110 poster Successful radiotherapy of an infantile hepatic hemangioma with severe hypothyroidism. a case report

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107 poster Spinal cord compression due intermedia: results of re-irradiation

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beta-thalassemia

A. Montero, S. Sancho, A. Hervas, R. Morera, S. Cordoba, I. Rodriguez, A. Ramos University Hospital Ramon y Cajal, Radiation Oncology, Madrid, Spain Introduction: The presence of extramedullary hematopoietic foci (EHF) are associated with a variety of hematological disorders such as hemolytic anemia, polycythemia vera, myelofibrosis or thalassemias and usually represents a compensatory mechanism for long lasting anemia. Spinal cord compression secondary to EHF is a rare phenomenon occasionally reported in scarcely transfused patients affected of beta-thalassernia. Treatment options comprises of surgical decompression, repeated red cells transfusions, systemic treatment with hydroxyurea or radiotherapy. Methods: A 45 year-old male with previous history of heterozygous beta-thalassemia intermedia presented in 1995 with symptomatic thoracic spine cord compression secondary to the existence of paraspinal soft tissues masses extending from T3 to the T7 level. The patient underwent radiotherapy to a field encompassing thoracic spine from T2 through T9 up to a total dose of 3300 cGy in two weeks achieving a complete clinical recovery. Six years later the patient presented with back pain, progressive bilateral lower extremity weakness and numbness. Extramedullary soft tissue masses at T5 level causing canal narrowing were demonstrated by magnetic resonance imaging. Surgical decompression was discarded and the patient underwent a new course of radiation therapy to a total dose of 1400 cGy with standard 2 Gy daily fractionation. With a two years follow-up the patient remains ambulatory with slight residual weakness but no numbness. No treatment-related toxicity has been observed on follow-up. Conclusions: "Spinal cord compression due to EHF is a rare clinical entity capable of being managed by radiotherapy. Total dose ranging from 750 cGy to 3000 cGy has been traditionally associated with a complete resolution of symptoms. Reirradiation with low doses (1000-1500 cGy) is feasible, efficacious and well tolerated and should be considered in all of those patients presented with local recurrence not amenable of other treatment modalities. 108 poster Efficacy of intracoronary brachytherapy for the treatment of in-stent restenosis in patients with diabetes mellitus

J. Lyczek ~, A. Witkowskiz, Z. Chmielal~, J. Pregowskf , L. Kalinczuk2, A. Kulik ~, M. Kawczynska 3, W. Bulsk~, W. Ruzyllo2 ~M.Sklodowska-Cude Memorial Cancer Center, Brachytherapy, Warsaw, Poland 2National Heart Institute, Haemodynamic, Warsaw, Poland ~M.Sklodowska-Curie, Medical Physics, Warsaw, Poland Diabetic patients, particularly with in-stent restenosis (ISR), are at increased risk of restenosis, repeat revascularization and mortality after percutaneous coronary intervention. The purpose of this study was to examine the efficacy of intracoronary betabrachytherapy (beta-B) in diabetic patients with ISR and retrospective comparison with non-diabetic. The studu cohort consisted of 68 consecutive patients with ISR who were treated with beta-Bat our centre. Diabetic patients (10) were compared with non-diabetic (58). Clinical and angiographic characteristics were similar between two groups. Immediately after successful angioplasty af ISR all patients were treated with P32 betaradiation. At 6-month follow-up diabetic and non-diabetic patients experienced similar restenosis (20.0% vs. 29.8%, p=0.7) and MACE ( 30.0% vs 34.5%, p=l.0) rates. In

multivariate logistic analysis diabetes mellitus was not an independent predictor of restenosis in MACE. Similar rates of restenosis and MACE were found in irradiated diabetic and nondiabetic patients with ISR. In view of these results, beta-B should be considered as a valuable treatment modality in diabetic patients with ISR 109 poster Epistaxis of geriatric patients - effect of radiation therapy

