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301 poster Carcinoma of the oral tongue T1-t2 with positive margins. Postoperative brachytherapy
Posters
MV photons without midline shielding. We have applicated a vaginal cylinder brachytherapy with a High Rate Dose Varisource® 200 after loading equipment, with a dose per application of 5 Gy in all the cases. The number of applications was 2 in the low risk group of patients and 4 in the high risk one. Brachytherapy was applied during the external beam radiotherapy (one time per week) in 48% of the cases and the remainders when external beam radiotherapy was completed. Results: Characteristic of the patients: Stage I: 53.5%, Stage Ih 37%, Stage IIh 8.3% and Stage IV 1.4% (low risk group 71% of the patients and high risk ones 29%). Pathologic classification: 91.8% adenocarcinoma, 4.1% squamous cell carcinoma, and 2.7% sarcomas. Related to the treatment 50.7% of the patients went to 2 HDR brachytherapy applications, 37% 4 applications, 4.1% 5 applications and 8.2% 8 applications. Toxicity: RTOG gastro-intestinal toxicity was 12.3% grade II and 8.2% grade I. Rectal toxicity was 31.5% grade I and 13.7% grade I1. Genitourinary toxicity was 21.9% grade I and 13.7% grade II. We did not observe other types in our series. Conclusions: related to our experience HDR brachytherapy combined with external beam radiotherapy in endometrium carcinoma is a feasible treatment, well tolerated, with a low toxicity rate and a high grade of fulfilment (98.6%). 300 poster The intracoronary brachytherapy for in-stent restenosis: clinical and film dosimetric results
R. Baumann ~, A. Warszawski I, H. Grundtke ~, B. Homig2,'j.H. Karstens ~ ~Medical University Hannover, Radiotherapy, Hannover, Germany 2Medical University Hannover, Cardiology, Hannover, Germany Background: The intracoronary brachytherapy is a well accepted method to prevent in-stent restenosis. The clinical results will be retrospectively analysed and the film dosimetric analysis of the 32p radiation source will be presented. Methods: From 2/01 to 12/03 106 patients underwent an intracoronary brachytherapy with the Galileo@-13-remote afterloader. The median age was 61 years, in all cases the stent region was irradiated including 4 mm distal and proximal. The delivered dose was 20 Gy in 1 mm beyond the average luminal radius using a centering catheter. In all used #-emitting sources the absolute dosimetry and the homogeneity were analysed. Results: in accordance with the international data the actuarial restenosis rate at 6 months follow up was 15-20%. The first 20 patients showed an increased risk for restenosis at the field edges. Therefore the active source was changed from 27 to 20 mm (minimal irradiated distance 40 mm). For physical quality assurance the absolute dosimetry of all sources was analysed. Longitudinal and radial dose profiles were measured using a video densitometer. Source strength was found to be within +~2.%compared to the source certificate and dose profiles within 5-10% of the manufacturers specification. Dose measurements of catheter movement simulation ("pullback" for treatment of longer lesions) showed a good homogeneity of dose distribution without significant deviation in the overlap zone. Conclusion: Intracoronary brachytherapy is an effective and safe method for reduction of the restenosis rate in patients treated for in-stent restenosis. Our physical quality assurance showed a good homogeneity of all used sources.
