ONCOLOGY CARTOONS JANUARY 2024

1. DR KANHU CHARAN PATRO
M.D, D.N.B[RT], MBA, FICRO, FAROI, PDCR,
CEPC
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94th volume/JANUARY 2024

4. FANG FANG/ FRONTIERS IN ONCOLOGY/2022
HYPOFRACTIONATION SBRT PALLIATION IN PORTAL VEIN TUMOR
THROMBOSIS
16th DEC 2023/STEREOTAXY

5. DR KANHU CHARAN PATRO
Stereotactic radiotherapy for cranial
AVM
17th DEC 2023/STEREOTAXY
Cranial arteriovenous malformation
You can treat with stereotactic radiation.
Embolization, surgery, and radiation
Also, you can plan for observation.
Do not target the feeder or drainer.
Nidus is your target localizer.
Best is digital subtraction angiogram.
If not available do MR/CT angiogram
Legends are Raymond KJellberg and Flickinger.
To prevent necrosis, follow the curve Flickinger.
If volume is large for single fraction
you can plan for multi fraction.
Not wrong with staged fraction
Combined work from neurosurgeon
Radiation oncology and radiology intervention
Small, eloquent areas are good for radiation.
Choose SRS over surgery and embolization.
Post SRS injury expression
Please follow PIE score calculation
Wait 3-4 years till the next fraction.
Preserve the contour and immobilization.
For the next planning session.
Percentage of obliteration after radiation
Depends upon the volume, breed, and location.
Follow various scales and score for calculation.
K index will guide you for dose calculation
Minimum eighteen Gray need for obliteration
If there is a bleeding recently
Wait 3 months to resolve strictly.
Then you can treat stereotactically
If you do embolization before radiation.
It may misguide you for target localization.
Six monthly follow up with MRA.
You can avoid more invasive DSA.
Radiation changes are also depicted by MRI.
Do confirmatory DSA if obliteration seen on MRI
Radiation causes inflammation.
Complications lead to endothelization.
That is the main mechanism for obliteration.

6. A R Khan /Journal of Hepatocellular Carcinoma/2021
Therapeutic options for HCC patients with PVTT
18th DEC 2023/STEREOTAXY

7. Brent C. Morel/JPM/2022
Decision-making algorithm for unruptured AVMs
19th DEC 2023/STEREOTAXY

8. Seong-Hyun Park/WORLD NEUROSURGERY/2017
SRS FOR DURAL CAROTID CAVERNOUS SINUS FISTULAS
20th DEC 2023/STEREOTAXY
17 Gy

9. Dr. Oriba Dan Langoya and 4
others
INFECTION AND CANCER
21st DEC 2023/GENERAAL
Bacteria, virus, protozoa, and fungus
Some of them are cancerous.
HHV8 causes Kaposi sarcoma.
Helicobacter for gastric lymphoma
HPV is related to orogenital and anal cancer.
EBV is etiology for nasopharyngeal cancer.
Bladder cancer by Schistosoma haematobium
colorectal by Schistosoma Japonicum
Opisthorchis viverrine causes bile duct cancer
Streptococcus Bovis is again related to colorectal cancer.
Merkel Cell carcinoma by Merkel cell Polyomavirus
Burkitt’s lymphoma is related to Epstein Barr virus.
Hepatitis B, C, and Flavus Aspergillosis
Leads to hepatocellular carcinomatosis.
Type 1 Human T-Cell Leukemia
This virus causes adult T-cell leukemia
Infection can cause cancers.
It is one of the etiological factors.
By affecting the immunological sectors.
Some can be prevented by immunization helper.

10. DR KANHU CHARN PATRO
BOLUS ON RADIOTHERAPY
22nd DEC 2023/PHYSICS
A bolus is a beam modifying material.
Increase skin dose with tissue like material.
Hundred percent dose not on surface.
Dmax is always below the surface.
It is due to secondary electron.
It happens in buildup region.
Keep the bolus always on the surface.
Wax or water gauze on contact with surface.
As energy increases bolus thickness increases
As increasing photon energy penetration increases.
Usually with electron treatment bolus not a criterion
as Reverse happens with the increased energy of electron.
Lucite, elastic-gel, super flab, polystyrene,
Rayon cloth, dental wax, polypropylene
All are of commercial artificial origin.
Bolus material used in breast and skin cancer.
A cut mask is useful in head and neck cancer.

11. INTRACRANIAL STEREOTACTIC RADIOSURGERY DOSAGE SCHEDULE
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
23rd DEC 2023/STEREOTAXY

12. IGRT solutions in different radiation machines
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
24th DEC 2023/PHYSICS

13. Dose constraints for SBRT lung
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
25th DEC 2023/STEREOTAXY

14. Management of cancer pancreas
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
26th DEC 2023/PANCREAS

15. Dose constraints for pancreatic SBRT
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
27th DEC 2023/STEREOTAXY

16. Dose constraints for liver SBRT
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
28th DEC 2023/STEREOTAXY

17. Selected ongoing studies of pancreatic
SBRT
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
29th DEC 2023/STEREOTAXY

