12/Objawy uboczne radykalnego leczenia radioterapią raka stercza: ocena 4-letnich doświadczeń

CelOcena wczesnych i późnych objawów radioterapii konformalnej u chorych z miejscowo zaawansowanym rakiem stercza.Materiał i metodyAnalizie poddano 267 chorych z rakiem stercza (T1-T3NxM0), którzy przebyli leczenie radioterapią 3D CRT w okresie od maja 1999 do lutego 2003 r. w Wielkopolskim Centrum Onkologii w Poznaniu. Pacjenci reprezentowali następujące stadium zaawansowania procesu chorobowego: (T1 = 65 chorych, T2 = 112 chorych, T3 = 90 chorych). Średni poziom PSA przed leczeniem radioterapią wynosił 18 ng/ml (0,5–112 ng/ml). Średnia dawka całkowita wynosiła 70.4 Gy (od 63.8 Gy do 74 Gy), a dawka frakcyjna 1.8 Gy lub 2.0 Gy. U 170 (64%) chorych przed rozpoczęciem napromieniania włączono leczenie hormonalne, a u 32 (12%) pacjentów również przed rozpoczęciem radioterapii przeprowadzono zabieg TURP. Wczesną i późną toksyczność ze strony układu moczowego (GU) i przewody pokarmowego (Gl) oceniono w oparciu o klasyfikację RTOG/EORTC. Średni czas obserwacji dla całej grupy wynosił 23.5 miesięcy (od 6 do 54 miesięcy).WynikiNasilenie wczesnego odczynu popromiennego ze strony przewodu pokarmowego (Gl) zawierające się w przedziale od 0-l stwierdzono u 80% pacjentów, a ze strony układu moczowego (GU) u 75%. Odczyn wczesny w stopniu II w odniesieniu do przewodu pokarmowego odnotowano u 20% leczonych pacjentów, a układu moczowego u 25%. U żadnego z analizowanych chorych nie stwierdzono nasilenia wczesnej reakcji popromiennej w stopniu III. Późne powikłania popromienne przedstawiały się następująco ze strony Gl: stopień 1 = 7% chorych, stopień II = 4% chorych, a powikłania w odniesieniu do GU: stopien I = 10% chorych, stopień II = 4%, a w stopniu III = 0.5%. Nie odnotowano powiklań w stopniu III dla GI. Średni czas ujawnienia się objawów póznych dla stopnia I wynosił 8 miesięcy, a stopnia II 13 miesięcy. Jedynie wysoka dawka całkowita (p=0.01) oraz wykonany zabieg TURP (p=0.02) byly związane z nasileniem późnych powikłań popromiennych.PodsumowanieWstępne wyniki leczenia wskazują, że radioterapia jest metodą bezpieczną i dobrze tolerowaną przez pacjentów. Do czynników wpływających na intensywność powikłań należy w pierwszej kolejności zaliczyć wysoką dawkę całkowitą oraz przebyty zabieg TURP

The influence of the gap in postoperative radiotherapy patients with carcinoma of the larynx

The aim of study was to evaluate the influence of gap in postoperative irradiation on the outcome. For this purpose the retrospective review the cases histories of 311 patients after total laryngectomy and postoperative radiotherapy between 1986 and 1990 was performed. All patients were divided into 3 groups : A- without gap (160 patients), B- with short gap up to 7 days (94 patients) and C- with long gap over 7 days (57 patients). The endpoint in analysis was loco regional rate control. All patients had a minimum follow up 3 years. Based on our data it was calculated that the prolongation of treatment resulted in decrease in loco regional control. The correlation between length the gap and decrease the outcome of treatment was very strong (

56 Efektywność elektronicznego obrazowania napromienianego pola w kontroli jakości radioterapii

Celem pracy jest ocena jakości i efektywności elektronicznego systemu portal imaging (EPID) z możliwością cyfrowego ulepszenia i analizowania otrzymanych obrazów w kontroli jakości radioterapii.Elektroniczne zdjęcia weryfikacyjne wykonano przed rozpoczęciem leczenia u 57% (97/170) napromienianych chorych. Procedura wykonywania djęć weryfikacyjnych przedłuża czas pojedynczej sesji napromieniania o 10% – 20% (1–2 minut). 87% z otrzymanych zdjęć elektronicznych nadawało się do oceny pod względem jakościowym. U 20% (19/97) chorych monitorowanych przy pomocy EPID wprowadzono poprawki przed rozpoczęciem napromieniania na podstawie zdjęć weryfikacyjnych.W monitorowanej grupie tygodniowe zdjęcia weryfikacyjne wykonano 78% napromienianych chorych. Codzienne zdjęcia weryfikacyjne z seriami zdjęć w trakcie napromieniania chorych. Różne błędy zostały zarejestrowane u 33% monitorowanych chorych w trakcie radioterapii. Większość błędów została skorygowana w trakcie leczenia, niektóre zostały zauważone podczas analizy po zakończeniu napromieniania. Zarejestrowano 2132 zdjęć elektronicznych do dalszej analizy. Target View umożliwia weryfikowanie poprawności leczenia u większości leczonych chorych bez zmniejszenia liczby napromienianych pacjentów. Otrzymane zdjęcia elektroniczne są dobrej jakości, co umożliwia zarejestrowanie i korekcję różnych błędów geometrycznych przed rozpoczęciem i w trakcie leczenia.Zarejestrowane zdjęcia elektroniczne mogą być precyzyjnie analizowane poprzez nakładanie na siebie i pomiary zauważonych rozbieżności w celu poprawy jakości radioterapii

