Asian Pacific Journal of Cancer Care

A Dosimetric Evaluation of Thyroid Sparing and Thyroid Optimised Radiotherapy in Locally Advanced Head and Neck Cancer

Gautam Vedagiri Vydia — 2025-01-12

Background: Radiation-induced hypothyroidism is a frequent complication of radiotherapy for head and neck cancers due to the thyroid’s proximity to treatment areas. Advances in radiation therapy, such as Intensity Modulated Radiation Therapy (IMRT), have made it possible to reduce radiation exposure to the thyroid while maintaining effective tumor coverage. This study evaluates the dosimetric outcomes of thyroid-optimized (TO-IMRT) and thyroid-sparing (TS-IMRT) techniques in reducing thyroid radiation dose without compromising treatment efficacy.

Methods: A retrospective analysis was conducted on 10 patients with oral cavity and oropharyngeal cancers treated with IMRT between 2020 and 2023. Three treatment plans were compared for each patient: thyroid-non-optimized (TNO-IMRT), TO-IMRT, and TS-IMRT. Dosimetric parameters including mean thyroid dose, dose-volume coverage (V100%, V95%), and target coverage were analyzed across the three plans. Statistical significance was evaluated using paired t-tests, with a p-value < 0.05 considered significant.

Results: Both TO-IMRT and TS-IMRT significantly reduced the mean thyroid dose compared to TNO-IMRT. The mean thyroid dose in TNO-IMRT ranged from 4951 to 5890 cGy, whereas TO-IMRT reduced it by an average of 12–15%, and TS-IMRT by up to 20–25%. PTV coverage was maintained across all plans, with V100% and V95% showing minimal reductions. For example, in PT1, V100% was 91.5% in TNO-IMRT, 90.6% in TO-IMRT, and 91.0% in TS-IMRT. Similar patterns were observed across all patients.

Conclusion: Thyroid-optimized and thyroid-sparing IMRT techniques effectively reduced thyroid radiation dose without compromising target volume coverage in head and neck cancer patients. The significant dose reduction observed with TS-IMRT suggests a promising approach to mitigating radiation-induced hypothyroidism, enhancing patient outcomes and long-term quality of life. Further studies with larger cohorts are recommended to confirm these findings.

Fast-track Palliation: Evaluating Accelerated Hypofractionated Radiotherapy in Advanced Oral Cavity Cancer

Kaluvoya Ramanaiah — 2025-01-12

Background: Advanced oral cavity squamous cell carcinoma (OCSCC) in patients with poor performance status presents significant challenges in management, as many are ineligible for curative treatment. Palliative care, particularly radiation therapy, aims to alleviate symptoms and improve quality of life. Accelerated hypofractionated radiotherapy offers a shorter, more intensive treatment course, which may improve patient compliance and provide rapid symptom control. The aim of this study was to evaluate the feasibility, symptom control, toxicity profile, and overall survival of a 5-day course of accelerated hypofractionated palliative radiation therapy in patients with locally advanced OCSCC who are not candidates for curative treatment.

Methods: This prospective single-arm pilot study included 8 patients with advanced OCSCC (ECOG performance status 2-3), who were treated with a total dose of 30Gy in 10 fractions of 300cGy twice daily over 5 days. Patients were assessed for symptom control, toxicity, and overall survival (OS) at 1 year. Symptom control was evaluated immediately post-treatment and mucosal/dermal toxicities were monitored at 4 weeks.

Results: The median age of patients was 71 years (range 62-80). All patients completed the treatment. Primary symptom control was achieved in 100% of patients, with a reduced need for analgesics post-treatment. Grade 3 mucositis occurred in 5 patients, while 2 experienced Grade 2 mucositis. No Grade 4 toxicities were observed. One patient expired before the 1-month follow-up; 50% of the remaining patients achieved complete remission, and 50% had a partial response. The 1-year overall survival rate was 50%, with a median survival of 16 months (range 1-22 months).

