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182 Adaptive interstitial HDR breast implants
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182
181
ADAPTIVE INTERSTITIAL HDR BREAST IMPLANTS
BRACHYTHERAPY FOR BREAST CANCER V. Spikalovas, A.Mud&nas. E.Karoesien& R.MickeviCius Department of Radiosurgery, Lithuanian Oncology Centre, Vilnius, Lithuania In 1997-1995 a total of 347 patients with breast cancer underwent interstitial treatment. Two methods of irradiation were applied. 1. When patients refused surgery, external radiotherapy was given followed by implant radiotherapy for a dose of 20-30 Gy. Needle sources were applied for treatment with an increasing activity on the ends. The application of special template devices made it possible to implant radioactive sources in a strictly preset geometry. This allowed to place the sources in the necessary geometry for the whole course of irradiation. Dosimetric planning was performed in Gray-equivalents to a selected isodose curve mostly 95%. Treatment time was 20-50 hours. 2. In cases when the tumour was localized in the medial quadrant of breast, interstitial therapy was applied to the parasternal lymph nodes. During mastectomy catheters were placed in a. thoracica interna of the corresponding side. On the first or second postoperative day flexible radioactive sources were inserted into catheters. Their active length was 1O-l 2 cm. Irradiation dose at a distance of 2 cm from the centre of source was 40-45 Gy. Results: There was minimum radiation effect on the adjustmg organs and tissues. Local recurrence of tumour in the region of irradiation was in 6 patients. Conclusions: The application of interstitial radiotherapy in treatment of breast cancer is effective and the results of radiation treatment are encouraging.
William Beaumont Hospital, Royal Oak, Michigan, USA Introduction: interstitial
A distinctive
implant
is described,
type of in which
outpatient high dose rate the
treatment
volume
is
expected lo change from one fraction to the next. This is due to resolution of edema or shifting of the implant due lo patient motion This treatment is given as the sole radiation modality for women with early stage breast cancer A novel treatment planning strategy is required,
in
generated
on demand,
multiple
which
treatment
a new without
optimized
treatment
the large
costs
plan
normally
is
ef?iciently
associated
with
plans
Methods and Materials:
Tu date. eight patients have been treated
using this technique A single implant is performed, which receives 8 fractions over a period of 4-S days The patient is sent home with the applicator in place between fractions A double-template technique is used, in which a lightweight but rigid applicator holds the needles in position. The template separation is adapted to the needle length chosen (12 to 20 cm), with plastic clips At determine
the range
with the sharp needle tips fixed and protected the time of each fraction. it is necessary to
of active
dwell
positions
in each needle
is accomplished through the use of a special worksheet. Generating a plan consists of recalling which all possible needle and dwell positions
used.
This
measuring jig and a master plan, in are defined, and
activating the appropriate dwell positions Geometric Optimization is then performed, and the calculated dwell times transferred to the treatment
unit
by means
of a program
card
Results: The localization and treatment planning require about 15 minutes, and are repeated only for fractions where there is a change in breast size or template position requiring more than 5 mm adjustment in any needle.
184
183 A NEW OPTIMISATION
B.P.H.M.
Gregory K. Edmundson, Frank A. Vicini, Peter Y. Chen and Alvaro A. Martinez
Geelen.
OF A BREAST
R de Graaf
Gasthuis,
IMPLANT
Delft,
The Netherlands.
The rules of the Paris system are nowadays standard practice when performing a breast implant using Iridium wire. With the advent of the HDR and more recently the PDR. it has become possible to optimise this kind of Implant. Usually an optimisation on dosepoints and geometry is considered. whereby It is possible to cover the treatment volume using an actwe length equal to or shorter than the length of the target volume. Against this very obvious advantage one has to put rts great disadvantage; in the transverse planes wthin the target volume the dose dtstribution no longer matches that of a standard implant according to Paris rules. The reference isodose now encompasses a greater volume, and the implant has lost its “hot spot” in its centre. It is however possible to optimise the Implant in another way. By lookmg at one needle separately and optrmising it at a distance equal to the distance of a needle to Its nearest basal point in the Implant under consideration, dwell weights are obtained whrch. when programmed manually for the other needles, will give a dose distribution which in the transverse planes within the target volume resembles that of the Paris system very closely indeed. The reason being is that within a transversal plane the dwell weight of the source is the same for each needle. And as each needle is optimised the one advantage of the standard optrmisation. an active length equal to or shorter than the length of the target volume, is not lost! Conclusion: It is possible to optimise a breast implant rn a way which gives the best of both worlds; an implant which has an active length smaller than or equal to the length of the target volume, yet wrth a dose distributton which in the transverse planes matches that of a standard implant according to Paris rules.
