173. Does the correlation between chemotherapy-induced leukopenia with response in locally advanced breast cancer exist?

PurposeThe correlation between chemotherapy-induced toxicity and treatment outcome in cancer patients has not been thoroughly studied. Our aim was to evaluate whether leukopenia following primary chemotherapy may be predictive for response in patients with locally advanced breast cancer.Patients and MethodsThe records of 164 breast cancer patients administered primary chemotherapy between 1985 and 1995 were analysed. Most of the patients presented with locally advanced disease, however included were also patients with large operable tumours. Chemotherapy included one of the three combinations: CMF; modified Cooper regimen (CMFVP); 31 patients (19%), anthracycline-based regimens (FAC and FEC); 16 patients (10%) and 118 patients (71%).ResultsThe objective response rate in the entire group was 58%; 75% in patients who developed grade 2–3 leukopenia during induction chemotherapy, and 52% in those who had no or grade 1 leukopenia (p < 0.01, multivariate analysis). No other patient- or treatment-related factor including age, performance status, T stage, N stage, supraclavicular Iymph node involvement, inflammatory carcinoma or chemotherapy regimen correlated with response to chemotherapy. There was no correlation between treatment-induced leukopenia and overall survival.ConclusionsThese findings suggest a relationship between chemotherapy induced leukopenia and tumour response in patients with locally advanced breast cancer. The prognostic impact of leukopenia is negliglble

2 Ocena porównawcza dawki w odbytnicy obliczonej dwiema metodami w brachyterapii śródjamowej chorych na raka szyjki i trzonu macicy

WstępW Klinice Onkologii i Radioterapii AMG od 1985 roku stosowana jest brachyterapia cezowa przy użyciu aparatu Selektron LDR. Dawkę maksymalną w odbytnicy do roku 1995 wyznaczano stosując wprowadzony doodbytniczo drucik ołowiany w osłonce plastikowej (R1), a w ostatnich latach zgodnie z zaleceniami Raportu 38 ICRU, dodatkowo oznacza się ją lokalizując tylną ścianę pochwy przez tamponowanie gazikami zawierającymi cieniującą na radiogramach nitkę (R2).Cel pracyPorównanie dawek fizycznych (R1 i R2) i równoważnych im dawek biologicznych (r1 i r2) w odbytnicy, obliczonych powyższymi dwiema metodami.Materiał i metodyAnaliza dotyczyła 124 aplikacji cezu u 102 chorych na raka szyjki lub trzonu macicy, leczonych śródjamowo podczas skojarzonego lub pooperacyjnego napromieniania. Rozkład dawki w miednicy małej obliczano za pomocą komputerowych systemów planowania, wykorzystując 2 prostopadłe radiologiczne zdjęcia lokalizacyjne.Dawki biologiczne obliczono przy pomocy modelu liniowo-kwadratowego, przyjmując α/β=4.WynikiW 83% przypadków wartość bezwzględna dawek R1 była niższa od R2. Wartości średnie dawek R1 i R2 oraz r1 i r2 wynosiły odpowiednio: 13,2 ±4,3 Gy i 16,9 ±4,4 Gy oraz 16,8 ±8,0 Gy i 24,0 ±9,6 Gy. Średnia różnica między R1 i R2 oraz r1 i r2 wynosiła 3,7 Gy (95% CI, 3,03–4,41 Gy) i 7,2 Gy (95% CI, 5,77–8,56 Gy), odpowiednio i jest statystycznie znamienna (

36 Ocena porównawcza dwu metod obliczania dawek w odbytnicy podczas śródjamowej brachyterapii (BT) chorych na raka szyjki i trzonu macicy

