Isocentre Archive - new forum threads

Irritation on the scalp part.

Tue, 02 Jan 2018 11:06:05 +0000

Since a week, I've been facing an issue where I can experience irritation on a part of my scalp. I tried rubbing my with my hands by applying little pressure but it didn't change the situation. What can possibly the reason?

In my Early 50′s I started to bleed from the Bowel

Mon, 04 Jun 2012 05:39:24 +0000

Naturally, my first feelings were to completely ignore it and hope it would go away and resolve itself. After intermittent heavy bleeding I decided to go and see my local doctor, he conducted some tests and asked me to come back when he had the results.

Several days later, he called me in to the office, asked me to be seated and presented me with something I just did not want to hear. “Peter” he said, “I’m afraid I have some rather bad news for you, you have a 3 inch malignant tumor in the bowel”.
He went on to say that the growth was large and aggressive. It began to pierce through the bowel wall and was taken up by the lymph glands.

The Doctor Gave me 18 Months to Live!

When I asked, what could be done? He said there was a lot that medical science today could do. The first thing to do was to book me in for surgery as soon as possible to remove the initial growth. This would be followed by chemotherapy, and radiotherapy to “mop up the possible spread of the cancer”.

As the conversation continued, I asked him how successful this was all going to be, and if that would actually fix the problem? With rather a blank face, he went on to say that he was afraid the cancer was too advanced and although medicine could give me some time, it could not save my life.

I asked “Well, how long do you think I may have before the cancer overtakes me?” He said that he really wouldn’t like to say, but he believed approximately 18 months, maybe 2 years was possible.
My Feelings at this point in time were in describable.

I was enjoying my life and all of a sudden it comes to a final stop. How could this possibly happen? What had I done? Was there an answer? There was a deep, deep sensation of finality. Everything I was familiar with and cherished had come to an end.So the options were to accept my doctor’s prognosis, go ahead with the procedures and claw out some months, or to do nothing, enjoy myself and to pass on. Not much of a choice at all. Of course my first preference was to go along with the medical side and hope that something would turn around and save my life. I might be one of the lucky ones.

I was booked for surgery in the next few weeks…but a friend of mine told me that they might be another option. By this time, so many sympathetic friends had told me of supplements, herbs, foods and the like. But this all seems so experimental, and although I was nice about it, none of them seemed to understand that I was dying. Perhaps it was out of desperation that I listened to this particular friend, who seemed so sure.

With assurance, told me that bowel cancer is completely reversible. How convinced was I? Perhaps about 20%, but that was better than nothing!

It was explained that although a reversal was not instant. It was achievable. I had nothing to lose. So I began the program and after a few adjustments and getting used to things, everything seemed to work.
It was apparent that in order to beat this cancer, I had to be consistent. Every day had to be a new day and the program was to remain strict. It was explained that the cancer was expected to gradually shrink and that this was a process that had to be taken steadily. If the process happens immediately, the cancer would die far too quickly, and that would be highly detrimental to me.

Approximately 10 months later…

After many abdominal sensations, and a few trials, that is exactly what happened. The cancer came through as a scab like growth, and finally I knew I was free of it. That was many years ago now. I have shared my experience with many others, and referred them back to those that helped me. I have also become very curious about their methods and this book is a direct report on the philosophy, strategies, methods and outcomes of what I have personally witnessed and am a direct benefactor.

User Migration is complete

Fri, 20 May 2011 23:28:31 +0000

Hi all,
All members have been dispatched their emails and passwords. Please remember to check your spam or junk mail if you dont see it in your inbox., Email will be from gro.retnecosi|nimda#gro.retnecosi|nimda
Please do tell us if you face any difficulties at our contact email gro.retnecosi|nimda#gro.retnecosi|nimda

Please note that Isocentre archive is now locked for posting new content.

Fri, 20 May 2011 06:41:25 +0000

Isocentre archives are now closed for comments and new content creation from members as the porting of the archive to the new site is begun. The first batch of members should start receiving their login details from Friday evening / saturday morning depending on your timezone. Please remember that you need to add gro.retnecosi|nimda#gro.retnecosi|nimda to your address book to prevent emails from going into the spam or junk email box.

Date and Time for migration

Thu, 19 May 2011 14:09:57 +0000

All Users should know that Isocenter is going to move. You will receive an email notification detailing what to expect. The move will begin at Saturday night 10 PM IST. All users will start receiving their new usernames and passwords along with detailed instructions on their email. Please make sure you check your spam / junk mail folder if you donot receive your email as it will come from admin AT isocenter.org
New discussions started since the last week will be ported over to the new isocenter.

Clival Chordoma

Thu, 19 May 2011 07:12:54 +0000

33/M
Prepontine cistern SOL compressing on mid brain and pons, displacing basilar artery posterolaterally.
Trans sphenoidal excision done
Post op CT shows residual disease.
Symptomatic improvement
HPR: Clival Chordoma

Plan: Radiotherapy (dose 55- 63 Gy) Thats maximum I think we can deliver in this location with photons.

Is there any role for hyperfractionated RT.

What should be the CTV margin/ volume from residual GTV?