10. The comparison between the three – field and four-field techniques of planning of radiotherapy in prostate cancer

Purposeevaluation 3-field(3F) and 4-field(4F) planning techiniques for patients with localized prostate cancer. Materials/methods: Five patients with prostate cancer (T3N0M0) were evaluated. CT images were obtained at 5 mm increments and were transferred to CadPlan_planning_workstation. The planning target volume (PTV) was defined as prostate and seminal vesicles with 15mm margins around clinical target volume (CTV) except prostate-rectum interface where 5 mm margin was applied. CTV was defined as prostate and seminal vesicles. Following organs at risk (OAR) were outlined: rectum, bladder, right femoral head. Following 3F and 4F plans were performed: 3F with angles (0deg-120deg-240deg; 0deg-90deg-270deg) and 4F (Odeg-90deg-180deg-270deg). We also created two versions of treatment plans including of energy; 6 MV and 20 MV for Clinac2300CD. Total dose was 74 Gy. Mean total doses of thirty plans in irradiated organs at risk (rectum, bladder and righ femoral head) were compared. For PTV mean and minimum dose were criteria for comparision of treatment plans. Results: There were no significant dose differenes between evaluated plans of treatment in PTV (0.05). Because mean dose in femoral head in each treatment plan was below tolerance dose, main dose-limiting organ was rectum and bladder. Lowest mean dose 42.7 Gy in rectum was achived by application of 3F technique of 20 MV(0deg-90deg-270deg). Bladder was also spared with the same 3F technique of 20 MV, where mean dose was 45.2 Gy. Conclusions: This study showed that the, T” three-field technique (an anterior and two opposing lateral fields) provided with 20 MV is optimal and assures the lowest rectal dose

45. Impact of Hb level during postoperative radiotherapy of patients with larynx cancer

AimAssessment the influence of low level of Hgb on the locoregional outcome of postoperative radiotherapy patients with advanced cancer of larynx.Material and methodsAn retrospective analysis of two hundred fifty four patients with larynx carcinoma with stage III or IV squamous cell carcinoma of larynx who were treated between January 1993 and December 1996 was performed. Postoperative radiotherapy was performed in coventional way to total dose of 60 Gy, 5 times a week. Of 254 patients, 86 patients (34%) were considered to have a low level of hemoglobin (below 13 g/dl) prior the beginning of radiotherapy and 56 patients (22%) at the end of treatment. We have noted also 38 patients (15%) of 254 patients, with deacresing hemoglobin level during treatment higher than 1 g/dl.ResultsNo impact on outcome of treatment was observed in the group of patients with low level of Hgb before irradiation. Inrease of locoregional failure of postoperative radiotherapy was noted in group of patients with Hgb level at the end of irradiation below 13 g/dl (p = 0,004) and also in group of patients with decreasing of Hgb level during treatment (p = 0,038).ConclusionsLow Hgb levels at the end of postoperative irradiation and decreasing during irradiation were associated with a statistically significant an increase in locoregional failure of patients with advanced carcinoma of larynx

58. Influence of total time of surgery and postoperative radiotherapy on the outcome patients with advanced laryngeal carcinoma

AimTo evaluate influence of total time of combined treatment on locoregional outcome of treatment in group patients with larynx cancer.Material/MethodsWe performed retrospective analysis of 254 patients with with stage III or IV squamous cell carcinoma of larynx who were treated between 1993 and 1996. There were 236 men, 18 women, median age was 56.3 years. Surgery consisted of total laryngectomy and elective/selective neck dissection. Patients postoperativly were irradiated in coventional way with total dose of 60 Gy. We used shrinking field technique with lateral opposed photon fields to tumor bed and upper-mid neck nodes. Supraclavicular regions (lower neck lymph nodes) were treated with an anterior field. Total time of combined treatment (from the surgery to the end of radiotherapy) was an average 92 days (range, 65–131 days). The interval between surgery and the beginning of radiotherapy was an average 45 days (range, 22–78 days) and time of irradiation was an average 45 day (range, 40–74 days).ResultsProlongation overall time of combined treatment beyond 90 days is strongly correlated with decreasing of locoregional outcome of treatment (p=0.00036). Also decreasing in outcome of treatment was noted when interval time between surgery and beginning of radiotherapy was more than 50 days (p=0.022) and when the time of irradiation was longer than 44 days (p=0.0026).ConclusionsDecreasing of total time of combined treatment (surgery and postoperative radiotherapy) is crucial in patients with advanced cancer of larynx

