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108 Results of HDR boost therapy in tracheobronchial carcinoma
S48 105
106
OIJR EXPERIENCE WITH LOW DOSE RATE ENDOBRONCHIAL IRRADIATION IN THE TREATMENT OF MALIGNANT AIRWAY OBSTRUCTION.
TRACHEAL AND BRONCHW CANCER : TARGET LOCALIZATION IN THE MICROSEL.I%CTRON HDR ~U~ALBRACHYTHERAFY
J. PETERA. 1. SPASOVA. J. ANDRLE Institute of Radiation Czech Rep.
Oncology,
Institute
of Chest Desease,
Prague,
From Feh 1 1900 to May 31 1993, 55 patients with a malignant inoperable tracheohronchial obstruction were treated by endobronchial brachytherapy with cS137. The most common histologic type was the squamous cell lung cancer (38 cases), followed by adenocarcinoma (G), small cell carcinoma (4). adenoid cystic carcinoma (21, 1 undifferentiated carcinoma, 1 carcinoma of the thyroid gland, 1 carcinoma of the larynx, 1 metastatic cancer, 1 malipant carcinoid. Most malignant lesions (40) were located in the proximal airways, trachea and main bronchi. 51 patients received prior external irradiation, 20 were given chemotherapy and 51 patients received a laser excision. 4 patients.were treated with a curative intend and 51 patients with a paliative iniend. 2 patients were treated three times,
14 patients twice, 39 patients once. Either Microselectron LDR (N = 54) or Selectron (N = 15) were used. In 35 hrachytherapy procedures 1 catheter was used, in 34 Procedures 2 afterloading catheters were used. The target volume was the area of the tumour and 2cm
hi. Sarik, J. Stank&L, 0. Prim, S. V&i&vi&, M. ‘Ikakovi~ Institute of oncology and radiology Ilaoa.&lgradeX&erQYa 14 ~ XilpsIavia
The target localization in the trachea and bronchus is the most important step in the MicroSelectron HDR planning. At the Institute of oncology and radiology -Belgrade the variable angle reconstruction was used. The angles charen wete 45 and 315 degrees respecrively The target was positioned at the radiotherapy simulator izocentar or near it. From the obtained radiographs localization and marking of the target was very d&ult. Because of that AI? radiography with same magnification as the previous two was used. Simple met&d of folding over was used for the target edges transmission from AI? to other two films. Sometimes brochoscope could be used for the localization of the target edges, but only usingAI? visualization technique. At the Institute 30 patients were treated using this target localisation and transmission technique. This transmission technique is useful especially wben two or three catheters were applicated.
proximal and distal of the tumour margins. Source length varied from 37 to 77mm, a dose rate between 0.50 and 12.15 Gy/h (in average 0.75 with Micro.selectron
107 Carcinoma of the oesophagus treatment with manual
108 Results of HDR boost therapy in tracheobronchial carcinoma
afterloading using iridium-192 Zvonko KusiC, *Boris Pokrajac, Josip Grab i Vladimir Lokner Department of nuclear medicine and oncology, UH “Se&e Milosrdnice”, Zagreb, Croatia *Allgemeines Krankenhaus der stadt Wien, Department for Radiotherapy and Radiobiology, Univ. of Vienna, Vienna Combination of external beam irradiation and intralumenal irradiation has been shown to increase survival and provide
prolonged symptomatic relief in carcinoma of the oesophagus. Owing to anatomical constraints it is not possible to irradiate the oesophagus to a sufficiently high dose with external beam radiotherapy alone without the risk of injury to surrounding structures. This work describes our experience in the palliative treatment of locally advanced and inoperable carcinoma of the oesophagus on 15 patients using combination of fractionated teletherapy (total of 40 Gy) and iridium-192 brachytherapy (20-25 Gy) which enables additional irradiation of a target volume to ti sufficiently high doses. For well defined size and position of lesion, radiograph of plastic applicator with dummy source was used for position calibrations. Mtiual afterloading with single 0.3 mm iridium192 wire (of the length surpassing 1 cm the length of lesion on both ends) in plastic tube was used. With dose rates from 0,250,35 Gy/h (calculated for the point 5 mm from the source in it’s central plane) sufficiently high local doses to lumenal aspects of the tumour were delivered in 60-80 hours. All the patients were with the evident diiculties of swallowing which considerably decreased 4 to 8 weeks after treatment.
P. Sehraube’, P. Fritz’, H.D. Beck&. M. Wannenmacherl lDepaItement of Radiotheqy, University of Heidellberg khesi Heidelbe~ Rohrbaeh
Hospital
The role of endobronchial HDR-afterloading treatment in primary radiotherapy of tracheobronchial carcinoma is not yet well defined. The own treatment results are presented regarding prognostic factors and side effects. In 25 patients with a tracheobronchial carcinoma, unresectable for medical or technical reasons, a combined percutaneous {51(46-60) Gy within 4,5-6 weeks) and endobronchial irradiation {(7,5 (9-20) Gy in 3-4 dictions) was delivered. patients were selected for combined therapy by a mostly endo/peribroncbially located tumour volume (median tumour diameter in CT 10 mm). After a median observation time of 17.,5 months (I-65) 9 patients are still alive and the median survival amounts to 20 months. Prognostic factors, significantly favourable, were the achievement of a complete remission, a tumour diameter below 10 mm, a good performance status and the lack of mediastinal involvement. In two patients with ongoing local tumour control, radiogenic tracheobronchitis occured up to a degree, which required endoscopic interventions. This study suggests, that in a selected patient collective endobronchial HDR-brachytherapy can be applied with an acceptable risk and this might be the subgroup of patients with tracheobronchial cancer, which gains by a combined radiation treatment.
