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112 poster Role of irradiation in complex treatment of giant abdominal and thoracic wall AVM
$42
Posters
radiotherapy should be considered as a therapeutic option in patients with excessively large hemangiomas despite the possibility of untoward long-term sequelae. Since a biopsy was not performed, it can be speculated that radiotherapy reduced the vascularity of the hepatic hemangioma and decreased the enzymatic activity of the 3 iodothyronine deiodinase. 111 poster Gafchromic dosimetry
hs
radiochromic
films for
ivbt sources
C. Bianchi ~, C. Sampietro ~, R. Novario 7, R. Lorussoz, F. Tanzi ~, L. ~ C . Cappellim4, M. Caccia 4 ~Ospedale di Circolo e Fondazione Macchi, Medical Physics, Varese, Italy 2University of the Studies, Specialisation School in Medical Physics, Milan, Italy 3University of Insubria, Department of Medical Physics, Varese, /ta/y ~University of Insubria, Department of Physics, Como, Italy Following the prescriptions for QA of IVBT sources, defined in Task Group 60, we have obtained the DDC (Depth Dose Curve) and the azimuthal homogeneity for a IVBT source in a PMMA dedicated phantom with GC (GafChromic) HS (High Sensitivity) film dosimeters. The source is an active cylindrical steel seed, 2.5 mm long with an outer diameter of 0.64 mm, containing the Sr-90 isotope in the form of Strontium titanate ceramic. Such seeds are used to assemble 30, 40, 60 mm long interventional trains of the Novoste BetaCath System. The measurements were performed using GC HS. They are ideal for mapping dose distribution in high dose rate electron BT (BrachyTherapy), because of their high sensitivity and large dynamic range (0.540 Gy). They are also tissue equivalent, dose rate and energy independent (above 0,2 MeV). The DDC has been obtained sandwiching the source in PMMA phantoms of different thickness ranging from 1.7 to 7 mm and positioning the GC film between the proper phantom and the backscatter layer. The data shows a good agreement with Novoste measurements, performed with OPTIDOS, a scintillator based system. The azimuthal homogeneity was measured injecting the source in a set up allowing the GC to rotate around the catheter, co-axial to the system and embedded in the 1.7 mm thick PMMA phantom. The dose has been measured at 30 ° intervals and tha data are normalized to the value at 90 °. The results show a clear topbottom asymmetry at the 10% level, fully compatible with a gravitational fall of the source in the catheter. This work is a part of the SUCIMA (Silicon Ultra fast Cameras for electron and gamma sources In Medical Applications) project. SUCIMA is a project supported European Commission within the Fifth Framework. 112 poster Role of irradiation in complex treatment of giant abdominal and thoracic wall AVM
J. Had/iev 1'3, G. Horvath 3, G. Antal 1, L. Horvath 2, I. Repa ~ I University of Kaposvar, Institute of Diagnostic Imaging and Radiation Onco, Kaposvar, Hungary 2University of Pecs, Medical Faculty, Department of Radiology, Pecs, Hungary 3University of Pecs, Medical Faculty, Department of Radiation Oncology, Pecs, Hungary Objective and importance: Arteriovenous malformations (AVMs) present a common yet versatile clinical confront, through the potential "steal" phenomena and hemorrhage risks, aspects which are not sufficiently understood because of the great individuality of the cases. Over the years several new kinds of therapies have been incorporated into their complex treatment.
