Recurrence patterns of locally advanced head and neck squamous cell carcinoma after 3D conformal (chemo)-radiotherapy

<p>Abstract</p> <p>Background</p> <p>To establish recurrence patterns among locally advanced head and neck non-nasopharyngeal squamous cell carcinoma (HNSCC) patients treated with radical (chemo-) radiotherapy and to correlate the sites of loco-regional recurrence with radiotherapy doses and target volumes</p> <p>Method</p> <p>151 locally advanced HNSCC patients were treated between 2004-2005 using radical three-dimensional conformal radiotherapy. Patients with prior surgery to the primary tumour site were excluded. The sites of locoregional relapses were correlated with radiotherapy plans by the radiologist and a planning dosimetrist.</p> <p>Results</p> <p>Median age was 59 years (range:34-89). 35 patients had stage III disease, 116 patients had stage IV A/B. 36 patients were treated with radiotherapy alone, 42 with induction chemotherapy, 63 with induction and concomitant chemoradiotherapy and 10 concomitant chemoradiotherapy. Median follow-up was 38 months (range 3-62). 3-year cause specific survival was 66.8%. 125 of 151 (82.8%) achieved a complete response to treatment. Amongst these 125 there were 20 local-regional recurrence, comprising 8 local, 5 regional and 7 simultaneous local and regional; synchronous distant metastases occurred in 7 of the 20. 9 patients developed distant metastases in the absence of locoregional failure. For the 14 local recurrences with planning data available, 12 were in-field, 1 was marginal, and 1 was out-of-field. Of the 11 regional failures with planning data available, 7 were in-field, 1 was marginal and 3 were out-of-field recurrences.</p> <p>Conclusion</p> <p>The majority of failures following non-surgical treatment for locally advanced HNSCC were loco-regional, within the radiotherapy target volume. Improving locoregional control remains a high priority.</p

The Role of Split-course Hypofractionated Palliative Radiotherapy in Head and Neck Cancer

Aims: A significant proportion of patients with head and neck squamous cell carcinoma are unsuitable for radical treatment due to factors including tumour stage, performance status and co-morbidity. Palliative radiotherapy has a useful role in the control of local symptoms. This study documented the outcome with split-course hypofractionated radiotherapy

Long-term outcome of soft tissue sarcomas of the foot treated with limb salvage surgery and radiotherapy Ekstremite koruyucu cerrahi ve radyoterapi uygulanan ayak yerleşimli yumuşak doku sarkomlarında uzun dönem takip souçları

Ekstremite Koruyucu Cerrahi ve Radyoterapi Uygulanan Ayak Yerleşimli Yumuşak Doku Sarkomlarında Uzun D&ouml;nem Takip Sou&ccedil;ları Bu &ccedil;alışmanın amacı; primer ayak yerleşimli yumuşak doku sarkomu tanısıyla ekstremite koruyucu cerrahi ve preoperatif veya postoperatif radyoterapi uygulanan hastalarda uzun d&ouml;nem takip sonu&ccedil;larının değerlendirilmesidir. 1980-2008 yılları arasında, ekstremite koruyucu cerrahi ve radyoterapi uygulanan primer ayak yerleşimli yumuşak doku sarkomlu 11 olgu retrospektif olarak değerlendirildi. T&uuml;m&ouml;r boyutu medyan 5.5 cm&rsquo;dir (2-8 cm). T&uuml;m olgulara ekstremite koruyucu cerrahi yapıldı. Beş olguda cerrahi sınır pozitif saptandı. En sık g&ouml;r&uuml;len histolojik grup sinovyal sarkom&rsquo;dur (73%). Sekiz olguya postoperatif radyoterapi, 3 olguya preoperatif radyoterapi uygulandı. Y&uuml;ksek grad ve b&uuml;y&uuml;k t&uuml;m&ouml;r&uuml; olan 6 olguya kemoterapi verildi. Medyan takip s&uuml;resi 73 ay&rsquo;dır (11-224 ay). 5 yıllık genel sağkalım %78.8&rsquo;dir. &Uuml;&ccedil; olguda medyan 12 ayda (6-13 ay) lokal n&uuml;ks gelişti. N&uuml;ks gelişen t&uuml;m olguların histopatolojisi sinovyal sarkomdu ve sadece bir olguda cerrahi sınır pozitifti. İki olguya n&uuml;ks nedeniyle amputasyon yapılırken, diğer olguya tekrar ekstremite koruyucu cerrahi yapıldı. Lokal n&uuml;ks gelişen bu &uuml;&ccedil; olguda akciğer metastazı gelişti ve 2&rsquo;si hastalıktan dolayı kaybedildi. Lokal n&uuml;ks&uuml; olmayan 8 olgu medyan 73 ay takip s&uuml;resi i&ccedil;erisinde hastalıksız olarak takip edilmektedir. Primer ayak yumuşak doku sarkomlarında iyi onkolojik ve fonksiyonel tedavi sonucu elde edebilmek i&ccedil;in diğer b&ouml;lge yumuşak doku sarkomlarında olduğu gibi multidisipliner yaklaşım olduk&ccedil;a &ouml;nemlidir. Radyoterapi iyi lokal kontrol oranı ile ektremite korunmasına olanak sağlamaktadır

