 1 patients who had BCS without radiotherapy,
the IIRR at 5 years was 1·0% (upper 95% CI 5·4%). In group 1,
one local recurrence occurred at 4·5 years and a second at 7·5
years. In group 2, nine patients had mastectomy (2% of total
cohort), and the 5-year IIRR was 1·7% (upper 95% CI 6·1%).
3. The only distant metastasis in the entire cohort was
genetically distinct from the index cancer.
4. The PROSPECT pathway increased QALYs by 0·019 (95% CI
0·008-0·029) and saved AU$1980 (95% CI 1396-2528) or £953
(672-1216) per patient.

18. Constantin Tuleasca/JNS/2018 30th JAN 2024/BRAIN
SRS TRIGEMINAL NEURALGIA- ISRS GUIDELINES

19. SALMAN FARUQI/PRO/2022 31st JAN 2024/BRAIN
SBRT FOR POST OP SPINE MET- ISRS GUIDELINES

20. Zain A. Husain/JNS/2017 1st FEB 2024/STEREO
ISRS-recommended spine SBRT outside a clinical trial

21. Michael Yan/LUNG CANCER/2023 2nd FEB 2024/STEREO
ISRS-recommendation- SBRT Ultra-Central lung Tumors

22. Sun Hyun Bae/IJROBP/2023 3rd FEB 2024/STEREO
ISRS-recommendation- SBRT FOR HCC

23. Marcello Marchetti/NEUROSURGERY/2020 4th FEB 2024/STEREO
ISRS-RECOMMENDATION- NON-CAVERNOUS MENINGIOMA SRS

24. CHENG-CHIA LEE/NEUROSURGERY/2017 5th FEB 2024/STEREO
ISRS-RECOMMENDATION- CAVERNOUS MENINGIOMA SRS

25. CONSTANTIN TULEASCA/JNO/2023 6th FEB 2024/STEREO
ISRS-RECOMMENDATION- SINGLE FRACTION VESTIBULAR SCHWANNOMMASRS

26. RUPESH KOTECHA/NEUROONCOLOGY/2019 7th FEB 2024/STEREO
ISRS-RECOMMENDATION- NON-FUNCTIONING PITUITARY ADENOMAS

27. SHANKAR SIVA/LANCET ONCOLOGY/2024 8th FEB 2024/STEREO
ISRS-RECOMMENDATION- SBRT FOR RENAL CELL CANCER

28. Raj Singh/NEUROSURGERY/2022 9th FEB 2024/STEREO
ISRS-RECOMMENDATION- Dural Arteriovenous Fistulas SRS

29. DIANA GRISHCHUK/PRO/2022 10th FEB 2024/STEREO
ISRS-RECOMMENDATION- Small Brain Metastases (≤1 cm in Diameter)SRS

30. Balamurugan Vellayappan/IJROBP/2023 11th FEB 2024/BRAIN
ISRS-RECOMMENDATION- Symptomatic Brain Radiation Necrosis Mx

31. Nuria E/JNS/2018 12th FEB 2024/STEREO
ISRS-RECOMMENDATION- SRS FOR TREMORS

32. Christopher S. Graffeo/NEUROSURGERY/2020 13th FEB 2024/STEREO
ISRS-RECOMMENDATION- SRS FOR AVMS

33. DIANA GRISHCHUK/PRO/2022 14th FEB 2024/STEREO
ISRS-RECOMMENDATION- SRS Small Brain Metastases (≤1 cm in Diameter)

34. worldcancerday.org 15th FEB 2024/PUBLIC
World cancer day – 4th February – the glossary
1. World Cancer Day was born on the 4 February 2000 at
the World Summit Against Cancer for the New
Millennium in Paris.
2. World Cancer Day held every 4 February is the
global uniting initiative led by the Union for
International Cancer Control (UICC).
3. World Cancer Day is an international day marked
on 4 February to raise awareness of cancer and
to encourage its prevention, detection, and
treatment. World Cancer Day is led by the Union
for International Cancer Control (UICC) to support
the goals of the World Cancer Declaration, written
in 2008.
4. In 2024, the global cancer community
commemorates World Cancer Day, on February
4, with the slogan "Close the care gap", and the
call to unite our voices and take action.
5. The official colors of World Cancer Day are blue
and orange.