Recommendation for newly diagnosed Brain metastasis
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BOOK ON REIRRADIATION
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
SRS AVM PLAN EVALUATION CHECK LIST
The document outlines the evaluation criteria for stereotactic radiosurgery (SRS) treatment planning for arteriovenous malformation (AVM), including:
1. Patient details and medical history
2. Imaging findings of the AVM including location, size, feeding arteries, and venous drainage
3. Scoring systems used to classify the AVM complexity
4. Prior treatments and the patient's treatment preferences
5. Treatment planning details including dose, margins, plan type and dose constraints to critical organs.
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TARGET DELINEATION OF CANCER ESOPHAGUS
1. The document discusses guidelines for delineating target volumes for radiation treatment planning in esophageal cancer.
2. It describes expanding the gross tumor volume (GTV) to create the clinical target volume (CTV) with margins of 4cm above and below the tumor and 1-1.5cm radially, plus inclusion of involved lymph nodes.
3. The planning target volume (PTV) is created by expanding the CTV by 0.5-1cm to account for setup variability and organ motion.
Head and neck reirradiation
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Contouring guidelines Cervix IMRT
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1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
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The document outlines the evaluation criteria for stereotactic radiosurgery (SRS) treatment planning for arteriovenous malformation (AVM), including:
1. Patient details and medical history
2. Imaging findings of the AVM including location, size, feeding arteries, and venous drainage
3. Scoring systems used to classify the AVM complexity
4. Prior treatments and the patient's treatment preferences
5. Treatment planning details including dose, margins, plan type and dose constraints to critical organs.
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Target delineation in GLIOMA
The panel discussion focused on target delineation in glioma. For low grade gliomas, the GTV includes the surgical cavity while the CTV expands 1 cm from the T2/FLAIR hyperintense area. For high grade gliomas, the GTV is the cavity plus enhancing tumor and the CTV expands 2 cm from the GTV while also including any FLAIR abnormalities. Proper trimming of the CTV is discussed to respect anatomical barriers like the ventricles, falx, optic apparatus, brainstem, and interthalamic area. OAR sparing is also emphasized to reduce treatment toxicity.
TARGET DELINEATION OF CANCER ESOPHAGUS
1. The document discusses guidelines for delineating target volumes for radiation treatment planning in esophageal cancer.
2. It describes expanding the gross tumor volume (GTV) to create the clinical target volume (CTV) with margins of 4cm above and below the tumor and 1-1.5cm radially, plus inclusion of involved lymph nodes.
3. The planning target volume (PTV) is created by expanding the CTV by 0.5-1cm to account for setup variability and organ motion.
Head and neck reirradiation
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Contouring guidelines Cervix IMRT
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The document provides guidance on contouring the hippocampus on MRI images for radiation treatment planning. It describes in detail how to contour each section of the hippocampus - the head, body, and tail - on axial MRI slices from inferior to superior. Landmarks used to define the boundaries include the temporal horn of the lateral ventricle, uncal recess, quadrigeminal cistern, and atrium of the lateral ventricle. A 5mm expansion of the hippocampus contour is used to create the hippocampal avoidance zone.
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Stereotactic body radiotherapy
Stereotactic body radiotherapy (SBRT) delivers high-dose radiation to tumors in a small number of fractions using high precision. For prostate SBRT, the target and organs at risk are contoured on planning CT. A dose of 35-38Gy in 5 fractions is used as primary treatment for low risk prostate cancer. Rigid image guidance and intrafraction monitoring are important to minimize setup errors. ExacTrac X-ray positioning co-registers X-rays with digitally reconstructed radiographs and corrects for rotational and translational deviations, achieving sub-millimeter accuracy. This allows safe dose escalation for prostate SBRT.
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- Early-responding tissues like skin generally recover better than late-responding tissues like fibrosis and can tolerate reirradiation with reduced doses. Spinal cord and lung data from rodent and monkey studies show some reirradiation is possible. Kidney and bladder do not recover from late damage.
- Clinical studies on reirradiation are limited but show it can provide local control and possibly survival for head and neck cancers, though with high risks of toxicity and functional
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Prophylactic cranial irradiation (PCI) is used to prevent brain metastases in cancers with a high risk of spreading to the brain. It is indicated for small cell lung cancer and certain leukemias. PCI significantly reduces the rate of brain metastases in small cell lung cancer, especially when administered early at higher doses. For extensive stage small cell lung cancer, MRI surveillance may be an alternative to PCI. While PCI reduces brain metastases in leukemia, the risk of brain involvement is low for some types such as AML. The standard dose for PCI is 1200-1800 cGy in fractions, with timing and volumes depending on the cancer type. Potential toxicities include neurocognitive effects, endocrine disorders, and secondary cancers.
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2. It describes the evolution of radiotherapy from conventional 2D techniques to newer approaches like 3D conformal radiation therapy and intensity-modulated radiation therapy.
