Boost advanced Head and Neck: BT vs IMRT

- S18-

Teaching Lecture Radiother. Oncol. 74:37-148, 200S Ash D, at a!. ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother. Oncol. 57:315-321,2000.

Boost Advanced Head and Neck: BT vs IMRT 30 speaker BRACHYTHERAPY AS BOOST IN HEAD AND NECK CANCER-USEFUL OR NECESSARY?TECHNIQUES, VALUE OF IMAGING,EFFICACY, SIDE EFFECTS V. Strnad UNIVERSITY HOSPITAl., Department of Radiation Oncology, Erlangen, Ger-

many The most often technique using for brachytherapy of head neck cancer IS the multicatheter interstitial technique with exception of nasopharyngeal cancer, who the intracavitarytechnique is more appropriate. The detailed description of these techniques is available in each textbook, but very little is written about the value of modern imaging techniques for implantation of head and neck tumours. Currentlysimultaneously to clinical investigation it is possible to use as furthermore information's the X-ray Imaging, CT-, or MR-imaging. The X-ray imaging allows very good catheter reconstruction, but no information's are available about tumor. In contrast to it the CT imaging make sometimes possible to distinguish the tumor bulk but in case of small tumors and particularlyin postoperative cases (only surgical scare is present!) no or very limited information's about the tumor size and region are available. Often also the metal artifacts' (teeth-fillings) hamper to distinguish the correct size and form of tumor bulk. Nearly the same limitations presents the MR-imaging (the teeth-fillings leads to effacements of MR-signal), but the diversity of soft tissue imaging is among all imaging methods the best. In summary:The finger and eye of the surgeon is by nothing to replace; but the support of the CT- or MR-imaglng is useful. The efficacy and side effects of LDR- and PDR-brachytherapy as boost for head and neck tumors are very good documented in a lot of clinical studies: The local control rates are mostly between 80-90% or better also in cases of locally advanced tumors and the probabilityof serious side effects such soft tissue necrosis or osteoradionecrosis is nowadays below 5%. In summary: Interstitial brachytherapy as boost for head and neck tumours' is a treatment option with excellent efficacy for carefully selected patients. The morbidityassociated with brachytherapy IS in experienced hands low and acceptable but can be significant and, therefore, should be performed at hospitals with adequate experience In planning and implementing this treatment. Ifdone properly, the interstitialbrachytherapy as boost is safe and delivers a dose that is higher and more conformal than what can be achieved byexternal beam radiation alone With the expected biologic advantages. 31 speaker

Friday, May 11, 2007 Background: Radiotherapy often comprises two phases, in which irradiation of a volume at risk for microscopic disease is followed by a sequential dose escalation to a smaller volume either at a higher risk for microscopic disease or containing only gross disease. This technique IS difficult to implement with intensity modulated radiotherapy, as the tolerance doses of critical structures must be respected over the sum of the two plans. Techniques that include a simultanuous integrated boost (SIB) have been proposed to address this problem. The purpose of thiS study was to compare IMRT and 3D conformal radiotherapy (3D-CRT) with regard to radiationinduced (RTOG acute toxicity(XERRTOG))and patient-rated xerostomia (EORTC QLQ-H&N35(XERpat))among patients with HNSCC. Material and methods: We included 248 patients with HNSCC treated with bilateral irradiation ± chemotherapy. Since 2000, all patients treated with HNSCC were included in a study program, in which acute and late morbidity according to the RTOG and QoL were prospectively assessed on a routine basis at regular intervals. Before October 2004, all patients were treated with 3D-CRT (n=l44). Afterclinical implementation in October 2004,104 patients received IMRT. In this study, the differences regarding XERRTOG and XERpat up to 12 months after radiotherapy were analysed. Dose-volume histograms (DVH) of the salivary glands were made in all patients. Results: The use of IMRT resulted in a significant reduction of the mean dose of the parotid glands (26.2 Gy versus 44.2 Gy(p
Gynaecology 32 oral INTEROBSERVER COMPARISON OF TARGET DELINEATIONIN MRI ASSISTED CERVIX CANCER BRACHYTHERAPYACCORDING TO THE GYN GEC-ESTRO RECOMMENDATIONS J. Dimopoulos', V. De Vos', D. Berger', P. Petric', I. Dumas', C. HaieMeder', R. Potter' 1MEDICALUNIVERSITY OF VIENNA, Department of Radiotherapy and Radiobi-

SIMULTANEOUS INTEGRATED BOOST TECHNIQUE WITH INTEN-

ology, Vienna, Austria,

SITY MODULATED RADIOTHERAPY (IMRT) IN HEAD AND NECK CANCER J. Langendijk',M-R. Vergeer', PAH. Doornaert', DHF. Rietveld', AP. Jellema 3, CR. Leemans·, BJ. Siotman' 'UNIVERSITY MEDICAL CENTER GRONINGEN, Department of Radiation Oncol-

'INSTITUTGUSTAVE Roussy, Department of Radiotherapy. Parts, France

ogy, Grontngen, The Netherlands, 2IJU UNIVERSITY MEDICALCENTER, Department of Radiation Oncology, Am-

sterdam, The Netherlands, 'ACADEMICMEDICALCENTER, Department of Radiation Oncology, Amster-

dam, The Netherlands, 'VU UNIVERSITYMEDICALCENTER, Department of Otolaryngology/' Amster-

dam, The Netherlands

Purpose/Objeetif: To investigate the interobserver variation after implementation of the GYN GEC ESTRO contouring recommendations for MRI assisted brachytherapy of cervIx cancer in two different Institutions representing two different traditions for CTV assessment: HR CTV and IR CTV. Materials/Methods: 19 patients, with biopsy proven cervical cancer, treated by radiotherapy in IGR-Paris (n=9 pts) and AKH-Vienna (n=l 0 pts.) were included for analysis. FIGO stage distribution was: IB1 =1, IIA=l, IIB=9, IIIB=6, IVA=2. Treatment planning was performed according to institutional practice for 3 D image based brachytherapy (MRI). Dose prescnption at IGR was to IR CTV and in Vienna to HR