- Email: [email protected]
Twice-daily, split course whole abdominal radiation following chemotherapy in patients with residual disease at laparotomy
Radiation Oncology, Biology, Physics October 1990, Volume 19, Supplement 1
168
m conclusion, IP Pa2 is a safe and well tolerated therapy. Our data suggest that lP P-32 conferred a DFS advantage to patients with a pathologically negattve 2LL, and to pattents with MRD. This advantage also appears to extend to patients who had gross disease at the outset of 2LL and were optimally debulked. These findings suggest a continued role for second-look laparotomy with the use of P-32 in selected patients. 5 Year DFS PATH NEG 2LL n with P-32 (Group A) no P-32 (Group B) p-value
68 86% 61% 0.05
MRD
h4RD-STAGE 111
GD 2LL
41 38% 0% 0.01
34 31%
31 39% 30% 0.06
09z
n= number of patients; PATH NEG 2LL = pathologically negative 2LL; GD 2LL = gross disease at outset of 2LL
85 SPLIT COURSE WHOLE ABDOMINAL RADIATION FOLLOWING TWICE-DAILY, DISEASE AT LAPAROTOMY Eifel, P.J. J.T.Wharton, *Dept.
of
M.D.:* M.D. Clin.
M.D.
D. Gershenson,
Radiotherapy,
**
Dept.
of
**
, L.J.
Gyn.
Peters,
Oncology,
M.D.*,
CHEMOTHERAPY IN PATIENTS
M.J.
Oswald,
B.S.*,
M.D. Anderson
Cancer
Center,
L.
WITH RESIDUAL
Delclos,
Houston,
M.D.*,
TX 77030
Between July, 1983 and December, 1988, 38 patients were treated with a twice-daily fractionated, abdominal irradiation. 37 patients had received chemotherapy prior to split-course regimen of whole Patients received a total of 30 Gy to the whole abdomen in 1 Gy fractions twice-daily with irradiation. a 3-week break after 15 Gy. 8 patients had localized boosts to sites of macroscopic residual disease. Only one patient was unable to complete therapy because of prolonged severe neutropenia. Chemotherapy consisted of 6 cycles of cis-platinum and cyclophosphamide (PC) in 26138 (70%) 3 patients had 3-4 cycles of PC, 6 patients had 6-9 cycles of PC and one patient with a low patients; grade lesion had no chemotherapy prior to whole abdominal RT. Three patients had adriamycin added to treated with RT following a positive 2nd look their regimen for 1, 6 and 8 cycles. Most patients were laparotomy after an initial course of chemotherapy. However 3 patients who relapsed after a negative second-look were treated following a third laparotomy and surgical de-bulking. The histologic subtype was 61% of patients had grade 3 adenocarcinoma and 32% had grade 2. in 8% and poorly differentiated described as serous in 63%, endometrioid in 13%, clear cell in 16%. At the completion of the surgery prior to irradiation, 26 patients (68%) had adenocarcinoma residual disease, 7 had <5 mm deposits (miliary studding in 2 cases) and 5 had 0.5-2 cm microscopic who had microscopic residual, relapse-free survival residual. For patients with grade 2 or 3 cancer (RFS) at 3 years was 10% (median 13 months) and 14% (median 9.0 months) respectively. Patients with rapidly (median RFS of 4.9 months) and no patients in this group are macroscopic residual recurred All three patients with grade 1 disease are surviving at 20, 42 and 50 months. currently surviving. patients had known Fourteen patients (38%) have suffered a bowel obstruction. In all cases, None of the 6 patients currently believed to be free of disease recurrent abdominal cancer at the time. A number of patients have been noted to have adhesions at laparotomy have suffered a bowel obstruction. from prior abdominal surgeries and from regressing to radiation therapy which may have resulted prior Twenty patients (53%) had undergone more than 2 abdominal surgeries prior to under chemotherapy. tumor Radiation therapy is one of several factors that can contribute whole abdominal irradiation. receiving series has clearly suffered a radiation-related smallsmall bowel injury, but no patient in this to bowel obstruction. Although this regimen is apparently able to sterilize persistent ovarian cancer in a small proportthose treated have after chemotherapy, most of ion of patients with microscopic residual disease this Patients with macroscopic residual disease experienced no appreciable benefit from relapsed. treatment.
86 COMPUTER AIDED REGISTRATION
OF SIMULATION
James Balter, Charles A. Pelizzari, S. Vijayakumar,
AND PORTAL IMAGES: AN EXPLORATORY
CLINICAL STUDY.
