Feasibility of intensity-modulated radiotherapy to treat gastric cancer

AimTo present a proposed gastric cancer intensity-modulated radiotherapy (IMRT) treatment planning protocol for an institution that have not introduced volumetric modulated arc therapy in clinical practice. A secondary aim was to determine the impact of 2DkV set-up corrections on target coverage and organ at risk (OAR).Methods and MaterialsTwenty consecutive patients were treated with a specially-designed non-coplanar 7-field IMRT technique. The isocenter-shift method was used to estimate the impact of 2DkV-based set-up corrections on the original base plan (BP) coverage. An alternative plan was simulated (SP) by taking into account isocenter shifts. The SP and BP were compared using dose-volume histogram (DVH) plots calculated for the internal target volume (ITV) and OARs.ResultsBoth plans delivered a similar mean dose to the ITV (100.32 vs. 100.40%), with no significant differences between the plans in internal target coverage (5.37 vs. 4.96%). Similarly, no significant differences were observed between the maximal dose to the spinal cord (67.70 and 67.09%, respectively) and volume received 50% of the prescribed dose of: the liver (62.11 vs. 59.84%), the right (17.62 vs. 18.58%) and left kidney (29.40 vs. 30.48%). Set-up margins (SM) were computed as 7.80mm, 10.17mm and 6.71mm in the left-right, cranio-caudal and anterior-posterior directions, respectively.ConclusionPresented IMRT protocol (OAR dose constraints with selected SM verified by 2DkV verification) for stomach treatment provided optimal dose distribution for the target and the critical organs. Comparison of DVH for the base and the modified plan (which considered set-up uncertainties) showed no significant differences

Intraoperative radiation therapy as part of breast conserving therapy of early breast cancer—Results of one-year follow-up

AimThe aim of this study was to assess the therapeutic effect of intraoperative radiotherapy, describe the method, and examine the occurrence of side effects and quality of life.BackgroundBreast conserving therapy has recently become a standard treatment modality in patients with early invasive cancer. Radiotherapy, along with surgery, is an integral part of such treatment. The important thing of radiotherapy is to deliver a high dose to the tumour bed. One of the methods is the intraoperative radiotherapy.Materials and methodsThe analysis comprised sixty Tis-T2N0-1A breast cancer patients treated with breast conserving surgery. Patients’ mean age was 57 years (range: 32–73 years). Intraoperative radiation therapy was delivered in the operating theatre during surgery and involved a single dose of 10[[ce:hsp sp="0.25"/]]Gy with an electron beam of 4, 6, 9 or 12[[ce:hsp sp="0.25"/]]MeV. After that, all patients were treated with whole breast irradiation. During one year observation photos and side effects examination were made.ResultsPhysical and imaging examinations performed during a one-year follow-up revealed no local or distant relapse and good tolerance of IORT. Acute mild responses to the radiotherapy occurred in 23.3% of patients. Based on the examination, a good and very good cosmetic effect was found in 78.3%, with 83.3% of patients evaluating their treatment effects in the same way.ConclusionsDue to its exceptional physical and radiobiological properties, intraoperative radiation therapy can be a good alternative to other methods of boosting dose to the post-operative site in management of low stage breast cancer, enabling a precise therapy to the tumour bed

Intraoperative radiotherapy in early breast cancer: effectiveness and toxicity assessment

Introduction: Breast-conserving therapy (BCT) with adjuvant radiotherapy in the management of patients with breast cancer is an effective alternative for mastectomy. A standard adjunct to BCT is irradiation of the entire breast for 5-7 weeks. Aim of paper: Evaluation of treatment effectiveness, analysis of early and delayed radiation- induced reactions, cosmetic effect and quality of life. Material and methods: Analysis encompassed 150 patients undergoing BCT, intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) followed up for at least one year. Follow-up examination 1 month, 6 months, 12 months and 24 months after completion of treat- ment included: physical examination, breast photography, analysis of early and delayed post-radiation reactions. Nuclear magnetic resonance mammography and sonography of the breasts was obtained after 6 months of observation. Results: No cases of local recurrence have been noticed. Acute radiation-induced reaction of the skin (grade 1 and 2) developed in 21.2% patients. No cases of grade 3 and 4 reactions have been noticed. Very good and good cosmetic effect was obtained in 81.5% of the patients. Breast pain has been reported by 20.6% of the patients, and skin hyperesthesia – by 17% of them. Breast edema was seen in 81.3% of the patients 1 month, in 63.4% 6 months, in 54.9% 12 months and in 56% 2 years after completion of radiotherapy. Altered skin pigmen- tation was noticed in 67.8% of the patients 1 month, in 44.1% 6 months, in 37.8% 1 year and in 31% 2 years after completion of radiotherapy. Conclusion: No cases of local recurrence or severe (high-grade) radiation-induced reactions were noticed during follow-up. Intraoperative radiotherapy reduced duration of treatment by one week, enabling inclusion the entire planning target volume (PTV) by a homogenous radiation dose and reduced the risk of geographic error.Wstęp: Oszczędzające leczenie chorych na raka piersi (breast-conserving therapy, BCT) z uzupełniającą radiotera- pią stworzyło skuteczną alternatywę dla mastektomii. Standardowym postępowaniem po BCT jest napromienianie całego gruczołu piersiowego przez 5-7 tygodni. Cel pracy: Ocena skuteczności leczenia, analiza wczesnych i póź- nych odczynów popromiennych, efektu kosmetycznego oraz jakości życia. Materiał i metody: Przeanalizowano 150 pacjentek po BCT, śródoperacyjnej radioterapii (intraoperative radiation therapy, IORT) oraz napromienianiu z pól zewnętrznych (external beam radiotherapy, EBRT) z minimalnym okresem obserwacji 1 roku. Obserwacja w 1., 6., 12., 24. miesiącu od zakończenia leczenia obejmowała: badanie kliniczne, zdjęcie gruczołów piersiowych, analizę odczynów wczesnych i późnych. Po 6 miesiącach wykonano MMR i USG gruczołów piersiowych. Wyniki: Nie stwierdzono wznowy miejscowej. Ostra reakcja popromienna (w stopniach 1. i 2.) w obrębie skóry wystąpiła u 21,2% chorych (brak odczynów w stopniach 3. i 4.), bardzo dobry i dobry efekt kosmetyczny leczenia odnoto- wano u 81,5% badanych. Ból w obrębie gruczołu piersiowego zgłaszało 20,6%, a zwiększoną wrażliwość skóry – 17% pacjentek. Obrzęk gruczołu piersiowego stwierdzono u 81,3% chorych po 1 miesiącu, 63,4% po 6 miesiącach, 54,9% po 12 miesiącach i u 56% po 2 latach od zakończenia radioterapii. Zmianę zabarwienia skóry odnotowano u 67,8% chorych po 1 miesiącu, 44,1% po 6 miesiącach, 37,8% po 12 miesiącach i u 31% po 2 latach od zakończe- nia teleradioterapii. Omówienie: W trakcie obserwacji chorych nie stwierdzono wznowy miejscowej oraz odczynów w stopniu ciężkim. Śródoperacyjna radioterapia skróciła czas leczenia o tydzień, umożliwiła objęcie jednorodną dawką PTV i zmniejszyła ryzyko błędu geograficznego