Prophylactic cranial irradiation in locally advanced non-small cell lung cancer: outcome of recursive partitioning analysis group 1 patients

<p>Abstract</p> <p>Background</p> <p>Prophylactic cranial irradiation (PCI) has been demonstrated to reduce or delay the incidence of brain metastases (BM) in locally advanced non-small cell lung carcinoma (LA-NSCLC) patients with various prognostic groups. With this current cohort we planned to evaluate the potential usefulness of prophylactic cranial irradiation (PCI) specifically in recursive partitioning analysis (RPA) Group 1, which is the most favorable group of LA-NSCLC patients.</p> <p>Methods</p> <p>Between March 2007 and February 2008, 62 patients in RPA group 1 were treated with sequential chemoradiotherapy and PCI for stage IIIB NSCLC. The induction chemotherapy consisted of 3 courses of cisplatin (80 mg/m²) and docetaxel (80 mg/m²); each course was given every 21 days. Thoracic radiotherapy (TRT) was given at a dose of 60 Gy using 3-D conformal planning. All patients received a total dose of 30 Gy PCI (2 Gy/fr, 5 days a week), beginning on the first day of the TRT. Then, all patients received 3 further courses of the same chemotherapy protocol.</p> <p>Results</p> <p>Six (9.7%) patients developed brain metastases during their clinical course. Only one (2%) patient developed brain metastasis as the site of first treatment failure. Median brain metastasis-free survival, overall survival, and progression free survival were 16.6, 16.7, and 13.0 months, respectively. By univariate analysis, rates of BM were significantly higher in patients younger than 60 years of age (p = 0.03). Multivariate analysis showed no significant difference in BM-free survival according to gender, age, histology, and initial T- and N-stage.</p> <p>Conclusion</p> <p>The current finding of almost equal bone metastasis free survival and overall survival in patients with LA-NSCLC in RPA group 1 suggests a longer survival for patients who receive PCI, and thereby have a reduced risk of BM.</p

Comparison of CT and integrated PET-CT based radiation therapy planning in patients with malignant pleural mesothelioma

<p>Abstract</p> <p>Background</p> <p>When combined with adequate tumoricidal doses, accurate target volume delineation remains to be the one of the most important predictive factors for radiotherapy (RT) success in locally advanced or medically inoperable malignant pleural mesothelioma (MPM) patients. Recently, 18-fluorodeoxyglucose positron emission tomography (PET) has demonstrated significant improvements in diagnosis and accurate staging of MPM. However, role of additional PET data has not been studied in RT planning (RTP) of patients with inoperable MPM or in those who refuse surgery. Therefore, we planned to compare CT with co-registered PET-CT as the basis for delineating target volumes in these patients group.</p> <p>Methods</p> <p>Retrospectively, the CT and co-registered PET-CT data of 13 patients with histologically proven MPM were utilized to delineate target volumes separately. For each patient, target volumes (gross tumor volume [GTV], clinical target volume [CTV], and planning target volume [PTV]) were defined using the CT and PET-CT fusion data sets. The PTV was measured in two ways: PTV1 was CTV plus a 1-cm margin, and PTV2 was GTV plus a 1-cm margin. We analyzed differences in target volumes.</p> <p>Results</p> <p>In 12 of 13 patients, compared to CT-based delineation, PET-CT-based delineation resulted in a statistically significant decrease in the mean GTV, CTV, PTV1, and PTV2. In these 12 patients, mean GTV decreased by 47.1% ± 28.4%, mean CTV decreased by 38.7% ± 24.7%, mean PTV1 decreased by 31.1% ± 23.1%, and mean PTV2 decreased by 40.0% ± 24.0%. In 4 of 13 patients, hilar lymph nodes were identified by PET-CT that was not identified by CT alone, changing the nodal status of tumor staging in those patients.</p> <p>Conclusion</p> <p>This study demonstrated the usefulness of PET-CT-based target volume delineation in patients with MPM. Co-registration of PET and CT information reduces the likelihood of geographic misses, and additionally, significant reductions observed in target volumes may potentially allow escalation of RT dose beyond conventional limits potential clinical benefits in tumor control rates, which needs to be tested in future studies.</p

Hodgkin lymphoma single centre experience: Akdeniz University paediatric haematology oncology

WOS: 000384818801160

Patoloji alanında çalışan hekimlerin adli patoloji pratiği ve eğitim sürecine yaklaşımları