Screening for 2nd primaries

Thu, 19 May 2011 06:45:27 +0000

Just a thought that's been bugging me lately—where does the idea of routine serial triple-scopy in follow-up of head and neck cancers stand? Would it help to diagnose 2nd primaries in a more effective way? What does the literature say?

Reirradiation Brain

Wed, 18 May 2011 04:13:58 +0000

Young 35 yr old well preserved male, previously (september 2005) operated n irradiated (Co-60, partial brain, parallel opposed portals, ?54 Gy/27 fr) for rt frontal lobe astro Gr I, has now presented with GBM within the post op cavity. The tumor was small approx 4X4 cms, n has been completely resected. the queries would be,
1. Wat wd be total target dose to the tumor.
2. wat wd be max allowable dose to previously treated n untreated brain (hairline being the only evidence for portals)
3. Critical structures viz. optic apparatus, eyes etc are quite distant from the tumor but must have been fired during first course of treatment, 0 dose to these structures might not be possible, do we have any evidence of recovery of these structures from radiation induced injury with time?
Suruchi

Carcinoma LID

Sun, 15 May 2011 03:24:31 +0000

a patient with lid malignancy - squamous or sebaceous or adenoid cystic; which is locally advanced with involvement of orbit, regional lymphnodes - what would be options for such patients.
1) NACT followed by surgical salvage +/- RT
2) salvage surgery followed by radiotherapy
3) palliative radiotherapy.
if neoadjuvant chemotherapy is given; is there any difference in sensitivity of these histologies to chemo?
any direct literature evidence? or just derived discussion from general head and neck cancers?

Verrucous carcinoma of the buccal mucosa

Fri, 13 May 2011 14:18:03 +0000

This problem is being posted here for Dr Nilesh Mahale.

62/M
5*4 cm Rt BM lesion involving lower alveolar mucosa. No palpacble LN
Biopsy: Verrucous Ca
CT not done yet
Unfit for surgery due to cardiac morbidity.
What are the treament options?
Should we offer him radical RT as there is no other treatment option?

New Isocenter and user migration

Fri, 13 May 2011 02:31:14 +0000

Hi Guys,
The new Isocentre is ready. Thanks to all beta testers we got some really good feedback and were able to catch several errors in time. We will be migrating the entire user database over the next few days and all users will be getting a email after their account has been automatically registered on the isocenter.
Once again you wont have to register .. however since we are not aware of the password that you use on this wikidot based site we are forced to allocate a new randomly generated password during the registration process which will be emailed to you. Registration will be done in alphabetical order ( A —- Z) based on first name.
The login process in the new site is much more simplified..
Hoping to see everyone of you on board shortly
P.S. To all beta testers the beta testing site should not be used any longer.

treatment of inoperable T4 buccal mucosa cancer

Tue, 10 May 2011 06:44:56 +0000

Hi,
i would like opinions regarding a case of buccal mucosa, T4N0 M0.
Middle aged patient presents with a buccal mucosa tumour, invading RMT and the mandible, inoperable even after 3 cycles of NACT.
What would now be the best course of action, considering a locally advanced tumour in a young patient with bone and skin involve ment.
Such cases are very comon in all cance OPDS.

PSA cut off level

Sun, 01 May 2011 15:48:22 +0000

Hi everyone,
I have lastly seen patients with very high PSA levels and negative staging studies. For example, in a young patient with a PSA of 400, Gleason 8, cT3b cN0 and no mets in staging studies. Can you recommend local treatment?? Do you know any references supporting radical treatment in these patients?

High grade poorly differentiated minor salivary gland tumor

Sat, 30 Apr 2011 05:57:43 +0000

34 years old married lady ( Young, GC- very good)
Presented with swelling in left submandibular region and cheek x 1 yrs
was taking some non specific treatment outside
A biopsy from the lesion revealed High grade poorly differentiated minor salivary gland tumor.
CT scan shows: primary and Conglomerate nodal mass in left submandibular region, Tx involving RMT, L Buccal mucosa and reaching superiorly upto ITF.
Surgeon refused surgery i/v/o ITF involvement.
Now referred for Chemo-RT

What would be the optimal management
1. NACT —> Assess for surgery —> PORT
2. Radical Chemo Radiotherapy
If 2. then which chemo? schedule… ( presently planned for 3 weekly cisplat conc with RT)
RT.. Target, Dose, Is there in role of altered fractionation ( I am planning for IMRT to a dose of 66-70Gy)

We don't have neutrons… so what can b done within available resourses

Paradigms Shift Bladder Cancer

Wed, 27 Apr 2011 14:36:49 +0000

Dear all,
You cannot miss this paper "International Phase III Trial Assessing Neoadjuvant Cisplatin, Methotrexate, and Vinblastine Chemotherapy for Muscle-Invasive Bladder Cancer: Long-Term Results of the BA06 30894 Trial"

http://www.ncbi.nlm.nih.gov/pubmed?term=International%20Phase%20III%20Trial%20Assessing%20Neoadjuvant%20Cisplatin%2C%20Methotrexate%2C%20and%20Vinblastine%20Chemotherapy%20for%20Muscle-Invasive%20Bladder%20Cancer%3A%20Long-Term%20Results%20of%20the%20BA06%2030894%20Trial

Pediatric RMS Badder n Prostate

Wed, 27 Apr 2011 05:56:01 +0000

the pt 6 yr old boy, with RMS of urinary bladder n prostate,,, at presentation he had large B/L iliac LAP along with huge primary tumor. He responded very well to chemotherapy with disappearance of nodes n residual thickening in bladder bt quite a volume of dis in prostate, but is still inop (as per our surgeons). Hence the kid is being planned for RT, we managed to get him funded for IMRT, but am facing quite a few problems while contouring n planning for this chap.
1. Do we have separate set of constraints for this age gp of pts for organs like rest of bladder, rectum, testes n small bowel.
2.Do we need to treat PA nodes also in this pt.
3. Wat would be constraints for bones in this pt, as most of them are unossified.

