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132Episcleral conformal brachytherapy in ocular tumours: Technical aspects
Posters
$36
at the brachytherapy unit. 130
poster
Survey of brachytherapy practice in Italy. Report from the Italian Group of Brachytherapy I. Cafaro, R, Mazzarotto, P. Guerrieri, G, Turacato, S. Gribaudo Co-ordinators of the/ta/ian Group of Brachytherapy Introduction: the aim of the study was to obtain reliable data on the extent of brachytherapy (BR) practice in Italy by conducting a comprehensive survey of all facilities. Material and methods: at the end of 1999 a structured questionnaire was mailed to 109 radiotherapy departments in Italy. Spontaneous replies were received from 71 centres (65%), while 31 gave a telephonic answer. The data were collected and elaborated in September 2000. Results: A BT section is present in 39 out of 109 (35.7%) radiotherapy centres, but 18 more departments (16.5%) have future plans to start a BT activity. Twenty-seven sections are located in the north of Italy, 8 in the centre and 4 in the south. To our knowledge no BT treatment is, at present, performed in Sicily or in Sardinia (total population 6.600.000) even if there are plans to introduce a BT section in Sicily. Twenty centres perform only HDR, 8 LDR, 6 HDR + LdR, 4 LDR + PDR and 1 HdR + PDR. Interst + intralum + intracav + plaque in 3, while only intralum and intracav are performed in 1 and 3 respectively. Endovascular BT is carried out in 5 centres, while BT in non neoplastic disease in 5. Eleven centres also have a metabolic radiotherapy (MRT) section, but in only 3 sections MRT and BT are performed by the same physician. Further and more detailed data will be presented. Conclusions: data regarding brachytherapy were obtained from all radiotherapy departments surveyed in Italy. Thirty-six percent of centres perform brachytherapy, while a further 16% have future plans to start BT activity. 131
poster
Brachytherapy in the treatment of rhabdomyosarcomas children. Early experience in a Chilean Hospital
in
K. Goset 1, L. Badinez 1, A. Cordova 1, H. Barriga 1, A. Quezada 1, F. Lucic 1, J. Guevara 1, L. Sepu/veda 2, M. Varas 3, V. Beressi2 1Radiation Onco/ogy Service, C/inica A/emana, 2pediatric Onco/ogy Service, Hospital Luis Ca/vo Mackenna, 3pediatric Onco/ogy Service, Hospital San Juan de Dios. Santiago de Chile. Introduction: brachytherapy may play an important role in the treatment of pediatric rhabdomyosarcomas. Brachytherapy is a cost effective treatment not regularly employed in our country. We present our experience in the first 6 patients treated between 1997 and 2000 at Clinica Alemana de Santiago, Chile. Material and methods: we used brachytherapy as a first-line treatment in 4 patients and as salvage treatment in 2 patients. Five of them were performed during surgery. Four patients were initially included in the IRS IV and 2 in the IRS III treatment protocol. Slavage brachytherapy as used in 2 patients as a complementary therapy after partial responses to ICE and Topotecan. The tumour sites were: 2 face, 1 tongue, 2 bladder, 1 prostate. We used the Paris system rules for the implantation with plastic tube applicators charged with Ir-192 LDR in all patients, A C T scan simulatioin was done in all patients with dosimetric studies in a TARGET II treatment planning system. Results: brachytherapy allowed a conservative treatment in all 6 patients. Median follow-up was 18 months (5 to 40 months). 4 patients are alive with no disease evidence. 2 patients died from metastatic disease without local failure. One patient with facial tumour had sequelae consisting in a mild cosmetic default. Conclusion: brachytherapy is a good conservative alternative to radical surgery in some pediatric rhabdomyosarcomas. It is important to evaluate these cases under a multidisciplinary approach. 132
poster
Episcleral conformal brachytherapy in ocular tumours: technical aspects G. Zelada L. Badinez, K. Goset, A. Cordova, H. Barriga, J. Guevara, F, Lucic, A. Quezada Radiation Oncology Service, Clinica Alemana de Santiago, Chile Introduction: the epislceral plaque brachytherapy is a conservative alternative in the treatment of choroid melanoma and retinoblastoma. The most common technique use preloaded standard metal plaques. These plaques constrain the option for CT imaging or MRI. Methods and materials: in 1997 we developed a thermoplastic applicator for episcleral treatment. The Plaque is made according to the eye curvature and adapted to the tumour size and location (up to 20 x 20 x 3 mm). Then,