Amaç:Türkiye’deki adli tıp pratiğinde otopsiler adli tıp, mikroskobik inceleme süreçleri ise patoloji uzmanlarınca yapılır. Süreçteki bu kopukluk her iki branşın eğitiminde sorunlar oluşturmaktadır. Bu çalışmanın amacı, patoloji çalışa nı hekimlerin adli tıp pratikleri ve sorumlulukları konusundaki farkındalıklarını ve adli tıp uzmanlığında patoloji eğitim modeli konusundaki görüşlerini saptamak; mevcut durum ve dünyadaki uygulamalar çerçevesinde tartışmaktır.Gereç ve Yöntem: 2011’de düzenlenen 21. Ulusal Patoloji Kongresi’nde kayıt esnasında katılımcı hekimlere dağıtılan 15 soruluk bir sorgulama formu değerlendirilmiştir. Bulgular:94 katılımcı yanıt vermiştir. Genel otopsi sürecine olan ilgi hakkında %72’ oranında olumsuz görüş belirtilmiştir. Patoloji uzmanının adli otopsi yapması için ayrı bir eğitimden geçmesi gerektiği görüşü hâkimdir ve otopsi süreçlerinin tüm çeşitlerine karşı genel bir ilgisizlik mevcuttur. Adli otopsilerde patoloji uzmanının yasal sorumluluğunu doğru olarak bildiğini ifade edenlerin oranı %37’dir. Adli Tıpta patoloji eğitimlerine katkı sağlamaları için “gerekli faktörlerin ne olduğu” ve “şartlar öne sürmesi gerekse, hangisini öne süreceği?” sorularına sırasıyla, “ilgi duyuyor olmam (%46)” ve “eğitimin daima patoloji uzmanları tarafından verileceği bir sistem garanti edilmeli (%67)” cevapları veri lmiştir. Katılımcı ların iki yılda adli tıp uzmanı olabilme imkanına rağmen “adli tıp uzmanı olmayı düşünmem” seçeneğine verdikleri cevap puan ortalaması 4.1’dir (4.1/5).Sonuç: Adli Tıp uzmanlarının post mortem mikroskobik incelemeleri yapabilmesi konusunda ülkemizdeki patologlar arasında bir gönülsüzlük izlenmektedir. Oysaki yasal sorumlulukları olmasına rağmen kendilerinin adli patoloji pra tiklerine ilgileri düşüktür. Yakın gelecekte bu ilgiyi arttıracak rasyonel bir sebep gözükmemektedir. Adli tıp uzmanlarının postmortem patoloji pratiklerinde yetkinleştirilmesi için işbirliği yapılmalıdır. İşbirliği, patoloji araştırma görevlilerinin eğitiminde de yarar sağlama üzerine kurulmalıdır.Objective: Forensic autopsies are performed by the forensic medicine department and the microscopic examination processes by pathology specialists within the forensic medicine practice in Turkey. Th is disconnection in the process raises problems in the training of both branches. Th e aim of this study was to determine the awareness of pathology staff on forensic medicine practices and responsibilities and their opinion on the pathology training model in the forensic medicine specialty and to discuss the matter within the framework of the present situation and global applications. Material and Method: A 15-item questionnaire form distributed to the participant physicians during registration at the 21st National Pathology Congress held in 2011 was evaluated. Results: 94 participants responded. A negative opinion was expressed by 72% about the interest in the general post-mortem process. Th e view that pathology specialists should undergo a separate training to perform autopsies was predominant and there was a general lack of interest in all kinds of autopsy processes. Th e percentage who said they knew the legal responsibility of a pathology specialist regarding forensic autopsies correctly was 37%. Th e questions what are the necessary factors to contribute to the pathology training in forensic medicine" and "if anything is require

Diagnostic delay in rare diseases

OBJECTIVE Post-operative radiotherapy (PORT) in non-small cell lung cancer (NSCLC), especially after complete resection, has long been an unresolved dilemma and debated among therapeutic disciplines. We aimed to evaluate the effects of different radiotherapy volumes and techniques on local-regional recurrence patterns and PORT results in patients with NSCLC. METHODS The results of 389 patients who underwent surgery and received PORT at 11 centers were analyzed retrospectively. The surgical margin was positive or closes in 100 (26%) patients. The PORT dose was a median of 50 Gy (36-60 Gy). Intensity-modulated RT methods were used in 68 (17.5%) patients. RESULTS The first recurrence of the patients who developed relapse, local recurrence was found in 77 (19.8%) patients, distant recurrence was found in 95 (24%) patients, and both recurrences was found in 30 (8%) patients. The median time to locoregional relapse was 14 months (1.84-59.7 months). Local-regional recurrence was not significantly higher in patients with positive surgical margins than in negative pa-tients (39% vs. 29%, p=0.1), but the dose administered to these patients was also higher. Mediastinal recurrence occurred in 28 (19%) patients who did not receive radiotherapy to the mediastinum; 25 of these recurrences (89%) were just near or outside the field. Cardiac events became 7% in all groups and did not change according to chosen mediastinal radiotherapy volume. CONCLUSION A clear description of the PORT volumes according to the localization of the primary tumor and the involved lymph nodes would be beneficial in terms of establishing the recurrence/toxicity balance better