Background: Occupational exposure to radon in working environments should be considered as chronic because the subjects involved undergo the effect due to the ionizing radiation from the same gas and decay products. The exposure characteristics create conditions for toxicological, radio-toxicological cellular, subcellular, and molecular mechanisms that lead to lung cancer. Aim: Our aim is to clarify the prediction of probable cases of lung cancer in ²²²Radon-exposed subjects in order to point out an obvious risk that should not be underestimated, particularly in subjects with an accumulated dose in many years of activity and for the previously underestimated gamma radiation (²¹⁴Bi). Materials and Methods: A total of 168 electret sensors were set in couples for 84 surveys in working environments; also a further pair of them was used in order to determine the background γ generated by cosmic rays and we considered four group: general population, never smokers, former smokers, and current smokers. Results: Results are expressed in terms of mean and standard deviation, standard error, geometric mean with statistical significance (P < 0.01 [t-test]), and excess lifetime cancer risk (ELCR). They demonstrate an increase of both mean concentrations (P < 0.01 [t-test]) and ELCR. This happens with multiple values of the allowed limits >150 Bq m³ (U.S. Environmental Protection Agency, EPA) or >300 Bq m³ (international commission radiation protection), until to an individual accumulated dose as 90–95 work level month. We have detected the environmental variability associated with the structural characteristics of the buildings and their construction. Conclusion: The results showed that exposure in underground environments is significant although generally these environments are used as archives. Surprisingly, data greater than expected are also evident on the ground floor and first floor of historic buildings with solid and compact walls, with other factors playing a role as reduced or absent air changes during the night and activation of heating when work is resumed after renovation.

Context: Liver cancer or hepatocellular carcinoma (HCC) is a dreadful complex disease generally occurring from chronic hepatitis B (HBV-CH) due to its latency, which leads to liver cirrhosis and ultimately liver cancer. To prevent cancer at root level, diagnosis of HBV-CH is highly necessary which based on clinical presentation, serum biochemistry, and viral markers. Aim: The aim of the present study was to detect and identify phosphorylated proteins in HBV-CH patients' sera, among chronic hepatitis B-induced liver cirrhosis (HBV-LC) and HCC by developing antibody against this targeted phosphoprotein by enzyme-linked immunosorbent assay (ELISA). This candidate phosphoprotein in patients' sera can be a noninvasive biomarker of HBV-CH. Setting and Design: Our experimental approach was to detect phosphoproteins in HBV-CH, HBV-LC, and HCC, their quantification by ELISA and Western blot. Identification of highly expressed targeted phosphoproteins was done by two-dimensional (2D) gel electrophoresis followed by MALDI-ToF-MS analysis. Antibody is to be developed against synthesized peptide of targeted phosphoprotein of HBV-CH to use by ELISA. This will be a non-invasive approach to identify candidate phosphoprotein as biomarker of HBV-CH. Methodology: Our experimental approach consisted of three steps: (1) detection of serum phosphoproteins by Pro-Q diamond dye in HBV-CH, HBV-LC and HCC patients' groups as well as control subjects; (2) quantification of serum phosphoproteins using different phospho-specific monoclonal antibodies viz., antiphosphoserine (p^Ser), antiphosphothreonine (p^Thr), and antiphosphotyrosine (p^Tyr) antibodies by ELISA and Western blot; (3)identification of differentially expressed phosphorylated proteins in HBV-CH, HBV-LC and HCC by 2D electrophoresis (2DE) followed by in gel trypsin digestion and subsequently by MALDI-ToF-MS analysis. Statistical Analysis Used: Student's t-test and ANOVA was applied for statistical analysis. Results: There were four phosphoprotein bands namely at 25, 50, 70, 75 kDa in HBV-CH, HBV-LC, HCC and control subjects detected by ProQ diamond dye. Besides there appeared one more band at 60 kDa in HCC. The phosphorylation level at serine and threonine residues was highest in HCC patient groups among HBV-CH, HBV-LC and control groups whereas no phosphorylation level of tyrosine was observed among liver disease patient and control groups. Serum phosphorylated proteins were detected and quantified by Western blot. The results were corroborated to those obtained by ELISA. The differential expression of seven phosphoprotein spots was detected in HBV-CH, HBV-LC, HCC patients and control subjects by 2DE and were identified by MALDI-ToF-MS analysis. Conclusion: Thus circulating phosphoproteins could represent important disease biomarkers because of their differential expression in liver diseases.