Conclusion: Accelerated hypofractionated palliative radiotherapy is a feasible and well-tolerated option for patients with locally advanced OCSCC who are not eligible for the conventional hypofractionated regimens The regimen demonstrated effective symptom control with acceptable toxicity and showed comparable survival outcomes to other palliative radiation regimens. Further studies with larger cohorts are warranted to validate these findings.

Pattern of Prostate Cancer in Karbala Province of Iraq: Data from Developing Country

Ahmed Mjali — 2025-02-05

Background: Global patterns of prostate cancer differ with respect to environmental and demographic factors.

Objective: Our study’s objective was to evaluate the prostate cancer pattern in Karbala province of Iraq, make comparisons with other populations to detect potential changes.

Methods: A retrospective descriptive research was conducted at Al-Hussein Cancer Center in Karbala, Iraq, on 265 patients found to have prostate cancer from January 2012 to December 2020 with assessment of age, presenting symptoms, pathological characteristics and stage.

Results: Median age was 70 years. The most common symptoms were irritative symptoms in 58.11% of patients, the most frequent histopathology was adenocarcinoma in 95.85% of patients, A prostate-specific antigen level (PSA) was > 20 ng/ml in more than 56% of patients. The Gleason score was ≥7 in (86.22%) of adenosarcomas patients. Unfortunately, more than half of our patients (51.32%) presented as stage IV.

Conclusion: This is the first statistical research about prostate cancer in Karbala province of Iraq. It can be used as a starting point to examine epidemiological characteristics, evaluate current developments, and develop therapeutic strategies.

A Comparative Study of 3D Conformal Radiotherapy Versus Intensity Modulated Radiotherapy with Simultaneous Integrated Boost in Locally Advanced Head and Neck Cancer Patients

Shrenuka Sudhanshu — 2025-02-05

Introduction: Role of radiotherapy in comprehensive management of head and neck cancer for achieving tumor control and organ preservation is now well established and radiotherapy is routinely used as definitive or in the adjuvant setting after surgery, concurrently with chemotherapy or targeted agents. Development of linear accelerator with Multileaf Collimator (MLC) have revolutionized radiation delivery techniques, allowing conformal and Intensity Modulated Radiotherapy (IMRT) to deliver highly conformal sculpted radiation dose to a very complex structure with improved sparing of adjoining critical structures like salivary glands, spinal cord, eyes, and brainstem amounting to better therapeutic gain.

Aim and Objective: This prospective study is to compare toxicity profile of IMRT-SIB with Three Dimensional Conformal Radiotherapy (3D CRT) in head and neck cancer.

Materials and Methods: A total of 80 patients with proven head and neck cancer were included in the study. They underwent radiotherapy on Linac 2300 CD for 3D-CRT and TRUEBEAM SVC machine for the IMRT comprised of 40 patients in each arm. Patients received 66Gy/30 fractions, as radical treatment in the IMRT arm for 6 weeks and 66 Gy/33 fractions in the 3DCRT arm for 6.5 weeks from Monday to Friday.

Results: The 3D-CRT group demonstrated significantly more acute toxic effects compared with the IMRT group in our analysis. Acute Grade 3 or greater toxic effects to the skin occurred in 7 of 40 (17.5%), patients in the 3D-CRT group compared with 3 of 40 (7.5%) patients in the IMRT group. Acute Grade 3 or greater toxic effects to the mucous membranes occurred in 15 of 40 (37.5%) patients in the 3D-CRT group and only 9 of 40 (22.5%) patients in the IMRT group. Statistically significant grade III dysphagia developed in 8 of 40 (20%) patients in 3D-CRT group compared with 4 of 40 (10%) patients in IMRT group, while significant grade II xerostomia developed after 6 month of treatment; 20 of 40 patients in 3D-CRT group (50%), compared with 13 of 40 (32.5%) patients in IMRT group.