Evaluation of Interfractional Movement of the Seminal Vesicle and Dose Variations with IGRT Throughout the Prostate Cancer Radiotherapy

To validate the actual cumulative doses delivered to the seminal vesicle (SV) depending on the organ movement using kV-Cone Beam CT (kV-CBCT) datasets acquired during prostate image-guided radiation therapy. Ten patients with intermediate risk prostate cancer treated with IMRT were included in this study. Both the prostate and the first 2 cm of the SV were included in the CTV. PTV margin was 8 mm in all directions except posterior, where it was 5 mm. Sixteen kV-CBCT scans per patient were used for assessments. After each kV-CBCT was matched with the planning CT based on prostate, the SV were recontoured as proximal, distal SV and both of them together (the whole SV). Actual delivered doses to the SV were assessed by means of DVH. The variations in certain dose-volume parameters were analyzed using the Student's test. Systematic and random errors of the SV and margins were assessed using the van-Herk formula. We observed that the SV movement in the anterior-posterior direction was significantly more compared to superior-inferior and left-right direction. The dose volume variations for the whole SV (D98%, D50%, D2%) and the distal SV (D98%, D95%, D50%) were significantly different than the planned doses. However, both the whole SV and the distal SV received the prescribed dose. Although it seems that there is a need to give larger margin to the SV in posterior direction, the actual cumulative doses delivered to SV throughout the treatment were within the prescribed dose

Review of Current Status of Radiotherapy Facilities and Assessment of Required Time for Radiotherapy Delivery Workflow in Turkey: On Behalf of Turkish Society for Radiation Oncology

The aim this study is to evaluate current status and workload of radiotherapy (RT) centers in Turkey, by assessing time and staff required during core treatment procedures in patients with different tumor sites. A survey sent via e-mail to all hospitals that are actively treating patients with RT, that aimed expose the details on type of the techniques being used and the time spent for treatment planning and delivery for the different techniques according to different tumor sites. The results were evaluated by several variables, the type of the center (university hospitals or state-run hospitals) and the number of patients treated per year per center (<1000 patients/year treated vs. 000 patients/year treated). The survey was sent to 48 centers and the return rate was 71% (34 centers). Average daily treatment course performed by one physician was 192 per year (range: 41 - 650). Median number of patients treated by a specialist per year was 210 (range: 79 - 650) in the university hospitals and 101 (range: 41 - 167) in the state-run hospitals. Median time spent for treating a patient with 3-dimensional conformal RT (3DCRT) was 4 h, and it was 5 h 45 min for intensity-modulated AT (IMRT). The time spent for all cancer types treated with 3DCRT and IMRT was higher in state-run hospitals compared to university hospitals. With increasing use of newer AT techniques, the time spent for treating patients increases. Besides adequate equipment, sufficient and well-trained staff is required to achieve these newer AT technique benefits for the patients

Review of Current Status of Radiotherapy Facilities and Assessment of Required Time for Radiotherapy Delivery Workflow in Turkey: On Behalf of Turkish Society for Radiation Oncology

The aim this study is to evaluate current status and workload of radiotherapy (RT) centers in Turkey, by assessing time and staff required during core treatment procedures in patients with different tumor sites. A survey sent via e-mail to all hospitals that are actively treating patients with RT, that aimed expose the details on type of the techniques being used and the time spent for treatment planning and delivery for the different techniques according to different tumor sites. The results were evaluated by several variables, the type of the center (university hospitals or state-run hospitals) and the number of patients treated per year per center (<1000 patients/year treated vs. 000 patients/year treated). The survey was sent to 48 centers and the return rate was 71% (34 centers). Average daily treatment course performed by one physician was 192 per year (range: 41 - 650). Median number of patients treated by a specialist per year was 210 (range: 79 - 650) in the university hospitals and 101 (range: 41 - 167) in the state-run hospitals. Median time spent for treating a patient with 3-dimensional conformal RT (3DCRT) was 4 h, and it was 5 h 45 min for intensity-modulated AT (IMRT). The time spent for all cancer types treated with 3DCRT and IMRT was higher in state-run hospitals compared to university hospitals. With increasing use of newer AT techniques, the time spent for treating patients increases. Besides adequate equipment, sufficient and well-trained staff is required to achieve these newer AT technique benefits for the patients

Recurrence patterns of locally advanced head and neck squamous cell carcinoma after 3D conformal (chemo)-radiotherapy

Background: To establish recurrence patterns among locally advanced head and neck non-nasopharyngeal squamous cell carcinoma (HNSCC) patients treated with radical (chemo-) radiotherapy and to correlate the sites of loco-regional recurrence with radiotherapy doses and target volume