A new Isocentre and call for beta testers

Sat, 23 Apr 2011 05:20:14 +0000

Hi all,
Earlier this year we overhauled the appearance of isocentre and made it more simple for everyone to join in the content creation process. At that time the admins (me, nikhilesh, indranil, ayan, pramod and abhishek) had felt that the present way isocentre is being run is limited. There are two main issues that we face in terms of day to day running.

Our user database is not under our direct control - so essentially when our users register we dont know them .. the present two step process was designed to let us know who registered when. Over the past four months we have seen a steady increase in readership and without a dedicated membership drive we are now averaging 4-5 new members each month (no twitter / facebook but not bad)
The content is scattered and not accessible : The forum based structure is not really helping matters here - plus the content is being placed on an external wiki hosting system called wikidot. While wikidot people are great we have no way of controlling the actual data.

There are other major issues I will highlight but to come to the point we had decided to see if we could move isocentre to a completely new way of managing information and add more value to it so people come back and take a look. The way to go about this was to bring in what is called a content management system. Yes a heavy word but in the end what it means is a way of managing all the little blurbs of information that is being put in various way and structuring it so that finding it and displaying it for you becomes easier and more intuitive. Over the past 3 months I and abhishek (who goes by radtuxabhishek) have been working to make this migration possible. However before we shift isocentre to this new system we need your feedback and for that we need few intrepid oncologists who are not afraid to tread new ground. Your work would be to stress test the news system and tell us what is missing and what you would like to see. Indicate your interests below and we will send u the link.

Isocentre is your community and we have lots of new things in the new version. So please help us help you. It has no risk for you essentially.
Hoping to see you in the new Isocentre.

Adjuvant RTin Ca penis

Fri, 22 Apr 2011 09:38:29 +0000

42/M
Partial Penectomy + Bilateral INguinal LND
HPR
Basaloid Squmuas Ca
pT3.5*2.7
DEpth 1.5 cm
Corpora and urethra free
LVE+, PNI+
Shaft c/m 3 cm free
Skin c/m 8 cm free
Right superfacial ing LN 1/10 involved with extensive necrosis & PNE
Left superfacial ing LN 3/8 involved with extensive necrosis & PNE. 4 Left deep ing LN free

Stage pT1pN2

Ideally his bilteral pelvic LND should have been done.
Not possible now for logistics reasons.

Role of RT i believe is to prevent LN relapse. Hence I need to treat bilateral Inguinofemoral and pelvic LN to a dose of 50-60 Gy (60 Gy for lt groin)

I need opinion of house

Extended Field Radiotherapy for Locally Advanced Cervical Cancer

Mon, 18 Apr 2011 17:58:04 +0000

Wanted to know what does the house think about this question.
In the chemoRT era is it standard to offer Extended Field (Para-aortic) RT for Locally Advanced Cervical Cancer ? How many of you routinely prophylactically treat para-aortic LN in absence of para-aortic LN on imaging (CT/MRI/PET) ?

http://www.ncbi.nlm.nih.gov/pubmed/11704321
http://www.ncbi.nlm.nih.gov/pubmed/19010522 (study closed)
http://www.ncbi.nlm.nih.gov/pubmed/19398095

26 yrs, low grade serous Adenoca of ovary

Wed, 13 Apr 2011 19:39:39 +0000

Dear all, interesting case
26 yrs young lady,
Jan 2009: Presented with Ascites: was found to have ovarian tumor(9cms): Surgery- oophorectomy, uterus left behind in situ (patient wants her own baby). Path: Serous Borderline Tumor. Ca-125 =88 prior to surgery.
Nov 2010: Abdominal recurrence on imaging:Complex cystic and solid masses located within the pelvis overall (combined) size of all of these lesions is approximately 7.3 x 6.7 x 9.0 cm (sag x TV x AP), anterosuperior to the urinary bladder with a single one identified within the subcutaneous fat of the anterior lower abdomen. There is also an isolated lesion seen within the right adnexa. The enhancing/vascular nodular components make these consistent with tumour recurrence.
Feb 2011: Interventionist did a guided biopsy: Recurrent Serous Borderline Tumor.
March 2011, de-bulking surgery: Path: Low Grade Serous Adenocarcinoma.

Chemo Vs RT? Role of Chemo in low grade serous adenoca ? If RT, how do we do that, ? Whole Abdomen (patient has uterus in situ and wants her own baby, has tried IVF with 3 futile attempts in 2009-2010).

What is the treatment of choice here ?

