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121P CLINICAL EVALUATION OF A NOVEL 4D IN-VIVO DOSIMETRY SYSTEM FOR LUNG CANCER RADIOTHERAPY
Early and locally advanced NSCLC 121P CLINICAL EVALUATION OF A NOVEL 4D IN-VIVO DOSIMETRY SYSTEM FOR LUNG CANCER RADIOTHERAPY G. Perry1 , A. Cherpak2 , J.E. Cygler2 , S. Andrusyk3 , J. Panarotto1 , R. Macrae1 , C. Lochrin1 1 Radiation Oncology, The Ottawa Hospital Cancer Center, Ottawa, Canada, 2 Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Canada, 3 Radiation Therapy, The Ottawa Hospital Cancer Centre, Ottawa, Canada Background: A novel 4D dosimetry system called RADPOS has recently been developed and is in use at The Ottawa Hospital Cancer Centre as part of a clinical trial to determine its potential for use in external beam treatment for lung cancer patients. The RADPOS combines a MOSFET dosimeter with an electromagnetic positioning sensor to allow for simultaneous measurement of dose and spatial coordinates at a specific location. The probe is small (1.3 mm diameter) and it can be used either on patient skin or inside natural body cavities. The RADPOS system can be used on patients as a real time treatment verification tool providing immediate feedback about patient motion and the accuracy of the delivered dose. Preliminary tests have shown that the RADPOS has dosimetric characteristics similar to microMOSFET detectors, when used alone. The system can measure displacement with an accuracy of (0.75±0.07) mm for total displacements up to 200 mm. The stability of the RADPOS position readout is within 0.21±0.07 mm and is not affected by the linac beam. Aluminum, brass, steel and lead were the only materials of those tested that caused significant interference with this accuracy. Methods: The clinical trial involves lung cancer patients treated with external beam radiotherapy. Four RADPOS detectors are positioned at marked points on the patients’ abdomen during an initial 4DCT and subsequent treatment fractions. Position coordinates of the sensors are read in real time at a rate of 20 25 Hz and total dose is read at the end of each fraction. Amplitude and period of the breathing motion are analyzed and compared to determine deviation from initial breathing patterns measured during the 4DCT. Results: Results show that the RADPOS system can be set-up quickly, requiring minimal additional time for each scheduled treatment fraction. The RADPOS measured breathing pattern agrees very well with the simultaneous measurement done with the Philips Bellows System and Varian RPM systems. When used to measure simulated breathing motion on a 4D Quasar phantom, the RADPOS-measured amplitude was within 0.2 mm of measurements made by the Philips Bellows System. Conclusions: In conclusion, the RADPOS provides sufficient information to identify changes in the patients breathing pattern and other patient motion. 122P ENDOBRONCHIAL RADIOTHERAPY IN THE TREATMENT OF TRACHEA MALIGNANT TUMORS A.V. Chernichenko1 , A. Boiko1 , I. Mescheryakova1 , V. Sokolov2 1 Radiotherapy, P.A. Gertsen Oncological Research Institute, Moscow, Russian Federation, 2 Endoscopy, P.A. Gertsen Oncological Research Institute, Moscow, Russian Federation Background: Radiotherapy is almost the only one means of treatment for patients with primary and recurrent trachea cancer because of limited possibilities for surgical treatment. Its summary doses in case of external beam radiation (EBT) cannot be more than 60 Gy. And this doesn’t provide the full tumor regression and have only palliative effect. Perspectives of oncological results improvement are connected with the use of complex external and endobronchial radiotherapy (ERT). Methods: Our experience includes 32 patients with the trachea cancer, age 17 69 years. Primary trachea cancer 25 cases, patients with recurrent trachea cancer after surgical, combined and X-ray
S51 treatment 7 cases. 25 patients with primary trachea cancer had tumor extend 3.5 9.5 cm with the depth side invasion of 1.5 cm. From this amount 17 patients had extend on one or two main bronchies. 15 patients from 25 had trachea stenosis of the third level and this required laser destruction (LD) for lung ventilation and possibility of endostat installation. Results: Depending on clinical situation successiveness of EBT, ERT and LD was different. All patients with primary trachea cancer had been provided with combined (EBT+ERT) radiotherapy. Summary doses of external treatment were 50 60 Gy, summary doses of ERT 28 35 Gy (7 Gy per week). At the present days from 25 patients of primary trachea cancer 18 patients are alive without recurrent in follow up period of 3 12 years. EBT was provided in 40 60 Gy dose to 5 patients from 7 with recurrent trachea cancer in the past periods of treatment. Possibilities for X-ray therapy in these cases were limited or impossible completely. only ERT 35 Gy. 3 patients received combined treatment, 4 5 patients from 7 are alive without recurrent in follow up period of 2 5 years. Conclusions: We find ourselves in a position of the maximum realization of radiotherapy treatment possibilities. It is our opinion that success of ERT method first of all depends from adequacy the treatment volume and definition of the reference point. In cases of above mentioned category of patients, started treatment as an attempt of palliative help, thanks to ERT we have managed to provide radical therapy. Such strategy allowed us to achieve stable and durable remission with the majority of our patients.