CURIETHERAPIE PER-OPERATOIRE AVEC LAMBEAU MYOCUTANE DANS LE TRAITRMENT DES RECIDIVES PARIETALES DES CANCERS DU SEIN. A. Benider, A. Acharki, S. Sahraoui, R. Samlali, A. Kahlain Centre d’oncologie CHU. Ibn Rochd Casablance Marx Les r6cidives parietales du cancer du sein apr&s traitement initial sent fr6quentes (IO B 40%). Elles posent des problkmes thCrapeutiques ntcessitant un traitement agressif seul garant d’une sterilisation tumorale. Le but de notre travail est I’analyse des rCsultats thCrapeutiques de I’association chirurgie large avec reconstruction par lambeau myocutanC et curiethtrapie interstltlelle per-opCratoire chez dix malades trait&es au centre d’oncologie Ibn Rochd de Casablanca enfre 1992 et 1993. La moyenne d’Lge de nos malades a &e de 54.5 am. Le traitement initial du cancer du sein a BtC une chnurgie (Intervention Patey) associte g une radiothtrapie loco-rtgronale dam 6 cas et Q une ChrmiothCrapre dans 3 cas. L’analyse des r&crdrves a montri que I’&endue moyenne a ttC de 1.3 cm. sous forme de nodules sous cutan& (7/lO cas). Lr trartement a consist& dans tow les cas en une rxCr&\e large passant Q 4 cm de la timite macroscopique saine. La cowerturr de la pene de substance a ttt rtali& par le lambeau myocutane du gmnd dorsal verncal. Cette chnwgie a ttC associte ?I une curiethtrapie rnterstmelle per-optratoire qui a consist6 en la mise en place par le curieth&rapeutc de tubes plastrques dent Ic chargement est diffkrt au JI po\top&atorre. L’&!mcnt redioactif utilisC a et& I’lrrdium 192. La dose Une radiothPraple exteme a 616 pratlquCe dt’lwr& it 616 de I5 a 20 Grays. dam to”\ les cas. a\wci& B uric chlmiothCrapie dans 5 cas et B une une d&union des hormonoth&rapre dam 3 cas. Au cows de Kvolution, wture\ L‘\L ~urvenue chez uric malade et une surinfection chez une autrc. .iyant horn &olu6 d;ms ler 2 cas. Apr&s un recul moyen de 17.5 mois, six mnladra ant ~lt: en rCmlhaion compl?te. trois sent d&d&s par tvolutivitC m~t;~rt;nlque et une patlente a present6 une rkcidive loco-rkgionale et m5tactat!quea X 1nws. Vue lc raw &lcvC d’&zhec et de r&idives apr&s wa~temcn~ chlrurgrcal ou radroth&+quc wula. I’a.raocration curiethCrapie interstitwlle per-upC~-.norrc CI chnurgic d’cx&se avec lambeau myocutane du grand dorwl xIopl>e par certan\ antcurs \emblr dormer de meilleurs rCsultats thCrapcutiquc\
182
181
ADAPTIVE INTERSTITIAL HDR BREAST IMPLANTS
BRACHYTHERAPY FOR BREAST CANCER V. Spikalovas, A.Mud&nas. E.Karoesien& R.MickeviCius Department of Radiosurgery, Lithuanian Oncology Centre, Vilnius, Lithuania In 1997-1995 a total of 347 patients with breast cancer underwent interstitial treatment. Two methods of irradiation were applied. 1. When patients refused surgery, external radiotherapy was given followed by implant radiotherapy for a dose of 20-30 Gy. Needle sources were applied for treatment with an increasing activity on the ends. The application of special template devices made it possible to implant radioactive sources in a strictly preset geometry. This allowed to place the sources in the necessary geometry for the whole course of irradiation. Dosimetric planning was performed in Gray-equivalents to a selected isodose curve mostly 95%. Treatment time was 20-50 hours. 2. In cases when the tumour was localized in the medial quadrant of breast, interstitial therapy was applied to the parasternal lymph nodes. During mastectomy catheters were placed in a. thoracica interna of the corresponding side. On the first or second postoperative day flexible radioactive sources were inserted into catheters. Their active length was 1O-l 2 cm. Irradiation dose at a distance of 2 cm from the centre of source was 40-45 Gy. Results: There was minimum radiation effect on the adjustmg organs and tissues. Local recurrence of tumour in the region of irradiation was in 6 patients. Conclusions: The application of interstitial radiotherapy in treatment of breast cancer is effective and the results of radiation treatment are encouraging.
William Beaumont Hospital, Royal Oak, Michigan, USA Introduction: interstitial
A distinctive
implant
is described,
type of in which
outpatient high dose rate the
treatment
volume
is
expected lo change from one fraction to the next. This is due to resolution of edema or shifting of the implant due lo patient motion This treatment is given as the sole radiation modality for women with early stage breast cancer A novel treatment planning strategy is required,
in
generated
on demand,
multiple
which
treatment
a new without
optimized
treatment
the large
costs
plan
normally
is
ef?iciently
associated
with
plans
Methods and Materials:
Tu date. eight patients have been treated
using this technique A single implant is performed, which receives 8 fractions over a period of 4-S days The patient is sent home with the applicator in place between fractions A double-template technique is used, in which a lightweight but rigid applicator holds the needles in position. The template separation is adapted to the needle length chosen (12 to 20 cm), with plastic clips At determine
the range
with the sharp needle tips fixed and protected the time of each fraction. it is necessary to
of active
dwell
positions
in each needle
is accomplished through the use of a special worksheet. Generating a plan consists of recalling which all possible needle and dwell positions
used.
