Treatment of squamous cell carcinoma of the uterine cervix with radiation therapy alone: long-term survival, late complications, and incidence of second cancers

The objective of this retrospective study was to determine the survival rate, incidence of late complications, and incidence of second cancers when radiation therapy alone is used for carcinoma of the uterine cervix. Between 1971 and 1995, 1495 patients with squamous cell carcinoma of the uterine cervix (stages I–IV) were treated with radiation therapy alone in our hospital. Radiation therapy consisted of a combination of high-dose-rate intracavitary brachytherapy and external beam radiotherapy. The cumulative 5-year survival rates for stages Ib, II, and III/IVa carcinoma were 93.5, 77.0, and 60.3%, respectively, and the 10-year survival rates were 90.9, 74.5, and 56.1%, respectively. Local control rates for stages Ib, II, and III/IVa carcinoma were 92.0, 79.4 and 64.2%, respectively. Eighty-two (5.5%) patients suffered grade III/IV or V (fatal) complications. A second cancer developed in 13 (0.87%) patients. Second cancers were observed most frequently in the rectum (five cases), colon (three cases), and uterine body (two cases). Long-term follow-up data revealed that our method of radiation therapy alone for locally advanced carcinoma of the uterine cervix is effective, with low incidences of late complications and second cancers

Principles of total body irradiation

Total body irradiation delivered prior to bone marrow transplantation remains an important component of the conditioning regimen. Proper engraftment of autologous or allogeneic bone marrow is possible because of the multifarious effects of high doses of ionizing radiation on tumor cells and the host immune system.We will broadly outline the techniques used to deliver total body irradiation, and the effects of ionizing radiation on normal and tumor cells from a biological and molecular point of view. Finally we will report the results of randomized c1inical trials that have been conducted in our institution during the last ten years

Radiotherapy and radiology: joint efforts for modern radiation planning and practice

International audienceWith new irradiation techniques, the dose can be better matched to the contours of the tumour. The corollary is that greater precision is required. Recent intercomparison studies of treatment plans have emphasized the need to harmonise contouring practices. More of a consensus approach is based on using adaptive imaging modalities, expert group recommendations and automatic segmentation atlases, on harmonisation of dosimetric decisions through employing exhaustive nomograms for organs at risk, and on indexes for choosing optimal treatment plans. On another level, quality assurance and data pooling programmes have been set up, making use of DICOM-RT data transfer (image networks). The combination of several irradiation techniques (for example, intensity-modulated conformal radiation therapy plus CyberKnife((R)) boost and re-irradiation), making it possible to irradiate tumours better, requires the cumulative doses to be recorded by dose summation software. Real awareness has been achieved in recent years as regards improving the quality of treatment, pooling data and harmonising practices

Clinical achievements of the EORTC Lymphoma Group and aspects of future group strategy

AbstractSince 1964, the EORTC Lymphoma Group has conducted nine consecutive randomized phase III trials on early-stage Hodgkin lymphoma aimed at increasing efficacy while decreasing short- and long-term toxicities. Event-free and overall survival significantly improved from about 50% and 70%, respectively, in the early years to over 80% and 90%, respectively, more recently. Identification of prognostic subgroups appeared to be a successful method to tailor treatment strategies. Radiotherapy fields have become more restricted whereas chemotherapy has become standard. Early PET-CT has been introduced to investigate the possibility of treatment adaptation. Longitudinal quality-of-life assessment has become an integral part of our studies. An ongoing study focuses on the rehabilitation and quality of long-term survival in all 6658 Hodgkin lymphoma patients treated in EORTC trials since the earliest beginning. In advanced stages overall outcome has improved as well with 10-year survival rates of over 75%

Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines.

Contains fulltext : 50789.pdf (publisher's version ) (Closed access)BACKGROUND AND PURPOSE: To describe new concepts for radiation fields in patients with early stage Hodgkin lymphoma treated with a combined modality. PATIENTS AND MATERIALS: Patients receiving combined modality therapy with at least 2 or 3 cycles of chemotherapy prior to radiotherapy. Pre- and postchemotherapy cervical and thoracic CT scans are mandatory and should be performed, whenever possible, in the treatment position with the use of image fusion capabilities. A pre-chemotherapy PET scan is strongly recommended to increase the detection of involved lymph nodes. RESULTS: Radiation fields are designed to irradiate the initially involved lymph nodes exclusively and to encompass their initial volume. In some cases, radiation fields are slightly modified to avoid unnecessary irradiation of muscles or organs at risk. CONCLUSIONS: The concept of involved-node radiotherapy (INRT) described here is the first attempt to reduce the size of radiation fields compared to the classic involved fields used in adult patients. Proper implementation of INRT requires adequate training and an efficient prospective or early retrospective quality assurance program