D. FrSh/ich, M. G/atze/, G. Schaa/ ZentralklinikumSuhl gGmbH, Department of Radiotherapy, Suhl, Germany Aim: To evaluate the effect and the meaning of external radiotherapy for epistaxis in geriatric patients. Patients and methods: In the last 30 years 80 patients were treated with radiotherapy for epistaxis in geriatric patients. We irradiate the nose region with a direct field with single doses of 3 Gy (300 rd) 2 times a week up to a total dose of 18 - 21 Gy (1,800 - 2,100 rd). Radiotherapy was carried out using the orthovoltage therapy unit with 60 (Tube d, SSD 5 cm) resp. 150 kV (Field size 6x8 cm, SSD 40 cm), 8mA. Results: At 62 of 80 patients (77%) a hemostasis could be reached by the radiation therapy. Another 15 patients had only once a short period of epistaxis after radiation. Only 3 patients were resistant to our therapy. This treatment does not effect at Morbus Osier. At lower total dose the treatment was not successful. The therapy effect was in a sufficient degree at short distance irradiation and also the same at half deep therapy. Conclusion: The radiation therapy of senile epistaxis is a method with high effectiveness and low risk in relation to tamponade or operation. If treatment with tamponade or operation is not successful, you should always think of the very good effect of the radiation therapy. 110 poster Successful radiotherapy of an infantile hepatic hemangioma with severe hypothyroidism, a case report.

S. Hesse~mann7, O. Micke I, U. Schaefer ~, J.H. Bramswig2, C. Warnerz, N. Wi//ich~ 1University Hospita/ Muenster, Radiotherapy - Radioonco/ogy, Muenster, Germany 2University Hospita/ Muenster, Paediatric Endocrino/ogy Children's Hospital Muenster, Germany Introduction: Large hepatic hemangiomas can cause respiratory failure, requiring the use of mechanical ventilation, heart failure, coagulopathy and severe and often fatal hypothyroidism in infants. Patient and Method: We report the case of a male neonate with a large inoperable hepatic hemangioma, who developed highoutput cardiac failure, respiratory distress and most severe hypothyroidism. Treatment of the hepatic hemangiorna was unsuccessful even when high doses of prednisolone and alpha interferon-2b were used. Hypothyroidism was controlled only with excessive oral doses of T4 and T3. Because there was no response to medical therapy and the patients clinical condition deteriorated, an emergency radiotherapy of the liver was performed at the age of 5 months with a total dose of 6.4 Gy HD ( l x 1.0 Gy HD and 9x 0.6 Gy HD over 14 days). We observed a rapid improvement of the child during the treatment period. Highoutput cardiac failure resolved during the subsequent 9 months. Hepatomegaly began to regress and the liver function normalized. T3 treatment was discontinued at 11 months, T4 therapy at 22 months of age. Thyroid function was normal. Conclusion: In this patient with a large hepatic hemangioma radiotherapy was successful in treating high cardiac output failure, respiratory distress and life-threatening hypothyroidism. Thus,

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radiotherapy should be considered as a therapeutic option in patients with excessively large hemangiomas despite the possibility of untoward long-term sequelae. Since a biopsy was not performed, it can be speculated that radiotherapy reduced the vascularity of the hepatic hemangioma and decreased the enzymatic activity of the 3 iodothyronine deiodinase. 111 poster Gafchromic dosimetry

hs

radiochromic

films for

ivbt sources

C. Bianchi ~, C. Sampietro ~, R. Novario 7, R. Lorussoz, F. Tanzi ~, L. ~ C . Cappellim4, M. Caccia 4 ~Ospedale di Circolo e Fondazione Macchi, Medical Physics, Varese, Italy 2University of the Studies, Specialisation School in Medical Physics, Milan, Italy 3University of Insubria, Department of Medical Physics, Varese, /ta/y ~University of Insubria, Department of Physics, Como, Italy Following the prescriptions for QA of IVBT sources, defined in Task Group 60, we have obtained the DDC (Depth Dose Curve) and the azimuthal homogeneity for a IVBT source in a PMMA dedicated phantom with GC (GafChromic) HS (High Sensitivity) film dosimeters. The source is an active cylindrical steel seed, 2.5 mm long with an outer diameter of 0.64 mm, containing the Sr-90 isotope in the form of Strontium titanate ceramic. Such seeds are used to assemble 30, 40, 60 mm long interventional trains of the Novoste BetaCath System. The measurements were performed using GC HS. They are ideal for mapping dose distribution in high dose rate electron BT (BrachyTherapy), because of their high sensitivity and large dynamic range (0.540 Gy). They are also tissue equivalent, dose rate and energy independent (above 0,2 MeV). The DDC has been obtained sandwiching the source in PMMA phantoms of different thickness ranging from 1.7 to 7 mm and positioning the GC film between the proper phantom and the backscatter layer. The data shows a good agreement with Novoste measurements, performed with OPTIDOS, a scintillator based system. The azimuthal homogeneity was measured injecting the source in a set up allowing the GC to rotate around the catheter, co-axial to the system and embedded in the 1.7 mm thick PMMA phantom. The dose has been measured at 30 ° intervals and tha data are normalized to the value at 90 °. The results show a clear topbottom asymmetry at the 10% level, fully compatible with a gravitational fall of the source in the catheter. This work is a part of the SUCIMA (Silicon Ultra fast Cameras for electron and gamma sources In Medical Applications) project. SUCIMA is a project supported European Commission within the Fifth Framework. 112 poster Role of irradiation in complex treatment of giant abdominal and thoracic wall AVM

