Favorable long-term results of primary pterygium removal by bare sclera extirpation followed by a single (90)Strontium application

PURPOSE. To describe and compare long-term (>= 36 months) effects of patients with 86 primary pterygia treated with bare sclera extirpation ( BSE) followed by beta-RT or by sham irradiation. METHODS. Prospective, multicenter, randomized, double-blind study. After BSE of their pterygium, patients were randomized to either beta-RT or sham irradiation. In the case of beta-RT, within 24 hours after the operation, a 90Sr eye applicator was used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Sham irradiation was given using the same type of applicator without the 90Sr layer. After treatment, both a masked ophthalmologist and a radiation oncologist performed follow-up examinations. These were continued until either a relapse occurred or at least 36 months had elapsed. RESULTS. Adequate follow-up was available of 86 pterygia in 81 patients, treated between February 1998 and September 2002. Fifty-two (60%) patients were male. The mean age of the patients was 50 years ( range: 24-77). After a follow-up of at least 36 months ( mean: 40 months, SD: 13.9 months), 5 out of 44 eyes (11%) treated with beta-RT showed a recurrence versus 32 out of 42 eyes (76%) treated with sham-RT ( after a mean follow-up of 22 months) (p <0.001). In the beta-RT group, 80% were satisfied with the cosmetic result, whereas in the sham group this percentage was 41% ( p <0.001). In the beta-RT group, no scar or a white scar could be detected in 86% of the treated eyes, versus in 24% of the sham irradiated eyes (p <0.001). A change of keratometry (Javal) was seen in 5 patients (12%) following beta-RT compared to 16 (38%) after sham irradiation (p= 0.002). Complications were few: a granuloma was seen in three patients after sham irradiation, mild limitation of abduction in two beta-RT patients versus in five after sham irradiation, and mild scleromalacia in one beta-RT patient. CONCLUSIONS. Bare sclera extirpation of a pterygium without adjuvant treatment has an unacceptably high recurrence rate and therefore should be considered obsolete. Bare sclera extirpation of a primary pterygium followed by a single-dose beta-RT is a simple, effective, and safe treatment with lasting results and very few complication

Variability in Clinical Target Volume Delineation for Intensity Modulated Radiotherapy in Three Challenging Cervix Cancer Scenarios

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Importance of training in external beam treatment planning for locally advanced cervix cancer: Report from the EMBRACE II dummy run

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Vaginal brachytherapy versus external beam pelvic radiotherapy for high-intermediate risk endometrial cancer: Long term results of the randomized PORTEC-2 trial

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Image-guided Adaptive Radiotherapy in Cervical Cancer

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

CONSENSUS GUIDELINES FOR DELINEATION OF CLINICAL TARGET VOLUME FOR INTENSITY-MODULATED PELVIC RADIOTHERAPY FOR THE DEFINITIVE TREATMENT OF CERVIX CANCER

Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines fir IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aid in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting. (C) 2011 Elsevier Inc.Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Use of 'sham' radiotherapy in randomized clinical trials

The objective of this systematic review was to identify quality trials that use sham radiotherapy in their design and review them to determine its potential value. The Cochrane Library, Pubmed and a Reference Search served as data sources. Trials were included if they met a minimum quality score of 3 on a validated assessment instrument (which assesses randomization, control and blinding) and if they compared sham radiotherapy to active treatment. External beam therapy and brachytherapy trials were considered. Twenty-six trials were identified, collectively including 2663 participants in the period of 1970-2004. All the trials studied the value of radiotherapy for treatment or prevention of benign diseases, including multiple sclerosis, coronary artery restenosis, age-related macular degeneration and Graves' ophthalmopathy. There were no trials relating to the use of radiotherapy in the treatment of malignancy. This review showed that it is possible to carry out sham radiotherapy with due regard for ethical concerns, with effective blinding and high levels of patient acceptance. Large sample sizes with multicentre trial designs were achievable. Although the statistical philosophy for using sham radiotherapy in trials is legitimate, it is no longer routinely used