Clinical presentation: The patient had had no subjective symptoms fore 13 years since when the disease was first diagnosed and histologically proved. However, at the age of 35, he complained of severe dyspnea with exercise and was admitted for further examination. Diagnostic thoraco-abdominal angiography revealed a 39x25 cm lesion supplied by numerous arteries between the 8. right intercostal branch of the aorta and the right common femoral artery. Intervention: In 12 sessions microcatheter was periodically superselectively introduced into each of the feeding arteries and the AVM was treated primarily by transarterial embolization with polyvinyi-alcohol particles. Additional direct puncture embolization was performed in one session. Contrast-enhanced computerized tomography and angiography scanning were used for threedimensional imaging of the nidus and irradiation treatment planning. Fractionated radiotherapy was performed using a linear accelerator, body immobilization system, and orthogonal linacographic verification was performed weekly. The radiation dose was 32.4 Gy in a regimen involving 1.8 Gy daily fractions. After the clinically less-successful interventional radiology procedures the adjuvant use of external irradiation led to significant reduction of the lesion volume and relief from clinical symptoms. Conclusion: Although rarely observed giant arteriovenous malformations are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller ones. In the cases, when complete surgical removal is impossible, embolisation, together with the focal fractionated radiotherapy plays the fundamental role today. These two techniques present the only opportunity for sufficient nidus obliteration. 113 poster Kasabach=merritt syndrome. Successful treatment with interferon alpha and radiotherapy
S. Hesselmann 7, O. Micke 1, T. Marquardt ~, S. Baas 2, J.H, Bramswig 2, E. Harms 2, N. Willich ~ University Hospital Muenster, Radiotherapy - Radiooncology, Muenster, Germany 2University Hospital Muenster, Pediatrics, Muenster, Germany Purpose: We describe the successful treatment of a neonate with Kasabach-Merritt syndrome who received local irradiation and interferon alpha therapy after failure of corticosteroid treatment. Patient and Method: A male neonate, born after an uneventful pregnancy had a huge hemangioma involving the upper right cervical region and severe thrombocytopenia. He was treated with corticosteroids, interferon alpha and radiotherapy. Prednisolone therapy (5 mg/kg/day) was started at 41 days of age. No therapeutic effect was observed after two weeks; the tumour size had increased dramatically, platelet counts had progressively decreased and coagulation abnormalities had developed. Because corticosteroid therapy had been ineffective and the child was in a life-threatening condition, irradiation was delivered up a total dose of 9,5 Gy in 5 fractions. Simultaneously, prednisolone therapy was slowly decreased and a therapy with interferon alpha therapy (3 million U/m2/day) was started and continued for 6 weeks. Results: After irradiation with 9,5 Gy and the beginning of an interferon alpha therapy, the tumour decreased in size and coagulation parameters normalized within 4 weeks. 6 months later, platelet counts and coagulation parameters were still normal. The tumour had further decreased in size. No acute severe sideeffects were observed. Conclusion: Radiation therapy combined with interferon alpha treatment are an alternative treatment modality when high dose corticoid steroid therapy has been ineffective in patients with Kasabach-Merritt syndrome despite the risks of growth delay and secondary malignancy. In children without response to
Posters
radiotherapy should be considered as a therapeutic option in patients with excessively large hemangiomas despite the possibility of untoward long-term sequelae. Since a biopsy was not performed, it can be speculated that radiotherapy reduced the vascularity of the hepatic hemangioma and decreased the enzymatic activity of the 3 iodothyronine deiodinase. 111 poster Gafchromic dosimetry
hs
radiochromic
films for
ivbt sources
C. Bianchi ~, C. Sampietro ~, R. Novario 7, R. Lorussoz, F. Tanzi ~, L. ~ C . Cappellim4, M. Caccia 4 ~Ospedale di Circolo e Fondazione Macchi, Medical Physics, Varese, Italy 2University of the Studies, Specialisation School in Medical Physics, Milan, Italy 3University of Insubria, Department of Medical Physics, Varese, /ta/y ~University of Insubria, Department of Physics, Como, Italy Following the prescriptions for QA of IVBT sources, defined in Task Group 60, we have obtained the DDC (Depth Dose Curve) and the azimuthal homogeneity for a IVBT source in a PMMA dedicated phantom with GC (GafChromic) HS (High Sensitivity) film dosimeters. The source is an active cylindrical steel seed, 2.5 mm long with an outer diameter of 0.64 mm, containing the Sr-90 isotope in the form of Strontium titanate ceramic. Such seeds are used to assemble 30, 40, 60 mm long interventional trains of the Novoste BetaCath System. The measurements were performed using GC HS. They are ideal for mapping dose distribution in high dose rate electron BT (BrachyTherapy), because of their high sensitivity and large dynamic range (0.540 Gy). They are also tissue equivalent, dose rate and energy independent (above 0,2 MeV). The DDC has been obtained sandwiching the source in PMMA phantoms of different thickness ranging from 1.7 to 7 mm and positioning the GC film between the proper phantom and the backscatter layer. The data shows a good agreement with Novoste measurements, performed with OPTIDOS, a scintillator based system. The azimuthal homogeneity was measured injecting the source in a set up allowing the GC to rotate around the catheter, co-axial to the system and embedded in the 1.7 mm thick PMMA phantom. The dose has been measured at 30 ° intervals and tha data are normalized to the value at 90 °. The results show a clear topbottom asymmetry at the 10% level, fully compatible with a gravitational fall of the source in the catheter. This work is a part of the SUCIMA (Silicon Ultra fast Cameras for electron and gamma sources In Medical Applications) project. SUCIMA is a project supported European Commission within the Fifth Framework. 112 poster Role of irradiation in complex treatment of giant abdominal and thoracic wall AVM
J. Had/iev 1'3, G. Horvath 3, G. Antal 1, L. Horvath 2, I. Repa ~ I University of Kaposvar, Institute of Diagnostic Imaging and Radiation Onco, Kaposvar, Hungary 2University of Pecs, Medical Faculty, Department of Radiology, Pecs, Hungary 3University of Pecs, Medical Faculty, Department of Radiation Oncology, Pecs, Hungary Objective and importance: Arteriovenous malformations (AVMs) present a common yet versatile clinical confront, through the potential "steal" phenomena and hemorrhage risks, aspects which are not sufficiently understood because of the great individuality of the cases. Over the years several new kinds of therapies have been incorporated into their complex treatment.