Conclusion: In our comparative study, IMRT was associated with a significantly lower incidence of Grade 3 or greater xerostomia, acute toxic effects to skin (dermatitis) and mucous membranes (mucositis) than 3DCRT. In addition, compared to 3D-CRT, IMRT had lower rates of feeding tube use during radiotherapy. Our analysis showed potentially less toxicity in patients treated with IMRT in comparison to 3D-CRT.

A Comparative Analysis between Sequential Boost and Simultaneous Integrated Boost Volumetric Modulated Arc Therapy in Head and Neck Cancer Patients

Divya Sharma — 2025-02-18

Background: In head and neck cancer radical VMAT can be delivered by two techniques: Sequential Boost (SEQ) and Simultaneous Integrated Boost (SIB). Our aim is to compare SEQ and SIB planning techniques of VMAT in patients of Head and Neck Squamous Cell Carcinoma (HNSCC) in terms of acute toxicities and disease response.

Materials and Methods: A prospective randomized comparative study was conducted at ATRCTRI, S.P. Medical college Bikaner from January 2023 to December 2024. A total of 60 patients of locally advanced HNSCC of stage II- IVA planned for radical chemoradiation were enrolled into two arms equally between SEQ-VMAT and SIB-VMAT. Concurrent Chemotherapy was given with weekly cisplatin (40 mg/m²). Acute toxicity evaluation was done at end of the treatment. Response evaluation was done as per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 at the 3- and 6-months post treatment.

Results: Acute toxicities at the end of the treatment, mucositis, dysphagia, and xerostomia are comparable in both arms, SIB has statistically significant dermatitis. At 3 months of follow up, 76 % patients in SIB arm and 70% patients in SEQ arms had complete response, 5 in SIB and 6 in SEQ patients had partial response, 2 in SIB arm and 3 patients in SEQ arm had progressive disease. At 6 months of follow up, all the patients in both arms who achieved PR by 3^rd month had stable disease and 1 patient in SIB arm who had PD achieved PR. All responses were statistically nonsignificant.

Conclusion: SIB-VMAT and SEQ-VMAT are comparable in terms of overall response. Whereas SEQ-VMAT appears better in terms of acute toxicities but SIB-VMAT was more convenient as it has 6 weeks treatment compare to SEQ (7-week treatment) and no re-planning is required in SIB arm.

Insights into Low-risk Gestational Trophoblastic Neoplasia from a Tertiary Care Institute in India: A Short Communication

Sumedha Gupta — 2025-02-05

Objective: To report clinical characteristics, treatment outcomes and chemotherapy-related toxicities in patients with low-risk GTN at tertiary care centre in India.

Material and methods: This retrospective observational study was conducted at the Department of Medical Oncology of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi over 2 years. From December 2021 to December 2023, the medical records of all the patients diagnosed with GTN were retrospectively analyzed for clinical and treatment details. Low-risk GTN patients received methotrexate (MTX) with folinic acid (FA) rescue. The Chemotherapy regimen for Low-risk GTN resistant to first-line chemotherapy had received multiagent chemotherapy EMA-CO every 2 weeks.

Results: Of the 40 patients with low-risk GTN, only 35 women were available for evaluation as 5 were lost to follow-up during the treatment period. The study found that the majority of patients (71.4%) experienced a molar pregnancy before developing gestational trophoblastic neoplasia (GTN), with 91.4% developing GTN within the first 4 months. Of these, 32 patients achieved complete responses (91.4%), while 3 experienced treatment failure (8.5%). All three patients who failed primary MTX therapy were subsequently treated with multiagent chemotherapy and achieved complete remission (CR). Overall survival (OS) and cure rates for all patients with low-risk GTN were 100%.

Conclusion: The MTX regimen was remarkably effective in treating women with low-risk GTN, achieving a complete response (CR) rate of 91.4% without encountering severe adverse effects.