1.7 mm external diameter plastic tubes are inserted within the plaque, regarding the Paris system rules. We use 3 or 4 catheters with 4 to 6 mm separation. Once the applicator is ready and the length of the Ir-192 lines are defined, we made cooper dummy sources and take orthogonal x-ray plaques to perform a provisional dosimetry using a Target II RTPS. The sterilised plaque is installed in the operating room by an Ophthalmologist, assisted by the radiation oncologist and physicst. We make a spiral CT scan after the operative procedure for a precise source location and the final dosimetry. Ir-192 sources are inserted in to the applicator catheters. The sources are fixed to the catheters to avoid any movement. X-rays are done to verify sources positioin. Results: from 1997 to 2000, 12 treatment in 11 patients were performed with excellent tolerance and without incidents. The clinical aspects are presented elsewhere. Conclusions: we demonstrated the feasibility of this technique which is simple to implement. It allows optimisation by adapting the applicator shape and size, according to the Paris system rules, to the tumour characteristics. We thing this applicator could be adapted to HDR and PDR afterloading devices or to 1-125 sources. 133
poster
Episcleral brachytherapy with thermoplastic afterloading plaque K. Goset 1. L. Badinez 1, A. Cordova 1, G. Zelada 1, G. Gonzalez2. R. Garcia2 l Clinica Oftalmologica Pasteur, 2Radiation Oncology Service, Clinica Alemana, Santiago, Chile Introduction: the episcleral brachytherapy is a conservative treatment alternative for choroid melanoma and retinoblastoma. We developed a thermoplastic plaque for episcleral treatment. We present our early experience in retinoblastoma (RB). Methods and materials: the technical aspects of the plaque are presented elsewhere. From 1997 to 2000 we performed 11 treatments in 10 children with RB. The first 4 patients relapsed after external beam radiotherapy and were treated with brachytherapy as salvage option. Six patients had unilateral RB and 4 patients had bilateral RB (oculus ultimus). All ptients had previous chemoreduction. Mean age at brachytherapy was 40 month (9-120 month). The lesions were evaluated with ocular ultrasound. Mean tumour size was 10.9mm (6.4-15mm) at the base and 5.8mm (4-10mm) high. Mean distance to the optic nerve was 1.75mm. Four patients had Iocalised vitreous seeding. All patients had spiral CT scan for dosimetry, performed with TARGET II RTPS. We used CT Ir-192 sources. Mean dose to the tumour apex was 45 Gy (32-60 Gy). Mean dose to the base of the tumour was 101 Gy (60-130 Gy). Mean follow-up 14 months (6-48 month). Results: all the patients had tumour regression at two month evaluation. Four patients have been enucleated, 2 for suspected tumour progression, 1 for vitreous seeding progression and the last for painful vascular glaucoma. Tumour was demonstrated in two patients. Vision was preserved in all other patients. Vascular glaucoma was seen in 3 of the previously irradiated patients, and in one patient who had two plaques in the sam eye. Conclusions: the treatment results are similar to those published. We think this is a viable and low cost treatment option. 134
poster
Intraluminal brachytherapy without stenting in p a l l i a t i o n o f a papillary adenocarcinoma of the liver. A case report. A.G. Morqanti 1, D. Smaniotto 1, S. Luzi I, G, Macchia 1. V. Valentini 1, M. Mutignani 2, F. Giuliante 2, G. Costamagna 2, G. Nuzzo2, N. Cellini 1 1Department of Radiotherapy and Surgery, 2of Universita Cattolica S.C., Rome, A 46 year-old female patient, with a large (9.5 cm maximum diameter) unresectable papillary-cholangiocarcinoma, involving the left hepatic lobe and the caudate lobe, was referred to the Radiotherapy Department of our institution with mild cholestasis and normal bilirubin level. ERCP showed the infiltration of the main biliary confluence and of the left bile duct wich appeared filled by papillary neoplastic tissue. Hemobilia was present. The possibility to treat the obstructive jaundice by positioning an endoscopic biliary stent or a percutaneous biliary drainage was evaluated, but the risk of early tube obstruction due to clots and products of tumor desfoliation was judged very high. In order to prevent this risk, a nasobiliary tube was inserted into the stenotic tract of the biliary duct. Subsequently, an 192-Iridium wire (8 cm length) was inserted into the tube, and a dose of 50 Gy was delivered at 1 cm from the source axis in 6 days and 3 hours (dose-rate: 35 cGy/h). During and
