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189 Combined chemoradiation & interstitial Ir-192 implant for T3 & T4 anal cancer
190
189 COMBINED :MPLANT
CHEMclPmIATION FOR T3
6 T4
Frost-CB,
R.s0-A,
Southern
Calrfornia
Sunset
Blvd.,
h INTERSTITIAL ANAL
Latma-F,
Kagan-AR
Permanente
Los Angeles,
INTRALUMINAL HIGH DOSE RATE BRACHYTHERAPY BOOST IN THE RADICAL TREATMENT OF CARCINOMA OF THE RECTUM AND ANAL CANAL USING COMBINED CHEMO-RADIATION
IR-192
CANCER
Medical
CA 90027
Group,
4950
USA.
Hoskin PJ, Centre for Rickmansworth
Glynne-Jones R, Simpson .I. Cancer Treatment, Mount Vernon Road, Northwood, Middlesex
Hospital, HA6 ZRN,
U.K.
Introduction: we have previously show" that 30 Gy + 5modality therapy (CM) FU + Mltomycln-C U-lMC) combined ~11 control Tl i T2 anal cancers with no late morbldlty. However control of T3 L T4 cancers was poor, wlEh a" overall local control rate (LCR) of 36%. We now report our experience with the addition of a" mterst~tlal 1~192 implant (sP1) for persistent disease (PD) or T3 or T4 tumors. Ythob: All patients received 30 Gy EBRT + infusional 5-W (1000 mg/dl + 1 dose of MMC ClOmg/r?). The radiation field encompassed the lnguinal "odes 6 pelvis from mid 61 joint to 1 cm below the anus. This was followed by a single plane circular unplant (WI) using a proprietary template which can be loaded with up to 8 needles. Median dose was 28.48 Gy (range 20 to 31.6 Gy), delivered at a medla" rate of 0.43 Gy/Hr (range 0.28 to 0.50 Gy/Hrl. All patients were followed-up at regular intervals mcludrng slgmoldoscopy. metits: ,Of 2 male L 10 female patients treated with CM + implant, 10 were stage T3, 1 was stageT4 h 1 was stage Tli 1 was Nl, 11 were NO, 1 was grade 1, 5 were grade 2 6 6 were grade 3. Average tumor size was 6 cm (range 2 to 3 cm). The median r,rerval from EBRT to WI was 6 weeks (range 4 to 12 weeks,. The median decrease in tumor sire after CM, but before SPI, was 34% {range 0% to 66%). With a follow-up of 2 to 38 months the LCR 1s 67% (E/12). Pour patients had PD and 3 subsequently underwent salvage su;gery, 2 of whom died of dxsease. Overall survival is 75% (9,121. Conclusioru: Although follow-up tune IS strll relarlvely short, the addition of SPI to our standard CM protocol appears to markedly xnprave the LCR for this group of anal cancers.
192
191 RETROSPECTIVE BRACHYTHERAPY
STUDY FOR FACIAL
OF 87 INTERSTITIAL SKIN CARCINOMAS
BERLAND E,BOLLA M, SAILLARD F, BEAN1 JC, LEBEAU J, FILLON JP, VROUSOS C. Service de RadiothCrapielUnitt de Concertation des Affections CancCreuses. CHU MICHALLON GRENOBLE FRANCE From 1977 to 1983,83 patients (pts) with 87 facial skin carcinomas (FSC) were treated with interstitial brachytherapy (BT) in our department.Median age was 70 years (43-97 y), There was 61 basal cell carcinomas and 26 squamous cell carcinomas. 28 of them corresponded to local relapse of FSC initially treated without BT. TNM stadification was as following:Tl+rTl=72,4%; T2+rT2=23%; T3+rT3=2,3%; T4+rT4=2,3%. The median follow-up was 53 months (8 months to 15 years). Different techniques were used:hypodermic needle&plastic tubes,Raynal method. A dose of 60 Gy was prescibed on the reference isodose, according to the PARIS system. Specific overall survival was 98,8% at 5 and 10 y Local control at 5 and 10 y was 100 and 90% for FSC treated in first intention, and 81.2% for recurrent FSC. This was highly significant (p=O,oO2 Logrank test) Functionnal sequelae were appreciated according to the RTOG/EORTC scale: 29 occured in 21 ots.60% of them were depigmentation (11129)and epilation (6/29j. Among the 2 1 FSC of the eyelid, one lacrimal stenosisoccured (4.8%) Cosmetic results were judged “good” or “very good” for 83% of the pts ( BONVALLOT criteria). Bad results occured more frequently for recurrent FSC According to the litterature, our study shows that interstitial BT is a good alternative to surgery for facial skin carcinoma for elderly patients.