First Case of Rothmund-Thomson Syndrome Type II Presenting with Osteosarcoma in Palestine: A Case Report and Review of Literature

Muhammad Takhman — 2025-01-12

Rothmund-Thomson syndrome (RTS), also known as poikiloderma congenitale, is a rare genetic disorder characterized by its pleiotropic nature, affecting multiple organ systems. Key features of RTS include early photosensitivity and facial erythema that progresses to poikiloderma, as well as sparse scalp hair, absent or sparse eyebrows and eyelashes, juvenile cataracts, short stature, and skeletal abnormalities. Patients with RTSII, often attributed to mutations in the RECQL4 helicase gene, are predisposed to osteosarcoma and skin cancer. Herein, we present a case study of an eight-year-old female with heterogeneous mutations in RECQL4. The patient exhibited an exfoliative erythematous rash on face and diaper area at the age of 7- months, along with absent eyelashes and scanty eyebrows. Subsequently, she developed osteosarcoma, and she is currently undergoing treatment.

Management of Oligometastatic Gynecological Cancer: Use of Systemic Chemotherapy to Select Patients for Curative Treatment

Ana Paula Galerani Lopes — 2025-02-05

Introduction: Oligometastatic cancer is a growing field in oncology, offering potential curative-intent treatments for highly selected patients with a limited number of metastases beyond the primary tumor. The definition of oligometastatic cancers varies according to tumor type. Careful selection of patients is important. We describe the role of short-course systemic chemotherapy in selecting patients for curative treatment of gynecological malignancies.

Methods: Three cases of gynecological cancers with oligometastatic disease treated with systemic chemotherapy followed by radiotherapy and/or surgery are reported and discussed.

Results/Discussion: All three patients had a complete or very good partial response to 3 cycles of carboplatin and paclitaxel, followed by either surgery or curative radiotherapy. All patients are alive and disease-free when writing this report, with follow-up periods ranging from 10 to 33 months after primary diagnosis.

Conclusion: This case series highlights the feasibility and potential benefits of curative-intent treatments in carefully selected oligometastatic cancer patients with underlying gynecological malignancies. Challenges in defining the optimal treatment approach and sequencing of therapies remain, emphasizing the importance of personalized plans and ongoing research. Integrated care and multidisciplinary team discussions were crucial in tailoring treatment plans.

Acute leukemias in a Background of Neurocutaneous Syndromes

Shipla Roy — 2025-02-05

Background: Neurocutaneous syndromes are a group of hereditary disorders affecting the skin and the central nervous system. The association between neurocutaneous syndromes and acute leukemias is rare, and very few cases have been described in the literature.

Methods: Here we present three cases: two cases of acute lymphoblastic leukemia associated with sturge-weber syndrome and one case of acute myeloid leukemia in a known case of tuberous sclerosis.
Results: The association between NCS and acute leukemia denotes a poor prognosis, as evident by the fact that two out of three patients in the present triology series expired.

Conclusions: One should have a high index of suspicion for malignancies in cancer-predisposing syndromes to help in early diagnosis and treatment. Drugs affecting the mTOR pathway could be of possible benefit to these group of patients along with prophylactic anticonvulsant therapy for seizure prevention.

Insights into Clinical Characteristics and Management Strategies: A Case Series of Granulosa Cell Tumors

Sumedha Gupta — 2025-02-12

Background: Granulosa cell tumors (GCTs) are rare neoplasms with predominantly low malignant potential, primarily affecting peri-menopausal individuals. This case series investigates six patients diagnosed with GCT, emphasizing clinical features, prognostic markers, and treatment strategies.

Methods: This retrospective analysis focuses on patients diagnosed with GCT at Safdarjung Hospital between June 2022 and June 2023. Data collection included demographics, clinical presentations, diagnostic findings, treatment modalities, and follow-up outcomes.

