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120Comparision between plato isodose distribution of a 192 Ir source and those simulated with geant4 toolkit
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intraluminal irradiation (Irt) with pure palliative intend only; 142 patients underwent intraluminal (Irt) and external (ERt) irradiation. At first our aim was to provide lasting palliation with a moderate dose (MRtgroup), later we increased the dose of radiotherapy with a "curative intend" (HRt-group). A number of patients in the HRt-group additionally received cisplatin as a radiosensitizer (CPt). Mean age was 67 years (33-88), 71% male, 61% adenoca, 81% T3 or T4, 73% nodal involvement and 15% extension into the cardia. Mean tumour length 8 cm (6-22). The MRt-group received 10 Gy IRt and 30-40 Gy ERr, 2-3 Gy per fraction; in the HRT-group 10-15Gy IRt, 2 fractions, and 50-60 Gy ERt, 2 Gy per fraction. 26 patients received cisplatin with the first 10-15 fractions of ERt. At 6, 12, 18 and 24 months resp. 54, 25, 17 and 4% of the MRt-patients, 65, 29, 16 and 16% of the HRt-patients, and 92, 56, 28 and 28% of the CPt-patients are alive (p=0.02). Neither gender, pathology nor extension into the cardia influenced survival. Within the HRt-group patients receiving cisplatin ahd a superior survival (p=0.05). Multivariate analysis for survival-duration showed the addition of cisplatin as radiosensitizer to high close radiotherapy and the biological equivalent dose (BED) to be the only independent significant factor. Conclusion: high dose radiotherapy, IRt+ERt, results in a good palliation and the addition of cisplatin as a radiosensitiser improves results.
respectively. Locoregional recurrences developed in 8 pts and metastases developed in 6 pts. With a median follow-up of 121 months, 23 pts died. The cause of death was bladder cancer in 11 pts, whereas 2 patients died of a second primary and 7 of nonmalignant disease. The 5 and 10-year overall survival were 61% and 43%, respectively. Acute complications were seen in 25 pts and a total of 19 late complications (all grade) were recorded. One factor was significantly predictive of late complications: the preoperative radiotherapy dose: median 16 Gy (p=0.03), the other factors were not significant in univariate analysis. Conclusion: BT in combination with TRU and EBRT yields a high probability of bladder preservation, a rigorous selection of patients is needed to improve local control.
117
Introduction: recurrent benign hyperplasia is a complication occurring in patients after lung transplantation. Exophytic granulation tissue can partially or completely occlude the airways requiring multiple bronchoscopic laser treatment, stenting or dilation. These therapeutic approach obtain symptomatic relief, but also cause a continuous inflammatory response thus perpetuating granulation tissue formation and stenosis relapse which occur in 10 to 50% of cases. The anti-inflammatory effects of radiotherapy are well known and could be useful in the treatment of benign hyperplasia. Material and meethods: from November 1999 to April 2000, 3 patients with recurrent benign hyperplasia underwent endobronchial HDR-BT for a total of 5 courses of therapy. Patient 1 received a single course of HDR-BT (9 Gy in 3 fractions in 3 weeks), patient 2 received 2 courses of therapy, one in the right and one in the left transplanted bronchi, and patient 3 received two courses of therapy in the same bronchi, four months apart, due to hyperplasia relapse. Results: patient 1 obtained a CR, but died due to infectious pneumonitis and acute myocardial infarction 2 mths after completion of therapy. Patient 2 obtained a CR, in both treated sites, still lasting for 10 mths. Patient 3 obtained a PR after the first treatment and a further improvement after the second treatment and has not required any further treatment for the past 11 mths. No side effects related to HDR-BT treatment were reported. Conclusions: HDR-BT can successfully and safely treat recurrent benign hyperplasia in transplant bronchi.