Radiotherapy in pts with connective tissue disorders & vitiligo

Thu, 07 Apr 2011 08:14:25 +0000

In our practice we encounter patients with connective tissue disorders & vitiligo in whome radiation is indicated by virtue of malignancy stage.
We all have read in text books that they tolerate RT poorly
Given the oncological compulsions to irradiate them what are experiences of the member of this forum?

Childhood Naso-pharyngeal Carcinoma

Mon, 04 Apr 2011 18:09:07 +0000

What is the optimal radiation dose in Childhood Ca Nasopharynx and the role of neo adjuvant chemotherapy in this sub group.

Brachytherapy in Retroverted Uterus

Sat, 19 Mar 2011 07:35:27 +0000

All of us have faced problems during IC brachytherapy for Ca Cervix in patients with retroverted uterus.
There are some reports about benefit of US guidance during placement (London Regional cancer Centre, Nina Mayr et al).

Would like to know about personal experiences of members on this

Also it will be great if somebody can mail me full text of following paper

Brachytherapy management of the retroverted uterus using ultrasound-guided implant applicator placement

Nina A. Mayr12Corresponding Author Informationemail address, Joseph F. Montebello12, Joel I. Sorosky3, Jamie S. Daugherty4, Dan L. Nguyen4, George Mardirossian4, Jian Z. Wang4, Susan M. Edwards4, Wenbin Li4, William T.C. Yuh2
Brachytherapy
Volume 4, Issue 1, Pages 24-29 (2005)

Radiation Oncology Mastercourse at Kokilaben Dhirubhai Ambani Hospital, Mumbai

Fri, 18 Mar 2011 15:47:56 +0000

Dear Doctors ,

I take this opportunity to announe the MASTERCOURSE
in radiation oncology at Kokilaben Dhirubhai Ambani Hospital on
16.4.2011 . This meeting has specilly been designed for PG students ,
Registrars and young radiation oncologists. A major part of this
program includes research protocol presentation by students/ young
radiation oncologists to expert panel and the best 2 protocols having
prizes . I would request you all to encourage PG students/ registrars
/ young radiation oncologists to submit research protocols .Please
find the copy of the programme attached.

MASTERCOURSE FLYER

Thanking you

Dr. Kaustav Talapatra

Consultant Radiation Oncologist

Kokilaben Dhirubhai Ambani Hospital , Mumbai 53

ph 9321550361

moc.liamg|eetsuak#moc.liamg|eetsuak

Uterine Leiomyosarcoma

Fri, 18 Mar 2011 12:30:05 +0000

52/F
TAH & BSo for vaginal bleeding done
pT: 6*7*9 cm
High Gr leiomyosarcoma

I have searched lit.
Lack of clear evidence for adjuvant therapy.
However some suggetion that RT may reduce rate of pelvic rec. While systemic relapse rates are also reported hence phase2 data supporting use of adjuvant CT is also available.
Comments of the house please
If RT is to be given what should be the volume of radiation

D 4-5 CORD - HAEMANGIOPERICYTOMA, WHO GR. II

Thu, 10 Mar 2011 12:11:28 +0000

CLINICAL:
PRESENTED \VITH LT. THORACIC RADICULAR PAINS & RECENT ONSET SPASTIC
PARAPARESIS.
MR : IDEM TUMOR AT D 4-5 LEVEL, MAINLY oN LEFT SIDE.

gROSS TOTAL EXCISION DONE

INTRA - OP - RECENT BLEED IN TI{E TUMOR.IT WAS TOUGH, YELLOWISH, WAS ARISING
FROM THORACIC NERVE ROOT & WAS NOT VERY VASCTJLAR
PROVISIONAL DIAGNOSIS: ? NEUROFIBROMA

POST OP IMPROVEMENT IN POWER

GROSS APPEARANCE:
A MASS, I.5 X 0.8 X 0.7 CMS., REDDISH IN COLOUR. C/S SHOWS WHITISH & PINKISH AREAS.
ALL PROCESSED. ( I BLOCK)
HISTOLOGICAL EXAMINATION :
SECTIONS SHOW A GANGLION & A MASS SHOWING AREAS OF HAEMORR.HAGE. CYSTIC
tlEAs ARE sEEN. LoBULAR AREAS WITH MANY SEPERATE CAPILLARIES, sEeERATE PLUMP
CELLS ARE SEEN. NEUCLEI ARE ROUND OR OVAL. MITOSIS IS OCCASIONAL.
FIBROUS AREAS ARE SEEN
IMPRESSION:
D 4-5 IDEM TUMOR - HAEMANGIOPERICYTOMA, WHO GR. II

CAN WE OBSERVE SAFELY?

Job opening at IVY Hospital Mohali

Thu, 03 Mar 2011 07:39:30 +0000

I am posting the requirements here on behalf of Dr. Arvind Verma who is a visiting consultant at Ivy Hospital, Mohali.
For details of remuneration/job profile please contact him directly at 0 98154 00609. They require a resident doctor (awating results of MD/DNB) or fresh post graduate (0-3 years).

