The Journey of SRS: An Initial Experience of Starting Sterotactic Radiosurgery Facility at Purbanchal Cancer Hospital—First in Nepal

Introduction: Radiotherapy (RT) is a vital cancer treatment modality for both curative and palliative purposes. Nepal is a developing country with a population of around 30 million people. Cancer affects 100 - 120 people out of every 100,000, and the figure is increasing. The number of radiation facility machines in the country is still countable in fingers. Purbanchal Cancer Hospital, Nepal is the first comprehensive cancer facility capable of performing stereotactic radiosurgery (SRS). Our facility has cutting-edge Varian Truebeam Linear Accelerators with millennium MLC, which makes SRS and SRT’S for intracranial lesions such as small benign and malignant tumors much easier. In addition to SRS, we are the pioneers of SBRT for lung using 4DCT, interstitial & intraluminal brachytherapy, RPM Gated & DIBH modalities in Nepal. Methods & Materials: The purpose of this study is to share our experience in establishing an SRS facility in the country, which includes training the RT team on the importance of process accuracy, patient selection, patient assessment, mould preparation, and describing image data acquisition, target, and organ at risk delineation on CT and MRI images, treatment planning process, and quality assurance. Results & Discussion: The plans for all SRS and SRT cases are based on target coverage, OAR sparing, hotspot inside the target, conformity index, heterogeneity index, and dose fall off. To select the final plan, we used strict passing criteria such as a conformity index Paddick (CIPaddick) more than 0.85, a falloff between 100% and 50% of less than 5.5 mm (maximum 6 mm in irregular targets), and a hotspot inside the target between 115 to 140 percent, as per clinical standards. In addition, we determined the CILomax and CIRTOG for each case. Passing criteria for verification plans are set as minimum of 95% for a 2% percentage dose difference (% DD) and a 2-mm distance to an agreement (DTA). We also gathered demographic data from patients treated in the first year, such as diagnosis, lesion size, dose fraction, heterogeneity index (HI), conformity index (CI) and gamma index. SRS/SRT treatment was successfully implemented, and over 40 patients were treated with positive clinical outcomes. Conclusion: SRS now has a wider range of alternatives, thanks to technology advancements in recent years. SRS’s dosimetric advantages have steadily been extended to extracranial locations. Purbanchal Cancer Hospital, Birtamode, Nepal established a comprehensive cancer facility with qualified workforce with the goal of providing high-quality treatment to the people of Nepal.

Expression of PANDA, LincRNA-p21, PUMA in lung tissues of lung cancer patients in the Xuanwei and non-Xuanwei areas of Yunnan Province

Aim:To study the expression of PANDA,LincRNA-p21,and PUMA in lung tissue of patients with lung cancer from Xuanwei of Yunnan Province.Methods:Forty-five cases of lung cancer patients from Xuanwei and 42 lung cancer cases from non-Xuanwei were enrolled.Extraction of RNA was done using the Trizol kit.Real-time fluorescence quantitative PCR assay was done to obtain the relative expression.Results:Expressions of PANDA,LincRNA-p21,and PUMA in male and female patients or in squamous cell carcinoma and adenocarcinoma were not significantly different(P>0.05).However,expression of LincRNA-p21 in Xuanwei patients was higher than non-Xuanwei patients(P<0.05).Expression of PUMA in tumor tissue was lower than that in normal lung tissue(P<0.05),and i n Xuanwei patients was lower than non-Xuanwei patients(P<0.05).In patients from non-Xuanwei regions,expression of LincRNA-p21 in patients with smoking index>400 was higher than in those<400 and non-smokers.Conclusion:Expressions of PANDA,LincRNA-p21,and PUMA in lung tissues have no gender differences or tissue specificity.High expression of LincRNA-p21 in Xuanwei patients may have relationship with cell damage caused by coal burning pollution in Xuanwei.