Reports of Radiotherapy and Oncology
Volume:3 Issue: 1, Mar 2016

To evaluate the incidence of pain flare after palliative radiation for painful osseous metastases, and whether a single or short course of radiotherapy increases the risk of pain flare using a physician-based assessment.
A series of 55 consecutive patients who underwent palliative radiotherapy were included in this analysis. Their treatments were as follows: 8 Gy, single fraction (n = 5), 20 Gy, 5 fractions (n = 11), 30 Gy, 10 fractions (n = 39). Pain flare was defined as a 2-point increase in the present pain intensity (PPI) with no decrease in analgesic score or a 25% increase in the analgesic score with no decrease in PPI for at least 2 consecutive days. The assessment was performed by a radiation oncologist.
Using the definition of pain flare, 8 out of 34 (24%) patients experienced a pain flare with a median duration of 3 days (range: 2 to 6 days). The median onset of pain flare was the day after the start of radiotherapy (day 2; range, day 1 to 3). Two of the 5 (40%) patients and 4 of the 11 (36%) patients who received total doses of 8 Gy and 20 Gy, respectively, experienced a pain flare.In contrast, 2 of the 39 (5%) patients who received a total dose of 30 Gy experienced a pain flare.
Pain flare is common after palliative radiotherapy for bone metastases.Single fraction or short course radiotherapy may be associated with a higher risk of pain flare.

Gliomas are the most common primary brain tumors. The combination of surgery, post-operative radiotherapy with concurrent and adjuvant chemotherapy represents the standard approach to the treatment of high grade gliomas. Three-dimensional conformal therapy (3DCRT) is increasingly used in the treatment of primary brain tumours. The use of intensity-modulated radiotherapy (IMRT) yields conformal dose distributions and better avoidance of organs at risk. Memory impairment is a well-documented side effect of cranial irradiation. One possible hypothesis focuses on a neurogenic stem cell compartment in the hippocampus that is highly sensitive to radiation and potentially central to radiation-induced memory impairment.
In this study we evaluated the possibility of sparing the hippocampi in post-operative radiation therapy for high grade glioma (3DCRT/IMRT technique) and its impact on preservation of memory function.
A total of 20 newly diagnosed, histologically confirmed cases of high grade glioma fulfilling the eligibility criteria were enrolled into the study. Patients received post-operative radiation therapy with concurrent and adjuvant temozolomide via the 3DCRT (3DCRT arm) / IMRT (IMRT arm) technique. Evaluation of dose to hippocampi (ipsilateral and contralateral) was done along with serial evaluation of memory function. Two groups were compared for the dose received by hippocampi and its impact on memory function.
Bilateral hippocampal sparing was achieved in all patients in IMRT arm. Whereas, in 3DCRT arm ipsilateral, hippocampus could be spared in 60% of patients. Memory function analysis showed that patients in IMRT arm had maintenance of the score for a period of 3 months post radiotherapy, while patients in 3DCRT arm showed a decline immediately after radiotherapy.
Bilateral hippocampal sparing with preservation of memory function is achievable with IMRT technique for delivery of post-operative radiotherapy in patients with high grade glioma without compromise in prescribed dose delivery.

High-grade astrocytomas are among the most common neuroepithelial brain tumors. Because of their highly malignant nature, in most cases, in addition to maximal resection, they also require adjuvant treatments, such as chemotherapy and radiotherapy. A common accompanying condition, which may occur with this type of clinical presentation, is cognitive disorders. These can be caused by the tumor itself, the treatment used or may be patient related. The aim of this study was to evaluate the level of cognitive ability in patients with astrocytoma compared to the normal population and evaluating the factors possibly affecting them.
A case-control study was performed on 30 adults referred to Imam Reza and Omid hospitals, Mashhad, Iran, during year 2014. The studied patients had astrocytomas, for which they had performed surgery. All patients had also received radiotherapy. The control group consisted of 30 healthy individuals, among the patients’ family members, who were matched for age and gender with the patients. The tools used in this study were a checklist for demographic data, and the Farsi version of Addenbrook’s cognitive questionnaire. Data were entered in the SPSS 22 software and analyzed using the Student’s t test and Mann-Whitney test. P values of ≤ 0.05 were considered significant.
Normal cognitive disorders were seen in 33.3% and 80% of the patient and control groups, respectively. Mild cognitive disability was observed in 10% of both groups; and Alzheimer’s was observed in 56.7% and 10% of the patient and control groups, respectively. A statistically significant difference was found between cognitive function, age, and gender (P = 0.0001 in both). No meaningful difference, however, was observed between cognitive score and tumor location, chemotherapy, and the time, from which treatment had ended.
With the high prevalence of cognitive disorders among patients with astrocytoma, one can conclude that the tumor itself and the surrounding factors affect the cognitive function of the patient. Results of this study showed that the type of treatment and some properties of the tumor, such as the tumor’s location, do not affect the patient’s cognitive capacity.

Dihydropyrimidine dehydrogenase (DPD) is the initial enzyme in the catabolism of 5-fluorouracil (5-fu). Deficiency of this enzyme can lead to severe and lethal toxicity following the administration of 5FU or capecitabine. The aim of this study was to demonstrate the prevalence of the IVS14 1G > A mutation of the dihydropyrimidine dehydrogenase gene (DPYD) and important side effects of the adjuvant chemotherapy regimens in an ethnic Iranian group of colorectal cancer (CRC) patients.
The research population included patients with colorectal cancer during the period of October 2011 to January 2013. Genomic DNA was isolated from blood cells of 109 patients. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was carried out to identify the frequency of the IVS14 1G > A mutation. The side effects of chemotherapy regimens containing 5-FU or capecitabine were recorded during 1-6 courses of chemotherapy.
The IVS14 1G > A mutation was not found in the population studied. Overall 28.4% of patients reported to have at least 1 grade 3 or 4 toxicity.
We concluded that IVS14 1G > A mutation was rare in the population studied; however, a larger sample size may be required to determine the precise mutation frequency in this region.

Pancreatic leiomyosarcoma is a rare tumor and its clinical course and treatment is not well described.
This paper reports on a 57-year-old male, who presented epigastric pain and had a 12-cm pancreatic tail leiomyosarcoma. He received adjuvant radiotherapy after complete tumor resection. He developed local recurrence 11 months later and received no further treatment. He died after 3 months.
The literature search revealed that pancreatic leiomyosarcoma has a variable clinical course and behavior.