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The American Brachytherapy Society Recommendations for brachytherapy of s o f t tissue sarcoma S. Naq, D. Shasha, N. Janjan, I. Petersen, M. Zaider The American Brachytherapy Society, Oakbrook, IL, USA Purpose: this report presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with soft tissue sarcoma. Methods: members of the ABS with expertise in soft tissue sarcoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. Results: brachytherapy used alone or in combination with external beam irradiation is an established means of safely providing adjuvant local treatment after resection for soft tissue sarcomas in adults and in children. Brachytherapy options include low dose rate techniques with iridium-192 or iodine-125, fractionated high dose rate brachytherapy, or intraoperative high dose rate therapy. Recommendations are made for patient selection, techniques, dose rates, and dosages. Complications and possible interventions to minimize their occurrence and severity are reviewed. Conclusion: brachytherapy represents an effective means of enhancing the therapeutic ratio, offering both biologic and dosimetric advantage in the treatment of patients with soft tissue sarcoma. The treatment approach used depends upon the institution, physician expertise, and the clinical situation. Guidelines are established for the use of brachytherapy in the treatment of soft tissue sarcomas in adults and in children. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose reporting policies. These guidelines will be modified, as further clinical results become available. 118 poster I n t e r s t i t i a l b r a c h y t h e r a p y w i t h I r i d i u m 192 in the treatment of
bladder cancer K. Khanfir. S. Koscielny. M. Delapierre, B. Court, R. de Crevoisier, C. Breton-Callu, P. Wibault, A. Gerbaulet, C. Haie-Meder Institut Gustave Roussy, 94805 Villejuif, France Purpose: retrospective analysis of a series of patients treated by conservative surgery and interstitial brachytherapy (BT) using Iridium-192. Methods and materials: from December 1974 until October 1999, 46 patients (pts) with primary muscle invasive bladder cancer were treated with a combination of transurethral resection (TUR), preoperative external beam irradiation (EBRT) median dose 10 Gy (5-17) followed by lilac node dissection, limited partial cystectomy or cystotomy and brachytherapy. Characteristics of the population was: 41 men, 5 women, median age 62 years (2375). T1 was found in 14 pts (30%), T2a in 14 pts (30%), T2b in 7 pts (15%), T3a in 10 pts (22%) and unclassified in one patient. BT was performed using the plastic tube technique, secondarily loaded with iridium 192. The median radioactive line number was 2 (2 - 5). The median radioactive length was 10.5cm (6.5-21.5). The median delivered dose according to the rules of the Paris system was 60 Gy (25-76.5) at a median dose rate of 0.37 Gy/h. The median treated volume was 10.75 cm = (1.09-34.94). Results: Fifteen patients developed a bladder relapse, of which 9 were in field relapses (19.5%) and 6 (13%) were new bladder tumors. Of these, 4 pts underwent a total cystectomy. The bladder was preserved in 87% of the surviving patients. Local control rate at 5 and 10 years was 60% and 55%,
119
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Endobronchial high dose rate brachytherapy ( H D R - B T ) in the treatment of recurrent benign hyperplasia in l u n g transplant bronchi. Results of therapy in 3 patients R. Mazzarotto F. Rea 1, M. Loy 1, F. Sartori I, G. Di Vittorio 2, U. Fantoni2, A. Palamidese 2, G. Sotti 1Department of Radiotherapy, Thoracic surgery and 2pneumology Azienda Ospedaliera di Padova and Padova University - Padova - Italy
120
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Comparision between plato isodose distribution of a 192 Ir source and those simulated with geant4 t o o l k i t F. Foooiano 1, S. Agostinelli2, S. Garelli 1, G. Paoli 1, M. Bevegni 1. M.G. Pia 3, P. Franzone 4, T. Scolaro 4 1National Institute for Cancer Research, Medical Physics, Genova, Italy 21NFM, Genova, Italy 31NFN, Genova, Italy 4National Institute for Cancer Research, Radiotherapy Oncology, Genova, Italy A powerful and suitable tool for attacking the problem of the production and transport of different beams in biological matter and in other situations is offered by the simulation with Monte Carlo procedures. The Geant4 object oriented simulation toolkit is a general-purpose code, which allows particles tracing with any geometry and unhomogeneity and implements a variety of physical processes dominant in the energy range used in medical applications. In particular, the new low energy extensions of electromagnetic interactions are relevant