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This document provides an overview of key concepts in clinical radiobiology. It discusses how ionizing radiation interacts with matter and cells, causing ionization which can lead to cell death. The attenuation of radiation as it passes through different tissues is described, as well as different radiation interactions like the photoelectric effect. Cell survival curves are introduced, showing their exponential nature and how factors like oxygenation and fractionation affect the curves. The linear quadratic model is explained. Finally, the four R's of radiobiology - reoxygenation, redistribution, repopulation and repair - are summarized as the basis for fractionated radiotherapy.
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Liver sbrt
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1) Liver SBRT is used for 3 or fewer lesions 7cm or less in non-cirrhotic or cirrhotic livers, with controlled extrahepatic disease and a treatment history of local/regional/systemic therapies.
2) Treatment plans aim to spare at least 35% of the liver from the high SBRT doses to avoid liver decompensation. Special considerations are made for cirrhotic livers.
3) Treatments utilize respiratory motion management,
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This document discusses guidelines for target delineation in breast cancer radiotherapy, including contours for the chest wall, breast, lymph nodes, and organs at risk. It describes guidelines from organizations like EORTC, RTOG, TROG, and ESTRO for delineating targets like the supraclavicular fossa, internal mammary nodes, and three levels of axillary lymph nodes. It also discusses techniques like custom immobilization and image guidance that can help reduce planning target volume and guidelines for target volumes in post-mastectomy and breast-conserving settings.
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- Seminoma accounts for over 60% of testicular germ cell tumors with an incidence of 0.95 per 100,000.
- For stage I seminoma, prophylactic radiation to the para-aortic lymph nodes is the standard of care to reduce the risk of recurrence.
- For stage IIA/IIB seminoma, radiotherapy to the para-aortic, iliac, and inguinal lymph nodes is recommended, with 30Gy to the whole field and a 10Gy boost for stage IIA and 36Gy total for stage IIB.
- Intensity modulated radiation therapy (IMRT) allows for improved sparing of
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- For early stage NSCLC (stages I-II), surgery is the standard treatment but radiotherapy is an alternative for medically inoperable patients. Adjuvant chemotherapy may improve outcomes for stage II.
- For locally advanced NSCLC (stage III), combined modality treatment is usually recommended, with concurrent chemoradiotherapy being superior to sequential treatment for stage IIIB.
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TARGET DELINEATION IN ANAL CANAL CANCER BY DR KANHU
1. The document discusses target delineation and radiation therapy workflow for anal cancer, including definitions of gross tumor volume (GTV) and clinical target volumes (CTVs) based on anatomical locations.
2. It provides guidelines for determining margins around the GTV and nearby anatomical structures to create the CTVs for the primary tumor (CTVp), involved nodes (CTVn), and elective nodal regions (CTVnLR) to cover possible microscopic disease.
3. Treatment planning volumes (PTVs) are created by adding margins to the CTVs, with the PTV-HR receiving the full prescription dose and the PTV-LR receiving a lower dose.
TARGET DELINEATION IN VULVAL CANCER BY DR KANHU
The document outlines the steps and guidelines for target delineation in vulval cancer radiation therapy planning. It discusses delineating the gross tumor volume (GTV), clinical target volume (CTV), organs at risk (OAR), and planning target volume (PTV). Specific guidelines are provided for contouring depending on the location and extent of the primary tumor, including the vulva, mons pubis, vagina, anorectum, urethra, and clitoris. Radiation dose parameters and OAR constraints are also reviewed. The target delineation workflow aims to adequately cover suspected disease while minimizing dose to surrounding healthy tissues.
TARGET DELINEATION IN CERVIX CANCER BY DR KANHU
This document outlines the 10 step workflow for target delineation in cervical cancer radiotherapy treatment planning. It describes the clinical target volumes that should be contoured for the primary gross tumor (GTVp), primary clinical target (CTVp), nodal gross tumor (GTVn), nodal clinical targets (CTVn) and elective nodal volumes. It provides explanations and guidelines for delineating each target volume, including the parametrium and nodal regions. Diagrams and images are included to illustrate the anatomical locations and boundaries of the target volumes.
Oncology cartoons by Dr Kanhu Charan Patro
This document provides guidance on target volume delineation for vulval cancer from the Royal College of Radiologists. It outlines the clinical target volume (CTV) for different disease sites, including the vulva, mons pubis, vagina, anorectum, urethra and pelvic nodes. Contouring workflows and organ-at-risk constraints are also discussed. Recommendations are given for radiation dose and treatment of resectable and unresectable head and neck cancer. The final item notes that smoking increases the risk of kidney cancer.
RADIATION THERAPY IN BILIARY TRACT CANCER
This document provides information on biliary tract cancers and the role of chemoradiotherapy in their treatment. It discusses the anatomy and types of biliary cancers, risk factors, presentation, diagnosis, staging, and standard treatment approaches including surgery. It then focuses on the evidence and guidelines for use of radiation therapy, including as adjuvant therapy after surgery for positive margins or nodes, as radical/definitive therapy for unresectable disease, and for palliation of symptoms from local or metastatic disease. Key findings are that chemoradiation improves local control and survival as adjuvant or radical therapy, and brachytherapy and external beam radiation are effective for palliation. Optimal regimens involve fluorouracil or capec
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUME
Dr Kanhu Charan Patro provides summaries of statistical concepts in 3 sentences or less, beginning each summary with the date. Summaries from January 19th to February 15th are presented, covering topics such as p-values, censoring in survival analysis, hazard ratios, and ISRS guidelines for stereotactic radiosurgery. On February 15th, a 3 sentence summary of World Cancer Day is provided, noting the date it is held, the organization that leads it, and the 2024 slogan of "Close the care gap".