$36
at the brachytherapy unit. 130
poster
Survey of brachytherapy practice in Italy. Report from the Italian Group of Brachytherapy I. Cafaro, R, Mazzarotto, P. Guerrieri, G, Turacato, S. Gribaudo Co-ordinators of the/ta/ian Group of Brachytherapy Introduction: the aim of the study was to obtain reliable data on the extent of brachytherapy (BR) practice in Italy by conducting a comprehensive survey of all facilities. Material and methods: at the end of 1999 a structured questionnaire was mailed to 109 radiotherapy departments in Italy. Spontaneous replies were received from 71 centres (65%), while 31 gave a telephonic answer. The data were collected and elaborated in September 2000. Results: A BT section is present in 39 out of 109 (35.7%) radiotherapy centres, but 18 more departments (16.5%) have future plans to start a BT activity. Twenty-seven sections are located in the north of Italy, 8 in the centre and 4 in the south. To our knowledge no BT treatment is, at present, performed in Sicily or in Sardinia (total population 6.600.000) even if there are plans to introduce a BT section in Sicily. Twenty centres perform only HDR, 8 LDR, 6 HDR + LdR, 4 LDR + PDR and 1 HdR + PDR. Interst + intralum + intracav + plaque in 3, while only intralum and intracav are performed in 1 and 3 respectively. Endovascular BT is carried out in 5 centres, while BT in non neoplastic disease in 5. Eleven centres also have a metabolic radiotherapy (MRT) section, but in only 3 sections MRT and BT are performed by the same physician. Further and more detailed data will be presented. Conclusions: data regarding brachytherapy were obtained from all radiotherapy departments surveyed in Italy. Thirty-six percent of centres perform brachytherapy, while a further 16% have future plans to start BT activity. 131
poster
Brachytherapy in the treatment of rhabdomyosarcomas children. Early experience in a Chilean Hospital
in
K. Goset 1, L. Badinez 1, A. Cordova 1, H. Barriga 1, A. Quezada 1, F. Lucic 1, J. Guevara 1, L. Sepu/veda 2, M. Varas 3, V. Beressi2 1Radiation Onco/ogy Service, C/inica A/emana, 2pediatric Onco/ogy Service, Hospital Luis Ca/vo Mackenna, 3pediatric Onco/ogy Service, Hospital San Juan de Dios. Santiago de Chile. Introduction: brachytherapy may play an important role in the treatment of pediatric rhabdomyosarcomas. Brachytherapy is a cost effective treatment not regularly employed in our country. We present our experience in the first 6 patients treated between 1997 and 2000 at Clinica Alemana de Santiago, Chile. Material and methods: we used brachytherapy as a first-line treatment in 4 patients and as salvage treatment in 2 patients. Five of them were performed during surgery. Four patients were initially included in the IRS IV and 2 in the IRS III treatment protocol. Slavage brachytherapy as used in 2 patients as a complementary therapy after partial responses to ICE and Topotecan. The tumour sites were: 2 face, 1 tongue, 2 bladder, 1 prostate. We used the Paris system rules for the implantation with plastic tube applicators charged with Ir-192 LDR in all patients, A C T scan simulatioin was done in all patients with dosimetric studies in a TARGET II treatment planning system. Results: brachytherapy allowed a conservative treatment in all 6 patients. Median follow-up was 18 months (5 to 40 months). 4 patients are alive with no disease evidence. 2 patients died from metastatic disease without local failure. One patient with facial tumour had sequelae consisting in a mild cosmetic default. Conclusion: brachytherapy is a good conservative alternative to radical surgery in some pediatric rhabdomyosarcomas. It is important to evaluate these cases under a multidisciplinary approach. 132
poster
Episcleral conformal brachytherapy in ocular tumours: technical aspects G. Zelada L. Badinez, K. Goset, A. Cordova, H. Barriga, J. Guevara, F, Lucic, A. Quezada Radiation Oncology Service, Clinica Alemana de Santiago, Chile Introduction: the epislceral plaque brachytherapy is a conservative alternative in the treatment of choroid melanoma and retinoblastoma. The most common technique use preloaded standard metal plaques. These plaques constrain the option for CT imaging or MRI. Methods and materials: in 1997 we developed a thermoplastic applicator for episcleral treatment. The Plaque is made according to the eye curvature and adapted to the tumour size and location (up to 20 x 20 x 3 mm). Then,