in the domain of medical simulations. We considered the possibility to use the Geant4 toolkit in the field of brachytherapy applications and in particular with the MicroSelectron HDR Iridium source installed at the National Cancer Institute of Genova. As preliminary test of the use of the toolkit itself we simulate attenuation coefficient and stopping power in different material of interest and in the energy range of 10 keV and 1 MeV both with the Geant4 standard and with the low energy extenuation. These values are compared with that tabulated NIST ones. For what concern the brachytherapy application of the toolkit we simulate the iridium source dose deposition in water with the geometry specified by vendor and an energy of 356 keV (mean energy of iridium source). The simulated source is placed in a 30 cm water box and the dose deposition is
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intraluminal irradiation (Irt) with pure palliative intend only; 142 patients underwent intraluminal (Irt) and external (ERt) irradiation. At first our aim was to provide lasting palliation with a moderate dose (MRtgroup), later we increased the dose of radiotherapy with a "curative intend" (HRt-group). A number of patients in the HRt-group additionally received cisplatin as a radiosensitizer (CPt). Mean age was 67 years (33-88), 71% male, 61% adenoca, 81% T3 or T4, 73% nodal involvement and 15% extension into the cardia. Mean tumour length 8 cm (6-22). The MRt-group received 10 Gy IRt and 30-40 Gy ERr, 2-3 Gy per fraction; in the HRT-group 10-15Gy IRt, 2 fractions, and 50-60 Gy ERt, 2 Gy per fraction. 26 patients received cisplatin with the first 10-15 fractions of ERt. At 6, 12, 18 and 24 months resp. 54, 25, 17 and 4% of the MRt-patients, 65, 29, 16 and 16% of the HRt-patients, and 92, 56, 28 and 28% of the CPt-patients are alive (p=0.02). Neither gender, pathology nor extension into the cardia influenced survival. Within the HRt-group patients receiving cisplatin ahd a superior survival (p=0.05). Multivariate analysis for survival-duration showed the addition of cisplatin as radiosensitizer to high close radiotherapy and the biological equivalent dose (BED) to be the only independent significant factor. Conclusion: high dose radiotherapy, IRt+ERt, results in a good palliation and the addition of cisplatin as a radiosensitiser improves results.
respectively. Locoregional recurrences developed in 8 pts and metastases developed in 6 pts. With a median follow-up of 121 months, 23 pts died. The cause of death was bladder cancer in 11 pts, whereas 2 patients died of a second primary and 7 of nonmalignant disease. The 5 and 10-year overall survival were 61% and 43%, respectively. Acute complications were seen in 25 pts and a total of 19 late complications (all grade) were recorded. One factor was significantly predictive of late complications: the preoperative radiotherapy dose: median 16 Gy (p=0.03), the other factors were not significant in univariate analysis. Conclusion: BT in combination with TRU and EBRT yields a high probability of bladder preservation, a rigorous selection of patients is needed to improve local control.
117
Introduction: recurrent benign hyperplasia is a complication occurring in patients after lung transplantation. Exophytic granulation tissue can partially or completely occlude the airways requiring multiple bronchoscopic laser treatment, stenting or dilation. These therapeutic approach obtain symptomatic relief, but also cause a continuous inflammatory response thus perpetuating granulation tissue formation and stenosis relapse which occur in 10 to 50% of cases. The anti-inflammatory effects of radiotherapy are well known and could be useful in the treatment of benign hyperplasia. Material and meethods: from November 1999 to April 2000, 3 patients with recurrent benign hyperplasia underwent endobronchial HDR-BT for a total of 5 courses of therapy. Patient 1 received a single course of HDR-BT (9 Gy in 3 fractions in 3 weeks), patient 2 received 2 courses of therapy, one in the right and one in the left transplanted bronchi, and patient 3 received two courses of therapy in the same bronchi, four months apart, due to hyperplasia relapse. Results: patient 1 obtained a CR, but died due to infectious pneumonitis and acute myocardial infarction 2 mths after completion of therapy. Patient 2 obtained a CR, in both treated sites, still lasting for 10 mths. Patient 3 obtained a PR after the first treatment and a further improvement after the second treatment and has not required any further treatment for the past 11 mths. No side effects related to HDR-BT treatment were reported. Conclusions: HDR-BT can successfully and safely treat recurrent benign hyperplasia in transplant bronchi.