Results: The case series comprised various presentations, ranging from asymptomatic masses to complications such as ovarian torsion and tumor rupture. Most patients presented with hormonally active tumors, predominantly producing estrogen. Surgical management, including unilateral salpingo-oophorectomy or total abdominal hysterectomy with bilateral salpingo-oophorectomy, was the primary treatment modality. Prognostic factors such as tumor size, stage, and mitotic index were identified, guiding clinical decision-making. Close surveillance post-surgery was essential due to the potential for late recurrences.

Conclusion: This case series enhances understanding of ovarian GCTs, providing insights into their clinical management and prognosis. Early detection, prognostic marker assessment, and vigilant surveillance are crucial for optimizing patient outcomes

A Rare Case of Bilateral Ovarian Adult Granulosa Cell Tumors Associated with Uterine Lipoleiomyoma- Case Report and Review of Literature

Ipsita Dhal — 2025-02-05

Leiomyomas are the most common uterine tumors and uterine lipoleiomyoma is a rare variant. Lipomatous tumors of the uterus includes spectrum of lesions comprising of lipomas, lipoleiomyoma, angiomyolipomas and fibrolipomyomas in the benign category and liposarcomas in the malignant category. Sex cord-stromal tumors are uncommon ovarian neoplasms comprising of both benign and malignant entities with a wide spectrum of clinical presentation owing to hormonal manifestations. We present a case of a post menopausal female who complained of bleeding and had an incidental bilateral ovarian tumor, which turned out to be adult granulosa cell tumor of the ovary.

Primary Squamous Cell Carcinoma of Thyroid – A Case Report with Emphasis on Treatment Options and Review of Literature

Gautam Vedagiri Vydia — 2025-02-12

Introduction: Primary squamous cell carcinoma of thyroid (PSCCT) is a rare entity with less than 100 cases reported in literature. It constitutes about 1% of all thyroid cancers. It has an aggressive behaviour and unfavourable prognosis. We report a rare case of PSCCT and provide a review of literature on PSCCT.

Case Report: A 45 year old gentleman with hypertension as co morbid condition reported to our hospital with complaints of swelling in anterior part of the neck. He was diagnosed as a case of carcinoma of thyroid. He underwent Total Thyroidectomy under general anaesthesia. With histopathology and IHC correlation, diagnosed as PSCCT. He received adjuvant RT to tumor bed to a total dose of 60 Gray (Gy) over a period of 6 weeks.

Conclusion: PSCCT is a very rare disease with very aggressive course. There is no consensus on the line of management. Lenvatinib can be tried in PSCCT as it resembles ATC.

Current Role of Chemotherapy in Metastatic Carcinoma Stomach- A Case Presentation and Review of Literature on Chemotherapy

Manish Sahni — 2025-02-12

Introduction and Importance: Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic gastric cancer. First-line systemic therapy regimens with two cytotoxic drugs are preferred for patients with advanced disease because of their lower toxicity. The use of three cytotoxic drugs in a regimen should be reserved for medically fit patients with excellent performance status and easy access to frequent toxicity evaluations. But we are presenting a rare case report of 60 year old patient diagnosed with metastatic gastric carcinoma who showed long term complete response with single agent capecitabine based therapy which is a matter of contemplation in the current era.

Case Presentation: 60 year old gentleman with ECOG 2 presented with complaints of loss of apetite and loss of weight from last 6 months.Clinical Findings and Investigations: Upper gastointestinal endoscopy of gastric mass was undertaken which revealed ulceroproliferative gastric growth and subsequently, gastic growth biopsy was done which on histopathology report revealed moderately differentiated gastric adenocarcinoma.

