- Email: [email protected]
125I in prostate cancer
114
Radiation
Oncology,
Biology, Physics
Volume 24, Supplement
this favored subgroup still have pathologically documented residual transitional cell carcinoma therapy even in complete responding patients by surgery or external radiotherapy is warranted.
1
in the cystectomy
specimen.
Thus additional
Major improvements in the clinical complete response rates of the primary tumor have been reported with chemo-radiotherapy (@I-90%). Selecting for full chemo-radiotherapy only patients having complete response to the initial chemotherapy and/or to 4000-4500 cGy radiotherapy may further increase the success of bladder preserving programs and not compromise survival (relative to immediate cystectomy) but this is not as yet proven. Information from several institutional as well as RTGG trials will be reviewed. Clinical histopathologic and DNA flow cytometric features will be reviewed as possible significant prognostic factors to bladder preservation by chemo-radiotherapy. There is as yet no proven benefit to neoadjuvant systemic multi-drug chemotherapy. Proof of possible efficacy of the neoadjuvant multi-drug chemotherapy in curing subclinical systemic disease and/or improving bladder preservation by chemo-radiotherapy must await the results of ongoing randomized trials. Caution is necessary in recommending new treatment regimens outside of clinical trials.
505 CLINICAL
BRACHYTHERAPY
Louis B. Harrison, Memorial
M.D. and Baldassarre
Sloan-Kettering
Stea, M.D., Ph.D.
Cancer Center, New York, New York
Brachytherapy is a method of delivering radiation therapy directly into a tumor volume, with maximal sparing of adjacent normal structures. Because of the potential for an improved therapeutic ratio, this modality is gaining increasing importance in clinical oncology. Applications for brachytherapy are increasing, and the number of radiation oncologists who are skilled in this area is also increasing. In this refresher course, we will discuss techniques, treatment delivery and results for brachytherapy in a variety of tumors. In head and neck cancer, we will discuss brachytherapy for nasopharyngeal cancer, tongue cancer, and local recurrences at various Iridium-192, Iodine-125, Palladium-103 will be mentioned, and many clinical examples will be shown to demonstrate technique and results. For soft tissue sarcoma, the prospective randomized brachytherapy of clinical examples will illustrate both technique and treatment outcome.
trial from Memorial
Sloan-Kettering
will be discussed.
There will be a brief discussion of inua-operative radiation, specifically to introduce a new method of delivering remote afterloader. Potential applications in GI cancer, sarcomas and liver tumors will be discussed.
sites.
Extensive
use
IORT via a high dose rate
Finally, we will discuss patient selection, stereotactic implantation techniques, results obtained using this technique and morbidity associated with brachytherapy of brain tumors. Drawing from our own experience, we will present the results of our phase I-II trial of interstitial thermoradiotherapy of high grade gliomas where hyperthennia was induced with ferromagnetic implants. The survival of this group of patients will be compared with that of a matched group of patients who were treated in a non-randomized trial with an interstitial implant but no hyperthermia.
506 TREATMENT
OF SALIVARY
Peter J. Fitzpatrick, Deparmrent
GLAND
MALIGNANCIES
M.B., B.S.
of Radiation
Oncology,
Dalhousie
University
and Cancer Treatment
& Research
Foundation
of Nova Scotia
The salivary glands are divided into two groups - major and minor. The major glands which are paired are the parotid, submandibular and sublingual. The minor salivary glands consist of more than 700 small glands situated in the mucosa of the upper digestive and respiratory tracts. Their function is to produce saliva which aids in the lubrication and digestion of food. Tumours of the salivary glands are uncommon with an overall incidence of approximately one per 100,000 and comprising 3% of all epithelial head and neck cancers. The first symptom is usually a painless lump and over 80% of tumours occur in the parotid and of these 20% are malignant. Approximately 10% develop in the submandibular gland of which 50% are malignant. Sublingual tumours are uncommon as are those of the minor salivary glands.
relatively
Both the clinical and histological diagnosis can be difficult and even benign lesions are prone to recurrence. insidious but some will prove fatal from distant metastases many years later.