poster
The American Brachytherapy Society Recommendations for brachytherapy of s o f t tissue sarcoma S. Naq, D. Shasha, N. Janjan, I. Petersen, M. Zaider The American Brachytherapy Society, Oakbrook, IL, USA Purpose: this report presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with soft tissue sarcoma. Methods: members of the ABS with expertise in soft tissue sarcoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. Results: brachytherapy used alone or in combination with external beam irradiation is an established means of safely providing adjuvant local treatment after resection for soft tissue sarcomas in adults and in children. Brachytherapy options include low dose rate techniques with iridium-192 or iodine-125, fractionated high dose rate brachytherapy, or intraoperative high dose rate therapy. Recommendations are made for patient selection, techniques, dose rates, and dosages. Complications and possible interventions to minimize their occurrence and severity are reviewed. Conclusion: brachytherapy represents an effective means of enhancing the therapeutic ratio, offering both biologic and dosimetric advantage in the treatment of patients with soft tissue sarcoma. The treatment approach used depends upon the institution, physician expertise, and the clinical situation. Guidelines are established for the use of brachytherapy in the treatment of soft tissue sarcomas in adults and in children. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose reporting policies. These guidelines will be modified, as further clinical results become available. 118 poster I n t e r s t i t i a l b r a c h y t h e r a p y w i t h I r i d i u m 192 in the treatment of
bladder cancer K. Khanfir. S. Koscielny. M. Delapierre, B. Court, R. de Crevoisier, C. Breton-Callu, P. Wibault, A. Gerbaulet, C. Haie-Meder Institut Gustave Roussy, 94805 Villejuif, France Purpose: retrospective analysis of a series of patients treated by conservative surgery and interstitial brachytherapy (BT) using Iridium-192. Methods and materials: from December 1974 until October 1999, 46 patients (pts) with primary muscle invasive bladder cancer were treated with a combination of transurethral resection (TUR), preoperative external beam irradiation (EBRT) median dose 10 Gy (5-17) followed by lilac node dissection, limited partial cystectomy or cystotomy and brachytherapy. Characteristics of the population was: 41 men, 5 women, median age 62 years (2375). T1 was found in 14 pts (30%), T2a in 14 pts (30%), T2b in 7 pts (15%), T3a in 10 pts (22%) and unclassified in one patient. BT was performed using the plastic tube technique, secondarily loaded with iridium 192. The median radioactive line number was 2 (2 - 5). The median radioactive length was 10.5cm (6.5-21.5). The median delivered dose according to the rules of the Paris system was 60 Gy (25-76.5) at a median dose rate of 0.37 Gy/h. The median treated volume was 10.75 cm = (1.09-34.94). Results: Fifteen patients developed a bladder relapse, of which 9 were in field relapses (19.5%) and 6 (13%) were new bladder tumors. Of these, 4 pts underwent a total cystectomy. The bladder was preserved in 87% of the surviving patients. Local control rate at 5 and 10 years was 60% and 55%,
119
poster
Endobronchial high dose rate brachytherapy ( H D R - B T ) in the treatment of recurrent benign hyperplasia in l u n g transplant bronchi. Results of therapy in 3 patients R. Mazzarotto F. Rea 1, M. Loy 1, F. Sartori I, G. Di Vittorio 2, U. Fantoni2, A. Palamidese 2, G. Sotti 1Department of Radiotherapy, Thoracic surgery and 2pneumology Azienda Ospedaliera di Padova and Padova University - Padova - Italy
120
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Comparision between plato isodose distribution of a 192 Ir source and those simulated with geant4 t o o l k i t F. Foooiano 1, S. Agostinelli2, S. Garelli 1, G. Paoli 1, M. Bevegni 1. M.G. Pia 3, P. Franzone 4, T. Scolaro 4 1National Institute for Cancer Research, Medical Physics, Genova, Italy 21NFM, Genova, Italy 31NFN, Genova, Italy 4National Institute for Cancer Research, Radiotherapy Oncology, Genova, Italy A powerful and suitable tool for attacking the problem of the production and transport of different beams in biological matter and in other situations is offered by the simulation with Monte Carlo procedures. The Geant4 object oriented simulation toolkit is a general-purpose code, which allows particles tracing with any geometry and unhomogeneity and implements a variety of physical processes dominant in the energy range used in medical applications. In particular, the new low energy extensions of electromagnetic interactions are relevant in the domain of medical simulations. We considered the possibility to use the Geant4 toolkit in the field of brachytherapy applications and in particular with the MicroSelectron HDR Iridium source installed at the National Cancer Institute of Genova. As preliminary test of the use of the toolkit itself we simulate attenuation coefficient and stopping power in different material of interest and in the energy range of 10 keV and 1 MeV both with the Geant4 standard and with the low energy extenuation. These values are compared with that tabulated NIST ones. For what concern the brachytherapy application of the toolkit we simulate the iridium source dose deposition in water with the geometry specified by vendor and an energy of 356 keV (mean energy of iridium source). The simulated source is placed in a 30 cm water box and the dose deposition is