$129
301 poster Carcinoma of the oral tongue Tl-t2 with positive margins. Postoperative brachytherapy
A.B. Bezares Alarcon, M. Martinez Carrillo, J. Martinez Galan, M. Zurita Herrera, E. Lopez Ramirez, V. Hernandez Garcia, A. Martinez Plaza, B. Garcia Medina Hospital Universitario Virgen de las Nieves, Oncologia Radioterapica, Granada Spain Grupo de Investigacion del cancer de Cavidad Oral y Orofaringe. CTS 479, Hospital Universitario Virgen de las Nieves, Granada, Spain Aim: The aim of this study was to evaluate the efficacy of postoperative brachytherapy with low dose rate (LDR) in carcinoma of the oral tongue T1-T2 with close (<5 mm) or positive margins. Methods and materials: Between 1989 and 2002 we treated 33 patients with squamous cell carcinomas of the mobile tongue with close or positive margins following surgery. Median age was 54 years. Status T1 (76%) T2 (24%). Status NO (88%) N1 (12%). The technique used was interstitial Iridium 192 brachytherapy (LDR). Twelve patients had interstitial brachytherapy (iBT) procedures alone with D(REF): 64 Gy (range 54-68 Gy); in twenty-one patients, iBT procedures with D(REF): 19 Gy (range 16-20 Gy) in combination with external beam radiation (EBR). Mean dose rate of 0,65 Gy/h (range 0,42-0,90 Gy/h). Mean surgery to EBR was 28 days. Results:: After a median follow-up of 64 months, overall and cause-specific survivals were 45% and 79%, respectively. The local control was 85%: T1 (88%) and T2 (75%). We did not find significant impact in local control for prognostic factors analyzed: T2, iBT combined EBR, dose rate>0,6 Gy/h, total dose. In our series chronic sequelae were: bone necrosis G1 (6%) and G2 (3%). Conclusion:: Postoperative brachytherapy in carcinoma of the oral tongue with positive or close margins obtains high rate of Iocoregional control and low risk chronic sequelae, and it also obviates major surgery. 302 poster Interstitial HDR-brachytherapy in patients with oral cavity and oropharyngeal cancer -treatment results and complications based upon material of Institute of Oncology in Gliwice
B. Bialas 1, W. Sasiadek2, J. Bystrzycka 1, M. Fijalkowski ~, A. -Wygo~, C. Szymczyl~, A. Maciejewskz~, J. Wierzgon3, T. Rutkowskf, K. Skladowskf ~lnstitute of Oncology MSC Memorial Hospital, Gfiwi, Brachytherapy Department, Gfiwice, Poland 2Institute of Oncology , I Radiotherapy Clinic, Gliwice, Poland 3Institute of Oncology , Surgery Department, Gfiwice, Poland Aim: Aim of this study was to present treatment results and acute side effects of interstitial HDR-brachytherapy in patients with oral cavity and oropharyngeal cancers. Material and methods: Data charts of 25 - 17 (68%) male and 8 (32%) female patients treated between October 1999 and November 2003 in Brachytherapy Department of institue of Oncology In Gliwice were evaluated. Median age was 62 years. There were 17 (58,3%) patients with lip cancer, 5 (20 %) with oral cavity cancer. In 12 (48%) patients HDR-brachytherapy was performed after primary surgery; in 5 (20%) cases after teleradiotherapy to deliver the "boost" dose. In all cases interstitial radiotherapy was performed using flexible, afterloading catheters - in patients with oral cavity or floor of the mouth cancer with the "loop" technique. Applications were
MV photons without midline shielding. We have applicated a vaginal cylinder brachytherapy with a High Rate Dose Varisource® 200 after loading equipment, with a dose per application of 5 Gy in all the cases. The number of applications was 2 in the low risk group of patients and 4 in the high risk one. Brachytherapy was applied during the external beam radiotherapy (one time per week) in 48% of the cases and the remainders when external beam radiotherapy was completed. Results: Characteristic of the patients: Stage I: 53.5%, Stage Ih 37%, Stage IIh 8.3% and Stage IV 1.4% (low risk group 71% of the patients and high risk ones 29%). Pathologic classification: 91.8% adenocarcinoma, 4.1% squamous cell carcinoma, and 2.7% sarcomas. Related to the treatment 50.7% of the patients went to 2 HDR brachytherapy applications, 37% 4 applications, 4.1% 5 applications and 8.2% 8 applications. Toxicity: RTOG gastro-intestinal toxicity was 12.3% grade II and 8.2% grade I. Rectal toxicity was 31.5% grade I and 13.7% grade I1. Genitourinary toxicity was 21.9% grade I and 13.7% grade II. We did not observe other types in our series. Conclusions: related to our experience HDR brachytherapy combined with external beam radiotherapy in endometrium carcinoma is a feasible treatment, well tolerated, with a low toxicity rate and a high grade of fulfilment (98.6%). 300 poster The intracoronary brachytherapy for in-stent restenosis: clinical and film dosimetric results
