188 A new method for brachytherapy of the anal canal

s47

185

186

INTRAOPERATIVE HDR IMPLANT CANCER (PRELIMINARY RESULTS)

BOOST

FOR

BREAST

M. de la Torre, E. Gonzalez, V. Bowel Braqui - Buenos Aires, Argentina

1. Rodriguez,

Introduction: I” spite of the fact that It is bet” discussed w-hcther or not a boost IS “eccssa~ for all conservative treated breast cancer patients it is a ge”!enerabzed rad~otberapy practice. Smcc septrmbcr 1993 we dcvelopcd a breast conservative protocol for earl! stage breast cancer (TI-T2) with lntraopcrative HDR implant boost Side effczts. cosmetic results and rl?c”rr‘mce rates arc reviewed Method and Material: From September 1993 wc treated 55 patients vitb lntrsoperative HDR implant boost to the lumpectom~ site for clinical Tl or T2 invasive breast cancer. followed by external megavoltage We used the Nuclctron microselectron radIotherapy to the entire breast HDR remote aflcrload~ng system \r?tb flexible implant tubes Tbe geometric cbstrib”tio” of the tubes was perfonncd according to the “Paris” configuration Each ““plant was evaluated by calculatmg the dose-volume natural blstogrsms The HDR fractionatmn schedule consists of three fractions of 4.5% each given at least 48 hs apart. and starting behvcen JX-72hs from surgical proccdurc. The external radroticrapy to the enme breast started one week after the compldion of brach?tbcrap> “sing conventional fractronatlon of 5 fractions per week. I.XGy per fraction up fo J5-jOG: Results: So far there is not any local reccurrencc. but mediuln follow up is onI> I8 months. We did not observe any acute damage and the cosmetic outcome ~\as 60% excellent. 30% good and 10% acceptable. Two patients dcvelopcd locabxd fibrosis. in both the implant involved the submama? fold. Conclusion: Tbc lntraopcrabvc Implant is the most accurate na) to locabzc the lumpectom?- site. to define the target volume. decrease tbe total trcatmcnf time a”d avoId a second anesthetic procedure without delaying the Inpatient tlmc or rhe ““tral wound healing process

187 ENDORECTAL TREATEMENT INTERSTITIAL

INTRACAVITARY

RADIOTHERAPY

Gunnar Tanum, The Norwegian

Johan Radium

OF RECTAL

Wiig. Hospital,

TUNOIJRS

Oslo,

Norway

A total of 19 patients with rectal carcinoma or villous adenoma received intracavitary radiotherapy at the Norwegian Radium Hospital during 1991-93. These patients did not have a standard Miles' operation because of poor general condition or refused colostomy. All tumours were staged with rectal sonography. Only patients with tumour diameter < 3.5 cm were included in the study, 9 villous adenomas and 13 adenocarcinomas. Irradiation was delivered by a Philips RT 50 machine (50 kilovolt energy) through a special proctoscope according to Papillon . The patients received 30 Gy once every third week up to 150 Gy. No side effects were observed except one transitory irradiation necrosis. Median observation time was 32 (12-45) months. At evaluation 1 month after treatment 1 patient had stable disease, 3 partial reponse and 15 complete response. Of the latter, 1 patient devoped a recurrent tumour 3 years later. It is concluded that endoluminal radiotherapy should be offered patients who cannot have or refuse a Miles operation for small, distal rectal carr:l3mas or villous adenomas.

188 ULTRASONOGRAPHY IN THE OF ANAL CANAL CARCINOMA BY BRACHYTHERAPY.

JM. Hannoun-Lwl, R Rosello 2. M. S~mnlanl. D Cowenl, M. Nowclerc1, C Alzieul, M. Gwanninl 3, M. F?esbeutl Department of Radiotherapy 1, Radlofogy 2, Gastrcenterology lnstltut Paoli-Calm&es. 13009 Marseille France