18. PTEN, mTOR, AKTP,13K signaling pathway.
Together called (NSMP) nonspecific molecular pathway
NSMP has staged intermediate prognosis.
Consider post op vaginal brachy in diagnosis.
MMRd does DNA repair problematization.
That helps in cancer formation.
Same time bad for tumor formation.
And enhances the effect of radiation.
Again, by DNA repair inhibition.
So, it is under intermediate stratification.
p53 is a tumor suppressor gene.
Mutation leads to abnormal scene.
p53 mutation needs aggressive treatment.
Chemoradiation in the management.
Histological analysis by 1,2,3 PORTEC
Molecular analysis by 4 and RAINBO PORTEC
Retrospective molecular analysis from old PORTEC
Prospective analysis from 4 and RAINBO PORTEC
Adding PRAP inhibitor in p53 mutation
Whether MMRd needs immunization.
In NSMP hormonal addition
Or POLE needs only observation.
All are under investigation.
Under PORTEC randomization
Endometrial cancer molecular profiling.
Already incorporated in FIGO staging
Molecular profiling has predictive significance.
Adjuvant treatment cannot ignore its influence.
If endometrium is not molecular classified
Designate NOS as histologically classified.
Attach m suffix to define the stage.
If molecular profiling is in your cage
If endometrium is not molecular classified
Designate NOS as histologically classified.
P53, MMRd. NSMP and POLE mutation
All these will decide adjuvant decision.
POLE mutation downgrades the staging.
P53 mutation upgrades the staging.
POLE is excellent and P53 mutation is worse.
NSMP and MMRd are intermediate course.
POLE proofreading hypermutation
Causes more neoantigen formation.
That leads to tumor suppressor function.
So, it is under low-risk stratification.
Molecular analysis in endometrial cancer
Dr Kanhu Charan Patro 30th DEC 2023/ENDOMETRIUM

19. Treatment algorithm for soft tissue
sarcoma
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
31st DEC 2023/SARCOMA

20. Difference between Conventional RT and Stereotaxy
Handbook of Evidence-Based Stereotactic Radiosurgery and
SBRT
1st JAN 2024/PHYSICS

21. If nuclear atypia is unusual in excess
It may be a p53 mutation or a serous
Mucinous is a variant of low-grade.
Intestinal type Mucinous is high grade
Low grade histology and single ovary involvement
It is not a stage three confinement.
Take stage one if there is no high risk in the statement.
Intraluminal tubal tumor floating
Or in the positive cytology washing
Always a statement of confusing
Not included in the staging
Any sub mesothelial fibroconnective involvement
It is regarded as serosal involvement.
It is stage IIIc in the document.
Stage IIIc is involvement of paraaortic node.
Stage IVc above renal vessel if there is a node.
Let’s discuss endometrial staging.
The differences from 9th FIGO staging.
Hysterectomy and bilateral salpingo-oophorectomy
If it is a high grade, consider infracolic omentectomy.
Aggressive histology
Confined to endometrium is Stage one C
Involving the myometrium, changed to two C
III B2 is Pelvic peritoneal metastasis.
IVA is abdominal peritoneal metastasis.
Minimal or Focal if fewer than five vessels
IF substantial LVSI is five or more vessels
Undifferentiated, mixed, clear, and serous
Endometroid high grade and intestinal mucinous
All are aggressive including carcinosarcomatous.
If nuclear atypia in excession
Increase the grade by one.
New staging of endometrial cancer
Dr Kanhu Charan Patro 2nd JAN 2024/ENDOMETRIUM

22. Molecular and clinicopathological features of endometrial
cancer molecular subgroup
ESMO GUIDELINE 3rd JAN 2024/ENDOMETRIUM

23. Surgical management of stage 1 endometrial cancer
ESMO GUIDELINE 4th JAN 2024/ENDOMETRIUM

24. Risk stratification of endometrial cancer based on molecular basis
ESMO GUIDELINE 5th JAN 2024/ENDOMETRIUM

25. Management of low and intermediate endometroid cancer
ESMO GUIDELINE 6th JAN 2024/ENDOMETRIUM

26. Management of high intermediate and high risk endometroid cancer
ESMO GUIDELINE 7th JAN 2024/ENDOMETRIUM

27. Management of locally recurrent endometroid cancer
ESMO GUIDELINE 8th JAN 2024/ENDOMETRIUM

28. Management of recurrent metastatic endometroid cancer
ESMO GUIDELINE 9th JAN 2024/ENDOMETRIUM

29. TransPORTEC RAINBO program of clinical trials.
YANG et al./Int J Gynecol Obstet/2023 10th JAN 2024/ENDOMETRIUM

30. Risk stratification in endometrial cancer
Ye Yang/Int J Gynecol
Obstet/2023
11th JAN 2024/ENDOMETRIUM

31. Management of endometrial cancer
Ye Yang/Int J Gynecol
Obstet/2023
12th JAN 2024/ENDOMETRIUM

32. POLYMERASE EPSILON (POLE) MUTATIONS –GOOD PROGNOSIS - HOW?
XUAN XUAN XING/CANCERS/2022 13th JAN 2024/ENDOMETRIUM

33. MMR deficient protein endometrial cancer
XUAN XUAN XING/CANCERS/2022 14th JAN 2024/ENDOMETRIUM

34. January- Cervical cancer awareness month
DR KANHU CHARAN PATRO 15th JAN 2024/PUBLIC
BE LOYAL TO YOUR PARTNER
MAINTAIN GENITAL HYGIENE
GET VACCINATED
GET SCREENED