THE TREATMENT OF 783 KELOID SCARS BY IRIDIUM 192 INTERSTITIAL IRRADIATION AFTER SURGICAL EXCISION
Dr
ESCARMANT
- CHU de
Fort
de
France
Keloids are frequent in Iiartinique ; for a population of 360,000, we treat on average 6 keloids per month, and not all are passed on to us. Between 1977 and 1988, 544 patients (of whom 979. were of mixed race), with a total of 855 keloids, were treated by interstitial radiotherapy immediately following total excision. Recurrence rate is 219., as against 50 to 807. for surgery alone, according to most authors (depending on whether or not surgery was accom"anied bv a postoperative injection of corticosteroids). This recurrence rate is about the same as for external radiotherapy, but we prefer our method for practical reasons (cost, equipment, radiobiology, technique) . . 90% of recurrences occured in the year following therapy, which proves that e follow-up time of at least twelve months is needed for a study of keloids, or eve" 18 months according to some authors. I" our experience, the keloids that sre the most likely to recur are the largest and those giving rise to most syrup tams . Bruising and loosened stitches, but in particular infection during therapy, largely favour a recurrence, and in any case jeopardize a good cosmetic result. In our series, the symptoms disappeared or were much improved in 80% of cases, and the cosmetic result was judged good by 75% of the patients.
189 COMBINED :MPLANT
CHEMclPmIATION FOR T3
6 T4
Frost-CB,
R.s0-A,
Southern
Calrfornia
Sunset
Blvd.,
h INTERSTITIAL ANAL
Latma-F,
Kagan-AR
Permanente
Los Angeles,
INTRALUMINAL HIGH DOSE RATE BRACHYTHERAPY BOOST IN THE RADICAL TREATMENT OF CARCINOMA OF THE RECTUM AND ANAL CANAL USING COMBINED CHEMO-RADIATION
IR-192
CANCER
Medical
CA 90027
Group,
4950
USA.
Hoskin PJ, Centre for Rickmansworth
Glynne-Jones R, Simpson .I. Cancer Treatment, Mount Vernon Road, Northwood, Middlesex
Hospital, HA6 ZRN,
U.K.
Introduction: we have previously show" that 30 Gy + 5modality therapy (CM) FU + Mltomycln-C U-lMC) combined ~11 control Tl i T2 anal cancers with no late morbldlty. However control of T3 L T4 cancers was poor, wlEh a" overall local control rate (LCR) of 36%. We now report our experience with the addition of a" mterst~tlal 1~192 implant (sP1) for persistent disease (PD) or T3 or T4 tumors. Ythob: All patients received 30 Gy EBRT + infusional 5-W (1000 mg/dl + 1 dose of MMC ClOmg/r?). The radiation field encompassed the lnguinal "odes 6 pelvis from mid 61 joint to 1 cm below the anus. This was followed by a single plane circular unplant (WI) using a proprietary template which can be loaded with up to 8 needles. Median dose was 28.48 Gy (range 20 to 31.6 Gy), delivered at a medla" rate of 0.43 Gy/Hr (range 0.28 to 0.50 Gy/Hrl. All patients were followed-up at regular intervals mcludrng slgmoldoscopy. metits: ,Of 2 male L 10 female patients treated with CM + implant, 10 were stage T3, 1 was stageT4 h 1 was stage Tli 1 was Nl, 11 were NO, 1 was grade 1, 5 were grade 2 6 6 were grade 3. Average tumor size was 6 cm (range 2 to 3 cm). The median r,rerval from EBRT to WI was 6 weeks (range 4 to 12 weeks,. The median decrease in tumor sire after CM, but before SPI, was 34% {range 0% to 66%). With a follow-up of 2 to 38 months the LCR 1s 67% (E/12). Pour patients had PD and 3 subsequently underwent salvage su;gery, 2 of whom died of dxsease. Overall survival is 75% (9,121. Conclusioru: Although follow-up tune IS strll relarlvely short, the addition of SPI to our standard CM protocol appears to markedly xnprave the LCR for this group of anal cancers.