This
measuring jig and a master plan, in are defined, and
activating the appropriate dwell positions Geometric Optimization is then performed, and the calculated dwell times transferred to the treatment
unit
by means
of a program
card
Results: The localization and treatment planning require about 15 minutes, and are repeated only for fractions where there is a change in breast size or template position requiring more than 5 mm adjustment in any needle.
184
183 A NEW OPTIMISATION
B.P.H.M.
Gregory K. Edmundson, Frank A. Vicini, Peter Y. Chen and Alvaro A. Martinez
Geelen.
OF A BREAST
R de Graaf
Gasthuis,
IMPLANT
Delft,
The Netherlands.
The rules of the Paris system are nowadays standard practice when performing a breast implant using Iridium wire. With the advent of the HDR and more recently the PDR. it has become possible to optimise this kind of Implant. Usually an optimisation on dosepoints and geometry is considered. whereby It is possible to cover the treatment volume using an actwe length equal to or shorter than the length of the target volume. Against this very obvious advantage one has to put rts great disadvantage; in the transverse planes wthin the target volume the dose dtstribution no longer matches that of a standard implant according to Paris rules. The reference isodose now encompasses a greater volume, and the implant has lost its “hot spot” in its centre. It is however possible to optimise the Implant in another way. By lookmg at one needle separately and optrmising it at a distance equal to the distance of a needle to Its nearest basal point in the Implant under consideration, dwell weights are obtained whrch. when programmed manually for the other needles, will give a dose distribution which in the transverse planes within the target volume resembles that of the Paris system very closely indeed. The reason being is that within a transversal plane the dwell weight of the source is the same for each needle. And as each needle is optimised the one advantage of the standard optrmisation. an active length equal to or shorter than the length of the target volume, is not lost! Conclusion: It is possible to optimise a breast implant rn a way which gives the best of both worlds; an implant which has an active length smaller than or equal to the length of the target volume, yet wrth a dose distributton which in the transverse planes matches that of a standard implant according to Paris rules.
CURIETHERAPIE PER-OPERATOIRE AVEC LAMBEAU MYOCUTANE DANS LE TRAITRMENT DES RECIDIVES PARIETALES DES CANCERS DU SEIN. A. Benider, A. Acharki, S. Sahraoui, R. Samlali, A. Kahlain Centre d’oncologie CHU. Ibn Rochd Casablance Marx Les r6cidives parietales du cancer du sein apr&s traitement initial sent fr6quentes (IO B 40%). Elles posent des problkmes thCrapeutiques ntcessitant un traitement agressif seul garant d’une sterilisation tumorale. Le but de notre travail est I’analyse des rCsultats thCrapeutiques de I’association chirurgie large avec reconstruction par lambeau myocutanC et curiethtrapie interstltlelle per-opCratoire chez dix malades trait&es au centre d’oncologie Ibn Rochd de Casablanca enfre 1992 et 1993. La moyenne d’Lge de nos malades a &e de 54.5 am. Le traitement initial du cancer du sein a BtC une chnurgie (Intervention Patey) associte g une radiothtrapie loco-rtgronale dam 6 cas et Q une ChrmiothCrapre dans 3 cas. L’analyse des r&crdrves a montri que I’&endue moyenne a ttC de 1.3 cm. sous forme de nodules sous cutan& (7/lO cas). Lr trartement a consist& dans tow les cas en une rxCr&\e large passant Q 4 cm de la timite macroscopique saine. La cowerturr de la pene de substance a ttt rtali& par le lambeau myocutane du gmnd dorsal verncal. Cette chnwgie a ttC associte ?I une curiethtrapie rnterstmelle per-optratoire qui a consist6 en la mise en place par le curieth&rapeutc de tubes plastrques dent Ic chargement est diffkrt au JI po\top&atorre. L’&!mcnt redioactif utilisC a et& I’lrrdium 192. La dose Une radiothPraple exteme a 616 pratlquCe dt’lwr& it 616 de I5 a 20 Grays. dam to”\ les cas. a\wci& B uric chlmiothCrapie dans 5 cas et B une une d&union des hormonoth&rapre dam 3 cas. Au cows de Kvolution, wture\ L‘\L ~urvenue chez uric malade et une surinfection chez une autrc. .iyant horn &olu6 d;ms ler 2 cas. Apr&s un recul moyen de 17.5 mois, six mnladra ant ~lt: en rCmlhaion compl?te. trois sent d&d&s par tvolutivitC m~t;~rt;nlque et une patlente a present6 une rkcidive loco-rkgionale et m5tactat!quea X 1nws. Vue lc raw &lcvC d’&zhec et de r&idives apr&s wa~temcn~ chlrurgrcal ou radroth&+quc wula. I’a.raocration curiethCrapie interstitwlle per-upC~-.norrc CI chnurgic d’cx&se avec lambeau myocutane du grand dorwl xIopl>e par certan\ antcurs \emblr dormer de meilleurs rCsultats thCrapcutiquc\