J. Had/iev 1'3, G. Horvath 3, G. Antal 1, L. Horvath 2, I. Repa ~ I University of Kaposvar, Institute of Diagnostic Imaging and Radiation Onco, Kaposvar, Hungary 2University of Pecs, Medical Faculty, Department of Radiology, Pecs, Hungary 3University of Pecs, Medical Faculty, Department of Radiation Oncology, Pecs, Hungary Objective and importance: Arteriovenous malformations (AVMs) present a common yet versatile clinical confront, through the potential "steal" phenomena and hemorrhage risks, aspects which are not sufficiently understood because of the great individuality of the cases. Over the years several new kinds of therapies have been incorporated into their complex treatment.

Clinical presentation: The patient had had no subjective symptoms fore 13 years since when the disease was first diagnosed and histologically proved. However, at the age of 35, he complained of severe dyspnea with exercise and was admitted for further examination. Diagnostic thoraco-abdominal angiography revealed a 39x25 cm lesion supplied by numerous arteries between the 8. right intercostal branch of the aorta and the right common femoral artery. Intervention: In 12 sessions microcatheter was periodically superselectively introduced into each of the feeding arteries and the AVM was treated primarily by transarterial embolization with polyvinyi-alcohol particles. Additional direct puncture embolization was performed in one session. Contrast-enhanced computerized tomography and angiography scanning were used for threedimensional imaging of the nidus and irradiation treatment planning. Fractionated radiotherapy was performed using a linear accelerator, body immobilization system, and orthogonal linacographic verification was performed weekly. The radiation dose was 32.4 Gy in a regimen involving 1.8 Gy daily fractions. After the clinically less-successful interventional radiology procedures the adjuvant use of external irradiation led to significant reduction of the lesion volume and relief from clinical symptoms. Conclusion: Although rarely observed giant arteriovenous malformations are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller ones. In the cases, when complete surgical removal is impossible, embolisation, together with the focal fractionated radiotherapy plays the fundamental role today. These two techniques present the only opportunity for sufficient nidus obliteration. 113 poster Kasabach=merritt syndrome. Successful treatment with interferon alpha and radiotherapy

S. Hesselmann 7, O. Micke 1, T. Marquardt ~, S. Baas 2, J.H, Bramswig 2, E. Harms 2, N. Willich ~ University Hospital Muenster, Radiotherapy - Radiooncology, Muenster, Germany 2University Hospital Muenster, Pediatrics, Muenster, Germany Purpose: We describe the successful treatment of a neonate with Kasabach-Merritt syndrome who received local irradiation and interferon alpha therapy after failure of corticosteroid treatment. Patient and Method: A male neonate, born after an uneventful pregnancy had a huge hemangioma involving the upper right cervical region and severe thrombocytopenia. He was treated with corticosteroids, interferon alpha and radiotherapy. Prednisolone therapy (5 mg/kg/day) was started at 41 days of age. No therapeutic effect was observed after two weeks; the tumour size had increased dramatically, platelet counts had progressively decreased and coagulation abnormalities had developed. Because corticosteroid therapy had been ineffective and the child was in a life-threatening condition, irradiation was delivered up a total dose of 9,5 Gy in 5 fractions. Simultaneously, prednisolone therapy was slowly decreased and a therapy with interferon alpha therapy (3 million U/m2/day) was started and continued for 6 weeks. Results: After irradiation with 9,5 Gy and the beginning of an interferon alpha therapy, the tumour decreased in size and coagulation parameters normalized within 4 weeks. 6 months later, platelet counts and coagulation parameters were still normal. The tumour had further decreased in size. No acute severe sideeffects were observed. Conclusion: Radiation therapy combined with interferon alpha treatment are an alternative treatment modality when high dose corticoid steroid therapy has been ineffective in patients with Kasabach-Merritt syndrome despite the risks of growth delay and secondary malignancy. In children without response to