1.7 mm external diameter plastic tubes are inserted within the plaque, regarding the Paris system rules. We use 3 or 4 catheters with 4 to 6 mm separation. Once the applicator is ready and the length of the Ir-192 lines are defined, we made cooper dummy sources and take orthogonal x-ray plaques to perform a provisional dosimetry using a Target II RTPS. The sterilised plaque is installed in the operating room by an Ophthalmologist, assisted by the radiation oncologist and physicst. We make a spiral CT scan after the operative procedure for a precise source location and the final dosimetry. Ir-192 sources are inserted in to the applicator catheters. The sources are fixed to the catheters to avoid any movement. X-rays are done to verify sources positioin. Results: from 1997 to 2000, 12 treatment in 11 patients were performed with excellent tolerance and without incidents. The clinical aspects are presented elsewhere. Conclusions: we demonstrated the feasibility of this technique which is simple to implement. It allows optimisation by adapting the applicator shape and size, according to the Paris system rules, to the tumour characteristics. We thing this applicator could be adapted to HDR and PDR afterloading devices or to 1-125 sources. 133
poster
Episcleral brachytherapy with thermoplastic afterloading plaque K. Goset 1. L. Badinez 1, A. Cordova 1, G. Zelada 1, G. Gonzalez2. R. Garcia2 l Clinica Oftalmologica Pasteur, 2Radiation Oncology Service, Clinica Alemana, Santiago, Chile Introduction: the episcleral brachytherapy is a conservative treatment alternative for choroid melanoma and retinoblastoma. We developed a thermoplastic plaque for episcleral treatment. We present our early experience in retinoblastoma (RB). Methods and materials: the technical aspects of the plaque are presented elsewhere. From 1997 to 2000 we performed 11 treatments in 10 children with RB. The first 4 patients relapsed after external beam radiotherapy and were treated with brachytherapy as salvage option. Six patients had unilateral RB and 4 patients had bilateral RB (oculus ultimus). All ptients had previous chemoreduction. Mean age at brachytherapy was 40 month (9-120 month). The lesions were evaluated with ocular ultrasound. Mean tumour size was 10.9mm (6.4-15mm) at the base and 5.8mm (4-10mm) high. Mean distance to the optic nerve was 1.75mm. Four patients had Iocalised vitreous seeding. All patients had spiral CT scan for dosimetry, performed with TARGET II RTPS. We used CT Ir-192 sources. Mean dose to the tumour apex was 45 Gy (32-60 Gy). Mean dose to the base of the tumour was 101 Gy (60-130 Gy). Mean follow-up 14 months (6-48 month). Results: all the patients had tumour regression at two month evaluation. Four patients have been enucleated, 2 for suspected tumour progression, 1 for vitreous seeding progression and the last for painful vascular glaucoma. Tumour was demonstrated in two patients. Vision was preserved in all other patients. Vascular glaucoma was seen in 3 of the previously irradiated patients, and in one patient who had two plaques in the sam eye. Conclusions: the treatment results are similar to those published. We think this is a viable and low cost treatment option. 134
poster
Intraluminal brachytherapy without stenting in p a l l i a t i o n o f a papillary adenocarcinoma of the liver. A case report. A.G. Morqanti 1, D. Smaniotto 1, S. Luzi I, G, Macchia 1. V. Valentini 1, M. Mutignani 2, F. Giuliante 2, G. Costamagna 2, G. Nuzzo2, N. Cellini 1 1Department of Radiotherapy and Surgery, 2of Universita Cattolica S.C., Rome, A 46 year-old female patient, with a large (9.5 cm maximum diameter) unresectable papillary-cholangiocarcinoma, involving the left hepatic lobe and the caudate lobe, was referred to the Radiotherapy Department of our institution with mild cholestasis and normal bilirubin level. ERCP showed the infiltration of the main biliary confluence and of the left bile duct wich appeared filled by papillary neoplastic tissue. Hemobilia was present. The possibility to treat the obstructive jaundice by positioning an endoscopic biliary stent or a percutaneous biliary drainage was evaluated, but the risk of early tube obstruction due to clots and products of tumor desfoliation was judged very high. In order to prevent this risk, a nasobiliary tube was inserted into the stenotic tract of the biliary duct. Subsequently, an 192-Iridium wire (8 cm length) was inserted into the tube, and a dose of 50 Gy was delivered at 1 cm from the source axis in 6 days and 3 hours (dose-rate: 35 cGy/h). During and