Salvage radiotherapy after Radical prostatectomy

Sun, 27 Feb 2011 09:32:35 +0000

Hi everybody,
Would like to know how are you treating in your hospitals this clinical situation.
Standard will be RT (66-68Gy) no ADT.
There is some evidence about dose escalation (King 2008 ijrobp and Bernard 2010 ijrobp) there is also evidence about ADT (Choo 2009 ijrobp). Most of the ongoing phase III clinical trials (RTOG 0543, RADICALS, JCOG 0401…) are investigating the combination of RT and ADT.
Are you using this combination? Which dose are you administering?

Thanks

Is there an invite link?

Sat, 26 Feb 2011 05:15:08 +0000

Hello all

Is there an invite link? Something akin to the "yahoo groups invite" option,

A "default mail with link" with an inbuilt introduction and summary about ISOCENTRE; which could be sent to some of my contacts to invite them to this site and contribute?

Radiotherapy Technologist

Wed, 23 Feb 2011 07:05:56 +0000

Vacancy for the post of Radiotherapy Technologist at Nirali Memorial Radition Centre, Surat.

This centre is equipped with Siemens Oncor Expression Linear Accelerator for IGRT, IMRT along with CT Simulator and Nucletron HDR Brachtherapy.

It has Two Radiation Oncologists, two physicist and 4 technologist. Surat is 2 nd largest city of Gujarat with Cosmopolitan culture, well connected with Road and rail ways to all regions of country

Candidate should have completed course of B. Sc. Physics followed by 2 years course in radiotherapy technology. 1-3 years experience is desirable.

Salary will be best in the industry.

Contact: Dr Nilesh Mahale at 099099 84484 or e mail your CV to moc.liamg|elahamhselinrd#moc.liamg|elahamhselinrd

Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Wed, 23 Feb 2011 04:08:50 +0000

One of the most recent comparison of two common but different fractionation schedules practiced for intracavitory HDR gynecological brachytherapy.
http://www.ncbi.nlm.nih.gov/pubmed/20685179

T1No Vaginal Ca

Sat, 19 Feb 2011 18:38:05 +0000

DIAGNOSIS: Well-differentiated squamous cell carcinoma of the vagina, T1 N0.
55/F , First seen in the Colposcopy Clinic with abnormal cytology from the vaginal vault.
The vaginal vault was noted to have a whitened epithelium, particularly towards the apical region.
Bx: VIN 3 from the 12 o’clock position and from the vaginal apex. Also at the 3 o’clock position but additionally, several foci of small, well-differentiated invasive squamous cell carcinoma were seen all with a depth of less than 1 mm and a focal lymphovascular space invasion. Tumor was noted to extend to the base of the biopsy.
P/H: Testing for HPV done in 2005 which was positive. Was monitored with regular colposcopy.
TAH/BSo 2008 for dysplasia noted in the cervix. No invasive ca on path.
NO H/O STD (sexually transmitted diseases).

Another major problem: Significant Interstitial cystitis of unknown etiology. She was at the point where she was considering a cystectomy but a trial of MacroBID antibiotic has been very helpful in reducing her symptoms.
Now nocturia x2 but prior to MacroBID it was 8 times.
Local Exam: No inguinal femoral LNpathy. Inspection of the external genitalia unremarkable. On speculum exam no visible discreet lesions. On palpation there are no abnormal areas of thickening to suggest obvious disease.

IMPRESSION: 55/F old woman with biopsy proven squamous cell carcinoma of the vagina that is well differentiated with known prior HPV infection and prior dysplasia in the cervix with underlying interstitial cystitis of unknown etiology.

I saw this lady for treatment? Given the focal lympho vascular invasion should I worry out lymph nodes (para vaginal atleast)?

WOULD YOU TREAT THE IPSILATERAL NODAL STATIONS?

Sat, 19 Feb 2011 08:00:46 +0000

14 year old girl with a parameningeal embryonal rhabdomyosarcoma

post-op —>4 cycles of adjuvant chemotherapy (VAC/VAI)

plan to start radiotherapy at the earliest omitting AMD and Etoposide from her chemotherapy in consultation with the medical oncologist since she has a) large residual tumor b) orbital extension c) limited intracranial extension in ipsilateral temporal lobe —she is IRSG post-surgical Group 3 .

Planning CT scan showed the residual tumor with extension as mentioned above ( image attached)and we are trying to protect as much of the visual pathway and brain as achievable.

Pre-op CT/MRI showed no evidence of lymph node involvement -not sampled surgically.

WOULD YOU INCLUDE IPSILATERAL NODAL STATIONS IN THE CTV —IF SO , WHAT LEVELS? I could not find literature supporting prophylactic nodal irradiation in this scenario .

I am planning to deliver 50.4 Gy @ 1.8 in 28 # .

Intermediate and high risk Ca Prostate

Wed, 16 Feb 2011 18:05:40 +0000

Is there any benefit of adding Whole pelvic RT to Intermediate & high risk Ca prostate in comparison to Localized RT ?
Current recommendation still favoring whole pelvic RT despite at least 2 prospective randomized trials showing no benefit in 5 year PFS ?

