148. Changes in lateral dimensions of irradiated volume and their impact on the accuracy of dose delivery during radiotherapy for head and neck cancer

AimTo assess changes in lateral dimensions of irradiated volume during head and neck cancer radiotherapy and their impact on dose delivery accuracy.Material and methodsLateral dimensions of irradiated volumes were measured in 5 predefined points using computed tomography, simulator and manually with calipers, prior to treatment and then bi-weekly. For each measurement reference point dose was calculated and verified using in vivo dosimetry. Early radiation reactions, patient's weight changes and the need to modify radiotherapy accessories were also assessed. All these parameters were analyzed in relation to tumor site and stage, treatment field size, radiation dose and the degree of radiation reactions.ResultsThe study included 33 head and neck cancer patients (24 men and 9 women) aged 24–77 (median 56). All patients were irradiated using the parallel opposed megavoltage fields ranging from 49 to 180 cm2 (median 121 cm2) to the dose of 44 to 80 Gy (median 66 Gy). Radiation reactions included mucositis (grade 3 – 1 patient, grade 2 – 17 patients, grade 1 – 13 patients) and dysphagia (grade 2 – 12 patients, grade 1 – 16 patients). The body mass changes during radiotherapy ranged from −18 to +4 kg (median −5 kg). In 1 patient radiotherapy accessories had to be modified three times during the treatment, in 6 – twice and in 10 – once. Lateral dimensions changes >5 mm occurred in all but one patient (range −37 to +16 mm). Theoretical doses calculated for changed dimensions varied from prescribed by −2.5% to +6% (median +2%). Differences larger than 5% were present in 4.8% of calculations. In vivo dose measurements (after introduction of necessary corrections) demonstrated difference from prescribed dose larger than 5% in 7.6% of measurements.ConclusionChanges in the lateral dimensions of irradiated volume during head and neck cancer radiotherapy may lead to some inaccuracies in delivered doses. Such situations may necessitate adequate corrections of dose calculations and modification of radiotherapy accessories during the course of treatment

37. Multicenter, randomized study assessing the impact of amifostine on normal tissue radiation tolerance during head and neck cancer radiotherapy

A prospective, randomized multicenter study was conducted to assess the value of amifostine (Ethyol®) as a radioprotectant in head and neck cancer radiotherapy. The aim of the study was to evaluate the impact of the addition of daily amifostine (150 mg/m2) on the degree of early (mucositis, dysphagia, xerostomia) and late (mucosal, cutaneous, salivary gland, mandible and spinal cord) radiation reactions. Assessed were also patients’ quality of life, local control and overall survival. Sixty two patients from five Polish institutions were randomly assigned to radiotherapy alone (Arm A – 28 patients) or radiotherapy + amifostine (Arm B – 34 patients). There were 43 men and 19 women. Primary tumor was located in the oral cavity (27 patients), oropharynx (25 patients), nasopharynx (2 patients) and larynx/hypopharynx (8 patients). In 43 patients radiotherapy was used as the sole modality of treatment and 19 patients were irradiated postoperatively. The side effects of amifostine were manageable. In 6 patients amifostine infusion had to be temporarily stopped due to hypotension and in 5 patients its administration was permanently terminated due to hypotension, nausea and vomiting, septicemia or fever and visual disturbances. The early results of the study, focusing on early radiation reactions, will be presented at the conference

34. A multicenter randomized study of two regimens in paliative radiotherapy of bone metastases

In this study we compared two methods of radiotherapy in patients with painful bone metastases: 20 Gy in five fraction in five consecutive days vs 8 Gy in one fraction. A total of 115 patients (34 males, 81 females), median age 56 years (23–80), were randomly allocated to one of the treatment arms. In 56 pts. Primary tumor was located in the breast, in 14 pts in the lung, in ten pts in the kidney, in seven pts in the prostate, and in 28 pts in other sites. A total of 146 metastatic bone lesions were irradiated, seventy five (51%) were treated with 20 Gy and seventy one (49%) – with 8 Gy. The most frequent location of metastatic lesions was spine (36%), followed by pelvis (25%), long bones (18%), ribs (12%) and other sites (12%). Treatment techniques included single field (73%) or two parallel opposed fields (27%). Complete pain relief was achieved in 36% of the lesions irradiated with 20 Gy and in 41% of those irradiated with 8 Gy. Partial improvement was observed in 46% and 43% of lesions, respectively. The median time to reappearance of pain in both groups was 5.4 a 4.8 months and 5.0 a 5.4 months respectively. We conclude that a single exposure to 8 Gy is of the same efficacy as 20 Gy in five fractions in pain control of bone metastases and should be recommended as routine management

36. A prospective, randomized study to compare the value of two fractionation schemes of palliative radiotherapy for inoperable non-small cell lung cancer

A prospective, randomized study was conducted in eight Polish institutions to compare the value of two fractionation schemes of palliative radiotherapy for inoperable non-small cell lung cancer. Assessed was the impact of either treatment on the degree and duration of relief of tumor-related symptoms and on patient's performance status. Secondary endpoints included treatment side-effects, objective response and overall survival. One hundred patients were randomly assigned to the dose of 20 Gy/5×/5 days (Arm A) or 16 Gy/2×/8 days (Arm B). There were 90 men and 10 women aged between 47 and 79 (mean 66). Eighty four patients had locally advanced tumor and 16 patients had metastatic disease. Squamous cell carcinoma was diagnosed in 65 patients, adenocarcinoma – in 9 patients, large cell carcinoma – in 1 patient and unspecified non-small cell carcinoma – in 25 patients. Fifty five patients were assigned to Arm A and 45 – to Arm B. Ninety eight patients received assigned treatment whereas two patients died before the end of treatment. The final results of the study will be presented at the conference

The requirements of a specialist breast centre

Abstract This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.Peer reviewe