16. Tolerance of radiotherapy (3D-CRT) and androgen ablation for patients with prostate cancer

PurposeEvaluation acute tolerance of combined treatment (XRT and HT).Material/methodsBetween April 1999 and September 2000, 22 patients with prostate cancer (T1-T3NXMO) were treated with 3D-CRT and HT. Median age of patients was 68 years. EBRT was administered daily fraction of 1.8 Gy,total dose 70.2 Gy. Planning target volume (PTV) was defined as clinical target volume CTV (prostate and seminal vesicles) with 10 mm margins around prostate except posterior margin where 5 mm were used to decrease risk of rectum morbidity. Acute toxicities were evaluated using RTOG scoring scale. Median follow-up was 11 months.ResultsAcute effects in gastrointestinal tract (GI) noted were; rectal discomfort and mild diarrhea. Acute genitourinary (GU) symptoms included urgency, nocturia and dysuria. GI toxicity was observed in 75% of patients (grade 0 and 1), and 25% of patients (grade 2). GU toxicities were as follow: grade 0 and 1 – 80% of patients) and grade 2 – (20% of patients). No grade 3 or 4 GI and GU toxicities were observed.ConclusionsPreliminary results of treatment with 3D-CRT suggested that such modality is well tolerated. HT did not exacerbate radiation toxicity

The results of salvage surgery combined with reirradiation in nodal recurrence of larynx cancer

The recurrence in the regional lymph nodes of patients after total laryngectomy and postoperative radiotherapy is a still serious therapeutic problem. The conditions that are altered following the combined primary treatment make it difficult to achieve satisfactory results of the second surgical treatment.The aim of our study was to evaluate the outcome of a salvage operation (lymphadenectomy) and reirradiation in 50 patients with recurrence in regional lymph nodes (rN). Beetwen 1991 and 1996, 650 patients with larynx carcinoma were treated in our institiutions. All patients during the primary irradiation received a total dose of about 60 Gy. In the case of regional recurrence (rN) patients had selective lymphadenectomy and reirradiation (total dose 40 Gy) when capsulae were found to be infiltrated. The survival rates were for 1, 2 and 3 years : 34 (68%), 22 (44%), only 9 (18%) respectivly. This strategy of a second combined treatment had a good tolerance level, without any unacceptable side effects (complications)

91. Early toxicity in 3 D CRT of lung cancer

AimEvaluation the influence of irradiated volume of lung on pneumonitis in 3D radiotherapy.Material/methods and ResultsWe evaluated 49 patients with diagnosis of non-small-cell lung cancer (NSCLC) who were treated in our department between 1999 and 2000. The mean age of patinets was 62 years. The Karnofsky index was documented in all patients before, during and after completion of irradiation. All patients represented IIIA clinical stage of lung cancer. Fourteen patients were irradiated postoperatively due to the residual tumour or massive nodal involvment. Thirty five patients were treated with exclusive radiotherapy. No patients have been treated by chemotherapy. We performed 3D CRT with total dose in range 60 to 66 Gy in daily fractions of 2 Gy prescribed to isocentric point. Clinical and radiological evaluation of pneumonitis was performed. 21 patients of 49 had radiation pneumonitis, but intensity of pneumonitis was moderate. For better estimation the toxicity the dose volume histograms (DVH) were used. The volume of irradiated lung was an important factor for pneumonitis progress.ConclusionsDose volume histograms (DVH) with clinical evaluation can predict pulmonary toxicity (pneumonitis) and colud allow us to evaluate volume of irradiated lung with the highest acceptable dose

13. Immunogenetherapy combined with brain metastases irradiation in melanoma patients

AimsTo assess toxicity and results of melanoma brain metastases irradiation in patients treated with genetically modified tumour vaccine.Materials/methodsA group of 45 melanoma stage IV (AJCC) patients was treated with vaccine consisted of autologic melanoma cells admixed with allogeneic cells modified with IL-6 and slL-6R genes. During the treatment 14 patients developed symptoms of brain metastases. 5 patients had solitary metastases, 9 multiple lesions. 4 patients with single metastasis were treated surgically. All 14 patients were irradiated with the doses 30–39 Gy, using 3 Gy/fracion, 5 fractions/week. Toxicity of cranial irradiation (clinically, CT) and clinical results (CT, survival) were evaluated. Immunological cellular responses were assessed in vitro.ResultsAcute effects of irradiation were tolerable and manageable using standard dexamethasone treatment. There was no radiation encephalopathy or radiation necrosis. In 7/14 patients stabilization or partial remission of brain lesions was observed. Overall survival measured from brain metastases diagnosis ranged from 2 to 21 months (2 patients are still alive), median survival was 316 days. In 4 treated patients radiation enhanced immune responses to the vaccine.ConclusionsPalliative cranial irradiation is well tolerated by patients treated with novel systemic approaches such as immunogene therapy, relives symptoms and may extend survival. Radiation of metastases modulates immune responses to melanoma cells