63. Stereotactic radiotherapy for primary and recurrent brain tumors. A new method for improvement of the treatment results?

To evaluate the effectiveness of the stereotactic radiosurgery (SRS) and stereotactic fractionated radiotherapy in the primary, recurrent and metastatic brain tumors.To present potential usefulness of stereotactic boost in anaplastic astrocytomas (AA) and glioblastoma multiforme (GBM).Between March 2000 and December 2000, SRS was applied in 23 patients (pts) with brain tumors (metastatic tumors – 9 pts, recurrent tumors – 7 pts, primary meningiomas – 4 pts, vascular malformations – 3 pts).Fractionated stereotactic radiotherapy was applied in 6 pts (recurrent anaplastic gliomas – 2 pts, recurrent medulloblastoma – 1 pt, acustic neurinoma – 1 pt, meningioma – 1, pituitary adenoma – 1).Detailed technique of treatment planning is presented and discussed. The planning target volume (PTV) and organs at risk (OAR) were assessed comparing dose statistics, dose volume histograms and RTOG stereotactic radiosurgery criteria.Recommendations regarding the total dose level and fractional dose are proposed.The treatment tolerance and preliminary results are presented.The own protocol of stereotactic boost to residual tumor using SRS after initial conformal radiotherapy in patients with AA and GBM is presented and discussed

Dose escalation using 3-dimensional conformal radiotherapy in management of non-small cell lung cancer; preliminary results on 22 patients

PurposeTo determine the feasibility of radiation dose escalation > 70 Gy to Gross Tumour Volume (GTV) using 3-Dimensional Conformal Radiotherapy (3-DCRT).Methods and MaterialsFrom December 1997 to November 1998, 22 patients with non-small cell lung cancer (NSCLC) were included. Tumour stage was I in 3 cases, II in 6 cases, III in 10 cases, and there were 3 locoregional recurrences after surgery. A 3-D treatment planning system with BEV was used for all patients. Patients underwent limited elective nodal irradiation of 56 Gy. The GTV with 1 cm margin received a dose of at least 70 Gy. Acute and late toxicity were estimated according to the RTOG/EORTC score.ResultsThe mean follow-up was 217 (80–360) days. Seventeen patients received 74 Gy, two had 72 Gy, and one had 70 Gy. In one patient with the largest irradiation volume a toxic death due to radiation pneumonitis occured. Except this fatality acute toxicity was acceptable. Seventeen patients were evaluable for response. There were 3 (18%) complete responses, all in patients staged I and II, seven (41%) partial responses, 5 (29%) non-responses and two (12%) local progressions. Two local progressions and two distant failures occured in stage III patients.ConclusionsDose escalation >70 Gy using 3-DCRT in management of NSCLC is feasible with acceptable acute toxicity