192
191 RETROSPECTIVE BRACHYTHERAPY
STUDY FOR FACIAL
OF 87 INTERSTITIAL SKIN CARCINOMAS
BERLAND E,BOLLA M, SAILLARD F, BEAN1 JC, LEBEAU J, FILLON JP, VROUSOS C. Service de RadiothCrapielUnitt de Concertation des Affections CancCreuses. CHU MICHALLON GRENOBLE FRANCE From 1977 to 1983,83 patients (pts) with 87 facial skin carcinomas (FSC) were treated with interstitial brachytherapy (BT) in our department.Median age was 70 years (43-97 y), There was 61 basal cell carcinomas and 26 squamous cell carcinomas. 28 of them corresponded to local relapse of FSC initially treated without BT. TNM stadification was as following:Tl+rTl=72,4%; T2+rT2=23%; T3+rT3=2,3%; T4+rT4=2,3%. The median follow-up was 53 months (8 months to 15 years). Different techniques were used:hypodermic needle&plastic tubes,Raynal method. A dose of 60 Gy was prescibed on the reference isodose, according to the PARIS system. Specific overall survival was 98,8% at 5 and 10 y Local control at 5 and 10 y was 100 and 90% for FSC treated in first intention, and 81.2% for recurrent FSC. This was highly significant (p=O,oO2 Logrank test) Functionnal sequelae were appreciated according to the RTOG/EORTC scale: 29 occured in 21 ots.60% of them were depigmentation (11129)and epilation (6/29j. Among the 2 1 FSC of the eyelid, one lacrimal stenosisoccured (4.8%) Cosmetic results were judged “good” or “very good” for 83% of the pts ( BONVALLOT criteria). Bad results occured more frequently for recurrent FSC According to the litterature, our study shows that interstitial BT is a good alternative to surgery for facial skin carcinoma for elderly patients.
THE TREATMENT OF 783 KELOID SCARS BY IRIDIUM 192 INTERSTITIAL IRRADIATION AFTER SURGICAL EXCISION
Dr
ESCARMANT
- CHU de
Fort
de
France
Keloids are frequent in Iiartinique ; for a population of 360,000, we treat on average 6 keloids per month, and not all are passed on to us. Between 1977 and 1988, 544 patients (of whom 979. were of mixed race), with a total of 855 keloids, were treated by interstitial radiotherapy immediately following total excision. Recurrence rate is 219., as against 50 to 807. for surgery alone, according to most authors (depending on whether or not surgery was accom"anied bv a postoperative injection of corticosteroids). This recurrence rate is about the same as for external radiotherapy, but we prefer our method for practical reasons (cost, equipment, radiobiology, technique) . . 90% of recurrences occured in the year following therapy, which proves that e follow-up time of at least twelve months is needed for a study of keloids, or eve" 18 months according to some authors. I" our experience, the keloids that sre the most likely to recur are the largest and those giving rise to most syrup tams . Bruising and loosened stitches, but in particular infection during therapy, largely favour a recurrence, and in any case jeopardize a good cosmetic result. In our series, the symptoms disappeared or were much improved in 80% of cases, and the cosmetic result was judged good by 75% of the patients.