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1099 poster Conservative treatment in bladder cancer
Posters
Results: Pts were followed 37-189 (median 78) months. Survived 25/31 (81%) pts. Local control was maintained in 24/31 (77%) pts - invasive recurrence occured in 4 and superficial in 3 pts. In 6/8 pts local recurrence was the first site of recurrent disease. 10 year survival rate is 70-63% considering survival with intact, functioning bladder without either superficial or invasive recurrence. Pronounced chronic bladder toxicity (SOMA grade >2) was limited only to pts with repeated interventions due to recurrent diseases. Conclusion: In selected patients bladder sparing treatment is an effective alternative to radical surgery in terms of survival, local control (12% invasive recurrence rate) and function of retained bladder. 1098 poster
Use of sodium hyaluronate colution in patients suffering from post-radiation cystitis J. Diamantopoulos 1, Z. Kapsalis ~, G. Pliotas 1, N. Koliarakis 2, T. Antonadou2, P. Karagiorgis 2 1Western Attica General Hospital "St Barbara", Urology Departmetn, Athens, Greece 2"Metaxas" Cancer Hospital, 2nd Radiology Department, Piraeus, Greece Purpose: to improve symptoms of post-radiation cystitis in patients undergoing radiotherapy for pelvic cancer. Patients and methods: in a preliminary study, 20 patients suffering from post-radiation cystitis due to external beam radiation for pelvic cancer, were subjected to intravesical infusions of sodium hyaluronate in form of isotonic solution 80%. The onset of therapy was after finishing radiotherapy and as soon as symptoms had appeared. 50 mL of the solution were administered and kept in the bladder for one hour to drain it everywhere. This maneuver was repeated once a ~veek for a period of 4-6 weeks and, then, once a month for a total period of one year.
Results: 12/20 (60%) of the treated patients were improved significantly within 3-4 weeks after the onset of the infusions. 4/20 (20%) were improved slightly within the same interval; however, their clinical status became significantly better within the following 1-3 months. All these 16/20 (80%) patients were almost asymptomatic at the end of the therapy. Any withdrawal from treatment schedule was followed by various degree of recurrence, according to the time. Clinical improvement was in accordance with the endoscopic appearence of the bladder. 3 patients were slightly improved by the first month, but they remained ill, so they were withdrawn and subjected to urine diversion. One of them died three months later. The last patient did not refer any improvement and was subjected to urine diversion. She died two months after operation. Conclusion: intravesical infusions of Sodium Hyaluronate in patients suffering from post-radiation cystitis consists, in first view, a good challenge for clinical palliation. 1099 poster
Conservative treatment in bladder cancer 2 D. G~mez1, P. Foro 1, F. Ferret,1 M. Algara 1•, M. Domenech 3 , H. Lopez , N. Rodriguez1, N. Reig 1, C. Aui~on1, X. Sanz1 ~Hospital de I'Esperan~a, Radiation Oncology dept. IOR, Barcelona, Spain 2Universitat Pompeu Fabra, UPF, Barcelona, Spain ~Althaia-Centre Hospitalari de Manresa, Medical Oncology, Manresa, Spain 4AIthaia-Centre Hospitalari de Manresa, Urology, Manresa, Spain
$461
Purpose: Chemoradiotherapy is an alternative to radical cystectomy among patients with bladder cancer. The aim of this study was to analize the results of conservative bladder cancer treatment protocol in selected patients. MaterialslMethods: From June 1993 to April 2002, 34 patients we included in the study. Median age was 66 years (49-76), 30 males and 4 females. Stage distribution was as follows: 28 T2-3, and 2 T4. Treatment protocol began with a cytoreductive transuretral resection, followed by two cycles of CMV(cisplatin, methotrexate and vinblastine) chemotherapy. Then radiotherapy 44 Gy on pelvis volume was concomitantly administered with cisplatin chemotherapy on days 1-22. Response was evaluated by cystoscopy. Complete responder patients completed radiotherapy up to 65 Gy on bladder volume. Whereas cystectomy was performed in non responder patients. Median follow-up time was 51 months.