Most malignant
tumours
are
Proceedings of the 34th Annual ASTRO Meeting
115
Overall, from among 271 patients with parotid tumours the 5 and IO-year actuarial and cause-specific survival rates were 59 and 43% and 65 and 57% respectively. In a study of 91 patients with submaxillary tumours the 5- and IO-year actuarial and cause-specific survival rates were 62% and 49% and 49% and 35% respectively. The outcome for the various histologic subtypes stratified by different treatments will be presented. Also, the various prognostic factors including age, sex, duration of symptoms, size of primary tumour, the presence of regional and distant metastases. fixation. histologv. and treatment will be reviewed for significance both independently and through a multivariate analysis. Surgical excision is the primary trea;h;ent for most turnouts but radiotherapy-has an important roie in the adjuvant set&g and in palliation. -The place of radiotherapy, technique and dose, in radical and palliative treatment will be discussed.
507 HODGKIN’S DISEASE Nancy Price Mendenhall, M.D. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida This refresher course will present an overview of Hodgkin’s disease in 1992, a detailed description of the treatment technique employed at the University of Florida, and a discussion of management issues in patients with low, intermediate, high-risk, and recurrent disease based on prognostic factors and rates of relapse-free survival, overall survival, and cause-specific survival. Treatment morbidity from both radiation therapy and chemotherapy will be reviewed. The issues of optimal radiation dose, elective pelvic irradiation, and elective lung irradiation will also be discussed.
508 ‘=I IN PROSTATE CANCER Kent Wallner, M.D. Memorial Sloan-Kettering Cancer Center, Dept. of Radiation Oncology, 1275 York Avenue, New York, NY 10021 Radioactive implants have been used extensively for treatment of early stage prostate cancer. In general, their use has been associated with fewer side effects than surgery or external beam irradiation. Local control has generally been comparable to that achieved with the other modalities. Lower tumor control rates in some early series probably were related to inaccurate placement of radioactive pellets, since the older procedures were subject to substantial operator error. In this lecture, the radiobiologic and physical rationale for prostate brachytherapy will be presented. Available isotopes, rationale for permanent versus temporary implants, and criteria for patient selection will be discussed. Long-term results from retropubic implantation will be reviewed. Particular emphasis will be placed on the practical aspects of newer, transperineal techniques. The advantages of CT- or ultrasoundguided transperineal techniques will be discussed in detail, with a summary of early results from several centers.
509 RESULTS OF THE BRAIN TUMOR STUDY GROUP Melvin Deutsch, M.D. Department of Radiation Oncology, University of Pittsburgh Since 1966 the Brain Tumor Cooperative Group (BTCG), previously known as the Brain Tumor Study Group (BTSG), has completed eight randomized clinical trials evaluating radiotherapy and chemotherapy for newly diagnosed previously untreated supratentorial malignant glioma in adults. The first three trials (66-01,69-01,72-Ol), initiated in 1966, 1969 and 1972 respectively, demonstrated improved survival duration with radiotherapy versus supportive care alone or chemotherapy. These early studies also demonstrated an improvement in survival duration with increasing doses of whole brain irradiation up to 6,000 cGy. Three trials, 69-01, 72-01, 75-01, involved comparisons of radiotherapy versus radiotherapy and chemotherapy. In 75-01, the radiotherapy arm received prescribed high dose Methylprednisolone. There was no significant difference in survival between radiation alone and radiation and chemotherapy in trial 69-01. In 72-01, there was a trend for improved survival with radiation and BCNU versus radiation alone. In 75-01, patients receiving radiation and chemotherapy (either BCNU or Procarbazine) had a statistically significant improvement in survival duration compared to patients receiving radiation and corticosteroids. In all studies, there was an increased survival rate at 18 and 24 months in patients receiving radiation and chemotherapy versus radiation alone. Study 77-01 evaluated pre-op radiotherapy and BCNU versus postoperative radiotherapy and BCNU. There was no statistically significant difference in outcome. Study 77-02
Radiation
Oncology,
Biology, Physics
Volume 24, Supplement
this favored subgroup still have pathologically documented residual transitional cell carcinoma therapy even in complete responding patients by surgery or external radiotherapy is warranted.