First post in Isocentre (need opinions)

Mon, 14 Feb 2011 22:13:40 +0000

65y man.
Gleason 8 (4+4), iPSA 24ng/ml.
Bone scan negative. CT scan: 2 common iliac positive nodes.
KPS: 90%.
For sure ADT, but… what about EBRT?. If yes, which dose to prostate, and nodes?
I was thinking in 46Gy to Whole pelvis, boost to positive nodes to 60Gy, and prostate/seminal vesicles to 74-76. Does it make any sense to escalate doses to prostate?
Another concern, important obstructive symptoms, IPSS:25.

I'd really appreciate comments on this.

HDR Monotherapy for Prostate Cancer

Sun, 13 Feb 2011 22:42:57 +0000

As the life expectancy of Indian men increase, we will be seeing more of prostate cancer in near future. Availability of Iodine or Palladium Seeds can be an issue for permanent implantation. Here a solution where you can use your existing HDR setup to treat these cases. This paper is by one of the most famous brachytherapist Dr.Martinez group. He was the one who designed the HDR MUPIT (Martinez Universal Perineal Template) for gynecological implants in 1970's.

http://www.ncbi.nlm.nih.gov/pubmed/21310546

Axillary Dissection Vs No Axillary Dissection

Sun, 13 Feb 2011 22:15:48 +0000

64/ postmenopausal lady, presented with a lump in right breast. Metastatic Work up negative. Clinically mobile 4cm tumor with no axillary ln. Bx=IDC.
Sx: Lumpectomy with sentinel lymph node dissection done.
HPR: 4.6 cms IDC, Grade 3, NO EIC, LVI focally positive. ER/PR strong positive. Her2 neu Negative. Clear Margins.
LN: 3/4 positive no ECE.

Was sent to us for adjuvant radiation, my teaching was that this lady needs complete axillary ln dissection however things have changed and our breast surgeons do not do it anymore. This publication is an excellent example.
This study is published in full paper form and is ready to be discussed.
http://jama.ama-assn.org/content/305/6/569.full.pdf+html

Please feel free to discuss and tell us how your breast team is handling this issue.

RION (RADIATION INDUCED OPTIC NEUROPATHY)

Wed, 09 Feb 2011 13:55:42 +0000

Interesting article suggesting Rx for RION for Neuro-oncologists

Extracted Summary : -

Patient reports vision changes

URGENT ophthalmologic exam and brain MRI

If examination and brain MRI consistent with RION begin treatment immediately using:

Methylprednisolone 1 g IV daily for 3 days
Pentoxifylline 400 mg PO BID for 6-12 months
Vitamin E 400 mg PO BID for 6-12 months
Warfarin INR 2-2.5 for 6 months

Successful Treatment of Radiation-Induced Optic Neuropathy
Practical Rad Oncol. 2011 Jan 1;1(1):40-44, JA Weintraub, J Bennett, LE Gaspar
http://download.journals.elsevierhealth.com/pdfs/journals/1879-8500/PIIS1879850010000081.pdf

CTV for Stage I Seminoma

Mon, 07 Feb 2011 13:08:43 +0000

I understand from my reading that the standard treatment for Stage I seminoma (after orchidectomy) is radiotherapy to the para-aortic (retroperitoneal) nodes of the abdomen.
Typically this uses a parallel opposed pair with margins of:

Superiorly T_10-11 disc
Inferiorly L₅-S₁ disc
Laterally the tips of the transverse processes (except for left sided tumours where the field extends to the left renal hilum)

Given the spread of volume based planning I am trying to determine what volumes I should contour for a seminoma treatment. When the surgeons do a retroperitoneal dissection they only take tissue out below the renal arteries; with radiotherapy the field is extended a significant distance above this.
Is there a good reference that discusses the rationale for placing the fields as we do?

(PS. My first post! Thanks for the help!)

When can we omit a histological diagnosis of prostate cancer?

Mon, 07 Feb 2011 08:17:26 +0000

70/M
PSA 100
Bone scan shows multiple areas of avidity
What are the policies that you follow regarding histological diagnosis before starting hormonal treatment?

IMRT Plan Normalization

Thu, 03 Feb 2011 13:57:40 +0000

IMRT involves complex Treatment Planning Process & rigorous plan evaluation. Even when a plan is devised that meets many treatment-planning objectives, limitations in the planner’s ability to further adjust beam characteristics may require the radiation dose prescription to be normalized to an isodose level that best covers the target volume.

Commercial Treatment Planning Systems contain various plan normalization options

e.g

1. No Plan Normalization
2. Plan Normalization at Isocenter
3. Plan Normalization at Target Mean
4. Plan normalization at Target Minimum
5. Plan normalization at Target Maximum
6. % of Volume should Receive _ % of dose
7. Etc.,

Normalization at Isocenter is no long applicable to IMRT

Most of the institute uses no plan normalization. But the pitfall of this normalization method is it may be under dose / over dose to target if the constraints are not properly handled by the planner. So, it is purely depends on the planner constraints & priorities.

I personally would like to use plan "normalization at target mean / Median", which can standardize the plan normalization method in IMRT and it is “independent” of the Planner / user dose constraints & priorities.

I will appreciate if the forum further discuss about plan normalization in IMRT and their institute protocols of IMRT Plan normalization.