Results: Complete tumour response (CTR) was 90%. Fifty five percent of patients with CTR are free of disease. Overall survival probability was 81,7% at 5 years. In bladder spared patients overall survival probability reached 90,7% at 5 years whereas overall survival in cystectomy group was 25% at 5 years. Severe toxicity was uncommon. Neutropenia, cystitis and renal grade 3 toxicities were 13.3%, 6.7% and 3.3% respectively. Conclusions: We concluded that, conservative combination treatment may be an acceptable alternative to immediate cystectomy in select patients with bladder cancer.
Radiation Technologists 1100
Detailed analysis of respiratory 3D tumor motion in the organs for respiratory gated radiotherapy Y. Tsunashima, 7-. Sakae, K. Kagei, M. Hata, Y. Akine Pr(~ion Medical Research Center, Unversity of Tsukuba, Ibaraki, Japan Introduction: Respiratory gated irradiation technique is widely used in external beam radiotherapy with x-rays, protons and carbons. Although many studies on technical aspects of respiratory gated irradiation have been conducted recently, there are few reports on the three dimensional (3D) motion of the tumor. The purpose of this study is to analyze the 3D tumor motion due to breathing for the organs in detail.
Methods: The organs (lung, liver and esophagus) of 26 patients with 32 cancerous regions who received proton therapy in our facility in the last three years and whose tumors were directly or indirectly visible with digital radiography were selected for analysis. To observe the tumor motion, the Bi-plane Digital Radiography (BDR) unit, which is used to position patients at the beginning of treatment, was used. The x-ray systems crossing at right-angles (A-P and LR) in this unit make image-guided patient setup possible and enabled us to obtain the 3D target motion. The target motion in the lateral, cranial-caudal and ventral-dorsal directions were labeled as x, y and z respectively. To analyze the 3D tumor motion in each organ, first, the amplitude of each tumor's motion in the x, y and z directions was investigated. And in order to show the orbit for each tumor motion, we used the correlation coefficient of x-y and z-y planes respectively.
Result and discussion: Table 1 shows the average amplitudes and the squared correlation coefficients (r 2) of the tumor motions according to organs and dimensions. The tumor motion in the left upper lobe of the lung was influenced by the heartbeat rather than breathing because of its proximity to the heart. The tumor motions in the left and the
Results: Pts were followed 37-189 (median 78) months. Survived 25/31 (81%) pts. Local control was maintained in 24/31 (77%) pts - invasive recurrence occured in 4 and superficial in 3 pts. In 6/8 pts local recurrence was the first site of recurrent disease. 10 year survival rate is 70-63% considering survival with intact, functioning bladder without either superficial or invasive recurrence. Pronounced chronic bladder toxicity (SOMA grade >2) was limited only to pts with repeated interventions due to recurrent diseases. Conclusion: In selected patients bladder sparing treatment is an effective alternative to radical surgery in terms of survival, local control (12% invasive recurrence rate) and function of retained bladder. 1098 poster
Use of sodium hyaluronate colution in patients suffering from post-radiation cystitis J. Diamantopoulos 1, Z. Kapsalis ~, G. Pliotas 1, N. Koliarakis 2, T. Antonadou2, P. Karagiorgis 2 1Western Attica General Hospital "St Barbara", Urology Departmetn, Athens, Greece 2"Metaxas" Cancer Hospital, 2nd Radiology Department, Piraeus, Greece Purpose: to improve symptoms of post-radiation cystitis in patients undergoing radiotherapy for pelvic cancer. Patients and methods: in a preliminary study, 20 patients suffering from post-radiation cystitis due to external beam radiation for pelvic cancer, were subjected to intravesical infusions of sodium hyaluronate in form of isotonic solution 80%. The onset of therapy was after finishing radiotherapy and as soon as symptoms had appeared. 50 mL of the solution were administered and kept in the bladder for one hour to drain it everywhere. This maneuver was repeated once a ~veek for a period of 4-6 weeks and, then, once a month for a total period of one year.