Molecular Profile of Endometrial cancer.
The document discusses molecular analysis and classification of endometrial cancer, which impacts staging and treatment decisions. It describes aggressive histological subtypes and how molecular markers like POLE mutations, MMRd, and p53 abnormalities determine low, intermediate, or high risk stratification. Ongoing PORTEC trials are exploring the impact of molecular profiling on adjuvant treatment, with POLE mutations potentially downstaging while p53 mutations upstage disease. Molecular analysis provides predictive significance for personalized adjuvant therapies in endometrial cancer.
ONCOLOGY CARTOONS JANUARY 2024 BY DR KANHU CHARAN PATRO
This document discusses cervical cancer awareness month in January and provides 3 recommendations: 1) Be loyal to your partner to reduce risk of HPV infection, 2) Maintain genital hygiene, 3) Get vaccinated against HPV to prevent cervical cancer, and 4) Get screened regularly to detect cervical cancer early.
TYPES OF STATISTICAL DATA BY DR KANHU CHARAN PATRO
This document discusses types of data in statistics. It defines qualitative and quantitative data, and describes different types of quantitative data like discrete, continuous, ordinal, and nominal. Examples of love and fight data are provided to illustrate these concepts. The document concludes with a short poem about not fighting in marriage.
WHY STEREOTATXY IN CRANIAL AVM / DR KANHU CHARAN PATRO
This document discusses stereotactic radiosurgery (SRS) for the treatment of cerebral arteriovenous malformations (AVMs). It begins by explaining what an AVM is and the risks they pose if untreated, such as bleeding in the brain. It then covers treatment options for AVMs and why SRS is often preferred for certain cases, such as when the AVM is in an eloquent or deep brain area. The document provides details on patient selection, imaging and planning for SRS, anticipated outcomes, and risks of treatment complications. It emphasizes the importance of multidisciplinary discussion and informed consent when determining if SRS is appropriate for a patient's individual AVM.
PORTAL VEIN TUMOR THROMBOSIS SBRT/DR KANHU CHRAN PATRO
1) SBRT is an effective treatment for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). In a study of 70 HCC patients with PVTT treated with SBRT, median survival was 10 months and 6-month and 12-month survival rates were 67.3% and 40% respectively.
2) Patients who received SBRT combined with transarterial chemoembolization (TACE) had significantly longer survival compared to those who did not receive TACE after SBRT.
3) SBRT is a promising bridging therapy prior to liver transplantation or hepatectomy by downstaging PVTT to make these curative procedures possible.
DR KANHU CHARTAN PATRO/ FOR ENT SURGEONS
1. Radiotherapy plays a crucial role in the treatment of head and neck cancers, both as a primary treatment and in combination with surgery. It is used for cancers of the nasopharynx, larynx, hypopharynx, and as postoperative treatment for most oral cancers.
2. Advances in radiotherapy technology such as IMRT have allowed for better tumor targeting while minimizing doses to surrounding healthy tissues, reducing treatment toxicities. Imaging techniques such as PET-CT provide improved visualization of tumors and affected lymph nodes, helping determine accurate target volumes.
3. Organ preservation approaches using radiotherapy and chemotherapy are increasingly used to treat head and neck cancers, avoiding disfiguring surgeries while achieving high
DECEMBER 2023 ONCOLOGY CARTOONS DRKANHU CHARAN PATRO
Here are the key points about the hepatitis B vaccine and liver cancer:
- Hepatitis B virus (HBV) infection can lead to chronic hepatitis B and significantly increase the risk of developing liver cancer later in life.
- The hepatitis B vaccine is effective at preventing HBV infection and therefore helps prevent liver cancers caused by the virus. It was the first vaccine referred to as an "anti-cancer" vaccine by the FDA.
- Around 25% of people with chronic HBV infection may develop liver cancer according to the CDC. Getting vaccinated helps avoid this risk.
- The hepatitis B vaccine is available and affordable in India, ranging from around 45 rupees per pediatric dose to 250 rupees for the
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June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
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MAY 2024 ONCOLOGY CARTOONS BY DR KANHU CHARAN PATRO
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TARGET DELINEATION IN ANAL CANAL CANCER BY DR KANHU
TARGET DELINEATION IN ANAL CANAL CANCER BY DR KANHU
ONCOLOGY CARTOONS JANUARY 2024 BY DR KANHU CHARAN PATRO
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WHY STEREOTATXY IN CRANIAL AVM / DR KANHU CHARAN PATRO
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PORTAL VEIN TUMOR THROMBOSIS SBRT/DR KANHU CHRAN PATRO
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
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