Interventions and Outcome: For staging the disease, Whole body PET-CT scan was performed which showed FDG avid gastric lesion with multiple, bilobar liver metastasis and bulky retroperitoneal lymphadenopathy. All routine blood investigations were done simultaneously.Patient was counseled for ultrasound guided biopsy of liver lesions in Aug 2021. (Figure 1a, 1b, 1c) which showed metastatic deposits. We offered him to get IHC testing of biopsy sample for Her-2-neu, MSI testing and patient had Her2-neu negative disease. He was initiated on CAPOX dual agent regimen with tablet capecitabine 1000mg twice daily from day 1-14 cycled every 21 days and Injection oxaliplatin (Day 1) with dose of 130mg/m2 and repeated every 21 days for 8 cycles. He tolerated the chemotherapy well with improvement of general condition and showed partial response to treatment on whole body PET-CT scan (Figure 2) Case was discussed in multidisciplinary tumor board for further course of management and the plan to initiate tablet capecitabine monotherapy with 1000mg twice daily from day 1-14 cycled every 21 days was made as it was freely available in our tertiary cancer centre along with the nutritional support with enteral high protein diet. He was advised to remain on close follow up and after 1 month, he showed further improvement in symptoms with improved appetite and weight gain. Same cycles of capecitabine were continued and repeat whole body PET-CT scan was done at 6 months interval which showed no FDG avidity in the body. He is on same regimen till date and last repeat PET-CT scan was done in April 2024 which again showed complete response to treatment (Figure 3).

Relevance and Impact: For patients with metastatic gastric carcinoma, performance status determines the type of therapy and treatment. Also IHC markers aids in the decision making in the type of therapy to be offered to the patient. Lastly, in low resource settings, metronomics in the form of capecitabine therapy assists in the control of this subset of the disease.

Small Cell Neuroendocrine Carcinoma of the Cervix with Past History of Uterine Fibroids: A Rare Case Report

Javeria Haider — 2025-02-18

Small cell neuroendocrine carcinoma of the cervix (SCNECC) is an aggressive uterine tumor, comprising less than 2% of all cases of invasive cervical cancer. This malignancy is frequently associated with high-risk human papillomavirus (HPV) type 18. Compared to squamous cell carcinoma or adenocarcinoma, SCNECC is characterized by a significantly higher risk of both nodal and distant metastases. The scarcity of clinical trials and evidence-based treatment protocols results in a reliance on case series and individual case reports for guidance. This case report delineates a successful management strategy for SCNECC utilizing a regimen of chemotherapy in conjunction with concomitant chemoradiation therapy (CCRT) and single-channel brachytherapy.

Histological Harmony: A Distinct Case of Mixed Breast Carcinoma in an Elderly Female

Manjula Navakodi — 2025-03-08

Background: Breast cancer is classified morphologically into “Invasive Breast Carcinoma of No Special Type” (IBC-NST) and various special subtypes. Mixed breast carcinoma, characterized by the presence of two or more distinct histological types, poses unique diagnostic challenges and is relatively rare.

Case Presentation: A 74-year-old female presented with a six-month history of a lump in her left breast, with no significant family history. Clinical examination revealed an ill-defined lump, and imaging studies indicated a BIRADS score of IV-B. Fine Needle Aspiration Cytology (FNAC) suggested proliferative breast disease with atypia. Surgical excision uncovered two tumors: Tumor 1, an invasive papillary carcinoma, and Tumor 2, exhibiting features of IBC-NST and ductal carcinoma in situ (DCIS). A subsequent Left Modified Radical Mastectomy (MRM) confirmed no residual disease in the specimen or lymph nodes.

Immunohistochemistry Results: Both tumors tested positive for estrogen and progesterone receptors and negative for HER2-neu. Tumor 2 displayed a Ki67 index of 8%, indicating low proliferation.

Conclusion: This case exemplifies the complexity of mixed breast carcinoma involving IBC-NST and invasive papillary carcinoma. It underscores the importance of histopathological and immunohistochemical analysis in accurately diagnosing and managing such cases. As mixed breast cancers constitute a small percentage of diagnoses, ongoing vigilance and collaboration among oncologists and pathologists are essential for tailored treatment approaches.