1
in the cystectomy
specimen.
Thus additional
Major improvements in the clinical complete response rates of the primary tumor have been reported with chemo-radiotherapy (@I-90%). Selecting for full chemo-radiotherapy only patients having complete response to the initial chemotherapy and/or to 4000-4500 cGy radiotherapy may further increase the success of bladder preserving programs and not compromise survival (relative to immediate cystectomy) but this is not as yet proven. Information from several institutional as well as RTGG trials will be reviewed. Clinical histopathologic and DNA flow cytometric features will be reviewed as possible significant prognostic factors to bladder preservation by chemo-radiotherapy. There is as yet no proven benefit to neoadjuvant systemic multi-drug chemotherapy. Proof of possible efficacy of the neoadjuvant multi-drug chemotherapy in curing subclinical systemic disease and/or improving bladder preservation by chemo-radiotherapy must await the results of ongoing randomized trials. Caution is necessary in recommending new treatment regimens outside of clinical trials.
505 CLINICAL
BRACHYTHERAPY
Louis B. Harrison, Memorial
M.D. and Baldassarre
Sloan-Kettering
Stea, M.D., Ph.D.
Cancer Center, New York, New York
Brachytherapy is a method of delivering radiation therapy directly into a tumor volume, with maximal sparing of adjacent normal structures. Because of the potential for an improved therapeutic ratio, this modality is gaining increasing importance in clinical oncology. Applications for brachytherapy are increasing, and the number of radiation oncologists who are skilled in this area is also increasing. In this refresher course, we will discuss techniques, treatment delivery and results for brachytherapy in a variety of tumors. In head and neck cancer, we will discuss brachytherapy for nasopharyngeal cancer, tongue cancer, and local recurrences at various Iridium-192, Iodine-125, Palladium-103 will be mentioned, and many clinical examples will be shown to demonstrate technique and results. For soft tissue sarcoma, the prospective randomized brachytherapy of clinical examples will illustrate both technique and treatment outcome.
trial from Memorial
Sloan-Kettering
will be discussed.
There will be a brief discussion of inua-operative radiation, specifically to introduce a new method of delivering remote afterloader. Potential applications in GI cancer, sarcomas and liver tumors will be discussed.
sites.
Extensive
use
IORT via a high dose rate
Finally, we will discuss patient selection, stereotactic implantation techniques, results obtained using this technique and morbidity associated with brachytherapy of brain tumors. Drawing from our own experience, we will present the results of our phase I-II trial of interstitial thermoradiotherapy of high grade gliomas where hyperthennia was induced with ferromagnetic implants. The survival of this group of patients will be compared with that of a matched group of patients who were treated in a non-randomized trial with an interstitial implant but no hyperthermia.
506 TREATMENT
OF SALIVARY
Peter J. Fitzpatrick, Deparmrent
GLAND
MALIGNANCIES
M.B., B.S.
of Radiation
Oncology,
Dalhousie
University
and Cancer Treatment
& Research
Foundation
of Nova Scotia
The salivary glands are divided into two groups - major and minor. The major glands which are paired are the parotid, submandibular and sublingual. The minor salivary glands consist of more than 700 small glands situated in the mucosa of the upper digestive and respiratory tracts. Their function is to produce saliva which aids in the lubrication and digestion of food. Tumours of the salivary glands are uncommon with an overall incidence of approximately one per 100,000 and comprising 3% of all epithelial head and neck cancers. The first symptom is usually a painless lump and over 80% of tumours occur in the parotid and of these 20% are malignant. Approximately 10% develop in the submandibular gland of which 50% are malignant. Sublingual tumours are uncommon as are those of the minor salivary glands.
relatively
Both the clinical and histological diagnosis can be difficult and even benign lesions are prone to recurrence. insidious but some will prove fatal from distant metastases many years later.