Results: 12/20 (60%) of the treated patients were improved significantly within 3-4 weeks after the onset of the infusions. 4/20 (20%) were improved slightly within the same interval; however, their clinical status became significantly better within the following 1-3 months. All these 16/20 (80%) patients were almost asymptomatic at the end of the therapy. Any withdrawal from treatment schedule was followed by various degree of recurrence, according to the time. Clinical improvement was in accordance with the endoscopic appearence of the bladder. 3 patients were slightly improved by the first month, but they remained ill, so they were withdrawn and subjected to urine diversion. One of them died three months later. The last patient did not refer any improvement and was subjected to urine diversion. She died two months after operation. Conclusion: intravesical infusions of Sodium Hyaluronate in patients suffering from post-radiation cystitis consists, in first view, a good challenge for clinical palliation. 1099 poster
Conservative treatment in bladder cancer 2 D. G~mez1, P. Foro 1, F. Ferret,1 M. Algara 1•, M. Domenech 3 , H. Lopez , N. Rodriguez1, N. Reig 1, C. Aui~on1, X. Sanz1 ~Hospital de I'Esperan~a, Radiation Oncology dept. IOR, Barcelona, Spain 2Universitat Pompeu Fabra, UPF, Barcelona, Spain ~Althaia-Centre Hospitalari de Manresa, Medical Oncology, Manresa, Spain 4AIthaia-Centre Hospitalari de Manresa, Urology, Manresa, Spain
$461
Purpose: Chemoradiotherapy is an alternative to radical cystectomy among patients with bladder cancer. The aim of this study was to analize the results of conservative bladder cancer treatment protocol in selected patients. MaterialslMethods: From June 1993 to April 2002, 34 patients we included in the study. Median age was 66 years (49-76), 30 males and 4 females. Stage distribution was as follows: 28 T2-3, and 2 T4. Treatment protocol began with a cytoreductive transuretral resection, followed by two cycles of CMV(cisplatin, methotrexate and vinblastine) chemotherapy. Then radiotherapy 44 Gy on pelvis volume was concomitantly administered with cisplatin chemotherapy on days 1-22. Response was evaluated by cystoscopy. Complete responder patients completed radiotherapy up to 65 Gy on bladder volume. Whereas cystectomy was performed in non responder patients. Median follow-up time was 51 months.
Results: Complete tumour response (CTR) was 90%. Fifty five percent of patients with CTR are free of disease. Overall survival probability was 81,7% at 5 years. In bladder spared patients overall survival probability reached 90,7% at 5 years whereas overall survival in cystectomy group was 25% at 5 years. Severe toxicity was uncommon. Neutropenia, cystitis and renal grade 3 toxicities were 13.3%, 6.7% and 3.3% respectively. Conclusions: We concluded that, conservative combination treatment may be an acceptable alternative to immediate cystectomy in select patients with bladder cancer.
Radiation Technologists 1100
Detailed analysis of respiratory 3D tumor motion in the organs for respiratory gated radiotherapy Y. Tsunashima, 7-. Sakae, K. Kagei, M. Hata, Y. Akine Pr(~ion Medical Research Center, Unversity of Tsukuba, Ibaraki, Japan Introduction: Respiratory gated irradiation technique is widely used in external beam radiotherapy with x-rays, protons and carbons. Although many studies on technical aspects of respiratory gated irradiation have been conducted recently, there are few reports on the three dimensional (3D) motion of the tumor. The purpose of this study is to analyze the 3D tumor motion due to breathing for the organs in detail.
Methods: The organs (lung, liver and esophagus) of 26 patients with 32 cancerous regions who received proton therapy in our facility in the last three years and whose tumors were directly or indirectly visible with digital radiography were selected for analysis. To observe the tumor motion, the Bi-plane Digital Radiography (BDR) unit, which is used to position patients at the beginning of treatment, was used. The x-ray systems crossing at right-angles (A-P and LR) in this unit make image-guided patient setup possible and enabled us to obtain the 3D target motion. The target motion in the lateral, cranial-caudal and ventral-dorsal directions were labeled as x, y and z respectively. To analyze the 3D tumor motion in each organ, first, the amplitude of each tumor's motion in the x, y and z directions was investigated. And in order to show the orbit for each tumor motion, we used the correlation coefficient of x-y and z-y planes respectively.
Result and discussion: Table 1 shows the average amplitudes and the squared correlation coefficients (r 2) of the tumor motions according to organs and dimensions. The tumor motion in the left upper lobe of the lung was influenced by the heartbeat rather than breathing because of its proximity to the heart. The tumor motions in the left and the