Radioterapia nowotworów ginekologicznych wiąże się z wysokim ryzykiem uszkodzeń popromiennych pęcherza i odbytnicy. W skojarzonym leczeniu napromienianiem dawka, jaką otrzymuje pkt referencyjny w odbytnicy stanowi sumę dawek fizycznych z BT śródjamowej oraz napromieniania wiązką zewnętrzną. W Klinice Onkologii i Radioterapii AMG, rozkład dawki w miednicy małej podczas BT obliczany jest komputerowo dla każdej chorej. Punktową dawkę maksymalną w odbytnicy wyznacza się na podstawie wprowadzonego doodbytniczo ołowianego drucika w osłonie plastikowej (R1).Od 1995 roku dodatkowo dawkę tę wyznacza się w punkcie referencyjnym, zgodnie z zaleceniami ICRU (raport Nr 38) lokalizując tylną ścianę pochwy gazikami zawierającymi cieniującą na radiogramach nitkę (R2). Ponadto u wszystkich chorych obliczane są równoważne dawki biologiczne wyliczane z zastosowaniem modelu liniowo-kwadratowego (α/β=4).Celem pracy było porównanie dawek fizycznych i odpowiadających im dawek biologicznych (r1 i r2) obliczonych przy użyciu obu wymienionych metod. Analiza dotyczyła 124 aplikacji cezu u 102 chorych na raka szyjki lub trzonu macicy, leczonych śródjamowo podczas skojarzonego lub pooperacyjnego napromieniania.W 83% przypadków wartość bezwzględna dawek R1 była niższa od R2. Wartości średnie dawek R1 i R2 nosiły odpowiednio: 13,2±4,3 Gy i 16,4±4,4 Gy. Różnica między średnimi wynosząca 3,7 Gy jest zamienna statystycznie (test t-Studenta dla danych sparowanych, p=0,000), zarówno w przypadkach stosowania wyłącznie owoidów jak i pełnego układu (owoidów i sondy domacicznej). Różnica średnich pozostawała znamienna (p=0,016) przy uwzględnieniu 10% błędu metody. Wartości średnie dawek biologicznych r1 i r2 wynosiły odpowiednio: 16,8±8,0 Gy i 24,0±9,6 Gy, a średnia różnica dawek wynosiła 7,2 Gy (p=0,000).WnioskiWykazano istotną różnicę między dawkami wyznaczonymi dwiema metodami. W większości przypadków dawki w odbytnicy wyznaczone przy użyciu doodbytniczego drucika były niższe od dawek obliczonych w punkcie referencyjnym wg ICRU. Wprowadzenie osłon obszaru brachyterapii podczas leczenia wiązką zewnętrzną na podstawie obliczeń dawek R1 oznacza możliwość podania zbyt wysokiej dawki całkowitej na odbytnicę, co zwiększa ryzyko wystąpienia powikłań popromiennych. Z tego powodu metoda obliczenia dawki w odbytnicy przy użyciu doodbytniczego drucika nie powinna być zalecana

34. A multicenter randomized study of two regimens in paliative radiotherapy of bone metastases

In this study we compared two methods of radiotherapy in patients with painful bone metastases: 20 Gy in five fraction in five consecutive days vs 8 Gy in one fraction. A total of 115 patients (34 males, 81 females), median age 56 years (23–80), were randomly allocated to one of the treatment arms. In 56 pts. Primary tumor was located in the breast, in 14 pts in the lung, in ten pts in the kidney, in seven pts in the prostate, and in 28 pts in other sites. A total of 146 metastatic bone lesions were irradiated, seventy five (51%) were treated with 20 Gy and seventy one (49%) – with 8 Gy. The most frequent location of metastatic lesions was spine (36%), followed by pelvis (25%), long bones (18%), ribs (12%) and other sites (12%). Treatment techniques included single field (73%) or two parallel opposed fields (27%). Complete pain relief was achieved in 36% of the lesions irradiated with 20 Gy and in 41% of those irradiated with 8 Gy. Partial improvement was observed in 46% and 43% of lesions, respectively. The median time to reappearance of pain in both groups was 5.4 a 4.8 months and 5.0 a 5.4 months respectively. We conclude that a single exposure to 8 Gy is of the same efficacy as 20 Gy in five fractions in pain control of bone metastases and should be recommended as routine management

Pre-operative radiochemotherapy with raltitrexed for resectable locally-advanced rectal cancer : a phase II study

Background: The aim of the study was to evaluate the response to and toxicity of pre-operative radiochemotherapy containing raltitrexed (Tomudex) for resectable rectal adenocarcinoma. Patients and Methods: From November 2000 to June 2002, 18 consecutive patients staged T3 N0/N+ were treated with pre-operative chemotherapy (3 mg/m 2 of raltitrexed on days 1, 19, 38) and concurrent radiotherapy (RT) (50.4 Gy) in 6 weeks, followed by radical surgery within 8 weeks. Results: The treatment compliance was high. No major acute toxicity was reported. Concerning late toxicity, genitourinary adverse effects were prevalent. A complete response was observed in one patient (6%), partial response in eight (47%), stable disease in seven (41%) and progression in one case. Three-year actuarial disease-free and overall survival rates were 37% and 87.5%, respectively. Conclusion: Raltitrexed did not increase the pathological response rate compared with the rates obtained with use of preoperative RT alone and reported in the literature. Acute morbidity was low and acceptable, while late toxicity was considerable, prevalently concerning sexual dysfunction and urinary complications

National societies' needs as assessed by the ESTRO National Societies Committee survey: A European perspective

