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168 poster Brachytherapy of adenocarcinoma of cervix uteri and endometrial adenocarcinoma
Posters
Controversy continues between advocates of radical surgery and radiation therapy (RT). In all cases rigorous tumor staging before treatment has been advocated. The combination of external beam radiation therapy (EBRT) -+ chemotherapy (CT), brachytherapy (BCT) and surgery is the standard of care in the management of carcinoma of the cervix. According to the tumor stage BCT is indicated before (or after) surgery or is associated to exclusive EBRT. It can be delivered with intracavitary techniques with the use of a variety of applicators. Pulse dose rate (PDR) BCT presents potential advantages of low dose rate (LDR) and radiation protection of high dose rate (HDR) afterloading technology. Between 1995 and June 2003, 125 patients were referred to our department and received a PDR brachytherapy as a part of their treatment for carcinoma of the cervix. During the first treatment period (1995-1997) we have conducted a feasibility pilot study in 9 patients. The results in terms of toxicity and safety allowed us to use routinely the procedure in the management of carcinoma of the cervix. One hundred and six patients received ~921r-PDR BCT before or after surgery. All patients had a complete staging including bilateral lilac and/or para-aortic node dissections under celioscopy. Seventeen (17/106, 18%) patients with stage < IB2 and node negative (N-) were treated pre-operatively with a definitive 1921r-PDR BCT delivering a total dose of 60Gy at the reference isodose. For 89 patients (N+ and/or tumors > 4cm or Stages lllB, IVA) the strategy consisted of concurrent radio-chemotherapy (CRC) delivering 45 to 50.4Gy in 25 to 28 fractions using a 4-field box technique. Chemotherapy consisted of a weekly cycle of cisplatinum at a dose of 40mg/m 2. In our institution all patients had post CRC evaluation of the response by MRI. The patients with T>4cm, paraaortic N- status who had partial response < 50%, went radical surgery. The responders were treated with additional PDR BCT delivering a boost of 20Gy to the reference isodose (0.5Gy/h). The mean cumulative dose V and R points were 65Gy. W~ will present the results of this large series of 125 patients in which PDR BCT vas delivered prior surgery or in addition to pelvic CRC. Results of acute, late toxicities, local control and survival according to the different tumor stages will be discussed. 168 poster Brachytherapy of adenocarcinoma of cervix uteri and endometrial adenocarcinoma
L. Krikunova, N. Shentereva, L. Mkrtchyan, K. Salmanova Medical Radiological Research Center RAMS, department of radiotherapy of gynaecological disease, Obninsk, Russian Federat Combined radiotherapy using MDR brachytherapy with 137Cs (Selectron unit) was applied to 13 patients (pts) and 60Co-HDR (Agat-V unit) - to 52 pts with cervix uteri cancer Stages I-iV. The majority of pts were at the age from 40 to 60. In the both groups the Stage II of the illness dominated - in 69,2% pts (137Cs) and in 52,8% pts (60Co). Historically highly differentiated adenocarcinoma was revealed in 18,4%, moderately differentiated - in 37%, poor differentiated - in 17%, papillary - in 12,3%. The dominating types of growth were the endophyte type in the group with sources 137Cs and 60Co -61,5% and 59,6% respectively. Uterine type of the tumour extension dominated in 30,8% pts (137Cs) and in 28,8% pts (60Co) respectively. Combined radiotherapy was provided for 254 pts with endometrial adenocarcinoma Stages Fill having hard somatic pathology. The majority of pts were at the age of over 59. Brachytherapy carried out with sources 60Co (HDR) was delivered to patients with apparatus Agat-V (112 pts); with apparatus Anet-B (174 pts) gamma-neutron irradiation of the sources 252Cf was used; with apparatus Selectron (68 pts) treatment was provided with sources 137Cs (MDR). In all the
$79
groups middle differential forms of adenocarcinoma were predominating. At brachytherapy by the sources 60Co a magnitude of single dose was 5Gy, the total dose to a target was 50Gy.Using the sources 252Cf of gamma-neutron radiation single dose was 5 Gy, the total dose was 35-40 Gy. Brachytherapy was provided by the sources 137Cs on dose 11,7 Gy for endometrial adenocarcinoma and 10.6Gy for adenocarcinoma of cervix uteri, the total dose was 58,5 Gy. Five-year cumulative survival rate of pts with adenocarcinoma of cervix uteri was 65.0_+6.7% (137Cs) and 64.4+14.4% (60Co) (p>0,05). Best results of five-year survival rate were in patients with highly differentiated adenocarcinoma - 64,2_+14,2%, exophyte types of growth - 90,0-+9,5%. Five-year cumulative survival rate of pts with endometrial adenocarcinoma was 87,83%_+8,6% (137Cs), 73,7_+11,4%(252Cf), 70,5_+5,8% (60Co). We did not have any reliable differences in the survival depending on the degree of malignancy. The usage of different radiation sources for their physico-technical parameters represents maximum possibilities for making optimal plans of treatment taking in to the account individual features of adenocarcinoma of cervix uteri and endometrial adenocarcinoma. 169 poster Brachytherapy of the uterine cervix using 60Co-HDR and 137Cs-MDR