Clinical presentation: The patient had had no subjective symptoms fore 13 years since when the disease was first diagnosed and histologically proved. However, at the age of 35, he complained of severe dyspnea with exercise and was admitted for further examination. Diagnostic thoraco-abdominal angiography revealed a 39x25 cm lesion supplied by numerous arteries between the 8. right intercostal branch of the aorta and the right common femoral artery. Intervention: In 12 sessions microcatheter was periodically superselectively introduced into each of the feeding arteries and the AVM was treated primarily by transarterial embolization with polyvinyi-alcohol particles. Additional direct puncture embolization was performed in one session. Contrast-enhanced computerized tomography and angiography scanning were used for threedimensional imaging of the nidus and irradiation treatment planning. Fractionated radiotherapy was performed using a linear accelerator, body immobilization system, and orthogonal linacographic verification was performed weekly. The radiation dose was 32.4 Gy in a regimen involving 1.8 Gy daily fractions. After the clinically less-successful interventional radiology procedures the adjuvant use of external irradiation led to significant reduction of the lesion volume and relief from clinical symptoms. Conclusion: Although rarely observed giant arteriovenous malformations are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller ones. In the cases, when complete surgical removal is impossible, embolisation, together with the focal fractionated radiotherapy plays the fundamental role today. These two techniques present the only opportunity for sufficient nidus obliteration. 113 poster Kasabach=merritt syndrome. Successful treatment with interferon alpha and radiotherapy
S. Hesselmann 7, O. Micke 1, T. Marquardt ~, S. Baas 2, J.H, Bramswig 2, E. Harms 2, N. Willich ~ University Hospital Muenster, Radiotherapy - Radiooncology, Muenster, Germany 2University Hospital Muenster, Pediatrics, Muenster, Germany Purpose: We describe the successful treatment of a neonate with Kasabach-Merritt syndrome who received local irradiation and interferon alpha therapy after failure of corticosteroid treatment. Patient and Method: A male neonate, born after an uneventful pregnancy had a huge hemangioma involving the upper right cervical region and severe thrombocytopenia. He was treated with corticosteroids, interferon alpha and radiotherapy. Prednisolone therapy (5 mg/kg/day) was started at 41 days of age. No therapeutic effect was observed after two weeks; the tumour size had increased dramatically, platelet counts had progressively decreased and coagulation abnormalities had developed. Because corticosteroid therapy had been ineffective and the child was in a life-threatening condition, irradiation was delivered up a total dose of 9,5 Gy in 5 fractions. Simultaneously, prednisolone therapy was slowly decreased and a therapy with interferon alpha therapy (3 million U/m2/day) was started and continued for 6 weeks. Results: After irradiation with 9,5 Gy and the beginning of an interferon alpha therapy, the tumour decreased in size and coagulation parameters normalized within 4 weeks. 6 months later, platelet counts and coagulation parameters were still normal. The tumour had further decreased in size. No acute severe sideeffects were observed. Conclusion: Radiation therapy combined with interferon alpha treatment are an alternative treatment modality when high dose corticoid steroid therapy has been ineffective in patients with Kasabach-Merritt syndrome despite the risks of growth delay and secondary malignancy. In children without response to