Purpose: Human papillomavirus (HPV) is a common and necessary cause for cervical cancer development. However, association of other microbial infections such as bacterial vaginosis (BV), trichomonas vaginalis (TV), and hepatitis B virus (HBV) with HPV in development of the disease is not clear. This study aimed to evaluate the association of HPV with the other coinfections with the development of cervical lesions. Materials and Methods: Cervical smears of 120 women (age range 20–70 years) were screened by cytology/serology for detection of BV, TV, and HBV. The prevalence of HPV and its copy number were detected by polymerase chain reaction-based methods. Results: HPV infection was infrequent (4%) in normal cytology samples followed by increase in atypical squamous cell of undetermined significance (ASCUS) (60.4%), low-grade squamous intraepithelial lesion (LSIL) (94.1%), high-grade squamous intraepithelial lesion (HSIL) (100.0%), and squamous cell carcinoma (SCC) (100.0%). HPV 16 infection was prevalent than HPV 18 along their coinfections in some samples. The other microbial infections were comparatively less frequent (28.0%) in normal cytology samples than ASCUS (83.3%), LSIL (44.1%), HSIL (58.3%), and SCC (100.0%). BV infection was found in normal cytology as well as in ASCUS, LSIL, and HSIL samples, whereas TV infection was absent in normal cytology though prevalent in other cervical lesions. HBV infection was seen in only one ASCUS sample. Conclusions: Significant high HPV 16 copy number was seen to be associated with other microbial infections than the infection negative samples. Coinfection of HPV with other microbes has association with severity of cervical lesions.

Background: Colorectal cancer (CRC) is the most common gastrointestinal malignancy. CRC occurs more common in males than females worldwide. There are very few studies on the incidence of CRC in the state of Rajasthan. The present study evaluates its temporal variation and area-wise distribution. Materials and Methods: Five-year retrospective data on CRC incidence were obtained from Hospital-Based Cancer Registry of Regional Cancer Center (RCC), Bikaner, from January 2016 to December 2020. The collected data show the trend of CRC incidence over these 5 years. District- and tehsil-wise distribution of patients was also analyzed. Results: A total of 37,132 cases registered at RCC, Bikaner, from January 2016 to December 2020, there were 796 cases of CRC accounting for 2.14% of the total. Among these, there were 500 male and 296 female cases, respectively. The median age at the diagnosis of CRC was 53 years in females and 56 years in males. This 5-year data analysis showed an increasing trend of CRC incidence in the last 5 years. The highest incidence rate was found in the districts of Bikaner, Sri Ganganagar, Hanumangarh, and Churu, with most patients coming from Bikaner tehsil of Bikaner district. Conclusion: CRC cases have shown an increasing trend in the past 5 years in Rajasthan with a higher incidence in the North-western districts. There is a need to early diagnosis through screening and find out solutions for reducing the risk of CRC in future.

Background: In clinical practice, the management of cancer-related anorexia/cachexia syndrome (CACS) is a great challenge. We conducted an observational study to find the effectiveness and safety of megestrol acetate (MA) for the treatment of CACS. Patients and Methods: One hundred patients of advanced cancer were randomly assigned in the study. Patients received MA 160 mg/oral twice daily. The duration of treatment was 8 weeks. Results: The analysis of the study group demonstrated a statistically significant increase from baseline in body weight (P ≤ 0.01), quality of life (P = 0.02), appetite (P = 0.01), and the Eastern Cooperative Oncology Group performance status (P = 0.03). Conclusion: We concluded that MA is effective and safe in the treatment of CACS.

Purpose: In this study, we aimed to compare the doses of the prostate gland and organs at risk (OAR) using dose volume histograms after external body radiation therapy options, Intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and hybrid three-dimensional conformal radiotherapy (3DCRT), in patients diagnosed with high-risk prostate cancer. Materials and Methods: A total of 14 male patients with high-risk prostate cancer who received prostate radiotherapy combined with elective nodal irradiation, were selected; the total prostate doses were 78 Gy in 39 fractions and pelvic lymph nodes doses were 56 Gy in 28 fractions. The target coverage was evaluated in the PTV with the following parameters: D_mean, D_min, D_max, CN, and HI, and each normal tissue was evaluated using percentage volumes of reference doses which were previously defined by Radiation Therapy Oncology Group and QUANTEC criteria. Results: In target volumes, 95% of the targeted dose was adequately covered in all three of the 3BKRT, IMRT, and VMAT techniques. In terms of OAR, the percentages of volume exposed to high doses are much lower in the reverse plan IMRT and VMAT technique compared to the 3DCRT technique. There was no significant superiority between IMRT and VMAT in terms of reference values for rectum, bladder, femoral heads, bulbus penis, and small intestines. Conclusion: The superiority of IMRT and VMAT techniques over 3DCRT techniques has been clearly demonstrated, especially in terms of OAR, in patients with a diagnosis of high-risk prostate cancer. It is thought that one of these two techniques can be preferred by the possibilities in every radiotherapy clinic.