106
OIJR EXPERIENCE WITH LOW DOSE RATE ENDOBRONCHIAL IRRADIATION IN THE TREATMENT OF MALIGNANT AIRWAY OBSTRUCTION.
TRACHEAL AND BRONCHW CANCER : TARGET LOCALIZATION IN THE MICROSEL.I%CTRON HDR ~U~ALBRACHYTHERAFY
J. PETERA. 1. SPASOVA. J. ANDRLE Institute of Radiation Czech Rep.
Oncology,
Institute
of Chest Desease,
Prague,
From Feh 1 1900 to May 31 1993, 55 patients with a malignant inoperable tracheohronchial obstruction were treated by endobronchial brachytherapy with cS137. The most common histologic type was the squamous cell lung cancer (38 cases), followed by adenocarcinoma (G), small cell carcinoma (4). adenoid cystic carcinoma (21, 1 undifferentiated carcinoma, 1 carcinoma of the thyroid gland, 1 carcinoma of the larynx, 1 metastatic cancer, 1 malipant carcinoid. Most malignant lesions (40) were located in the proximal airways, trachea and main bronchi. 51 patients received prior external irradiation, 20 were given chemotherapy and 51 patients received a laser excision. 4 patients.were treated with a curative intend and 51 patients with a paliative iniend. 2 patients were treated three times,
14 patients twice, 39 patients once. Either Microselectron LDR (N = 54) or Selectron (N = 15) were used. In 35 hrachytherapy procedures 1 catheter was used, in 34 Procedures 2 afterloading catheters were used. The target volume was the area of the tumour and 2cm
hi. Sarik, J. Stank&L, 0. Prim, S. V&i&vi&, M. ‘Ikakovi~ Institute of oncology and radiology Ilaoa.&lgradeX&erQYa 14 ~ XilpsIavia
The target localization in the trachea and bronchus is the most important step in the MicroSelectron HDR planning. At the Institute of oncology and radiology -Belgrade the variable angle reconstruction was used. The angles charen wete 45 and 315 degrees respecrively The target was positioned at the radiotherapy simulator izocentar or near it. From the obtained radiographs localization and marking of the target was very d&ult. Because of that AI? radiography with same magnification as the previous two was used. Simple met&d of folding over was used for the target edges transmission from AI? to other two films. Sometimes brochoscope could be used for the localization of the target edges, but only usingAI? visualization technique. At the Institute 30 patients were treated using this target localisation and transmission technique. This transmission technique is useful especially wben two or three catheters were applicated.
proximal and distal of the tumour margins. Source length varied from 37 to 77mm, a dose rate between 0.50 and 12.15 Gy/h (in average 0.75 with Micro.selectron
107 Carcinoma of the oesophagus treatment with manual
108 Results of HDR boost therapy in tracheobronchial carcinoma
afterloading using iridium-192 Zvonko KusiC, *Boris Pokrajac, Josip Grab i Vladimir Lokner Department of nuclear medicine and oncology, UH “Se&e Milosrdnice”, Zagreb, Croatia *Allgemeines Krankenhaus der stadt Wien, Department for Radiotherapy and Radiobiology, Univ. of Vienna, Vienna Combination of external beam irradiation and intralumenal irradiation has been shown to increase survival and provide
prolonged symptomatic relief in carcinoma of the oesophagus. Owing to anatomical constraints it is not possible to irradiate the oesophagus to a sufficiently high dose with external beam radiotherapy alone without the risk of injury to surrounding structures. This work describes our experience in the palliative treatment of locally advanced and inoperable carcinoma of the oesophagus on 15 patients using combination of fractionated teletherapy (total of 40 Gy) and iridium-192 brachytherapy (20-25 Gy) which enables additional irradiation of a target volume to ti sufficiently high doses. For well defined size and position of lesion, radiograph of plastic applicator with dummy source was used for position calibrations. Mtiual afterloading with single 0.3 mm iridium192 wire (of the length surpassing 1 cm the length of lesion on both ends) in plastic tube was used. With dose rates from 0,250,35 Gy/h (calculated for the point 5 mm from the source in it’s central plane) sufficiently high local doses to lumenal aspects of the tumour were delivered in 60-80 hours. All the patients were with the evident diiculties of swallowing which considerably decreased 4 to 8 weeks after treatment.
P. Sehraube’, P. Fritz’, H.D. Beck&. M. Wannenmacherl lDepaItement of Radiotheqy, University of Heidellberg khesi Heidelbe~ Rohrbaeh
Hospital
The role of endobronchial HDR-afterloading treatment in primary radiotherapy of tracheobronchial carcinoma is not yet well defined. The own treatment results are presented regarding prognostic factors and side effects. In 25 patients with a tracheobronchial carcinoma, unresectable for medical or technical reasons, a combined percutaneous {51(46-60) Gy within 4,5-6 weeks) and endobronchial irradiation {(7,5 (9-20) Gy in 3-4 dictions) was delivered. patients were selected for combined therapy by a mostly endo/peribroncbially located tumour volume (median tumour diameter in CT 10 mm). After a median observation time of 17.,5 months (I-65) 9 patients are still alive and the median survival amounts to 20 months. Prognostic factors, significantly favourable, were the achievement of a complete remission, a tumour diameter below 10 mm, a good performance status and the lack of mediastinal involvement. In two patients with ongoing local tumour control, radiogenic tracheobronchitis occured up to a degree, which required endoscopic interventions. This study suggests, that in a selected patient collective endobronchial HDR-brachytherapy can be applied with an acceptable risk and this might be the subgroup of patients with tracheobronchial cancer, which gains by a combined radiation treatment.