and George T.Y. Chen
Michael Reese/ University of Chicago Center for Radiation Therapy and the Department of Chicago, Chicago IL
of Radiation and Cellular Oncology, University
Accurate registration of portal and simulation films is essential in determining errors in field placement, which in turn describe errors in dose deposition in the body. This registration is typically performed by eye, using geometric markers (bb’s) and anatomic landmarks in order to determine changes in rotation, translation, and magnification, and to separate positioning errors from differences due to placement of the film/cassette in the various imaging systems. We have developed a computer aided method to align digital images rapidly. The simulation and portal films are digitized on a Konica laser scanner. The system geometries are made to match by using bb’s placed in the path of the beam, and the resulting images are presented to the physician, who in turn delineates matching regions of anatomy through the use of corresponding open curve segments and/or point pairs. Using an algorithm which examines the curvature of open curves, and the solution to the Orthogonal
168
m conclusion, IP Pa2 is a safe and well tolerated therapy. Our data suggest that lP P-32 conferred a DFS advantage to patients with a pathologically negattve 2LL, and to pattents with MRD. This advantage also appears to extend to patients who had gross disease at the outset of 2LL and were optimally debulked. These findings suggest a continued role for second-look laparotomy with the use of P-32 in selected patients. 5 Year DFS PATH NEG 2LL n with P-32 (Group A) no P-32 (Group B) p-value
68 86% 61% 0.05
MRD
h4RD-STAGE 111
GD 2LL
41 38% 0% 0.01
34 31%
31 39% 30% 0.06
09z
n= number of patients; PATH NEG 2LL = pathologically negative 2LL; GD 2LL = gross disease at outset of 2LL
85 SPLIT COURSE WHOLE ABDOMINAL RADIATION FOLLOWING TWICE-DAILY, DISEASE AT LAPAROTOMY Eifel, P.J. J.T.Wharton, *Dept.
of
M.D.:* M.D. Clin.
M.D.
D. Gershenson,
Radiotherapy,
**
Dept.
of
**
, L.J.
Gyn.
Peters,
Oncology,
M.D.*,
CHEMOTHERAPY IN PATIENTS
M.J.
Oswald,
B.S.*,
M.D. Anderson
Cancer
Center,
L.
WITH RESIDUAL
Delclos,
Houston,
M.D.*,
TX 77030
Between July, 1983 and December, 1988, 38 patients were treated with a twice-daily fractionated, abdominal irradiation. 37 patients had received chemotherapy prior to split-course regimen of whole Patients received a total of 30 Gy to the whole abdomen in 1 Gy fractions twice-daily with irradiation. a 3-week break after 15 Gy. 8 patients had localized boosts to sites of macroscopic residual disease. Only one patient was unable to complete therapy because of prolonged severe neutropenia. Chemotherapy consisted of 6 cycles of cis-platinum and cyclophosphamide (PC) in 26138 (70%) 3 patients had 3-4 cycles of PC, 6 patients had 6-9 cycles of PC and one patient with a low patients; grade lesion had no chemotherapy prior to whole abdominal RT. Three patients had adriamycin added to treated with RT following a positive 2nd look their regimen for 1, 6 and 8 cycles. Most patients were laparotomy after an initial course of chemotherapy. However 3 patients who relapsed after a negative second-look were treated following a third laparotomy and surgical de-bulking. The histologic subtype was 61% of patients had grade 3 adenocarcinoma and 32% had grade 2. in 8% and poorly differentiated described as serous in 63%, endometrioid in 13%, clear cell in 16%. At the completion of the surgery prior to irradiation, 26 patients (68%) had adenocarcinoma residual disease, 7 had <5 mm deposits (miliary studding in 2 cases) and 5 had 0.5-2 cm microscopic who had microscopic residual, relapse-free survival residual. For patients with grade 2 or 3 cancer (RFS) at 3 years was 10% (median 13 months) and 14% (median 9.0 months) respectively. Patients with rapidly (median RFS of 4.9 months) and no patients in this group are macroscopic residual recurred All three patients with grade 1 disease are surviving at 20, 42 and 50 months. currently surviving. patients had known Fourteen patients (38%) have suffered a bowel obstruction. In all cases, None of the 6 patients currently believed to be free of disease recurrent abdominal cancer at the time. A number of patients have been noted to have adhesions at laparotomy have suffered a bowel obstruction. from prior abdominal surgeries and from regressing to radiation therapy which may have resulted prior Twenty patients (53%) had undergone more than 2 abdominal surgeries prior to under chemotherapy. tumor Radiation therapy is one of several factors that can contribute whole abdominal irradiation. receiving series has clearly suffered a radiation-related smallsmall bowel injury, but no patient in this to bowel obstruction. Although this regimen is apparently able to sterilize persistent ovarian cancer in a small proportthose treated have after chemotherapy, most of ion of patients with microscopic residual disease this Patients with macroscopic residual disease experienced no appreciable benefit from relapsed. treatment.
86 COMPUTER AIDED REGISTRATION
OF SIMULATION
James Balter, Charles A. Pelizzari, S. Vijayakumar,
AND PORTAL IMAGES: AN EXPLORATORY
CLINICAL STUDY.
and George T.Y. Chen
Michael Reese/ University of Chicago Center for Radiation Therapy and the Department of Chicago, Chicago IL
of Radiation and Cellular Oncology, University
Accurate registration of portal and simulation films is essential in determining errors in field placement, which in turn describe errors in dose deposition in the body. This registration is typically performed by eye, using geometric markers (bb’s) and anatomic landmarks in order to determine changes in rotation, translation, and magnification, and to separate positioning errors from differences due to placement of the film/cassette in the various imaging systems. We have developed a computer aided method to align digital images rapidly. The simulation and portal films are digitized on a Konica laser scanner. The system geometries are made to match by using bb’s placed in the path of the beam, and the resulting images are presented to the physician, who in turn delineates matching regions of anatomy through the use of corresponding open curve segments and/or point pairs. Using an algorithm which examines the curvature of open curves, and the solution to the Orthogonal