Wednesday, June 25, 2014

Cyberknife success - Retroperitoneal fibromatosis - biliary obstruction.

Retroperitoneal fibromatosis - biliary obstruction.

A 33 year old lady was evaluated and diagnosed to have a retroperitoneal fibromatosis.

She underwent surgery and post operative radiotherapy . She was on follow up. She delivered a baby boy after a couple of years. 4 months after delivery, she was evaluated for weight loss and poor appetite. She was found to  have biliary obstruction .

Pet ct showed a small recurrent mass causing the obstruction. She was re irradiated with cyber knife radio surgery.

Follow up pet ct showed regression in the size and activity of the mass  This patient benefited of this treatment modality without major surgery. She is doing well and enjoying with her baby

This is a case study discussion of Dr.Rathna who is a senior consultant , Radiation Oncology, Apollo Speciality Hospital, Chennai.

To know more about cyberknife kindly blog your comments or you can write to me at lakshmipriya_b@apollohospitals.com/9940675877

Back pain due to aortacaval mass - Success with Cyberknife.

Colon Carcinoma - Back pain due to aortacaval mass

A 49 year old man , a known case of carcinoma colon post op, post chemo( in August 2013) was evaluated for back ache. He was operated upon for spondylolisthesis in November 2013.

He had no relief of symptoms. A pet ct done in March 2014 showed an aortocaval mass. There was no lesion elsewhere in the body. He was treated with cyber knife radio surgery. He started having pain relief during treatment  and a substantial relief during follow up.

He was followed up by medical oncologist with chemo . 2 months follow up PET Scan revealed no lesion in the region treated with cyberknife radiosurgery

This is a case study discussion of Dr.Rathna who is a senior consultant , Radiation Oncology, Apollo Speciality Hospital, Chennai.

To know more about cyberknife kindly blog your comments or you can write to me at lakshmipriya_b@apollohospitals.com/9940675877

Success with Cyber Knife - Hepato Cellular Carcinoma


Hapato Cellular Carcinoma- Successful treatment with Cyberknife 

A 60 yr old gentleman was incidentally found to have a space occupying lesion in the liver  which was diagnosed as hepatocellular carcinoma in June 2013.

He underwent a resection of the lesion in July 2013.Follow up imaging showed a small residual lesion and hence he was started on Tab.Sorafinib from November,2013. But serial imaging showed
an increase in the size of the lesion. Biopsy of the lesion confirmed it to be hepatocellular carcinoma.

The various treatment options were discussed. The patient was not keen for surgery and due to the
proximity of the hepatic vein, RFA was also difficult. It was decided to give radio surgery with Cyber knife to the residual lesion. 


After fiducial placement for real time tracking of the lesion, a total dose of 40 Gy was delivered in 5 fractions. He underwent the treatment quite well with no difficulties. Follow up after 2 months imaging
showed a decrease in the size of the lesion with reduced activity of FDG uptake indicating good response to the treatment.

This is a case study discussion of Dr.Rathna who is a senior consultant , Radiation Oncology.

To know more about cyberknife kindly blog your comments or you can write to me at lakshmipriya_b@apollohospitals.com/9940675877

Thursday, March 6, 2014

Radiation therapy in modern era of cancer management:

Radiation therapy in modern era of cancer management:

