Small bowel and rectal toxicity after pelvic radiotherapy : histopathological development, the influence of ageing and modulation by conformal treatment

Throughout history, cancer has been one of the major causes of death. It has been estimated that in the western world approximately one in three people will develop some kind of cancer during their lifetime, and one in five will die of it. Longevity is associated with prolonged exposure of somatic cells to environmental carcinogens leading to carcinogenesis in these ageing cells. Therefore, cancer is predominantly a disease related to old age. In The Netherlands, the number of persons over 85 years of age increased from 99.000 in 1976 to 203.000 in 1995 (an increase of 1O5 %). It is predicted that by the year 2015 the total population living in The Netherlands will have increased by 8.4%, from 15.4 million in 1994 to 16.7 million. However the proportion of the population more than 65 years of age is expected to grow much faster (45%), although the proportion of persons of 85 years and older will remain the same. In view of the demographic developments, the number of cancer cases can be expected to increase dramatically in the near future. Compared to 1994, for 2015 an increase varying from 30-60 % for cancer of the colon, prostate and breast has been predicted

Quality control of involved-field radiotherapy in patients with advanced Hodgkin's lymphoma (EORTC 20884)

PURPOSE: To evaluate the impact of the quality of involved-field radiotherapy (IFRT) on clinical outcome in patients with advanced Hodgkin's lymphoma (HL) in complete remission (CR) after six to eight cycles of mechlorethamine, vincristine, procarbazine, prednisone-doxorubicin, bleomycin, and vinblastine (MOPP-ABV) chemotherapy. METHODS AND MATERIALS: A retrospective review of clinical and radiologic data, radiation charts, simulator films, and megavoltage (MV) photographs was performed. IFRT consisted of 24 Gy to all initially involved nodal areas and 16-24 Gy to all initially involved extranodal sites. Major violations were defined as no or only partial irradiation of an originally involved area, or a total dose <90% of the prescribed dose. RESULTS: Of the 739 patients who were enrolled in the trial between 1989 and 2000, 57% achieved a CR; 152 of 172 patients randomized to IFRT actually received radiotherapy; and in 135 patients, quality control was performed. The overall major violation rate was 47%, predominantly concerning target volumes. The total dose was correct in 81% of the patients. After a median follow-up of 6.5 years, there was no difference in cumulative failure rate between patients with or without major violations. There was no relationship between incidence or site of relapse and major protocol violations. CONCLUSION: In advanced-stage HL patients in complete remission after six to eight cycles of MOPP-ABV, the outcome was not influenced by violation of the radiotherapy protocol