M. Kiseleva, L. Krikunova Medical Radiological Research Ctr of RAMS, Gynaecological Department, Obninsk, Kaluga Region, Russian Federat Patients with cervix uteri cancer have gone through the course of the combined radiation therapy in the Department of Radiation Therapy of Gynaecological Diseases of the MRRC RAMS. In 108 patients, the internal radiation therapy was performed with the "Selectron" apparatus (produced by Nucletron) with ~37Cs-MDR source. The remaining 133 patients were irradiated by traditional technique with 6°Co-HDR source. In both groups, the stage II of the illness dominated. Basing on the results of the morphological examinations, the squamous cell cancer diagnosis was verified in 65% patients from the first group and in 77% patients from the second group. Of these, 61.5% and 55% cases, correspondingly, were squamous cell cancers. Adenocarcinoma has made up 18.2% and lowdifferentiated cancer case - 1% from the first group and in group number two: adenocarcinomas took place in 18.8%, lowdifferentiated - 3%. The dominating types of growth were the exophyte type in the first group (52.5%) and the endophyte one in the second group (43%). As regards the spread of the tumor process, the parametrium-vaginal version dominated in the both groups. In the 1st group, the required local dose equaled to 10.6 Gy. The total local dose was 53.0 Gy for the stage I, and 58.4 Gy for the remaining stages and for histologically unfavourable forms. In the 2nd group, the single local dose was 5.0 Gy, exposures were performed twice a week. The total local dose made up 40 to 45 Gy for the stage I and 50.0 Gy for the stages II and II1. The 5-year survival was: I - 76.7%, II 88.0%, III - 56.6% in the 1st group, and 92.6%, 69.3% and 52.8% in the 2nd group correspondingly. 170 Cervical cancer: experience in the department of radiation oncology. H.U. "Reina Sofia" Cordoba
S. Garcia, A. Bejar, A. Palacios, L. Tudela, E. Munoz, M. Rodriguez, M. Espinosa, J.L. Romeo, M.D. Lopez Radiation Oncology, H.U. "Reina Sofia", Cordoba, Spain
Controversy continues between advocates of radical surgery and radiation therapy (RT). In all cases rigorous tumor staging before treatment has been advocated. The combination of external beam radiation therapy (EBRT) -+ chemotherapy (CT), brachytherapy (BCT) and surgery is the standard of care in the management of carcinoma of the cervix. According to the tumor stage BCT is indicated before (or after) surgery or is associated to exclusive EBRT. It can be delivered with intracavitary techniques with the use of a variety of applicators. Pulse dose rate (PDR) BCT presents potential advantages of low dose rate (LDR) and radiation protection of high dose rate (HDR) afterloading technology. Between 1995 and June 2003, 125 patients were referred to our department and received a PDR brachytherapy as a part of their treatment for carcinoma of the cervix. During the first treatment period (1995-1997) we have conducted a feasibility pilot study in 9 patients. The results in terms of toxicity and safety allowed us to use routinely the procedure in the management of carcinoma of the cervix. One hundred and six patients received ~921r-PDR BCT before or after surgery. All patients had a complete staging including bilateral lilac and/or para-aortic node dissections under celioscopy. Seventeen (17/106, 18%) patients with stage < IB2 and node negative (N-) were treated pre-operatively with a definitive 1921r-PDR BCT delivering a total dose of 60Gy at the reference isodose. For 89 patients (N+ and/or tumors > 4cm or Stages lllB, IVA) the strategy consisted of concurrent radio-chemotherapy (CRC) delivering 45 to 50.4Gy in 25 to 28 fractions using a 4-field box technique. Chemotherapy consisted of a weekly cycle of cisplatinum at a dose of 40mg/m 2. In our institution all patients had post CRC evaluation of the response by MRI. The patients with T>4cm, paraaortic N- status who had partial response < 50%, went radical surgery. The responders were treated with additional PDR BCT delivering a boost of 20Gy to the reference isodose (0.5Gy/h). The mean cumulative dose V and R points were 65Gy. W~ will present the results of this large series of 125 patients in which PDR BCT vas delivered prior surgery or in addition to pelvic CRC. Results of acute, late toxicities, local control and survival according to the different tumor stages will be discussed. 168 poster Brachytherapy of adenocarcinoma of cervix uteri and endometrial adenocarcinoma
