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.

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.