123P BORDERLINE RESECTIONS AFTER NEO-ADJUVANT TREATMENT: SLEEVE LOBECTOMY VS. PNEUMONECTOMY A. Toker1 , B. Ozkan1 , S. Tanju1 , S. Ziyade1 , M. Erelel2 , E. Kaytan Saglam3 , Y. Eralp4 , S. Dilege1 , A. Aydıner4 1 Department of Thoracic Surgery, Istanbul University, Istanbul, Turkey, 2 Pulmonary Department, Istanbul University, Istanbul, Turkey, 3 Radiation Oncology, Institute of Oncology, Istanbul, Turkey, 4 Medical Oncology, Istanbul University, Oncology Institute, Istanbul, Turkey Background: Comparing the bronchoplastic procedures and pneumonectomy operations after neo-adjuvant chemotherapy, with or without irradiation. Methods: 40 patients (pts) underwent surgery (16 pts bronchial +/ vascular sleeve resections and 24 pneumonectomies) after neoadjuvant chemoradiotherapy or chemotherapy from January 2002 to August 2008. Eight pts received preoperative cisplatin based chemotherapy, and Eight pts has received chemo-radiation therapy (46 Gy/23 fr) in sleeve resection group (Group I). 19 patients with pneumonectomy (Group II) have received adjuvant chemotherapy and 5 patients received adjuvant chemoradiotherapy. Perioperative morbidity, mortality and survival were compared between Group I and Group II. Technically all stumps and anastomosis were covered with viable tissues and intercostal muscle fleps in chemoradiotherapy patients Results: There were no postoperative deaths in Group I but 3 (12.5%) mortalities in Group II. A major perioperative complication occurred in 6 pts (37.5%) of Group I and 11 patients of Group II (45.8%). Anastomotic dehiscence or pleural empyema were not observed in Group I. Stump fistula was not occurred in Group II. There is no statistically significant difference in complications and mortality between the two groups of patients. Complete resection rate was high in both groups (87.5% in Group I and 83.4% in Group II). The extent of nodal dissection was similar between sleeve resections and pneumonectomy pts. Median and mean survival was calculated to be 30 months and 27±4 months in Group I and 18 months and 22±3 months in Group II.
S51 treatment 7 cases. 25 patients with primary trachea cancer had tumor extend 3.5 9.5 cm with the depth side invasion of 1.5 cm. From this amount 17 patients had extend on one or two main bronchies. 15 patients from 25 had trachea stenosis of the third level and this required laser destruction (LD) for lung ventilation and possibility of endostat installation. Results: Depending on clinical situation successiveness of EBT, ERT and LD was different. All patients with primary trachea cancer had been provided with combined (EBT+ERT) radiotherapy. Summary doses of external treatment were 50 60 Gy, summary doses of ERT 28 35 Gy (7 Gy per week). At the present days from 25 patients of primary trachea cancer 18 patients are alive without recurrent in follow up period of 3 12 years. EBT was provided in 40 60 Gy dose to 5 patients from 7 with recurrent trachea cancer in the past periods of treatment. Possibilities for X-ray therapy in these cases were limited or impossible completely. only ERT 35 Gy. 3 patients received combined treatment, 4 5 patients from 7 are alive without recurrent in follow up period of 2 5 years. Conclusions: We find ourselves in a position of the maximum realization of radiotherapy treatment possibilities. It is our opinion that success of ERT method first of all depends from adequacy the treatment volume and definition of the reference point. In cases of above mentioned category of patients, started treatment as an attempt of palliative help, thanks to ERT we have managed to provide radical therapy. Such strategy allowed us to achieve stable and durable remission with the majority of our patients.
123P BORDERLINE RESECTIONS AFTER NEO-ADJUVANT TREATMENT: SLEEVE LOBECTOMY VS. PNEUMONECTOMY A. Toker1 , B. Ozkan1 , S. Tanju1 , S. Ziyade1 , M. Erelel2 , E. Kaytan Saglam3 , Y. Eralp4 , S. Dilege1 , A. Aydıner4 1 Department of Thoracic Surgery, Istanbul University, Istanbul, Turkey, 2 Pulmonary Department, Istanbul University, Istanbul, Turkey, 3 Radiation Oncology, Institute of Oncology, Istanbul, Turkey, 4 Medical Oncology, Istanbul University, Oncology Institute, Istanbul, Turkey Background: Comparing the bronchoplastic procedures and pneumonectomy operations after neo-adjuvant chemotherapy, with or without irradiation. Methods: 40 patients (pts) underwent surgery (16 pts bronchial +/ vascular sleeve resections and 24 pneumonectomies) after neoadjuvant chemoradiotherapy or chemotherapy from January 2002 to August 2008. Eight pts received preoperative cisplatin based chemotherapy, and Eight pts has received chemo-radiation therapy (46 Gy/23 fr) in sleeve resection group (Group I). 19 patients with pneumonectomy (Group II) have received adjuvant chemotherapy and 5 patients received adjuvant chemoradiotherapy. Perioperative morbidity, mortality and survival were compared between Group I and Group II. Technically all stumps and anastomosis were covered with viable tissues and intercostal muscle fleps in chemoradiotherapy patients Results: There were no postoperative deaths in Group I but 3 (12.5%) mortalities in Group II. A major perioperative complication occurred in 6 pts (37.5%) of Group I and 11 patients of Group II (45.8%). Anastomotic dehiscence or pleural empyema were not observed in Group I. Stump fistula was not occurred in Group II. There is no statistically significant difference in complications and mortality between the two groups of patients. Complete resection rate was high in both groups (87.5% in Group I and 83.4% in Group II). The extent of nodal dissection was similar between sleeve resections and pneumonectomy pts. Median and mean survival was calculated to be 30 months and 27±4 months in Group I and 18 months and 22±3 months in Group II.