Most malignant
tumours
are
Proceedings of the 34th Annual ASTRO Meeting
115
Overall, from among 271 patients with parotid tumours the 5 and IO-year actuarial and cause-specific survival rates were 59 and 43% and 65 and 57% respectively. In a study of 91 patients with submaxillary tumours the 5- and IO-year actuarial and cause-specific survival rates were 62% and 49% and 49% and 35% respectively. The outcome for the various histologic subtypes stratified by different treatments will be presented. Also, the various prognostic factors including age, sex, duration of symptoms, size of primary tumour, the presence of regional and distant metastases. fixation. histologv. and treatment will be reviewed for significance both independently and through a multivariate analysis. Surgical excision is the primary trea;h;ent for most turnouts but radiotherapy-has an important roie in the adjuvant set&g and in palliation. -The place of radiotherapy, technique and dose, in radical and palliative treatment will be discussed.
507 HODGKIN’S DISEASE Nancy Price Mendenhall, M.D. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida This refresher course will present an overview of Hodgkin’s disease in 1992, a detailed description of the treatment technique employed at the University of Florida, and a discussion of management issues in patients with low, intermediate, high-risk, and recurrent disease based on prognostic factors and rates of relapse-free survival, overall survival, and cause-specific survival. Treatment morbidity from both radiation therapy and chemotherapy will be reviewed. The issues of optimal radiation dose, elective pelvic irradiation, and elective lung irradiation will also be discussed.
508 ‘=I IN PROSTATE CANCER Kent Wallner, M.D. Memorial Sloan-Kettering Cancer Center, Dept. of Radiation Oncology, 1275 York Avenue, New York, NY 10021 Radioactive implants have been used extensively for treatment of early stage prostate cancer. In general, their use has been associated with fewer side effects than surgery or external beam irradiation. Local control has generally been comparable to that achieved with the other modalities. Lower tumor control rates in some early series probably were related to inaccurate placement of radioactive pellets, since the older procedures were subject to substantial operator error. In this lecture, the radiobiologic and physical rationale for prostate brachytherapy will be presented. Available isotopes, rationale for permanent versus temporary implants, and criteria for patient selection will be discussed. Long-term results from retropubic implantation will be reviewed. Particular emphasis will be placed on the practical aspects of newer, transperineal techniques. The advantages of CT- or ultrasoundguided transperineal techniques will be discussed in detail, with a summary of early results from several centers.
509 RESULTS OF THE BRAIN TUMOR STUDY GROUP Melvin Deutsch, M.D. Department of Radiation Oncology, University of Pittsburgh Since 1966 the Brain Tumor Cooperative Group (BTCG), previously known as the Brain Tumor Study Group (BTSG), has completed eight randomized clinical trials evaluating radiotherapy and chemotherapy for newly diagnosed previously untreated supratentorial malignant glioma in adults. The first three trials (66-01,69-01,72-Ol), initiated in 1966, 1969 and 1972 respectively, demonstrated improved survival duration with radiotherapy versus supportive care alone or chemotherapy. These early studies also demonstrated an improvement in survival duration with increasing doses of whole brain irradiation up to 6,000 cGy. Three trials, 69-01, 72-01, 75-01, involved comparisons of radiotherapy versus radiotherapy and chemotherapy. In 75-01, the radiotherapy arm received prescribed high dose Methylprednisolone. There was no significant difference in survival between radiation alone and radiation and chemotherapy in trial 69-01. In 72-01, there was a trend for improved survival with radiation and BCNU versus radiation alone. In 75-01, patients receiving radiation and chemotherapy (either BCNU or Procarbazine) had a statistically significant improvement in survival duration compared to patients receiving radiation and corticosteroids. In all studies, there was an increased survival rate at 18 and 24 months in patients receiving radiation and chemotherapy versus radiation alone. Study 77-01 evaluated pre-op radiotherapy and BCNU versus postoperative radiotherapy and BCNU. There was no statistically significant difference in outcome. Study 77-02