Radiation therapy is being used successfully in cancer treatment for more than a century and is one of the corner stone of success in fight against cancer.  In early days, radium, caecium, radon capsules, which are radioactive materials were inserted in cervix for management of cervical cancer. Dramatic response in these tumours had resulted in interest with radioactive material in cancer management. Initial euphoria regarding the usage of radioactive materials attracted many researchers and there was surge in the indications of it's usage. The potential of gamma rays and x-rays in damaging the tumour cells were used to cancer. With gamma and x-rays, the tumour cell DNA is damaged more than the normal cells, and hence tumour cells are killed where as normal cells are relatively spared. After invent of x-rays, deep x-rays were used to treat tumours. Several x-ray machines were introduced and x-ray was being used to treat almost all diseases including peptic ulcer, ankylosing spondylosis (bone problem), psoriasis (skin problem). However, the progress was halted with evidences of reactions, second malignancies and other toxicities. There was a lull period for few decades in the development of radiation oncology specialty. And, during 1960s and 70s after the discovery of artificial radioactive materials, there was again revival of this specialty with 'tele-cobalt' machines. There was 'simulator' for planning treatment, scientific dose calculation methods, and accurate treatment delivery technology. 'Shields' and 'blocks' were being used to protect normal tissues and deliver higher dose of radiation to the target- 'tumour'. Favourable outcome with this modern radiation therapy gave the required confidence to the clinicians and more and more cancer patients were treated with radiation therapy with success. However, still there was lot of limitations in both treatment delivery and planning. There was no imaging to see the target, no proper computer assisted planning tools and there was visible scope of improvement of treatment delivery technology.
Modern day radiation therapy coincided with the advent of computers, imaging and mechanical revolution and also incorporation of technology in medical science. In 1990s, with advent of computers, CT and MRI scan and most importantly active involvement of technologists in research and development has revolutionized radiation therapy speciality. Modern radiation therapy is one of the 'most sort after' and 'high tech' medical specialty. Computer guided planning enables us to deliver high dose of radiation to the tumour and spare normal tissues. Intensity modulated radiation therapy and Image guided radiation therapy is the advanced radiation therapy delivery technology with most modern techniques. Now, robotic radiosurgery has enabled us to deliver high dose of radiation in very short time and complete radiation therapy in less than one-week time. Side effects of radiation have dramatically reduced and now radiation therapy is more acceptable to the patients. Radiation therapy is the standard of care in early head & neck cancer, cervical cancer and an important component of organ preserving procedures such as breast conservation. After surgery, majority of advanced cancers are treated with radiation therapy. Stereotactic radiosurgery is now the alternative to surgery in deep-seated 'difficult to do surgery' cases. There are numerous randomized studies with level-I evidences showing survival (mainly loco-regional control and also over all survival) benefit of radiation therapy in brain tumours, head & neck cancers, breast cancer, cervical cancer and other cancers.
Radiation therapy is a cost-effective option in management of metastatic diseases and palliative situations such as bone metastasis and brain metastasis. In developing countries like India with resource constraints radiation therapy should be used in most of the clinical situations, especially in palliative and management of pain.
In future, proton beam therapy, intra-operative radiation therapy and shorter course of radiation therapy (fractionated radiosurgery) will be the one of the main ammonium to fight against cancer. However, there are still many challenges in radiation oncology that needs to be addressed.

More than 70% of cancers need radiation therapy at some point of time. In 2020, India will have one of the largest numbers of cancer patients in the world and there will be two times than the present cancer burden. Unfortunately, there are in a severe scarcity of radiation therapy facilities in developing countries like India. At present situation, with available radiation facility in India only 30% of patients who require radiation treatment can avail radiation therapy. Majority of the patients need to travel far from their native place for treatment, only a small proportion of patients who need treatment receive radiation therapy, there is lack of awareness and cost of the treatment (facility) is also an issue. There is a need for more number of cancer facility including radiation therapy machines in different small cities and towns in India.  


The author of this article is Dr.Debnarayan Dutta, consultant, Apollo Speciality Hospital 



For More information feel free to blog your comments or write to lakshmipriya_b@apollohospitals.com or I can be reached @9940675877

1 PINEAL REGION LESION - CYBERKNIFE TREATMENT.

1  PINEAL REGION LESION - CYBERKNIFE TREATMENT.

     This 32 year old lady was evaluated for headache and visual disturbances. She has also had urinary and bowel incontinence. She was found to have a pineal region space occupying lesion with hydrocephalus. She underwent a VP shunt and was referred for radiotherapy. She was initially treated with SRT and cyberknife was used to deliver the additional boost dose with maximal sparing of normal structures in November 2010. She is on follow up. She is asymptomatic and good resolution of the lesion.

The patient was under treatment with Dr.Rathna Devi, senior consultant Radiation Oncologist. 


For More information feel free to blog your comments or write to lakshmipriya_b@apollohospitals.com or I can be reached @9940675877