Dr. Charu Garg

EP-1244Neoadjuvant Chemo Radiation followed by Surgery in Ca Esophagus –Retrospective Review from IndiaV. Goel1, A.K. Anand1, H.K. Chaturvedi2, A. Verma1, P. Agarwal1, T. Saxena1, R. Shukla1, D. Arora3, A.K. Bansal3, A. Gulia1, C. Garg1, U. Mukherjee41Max superspecality hospital, Radiation Oncology, Delhi, India2Max superspecality hospital, Surgical Oncology, Delhi, India3Max superspecality hospital, Medical Physics, Delhi, India4Max superspecality hospital, Pathology, Delhi, India Purpose or Objective Neo-adjuvant Concurrent Chemoradiation (NACCRT) followed by Surgery is now the standard of care for middle & lower third esophageal carcinoma. However this is an intensive treatment regimen. Often there are concerns and doubts about its feasibility in Indian population, who do not have as good nutritional status as western patients. At our institute we have been following this treatment approach since 2009 and have analysed our own outcomes in terms of feasibility, toxicity, mortality and survivals. Material and Methods: We treated 62 patients with NACCRT followed by surgery from October 2009 to December 2015 at Max Hospital, Delhi, India. All patients underwent esophageal endoscopy, biopsy and PETCT scan for diagnosis and staging purpose. Inclusion criteria for NACCRT followed by surgery were, patients with bulky primary tumour, enlarged lymph nodes (LN) on imaging, adherence to surrounding organs and clinical suitability for trimodality therapy. All patients received radiation therapy (RT) with IMRT technique with single/double agent concurrent chemotherapy. PET CT was used in target volume delineation for IMRT in all patients.RT doses were 41.4 Gy/23 fractions and 45 Gy/25 fractions with double & single agent chemotherapy respectively. Patients underwent open transthoracic esophagectomy with 2-Field lymph node dissection; 6-8 weeks after completion of NACCRT. Results- Squamous cell carcinoma was present in 82% patients while only 18% patients had adeno carcinoma. Tumour was located in Middle, Lower and Lower and GE junction in 50%, 23% and 27% patients respectively. Total 60/62 (96.8%) patients completed NACCRT. Of these 46 (76.6%) were taken up for surgery. Three patients (5%) were considered unsuitable for surgery, 13.3% defaulted for surgery and 5%were lost to follow up after NACCRT. Resectability rate for patients taken up for surgery was 93.4%. Perioperative death occurred in 3 patients (6.6%). Pathological complete response was seen in 37.2% patients. At median follow up of 17.6 months, 3(7%) patients had a mediastinal nodal recurrence and 12% developed distant metastases. In all three patients with nodal recurrence, LN was located in superior mediastinum. Median disease free survival (DFS) and overall survival (OS) is not yet reached. The OS in our study at 1 and 2 year respectively was 76% and 62.8% for all patients. Conclusion- NACTRT followed by surgery is feasible in middle and lower third carcinoma esophagus patients in Indian population and yields high DFS and OS. Most common locoregional pattern of failure was in superior mediastinal nodal station, which needs to be further addressed in terms of RT planning volumes and surgical dissection.

Purpose: The aim of this study is to report a preliminary analysis of our clinical experience with extended field pelvic (conformal) radiation, with or without concurrent chemotherapy, in gynaecological malignancies. Materials and Methods: 27 women with gynaecological malignancies (17 with Carcinoma Cervix and 10 with Carcinoma Endometrium) were treated between November 2009 and October 2015 with Extended Field abdomino-pelvic radiation. All patients were treated with conformal radiation (Intensity Modulated Radiotherpy or Volumetric Modulated Arc Therapy). All patients underwent CT Simulation followed by target and OAR delineation as per RTOG guidelines. Dose prescriped was 45-50 Gy in 1.8 Gy per fraction and boost to gross node upto 54-56 Gy. Planning was done on Eclipse Planning system, and treatment was delivered on 6 MV linac. Concurrent chemotherapy was given when indicated. All toxicities were scored according to Common Terminology Criteria for Adverse Events (CTCAE v 4.03). Dosimetric parameters were correlated with toxicities. Results: Median follow up was 9.5 months (Range 0-52 months). 14 (51.8%) patients developed Grade 1 and 2 acute hematological toxicity and 1 (0.04%) developed Grade 3 toxicity. 10 (37%) patients developed Grade 1 and 2 acute gastrointestinal toxicity and 1 (0.04%) developed grade 4 toxicity. 3 (11.12%) patients had late toxicity in the form of prolonged leucopenia, SAIO, and Irritable Bowel Syndrome. 1 patient did not complete her treatment due to persistent leucopenia (Grade 3). Conclusion: Extended field Radiation in Gynaecological malignancies is a reasonably well tolerated procedure when treated with IMRT or VMAT, with acceptable toxicity profile.

Ependymoma accounts for 5% to 10% of all brain in the paediatric age group. The mainstay of the treatment is surgery followed by radiotherapy. The primary site remains the most common site (85%) for the recurrences followed by the metastatic disease (25%). Here we present a case report of a 5 year old male child who presented as an operated case of ependymoma and was treated with localized radiation therapy. After a disease free interval of one year the child relapsed in the brain and spine. He was re operated for the brain lesion and then was taken up for cranio spinal irradiation. This was followed by systemic chemotherapy. The follow up scans should complete resolution of the disease in the brain and the spine. Hence, longer follow up is needed to appreciate the long term effectiveness and toxicity of this treatment protocol

Coexistence of tuberculosis and neoplastic lesion in the oral cavity is a rare phenomenon. Till date, only three such cases have been reported in the English literature. A case of oral tuberculosis manifesting 3 months following the successful treatment of cancer of the oral tongue with chemoradiotherapy is presented. The diagnostic dilemma it posed, and its eventual successful control by anti-tubercular treatment, is discussed.