Purpose: To determine how ESTRO can collaborate with Radiation Oncology National Societies (NS) according to its mission and values, and to define the new roadmap to strengthen the NS network role in the forthcoming years. Materials and methods: The ESTRO NS committee launched a survey addressed to all European National Societies, available online from June 5th to October 30th 2018. Questions were divided into three main sections: (1) general information about NS; (2) relevant activities (to understand the landscape of each NS context of action); (3) relevant needs (to understand how ESTRO can support the NS). Eighty-nine European NS were invited to participate. Respondents were asked to rank ESTRO milestones in order of importance, indicating the level of priority to their society. Results: A total of 58 out of 89 NS (65.2%) from 31 European countries completed the questionnaire. The majority of NS ranked “Optimal patient care to cure cancer and to reduce treatment-related toxicity” as the highest level of priority. This aligns well with the ESTRO vision 2030 “Optimal health for all together.” NS also indicated a high need for more consensus guidelines and exchange of best practices, access to high quality accredited education, implementation of the ESTRO School Core Curriculum at the national level, and defining quality indicators and standard in Radiation Oncology, improved communication and increased channelling of information. Conclusion: The results of this survey will be used to strengthen the relations between ESTRO and European NS to promote and develop initiatives to improve cancer care

Modelling the correlation between EGFr expression and tumour cell radiosensitivity, and combined treatments of radiation and monoclonal antibody EGFr inhibitors

Purpose To estimate the effects of heterogeneity on tumour cell sensitivity to radiotherapy combined with radiosensitizing agents attributable to differences in expression levels of Epidermal Growth Factor Receptor (EGFr). Materials and methods Differences in radiosensitivity are not limited to cells of different cancer histotypes but also occur within the same cancer, or appear during radiotherapy if radiosensitizing drugs are combined with ionizing radiation. A modified biologically effective dose (MBED), has been introduced to account for changes in radiosensitivity parameters (alpha and alpha/beta) rather than changes in dose/fraction or total dose as normally done with standard biologically effective dose (BED). The MBED approach was applied to cases of EGFr over-expression and cases where EGFr inhibitors were combined with radiation. Representative examples in clinical practice were considered. RESULTS: Assuming membrane EGFr over-expression corresponds to reduced radiosensitivity (alphaH = 0.15 Gy-1 and alphaH/betaH = 7.5 Gy) relative to normal radiosensitivity (alpha = 0.2 Gy-1 and alpha/beta = 10 Gy), an increased dose per fraction of 2.42 Gy was obtained through the application of MBED, which is equivalent to the effect of a reference schedule with 30 fractions of 2 Gy. An equivalent hypo-fractionated regime with a dose per fraction of 2.80 Gy is obtained if 25 fractions are set. Dose fractionations modulated according to drug pharmacokinetics are estimated for combined treatments with biological drugs. Soft and strong modulated equivalent hypo-fractionations result from subtraction of 5 or 10 fractions, respectively. CONCLUSIONS: During this computational study, a new radiobiological tool has been introduced. The MBED allows the required dose per fraction to be estimated when tumour radiosensitivity is reduced because EGFr is over-expressed. If radiotherapy treatment is combined with EGFr inhibitors, MBED suggests new treatment strategies, with schedules modulated according to drug pharmacokinetics

Quality of life changes over time and predictors in a large head and neck patients’ cohort: secondary analysis from an Italian multi-center longitudinal, prospective, observational study—a study of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) head and neck working group

Purpose: The present study examined the longitudinal trajectories, through hierarchical modeling, of quality of life among patients with head and neck cancer, specifically symptoms burden, during radiotherapy, and in the follow-up period (1, 3, 6, and 12&nbsp;months after completion of radiotherapy), through the M.D. Anderson Symptom Inventory Head and Neck questionnaire, formed by three factors. Furthermore, analyses were conducted controlling for socio-demographic as well as clinical characteristics. Methods: Multi-level mixed-effects linear regression was used to estimate the association between quality of life and time, age, gender, household, educational level, employment status, ECOG performance status, human papilloma virus (HPV) status, surgery, chemotherapy, alcohol intake, and smoking. Results: Among the 166 participants, time resulted to be a predictor of all the three questionnaire factors, namely, general and specific related symptoms and interference with daily life. Moreover, regarding symptom interference with daily activities factor, HPV-positive status played a significant role. Considering only HPV-negative patients, only time predicted patients' quality of life. Differently, among HPV-positive patients, other variables, such as gender, educational level, alcohol use, surgery, age at diagnosis, employment status, and ECOG status, resulted significant. Conclusion: It was evident that quality of life of patients with head and neck cancer declined during RT, whereas it slowly improved after ending treatment. Our results clarified the role of some socio-demographic and clinical variables, for instance, HPV, which would allow to develop treatments tailored to each patient