L. Krikunova, N. Shentereva, L. Mkrtchyan, K. Salmanova Medical Radiological Research Center RAMS, department of radiotherapy of gynaecological disease, Obninsk, Russian Federat Combined radiotherapy using MDR brachytherapy with 137Cs (Selectron unit) was applied to 13 patients (pts) and 60Co-HDR (Agat-V unit) - to 52 pts with cervix uteri cancer Stages I-iV. The majority of pts were at the age from 40 to 60. In the both groups the Stage II of the illness dominated - in 69,2% pts (137Cs) and in 52,8% pts (60Co). Historically highly differentiated adenocarcinoma was revealed in 18,4%, moderately differentiated - in 37%, poor differentiated - in 17%, papillary - in 12,3%. The dominating types of growth were the endophyte type in the group with sources 137Cs and 60Co -61,5% and 59,6% respectively. Uterine type of the tumour extension dominated in 30,8% pts (137Cs) and in 28,8% pts (60Co) respectively. Combined radiotherapy was provided for 254 pts with endometrial adenocarcinoma Stages Fill having hard somatic pathology. The majority of pts were at the age of over 59. Brachytherapy carried out with sources 60Co (HDR) was delivered to patients with apparatus Agat-V (112 pts); with apparatus Anet-B (174 pts) gamma-neutron irradiation of the sources 252Cf was used; with apparatus Selectron (68 pts) treatment was provided with sources 137Cs (MDR). In all the
$79
groups middle differential forms of adenocarcinoma were predominating. At brachytherapy by the sources 60Co a magnitude of single dose was 5Gy, the total dose to a target was 50Gy.Using the sources 252Cf of gamma-neutron radiation single dose was 5 Gy, the total dose was 35-40 Gy. Brachytherapy was provided by the sources 137Cs on dose 11,7 Gy for endometrial adenocarcinoma and 10.6Gy for adenocarcinoma of cervix uteri, the total dose was 58,5 Gy. Five-year cumulative survival rate of pts with adenocarcinoma of cervix uteri was 65.0_+6.7% (137Cs) and 64.4+14.4% (60Co) (p>0,05). Best results of five-year survival rate were in patients with highly differentiated adenocarcinoma - 64,2_+14,2%, exophyte types of growth - 90,0-+9,5%. Five-year cumulative survival rate of pts with endometrial adenocarcinoma was 87,83%_+8,6% (137Cs), 73,7_+11,4%(252Cf), 70,5_+5,8% (60Co). We did not have any reliable differences in the survival depending on the degree of malignancy. The usage of different radiation sources for their physico-technical parameters represents maximum possibilities for making optimal plans of treatment taking in to the account individual features of adenocarcinoma of cervix uteri and endometrial adenocarcinoma. 169 poster Brachytherapy of the uterine cervix using 60Co-HDR and 137Cs-MDR
M. Kiseleva, L. Krikunova Medical Radiological Research Ctr of RAMS, Gynaecological Department, Obninsk, Kaluga Region, Russian Federat Patients with cervix uteri cancer have gone through the course of the combined radiation therapy in the Department of Radiation Therapy of Gynaecological Diseases of the MRRC RAMS. In 108 patients, the internal radiation therapy was performed with the "Selectron" apparatus (produced by Nucletron) with ~37Cs-MDR source. The remaining 133 patients were irradiated by traditional technique with 6°Co-HDR source. In both groups, the stage II of the illness dominated. Basing on the results of the morphological examinations, the squamous cell cancer diagnosis was verified in 65% patients from the first group and in 77% patients from the second group. Of these, 61.5% and 55% cases, correspondingly, were squamous cell cancers. Adenocarcinoma has made up 18.2% and lowdifferentiated cancer case - 1% from the first group and in group number two: adenocarcinomas took place in 18.8%, lowdifferentiated - 3%. The dominating types of growth were the exophyte type in the first group (52.5%) and the endophyte one in the second group (43%). As regards the spread of the tumor process, the parametrium-vaginal version dominated in the both groups. In the 1st group, the required local dose equaled to 10.6 Gy. The total local dose was 53.0 Gy for the stage I, and 58.4 Gy for the remaining stages and for histologically unfavourable forms. In the 2nd group, the single local dose was 5.0 Gy, exposures were performed twice a week. The total local dose made up 40 to 45 Gy for the stage I and 50.0 Gy for the stages II and II1. The 5-year survival was: I - 76.7%, II 88.0%, III - 56.6% in the 1st group, and 92.6%, 69.3% and 52.8% in the 2nd group correspondingly. 170 Cervical cancer: experience in the department of radiation oncology. H.U. "Reina Sofia" Cordoba
S. Garcia, A. Bejar, A. Palacios, L. Tudela, E. Munoz, M. Rodriguez, M. Espinosa, J.L. Romeo, M.D. Lopez Radiation Oncology, H.U. "Reina Sofia", Cordoba, Spain