Portal Dosimetry and Gamma Histograms

Thu, 03 Feb 2011 09:43:07 +0000

Would be interested to know how many / which centers are using portal dosimetry for radiotherapy plan evaluation :

1.Do you use Gamma Histograms to evaluate calculated dose distributions against measured ( Portal Dosimetry)?
2.Do you use Gamma Histograms to validate your planning systems ?
3.Is it acceptable to use an acceptance criteria of 3% Dose Difference & 3mm Distance To Agreement (DTA) for all sites?
4.Is it a valid concern that commercially available planning systems bundling different algorithms for Treatment Planning & Dose Calculation and a Monte Carlo for inter-comparison using Gamma Histograms OR Portal Dosimetry licenses for inter-comparison using Gamma Histograms might give a false sense of security during IMRT QA since they are on the same platform and from the same vendor?

Results of Poll for the 2nd Contouring Session

Thu, 03 Feb 2011 04:30:07 +0000

Hi people,
The votes are in for the poll which is closed today. Here are the stats.

21 unique responses ( overall 27 - 6 duplicates.)
Brachial Plexus wins with 11 votes
Supraglottic Larynx comes last with 2 votes.

We take your suggestions and will have the following contouring sessions in sequence:

Brachial Plexus
Oropharynx
Supraglottic Larynx
Nasopharynx (as suggested by someone).

Each session will be held at 2 weeks interval starting from this weekend. As usual they will be hosted on a separate page and links will be announced here. We have to use Scribblar for the present moment so if you have queries regarding the system please post them here and we will try to help you to the best of our abilities. Unfortunately we need flash, a decent internet connection and a relatively good browser (would strongly suggest chrome, firefox and opera .. please remember if you have Internet Explorer 6 or 7 they wont be working). Keeping in mind adjuvants suggestion I will be contouring on one side only to show you my reference. However please remember you are free to add your corrections and suggestions.

Radiotherapy with a metallic plate.

Wed, 02 Feb 2011 17:57:50 +0000

55 yr old male, a case of post op Ca buccal mucosa. Just before starting RT pt had spontaneous # mandible while eating. The # was fixed with a metallic plate n pt is now due for RT with completely healed skin wound.
What would be important points to be considered before RT planning?

Journal Club 4

Tue, 01 Feb 2011 21:59:40 +0000

A nice review of radiation effects on eye and periorbital tissue with pictures and treatment overview has been published. This page reviews and summarises the article. Comments on the page please

Help and Howtos

Sun, 30 Jan 2011 07:41:22 +0000

We understand that for most people posting on a wiki seems to be intimidating. This has partly to do with the fact that some content is difficult to create on a wiki for a person who doesnot know about wiki syntax. However help is at hand. At Isocentre there are lots of resources in the help sections if you are interested in learning how to add new content. In essence if you can post on the forum you can create a content.
Here are some helpful links:

Please feel free to browse through the pages. Remember the isocentre admins and moderators are always there to help you to the best of our abilities in addition to the help provided.
Have a great weekend.

Kodak 2000RT CR Plus System

Sun, 30 Jan 2011 03:02:16 +0000

Dear group members,
I am rquesting for information from Radiotherapist / Medical Physicists about the equipment & its uses. details of the users experience, as we are proposing to have it in our Hospital.

Thanking You
Das

Journal Club 3

Fri, 28 Jan 2011 21:20:16 +0000

The third journal club is online now at http://www.isocentre.org/lymph:is-rt-required-in-early-hodgkins-disease

Again a very controversial topic about the need of RT in an indication where it is being gradually replaced (without hard evidence IMHO).
Posts and comments in the page only please .. commenting to the post is disabled.

Extranodal lymphoma

Thu, 27 Jan 2011 11:39:52 +0000

Case Capsule:
36yr/M, NHL with RVD
HOPI:
(24.01.08) Laparoscopic resection & anastomosis: HPR:NHL small intestine, one margin positive, hyperplasia in 3 mesenteric nodes— CT (24.11.08)-14.6x12.6x11.9cm R lumbar & iliac region mass involving anterior abdominal wall musclesunderwent surgery, no details-advised chemotherapy but chemo not taken as medical oncologist was not ready for chemo along-with Anti-RVD-so conued Rx for RVD-recurred— (July'10) trucut biopsy at Mangeshkar hospital-DLBCLMib-1 index-60%, bone marrow uninvolved-chemotherapy 6#-interval CT after 5#(27.11.10) 5.9x4x5.4cms minimally enhancing soft tissue mass in right latral abdominal wall inseperable from external oblique musclein R lumbar regionjust above the iliac crest with 3.5x3.2x2.7 cms lesion on left side along left superolateral aspect of prostate, L seminal vesicle cannot be seperately visualised, multiple small mesenteric and retroperitoneal lymph nodes—Post-chemo-CT showed masses resp 5x4.8x6.1cm and 3x3x2.6cms-mass palpable in R lumbar region-
My opinion:WAR+Boost vs 2nd line chemotherapy sos RT
Please Opine—

2nd contouring session ... Suggestions please!!!

Wed, 26 Jan 2011 15:06:38 +0000

We are planning to have the next contouring session sometime in the first week of February. Please give your suggestions below.

