27. Time factor in postoperative radiotherapy for squamous cell head and neck cancer; a multivariate locoregional control analysis in 942 patients

PurposeTo analyze the influence of overall radiation treatment time and duration of the interval surgery-radiotherapy on local tumor control (LTC) in postoperative radiotherapy (PRT) for squamous cell head and neck cancer (SCHNC).Material/methodsA multivariate Cox proportional hazard regression analysis included 942 patients with locally advanced SCHNC. Mean total radiation dose, dose per fraction, treatment time, and the interval surgery-PRT were 62,5 Gy, 2,1 Gy, 46 days, and 62 days respectively. No interruptions during PRT (except for weekend brakes) appeared in 29% of patients, while 28% had more than 5 days of gap. The data were grouped into seven categories depending on the position of gap (weeks 1–7).ResultsIncrease in treatment gaps, the presence of tumor recurrence after surgery, N stage, and extra-laryngeal site of cancer were significantly related to decrease in LTC. The duration of time interval surgery-PRT had only marginal significance for LTC. Other variables did not appear significant. Consideration of seven time intervals for treatment gaps in the multivariate model has shown a significant progressive increase in the hazard of recurrence for gaps in the respective weeks 1 to 7.ConclusionsThis analysis shows a detrimental effect of interruptions during PRT, and only marginal decrease in LTC from the extension of the interval surgery-PRT. Therefore it seems unjustified to rush with PRT at the expense of possible increase in radiation treatment gaps. However, excessive delays in initiating PRT should be avoided, since they may lead to a recurrence prior to irradiation

27. Time factor in postoperative radiotherapy for squamous cell head and neck cancer; a multivariate locoregional control analysis in 942 patients

PurposeTo analyze the influence of overall radiation treatment time and duration of the interval surgery-radiotherapy on local tumor control (LTC) in postoperative radiotherapy (PRT) for squamous cell head and neck cancer (SCHNC).Material/methodsA multivariate Cox proportional hazard regression analysis included 942 patients with locally advanced SCHNC. Mean total radiation dose, dose per fraction, treatment time, and the interval surgery-PRT were 62,5 Gy, 2,1 Gy, 46 days, and 62 days respectively. No interruptions during PRT (except for weekend brakes) appeared in 29% of patients, while 28% had more than 5 days of gap. The data were grouped into seven categories depending on the position of gap (weeks 1–7).ResultsIncrease in treatment gaps, the presence of tumor recurrence after surgery, N stage, and extra-laryngeal site of cancer were significantly related to decrease in LTC. The duration of time interval surgery-PRT had only marginal significance for LTC. Other variables did not appear significant. Consideration of seven time intervals for treatment gaps in the multivariate model has shown a significant progressive increase in the hazard of recurrence for gaps in the respective weeks 1 to 7.ConclusionsThis analysis shows a detrimental effect of interruptions during PRT, and only marginal decrease in LTC from the extension of the interval surgery-PRT. Therefore it seems unjustified to rush with PRT at the expense of possible increase in radiation treatment gaps. However, excessive delays in initiating PRT should be avoided, since they may lead to a recurrence prior to irradiation

31/Palliative effectiveness and tolerance of endobronchial HDR brachytherapy in patients with lung cancer -the preliminary experience of Oncology Centre in Gliwice, Department of Brachytherapy

AlmEndobronchial HDR brachytherapy (E-HDR-BT) is a well-established method of palliative treatment in patients with lung cancer. There is, however, no consensus on optimal radiation and the rate of complications. The aim of the work is to evaluate early effectiveness and tolerance of E-HDR-BT in palliative treatment of patients with lung cancer treated in Oncology Centre in Gliwice.Material and methodsSince 2000 in Oncology Centre in Gliwice HDR (Ir192) E-HDR-BT is used in palliative treatment of patients with bronchial obturation due to lung cancer. Regression of bronchial obturation and improvement in dyspnoea, cough and haemoptysis after therapy was analyzed for the first thirty patients. The total dose was 18 Gy, calculated at 1cm from the source, in 3 fraction (of 6 Gy) given everyweek.ResultsTwenty-five patients finished therapy as planned. Five patients didn’t complete treatment: two of them (6.6%) died because of massive haemoptysis; one patients suffered from exaggeration of angina pectoris, one patients developed high hectic fever not responding for antibacterial treatment, one suffered from exaggeration of their symptoms prohibiting continuation of the treatment. Changes in obturation of the bronchi and in patient's symptoms are shown in Table 1.Table 1Changes in obturation of the bronchi and in patient's symptom.SymptomsImprovementNochangesExaggerationObturation #/%22/88%3/12%0Dyspnoea #/%15/54%11/40%2/7%Cough #/%4/27%10/67%2/7%Haemoptysis #/%2/14%10/72%2/14%More detailed analysis of improvements in symptoms has been carried out according to own scoring system for dyspnoea, cough and haemoptysis. Mean duration of palliative response was 55 days (1–405). Mean survival time was 114 days (2–406).ConclusionE-HOR-BT is an effective method of palliation of symptoms related to bronchial obturation in course of lung cancer. The most frequent serious treatment complication of E-HOR-BTwas massive haemoptysis