Background: Radiotherapy is one of the most effective treatments for cancer. However, delivering an optimal dosage of radiation to the patients is always challenging due to the movements of the patient during treatment. Immobilization devices are typically used to minimize patient movement. Aims: The current work has been carried out to investigate the effectiveness of Three-dimensional printing (3D) printing to create patient-specific immobilization devices in comparison to traditional devices. Earlier studies have reported the advantages of 3D printed materials in the form of phantoms included improved patient experience and comfort over traditional methods. Further, high levels of accuracy between immobilizer and patient, reproducibility, and similar beam attenuation properties were better achieved compared to conventional or thermoformed immobilizers. Methods: The additive manufacturing process, however, is considered time-consuming as it requires time to print the desired shape. In the current study, polyamide-based PA 2200 which is biocompatible was used as source material for printing the customized Immobilize devices for radiotherapy. Results: Computer-aided designing (CAD) was used to design following the computer tomography scan of patients. The design was fed to the 3D printer for further processing. Conclusions: The mechanical properties of materials are important to receive the geometrical requirement that fits every patient. We used PA 2200, which is more biocompatible compared to other materials to produce phantoms using the system-generated design of the patient geometry. Further, phantoms produced did not show much deviation in radio fractionation when compared to the thermoplastic molds.

Context: The COVID-19 pandemic has posed a big challenge to provision of health care. Cancer patients are considered to be at higher risk of developing complications from COVID-19 as they are often immunosuppressed. At the same time, treatment delays and late diagnosis during the pandemic due to travel restrictions, staff shortage, active COVID infections to patients or family members, etc., can lead to tumor progression and poor oncological outcomes. Aims: This retrospective observational study was undertaken to know the effect of the corona pandemic and consequent lockdown on the radiation treatment of oncology patients in our department. Materials and Methods: Subjects of the study were the patients who attended the Oncology Department of Kamineni Academy of Medical Sciences, Hyderabad, which is a tertiary care center, during the COVID-19 pandemic. The study period was 6 months starting from the lockdown on April 24, 2020. Results: In our study, treatment of 16 out of 150 patients (10.67%) was affected due to the lockdown situation consequent to COVID-19 pandemic. Eight patients had treatment interruptions for more than 5 days, six patients discontinued their treatment, and two patients delayed their treatment due to lockdown. Eight patients tested positive for COVID-19 before starting treatment. Out of them, four did not come back for treatment. The mean delay in radiation treatment in the other four patients was 35 days. Two patients had CORAD scores consistent with COVID-19 but were reverse transcription–polymerase chain reaction negative. Two patients turned positive during treatment after which they did not come back. Totally 9.3% (14/150) of the patients' treatment was affected due to corona infection. Conclusions: In our study, almost 20% of the patients' treatment was affected directly or indirectly by the COVID-19 pandemic situation. This in turn may lead to rise in cancer mortality in future.

Leiomyosarcoma is most common in adults and constitutes 38%–52% of primary prostatic sarcomas. Primary prostatic leiomyosarcoma is extremely rare which accounts for 0.1% of all prostatic malignancies. Patients present with signs and symptoms generally encountered with prostatic enlargement. A 41-year-old gentleman presented with complaints of burning micturition and difficulty in passing urine and stools for 1 month. Magnetic resonance imaging of the pelvis showed a 10 cm × 5.6 cm × 5.9 cm heterogeneous mass lesion originating from the prostate gland extending into bilateral seminal vesicles. There is loss of fat planes with bladder, rectum, and rectosigmoid. Transrectal ultrasound-guided biopsy and immunohistochemistry confirmed the diagnosis as leiomyosarcoma of the prostate. Because of the proximity of the prostate with urinary bladder and difficulty in resection, the patient received neoadjuvant stereotactic body radiotherapy (SBRT) to a dose of 30 Gy in 5 fractions alternate day over a period of 2 weeks. The patient underwent cystoscopy, followed by radical prostatectomy 1 month post-SBRT. Histopathological examination of the prostatectomy specimen was suggestive of high-grade spindle cell neoplasm. The margins were focally involved by the tumor. Because of positive margins, the patient underwent adjuvant radiation treatment to postoperative primary tumor bed to a dose of 30 Gy in 15 fractions by conventional fractionation on Halcyon 2.0. The patient tolerated the treatment well with minimal side effects. The patient is symptom-free and disease-free 3 months posttreatment and needs regular and long follow-up.

The incidence of two or more intracranial malignancies of different cell types is extremely rare with an incidence of <0.9% of all primary central nervous system tumors. Herein, we report the rare combination of pituitary macroadenoma, benign condition with glioblastoma multiforme, highly aggressive malignancy in a 33-year-old male with the initial complaints of intermittent headache and vomiting. The clinical presentation, radiological characteristics, and treatments received by the patient are briefly discussed along with review of literature. The patient was treated with surgery followed by chemoradiotherapy and medical management. Post radiation, contrast-enhanced computed tomography scan of the brain showed postoperative changes with the resolution of the pituitary lesion.