Journal Club 2

Tue, 25 Jan 2011 20:55:33 +0000

A new population based cohort study reveals changing pattern of practice w.r.t testicular seminoma in the Scandinavian nations. Published in the Journal of Clinical Oncology this article is sure to get lots of attention. However the assertion made by the authors regarding the role of RT in this indication merits greater examination.
So the 2nd journal club is now live at http://www.isocentre.org/gu:is-rt-required-in-csi-testicular-seminoma
Please use the comments box below the page to comment. No comments will be allowed here.

Whole neck IMRT Vs Low Ant Neck field with Split Beam Vs Gradient Matching

Mon, 24 Jan 2011 07:41:09 +0000

Excellent article discussing the pros & cons of 3 alternate head and neck IMRT techniques for supra-laryngeal primary tumors:

1.Whole neck IMRT
2.Upper head and neck IMRT with split beam matched low anterior neck fields
3.Upper head and neck IMRT with gradient matched low anterior neck fields

Link: http://download.journals.elsevierhealth.com/pdfs/journals/1879-8500/PIIS1879850010000056.pdf

Members' comments : would love to know which technique is preferred at different centers-i guess most centers have used all of the above and have decided to prefer one over the other - any particular reasons from your experience ?

I feel the final sentence sums up the practice @ Univ Florida : they use whole neck IMRT for patients with high risk of disease in the posterior portion of lower neck and matched ( split-beam or gradient matched ) low anterior neck fields with upper head and neck IMRT for patients with low risk of disease in the posterior portion of lower neck, since a standard prescription of 2Gy @ 3cm depth as they have followed would under-dose the posterior region of the lower neck.

Excellent new journal ( ASTRO)

Mon, 24 Jan 2011 05:57:15 +0000

"Practical Radiation Oncology " -new journal from Elsevier

Volume 1, Issue 1 out

Link : http://www.practicalradonc.org/current

Full text pdf , free access.

If only high impact factor medical journals would remain free forever!!

CTV guidelines for Cervix, Postop Cervix , Endometrium

Sun, 23 Jan 2011 07:04:12 +0000

Valuable Resources :

CTV contouring guidelines for post-op Cervix , Endometrium IMRT

Int J Radiat Oncol Biol Phys. 2008 June 1; 71(2): 428–434. doi:10.1016/j.ijrobp.2007.09.042.

CTV contouring guidelines for IMRT Cervix

Int. J. Radiation Oncology Biol. Phys., Vol. 79, No. 2, pp. 348–355, 2011

Isocentre Usage Survey

Fri, 21 Jan 2011 18:46:01 +0000

While we have been getting a lot of feedback from users about isocentre it seems that about a 20 - 30 odd people are actively participating in the site. In order to work further on the site so that we can improve it further your input is valuable. Please consider participating in this survey so we can know your preferences better.

Journal Club 1

Thu, 20 Jan 2011 22:06:28 +0000

Can IMRT reduce the risk of a SMN? A recent article has raised some thought provoking points. To see the JC online and to participate in the discussion follow the link here
Please note that this is a notification only. To participate on the discussion go to the original page as you wont be able to reply to the thread here

Open Source Treatment Planning Systems

Thu, 20 Jan 2011 17:49:53 +0000

If any one of you had seen the contouring sessions we organized you will realize one of the most important things missing from it was the ability to change windows. The reason - these are not DICOM RT files you are seeing but plain image files. For the moderators who created the system it was a greater pain in the ass - we had to take screenshots, upload them to scribblar in seperate pages and then contour them and then embed them on the page.
On the top of that several users reported they were unable to see the window - scribblar does require flash installed in your browser and a relatively speedy connection.
While searching for solutions I had found educase earlier but the site looks very ill maintained.
What we really need is a TPS - and guess what I searched for open source TPS and found not one but two

Both are open source solutions doing a lot more than what we require. What I want is some help from any of you guys for any ideas on how to itegrate them with us. What I have in mind is hosting them from a webserver and allowing users to login remotely via internet and using it for contouring purposes. We need an online collaborative environement so a given number of users may contour on the same patient at the same time
Any ideas guys?

Optic glioma

Wed, 19 Jan 2011 12:11:29 +0000

Greetings from Pune!
To opine on the following case.

Case Capsule:
Age: 21/2 yrs
Optic glioma, dimination of vision on one side
Case disscussed by Neurosurgeon on phone/no surgical intervention
My opinion was: to wait at least 6mths (should we wait for completion of 3yrs)
Nsx:what we will do if it progresses on other side meanwhile.

Regards!

Dr.Shailesh S. Shende

MBBS, MD (Radiation Oncology)

Consultant Radiation Oncologist,

Vimal Lalchand Mutha Cancer Centre,

Deenanath Mangeshkar Hospital & Research Center,

Erandwane, Pune-411004

Phone no - +91-(20)-66023000, Extn 2910

Fax - +91-(20)-25420104

Mobile No - 09890609830
Email - oc.liamffider|ednehshseliahs#oc.liamffider|ednehshseliahs

Number of isocentres for SRS

Wed, 19 Jan 2011 10:55:08 +0000

In Gamma Knife multiple isocentres are placed (ahem!) to create dose heterogeneity.

Is it justified to keep a single isocentre for say spherical target? Or multiple isocentres for the same? Or any other recommendation?