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

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

Denosumab for the prevention of skeletal complications in metastatic castration-resistant prostate cancer: comparison of skeletal-related events and symptomatic skeletal events

Abstract Background In a phase III trial in patients with castration-resistant prostate cancer (CRPC) and bone metastases, denosumab was superior to zoledronic acid in reducing skeletal-related events (SREs; radiation to bone, pathologic fracture, surgery to bone, or spinal cord compression). This study reassessed the efficacy of denosumab using symptomatic skeletal events (SSEs) as a prespecified exploratory end point. Patients and methods Patients with CRPC, no previous bisphosphonate exposure, and radiographic evidence of bone metastasis were randomized to subcutaneous denosumab 120 mg plus i.v. placebo every 4 weeks (Q4W), or i.v. zoledronic acid 4 mg plus subcutaneous placebo Q4W during the blinded treatment phase. SSEs were defined as radiation to bone, symptomatic pathologic fracture, surgery to bone, or symptomatic spinal cord compression. The relationship between SSE or SRE and time to moderate/severe pain was assessed using the Brief Pain Inventory Short Form. Results Treatment with denosumab significantly reduced the risk of developing first SSE [HR, 0.78; 95% confidence interval (CI) 0.66–0.93; P = 0.005] and first and subsequent SSEs (rate ratio, 0.78; 95% CI 0.65–0.92; P = 0.004) compared with zoledronic acid. The treatment differences in the number of patients with SSEs or SREs were similar (n = 48 and n = 45, respectively). Among patients with no/mild pain at baseline, both SSEs and SREs were associated with moderate/severe pain development (P < 0.0001). Fewer patients had skeletal complications, particularly fractures, when defined as SSE versus SRE. Conclusion In patients with CRPC and bone metastases, denosumab reduced the risk of skeletal complications versus zoledronic acid regardless of whether the end point was defined as SSE or SRE

88. Comparison results of different strategies of radiotherapy in nasopharyngeal carcinoma

Aim: Evaluation results of radiotherapy in nasopharyngeal carcinoma in years; 1980–1990 (before CT era) vs 1991–1995.Material/methods: One hundred eighty eight patients treated in our centre were included in this analysis. Two groups of patients were distinguished: I-st – 128 patients (treated between 1980–1990) and II-nd – 60 (treated between 1991–1995). The possibilities of diagnosis and radiotherapy techniques were diffrent in both groups. In the II-nd group; the shrinking field technique, CT in diagnosis and target delineation and also higher total dose (mean 66 Gy) were applied.Results: For all patients 5-years disease free-survival was 30%. During follow-up the first two years were crucial, because 80% of failures occured. The causes of failures were as follow: the local recurrence (43%), metastases to lymph nodes (39%) and distant metastases (18%).Conclusions: Introducing CT into diagnosis and target delineation, the shrinking field technique and higher total dose of irradiation caused in improvement of results of radiotherapy in nasopharyngeal carcinoma