3

Rectal dtgltal exam and Endorectal Ultrasonography (ERUS) are of mapr importance in the treatment and follow-up of anal canal carcinoma (ACC). From may 94 to december 95, 15 patients (pts) (2T1, 2T2, 7T3.4T4) were treated for a squamous cell carcinoma They were treated with externti beam radlatlon therapy (45 Gy) assoctated or not to concomitant chemotherapy (SFU-CDDP) followed by intertiitial brachyfherapy (15 to 20 Gy) For all patients. the chek-up was completed by ERUS Mean thickness of T3-4 ACC. measured by ERUS was 18 mm (range 12 to 24 mm) The thickness of the reference lsodoss (RI - 85hof the basal dose) of lnterstltlal brachylherapy usmg a Kelllng applicator ranged from 15 to 23 mm accordmg to the number of wires and to the geometry of the application (space between each wire) Intra-operative ERUS allowed to control the right positionning of each guide gutter accordmg 10 the expected doslmetry 01 the appkcatton and in accordance with an abacus” that we had elaborated The abacus helped to choose the distance between the wires and the Internal pact of the reference lsodose No lmmedlate complications were noted The follow-up was too shorl to analysa the rate of local control and of late complications but the use of intra-oparatlve ERUS, allowed 10 perform mterslltlal brachylherapy of ACC more praclsely and lo respect. as well as po&ble. the Pans System recommandatlons * Ultra sound Krefz Combinson (frequency 7 5 MHz) ‘* Abacus

with a multlplan

rectal probe

A NEW METHOD ANAL CANAL

FOR BRACHYTHERAPY

Flenlloing Kj;er-Kristoffersen, Ivan StrBycr. Herlev Dept. of Oncol.,

Kuren University

OF THE

Thcilade, Hospital,

Denmark

Until 1995 WC lrcalcd anal tumours wtfh external RT (2 opposed liclds - 8-25 MV) 10 JJ Gy/22 I: Immcdi;tfcly bercalier ” boost wns given by lntcrslificl bracbythcrapy (25 Gy/2 days - Ir-192 - Paris syslctn) C:llc \vas I:lhen lo avoId pcnclr:lllon o(‘fbe “Iucnus ~ICIII~I:IIIC. WC used 1111:Sycd/Ncblcll rcclnl ICIII~II~C (Best Indusfrics,

USA)

disfancc

from

wlfb

a rccfnl

the cylinder

of3

This melhod rind resulfs 1995 in York In order

IO ob~atn

were

cylinder mm.

nf 13.5 “II” 1-3 Ineedle

prcsenfed

:I be~tcr gcomcfry

and a needle

layers

were

used.

nf tbc GIXIESTRO

and IO prorccf

meeting

the mucous

nvx~bmnc \vc madc a “cw (cmplnte to dilnfe Ihc anal canal. The needles

w~tb an nnal cylinder (35 nvn@) are placed 6 mm liotn the

surfxe

and llle distance

oTtho

cylinder.

The dilation

01’6 ~nm arc

made to avoId pcncfrafton offhe mucous nvzmbrane. To oblaln the same doscratc al fbe surlhcc ol‘fhc cylinder WC incrcascd 111~ disfnnce bclwccn lbc nccdlcs lion1 IO 1nln1 fo I7 ,mm According lo fhc I’XIS sysfcnl ;I tlxkcr trc;llmcnl volun~c IS obfalncd so also laryor ~umours can be lrcnled wlth a single layer ~mplanr I lowevcr the lsodosc of ~bc IVII~ ~ncrcascd distance bchveen Ibc In 1995 wc perlhrmcd anal implants 3 “:lrrow :m:d Cillli~l lhC Sycdmlehlcll WC nnugmcd I( \vnuld Ix an ndvanl”gc dulmg 1111:frc;lflllc”, and lllC‘Ci,SC fllc

implanl is less homogeneus needles. in 6 parlen&. In 2 palicnfs w11h rcclnl Icmplxlc was apphcd lo dtlnfc lbc nnnl canal IlCCdlC I”,Icns;1 dI\I;IIlcc 10

nvo~d hotspo& 11, the n~ucos.1, ho\vcvcr lbc 35 I”,,, cylmder somc1!mcs been loo Inrgc. so a new fcmplnlc wllh a cylinder

have 01‘25

mn1 with

belwcen

fbc nccdlcs

cylinder

- needle

dlsfance

“1‘ I7 mm hnh hccn

of 5 mm and ” distance

produced