R. Baumann ~, A. Warszawski I, H. Grundtke ~, B. Homig2,'j.H. Karstens ~ ~Medical University Hannover, Radiotherapy, Hannover, Germany 2Medical University Hannover, Cardiology, Hannover, Germany Background: The intracoronary brachytherapy is a well accepted method to prevent in-stent restenosis. The clinical results will be retrospectively analysed and the film dosimetric analysis of the 32p radiation source will be presented. Methods: From 2/01 to 12/03 106 patients underwent an intracoronary brachytherapy with the Galileo@-13-remote afterloader. The median age was 61 years, in all cases the stent region was irradiated including 4 mm distal and proximal. The delivered dose was 20 Gy in 1 mm beyond the average luminal radius using a centering catheter. In all used #-emitting sources the absolute dosimetry and the homogeneity were analysed. Results: in accordance with the international data the actuarial restenosis rate at 6 months follow up was 15-20%. The first 20 patients showed an increased risk for restenosis at the field edges. Therefore the active source was changed from 27 to 20 mm (minimal irradiated distance 40 mm). For physical quality assurance the absolute dosimetry of all sources was analysed. Longitudinal and radial dose profiles were measured using a video densitometer. Source strength was found to be within +~2.%compared to the source certificate and dose profiles within 5-10% of the manufacturers specification. Dose measurements of catheter movement simulation ("pullback" for treatment of longer lesions) showed a good homogeneity of dose distribution without significant deviation in the overlap zone. Conclusion: Intracoronary brachytherapy is an effective and safe method for reduction of the restenosis rate in patients treated for in-stent restenosis. Our physical quality assurance showed a good homogeneity of all used sources.
$129
301 poster Carcinoma of the oral tongue Tl-t2 with positive margins. Postoperative brachytherapy
A.B. Bezares Alarcon, M. Martinez Carrillo, J. Martinez Galan, M. Zurita Herrera, E. Lopez Ramirez, V. Hernandez Garcia, A. Martinez Plaza, B. Garcia Medina Hospital Universitario Virgen de las Nieves, Oncologia Radioterapica, Granada Spain Grupo de Investigacion del cancer de Cavidad Oral y Orofaringe. CTS 479, Hospital Universitario Virgen de las Nieves, Granada, Spain Aim: The aim of this study was to evaluate the efficacy of postoperative brachytherapy with low dose rate (LDR) in carcinoma of the oral tongue T1-T2 with close (<5 mm) or positive margins. Methods and materials: Between 1989 and 2002 we treated 33 patients with squamous cell carcinomas of the mobile tongue with close or positive margins following surgery. Median age was 54 years. Status T1 (76%) T2 (24%). Status NO (88%) N1 (12%). The technique used was interstitial Iridium 192 brachytherapy (LDR). Twelve patients had interstitial brachytherapy (iBT) procedures alone with D(REF): 64 Gy (range 54-68 Gy); in twenty-one patients, iBT procedures with D(REF): 19 Gy (range 16-20 Gy) in combination with external beam radiation (EBR). Mean dose rate of 0,65 Gy/h (range 0,42-0,90 Gy/h). Mean surgery to EBR was 28 days. Results:: After a median follow-up of 64 months, overall and cause-specific survivals were 45% and 79%, respectively. The local control was 85%: T1 (88%) and T2 (75%). We did not find significant impact in local control for prognostic factors analyzed: T2, iBT combined EBR, dose rate>0,6 Gy/h, total dose. In our series chronic sequelae were: bone necrosis G1 (6%) and G2 (3%). Conclusion:: Postoperative brachytherapy in carcinoma of the oral tongue with positive or close margins obtains high rate of Iocoregional control and low risk chronic sequelae, and it also obviates major surgery. 302 poster Interstitial HDR-brachytherapy in patients with oral cavity and oropharyngeal cancer -treatment results and complications based upon material of Institute of Oncology in Gliwice
B. Bialas 1, W. Sasiadek2, J. Bystrzycka 1, M. Fijalkowski ~, A. -Wygo~, C. Szymczyl~, A. Maciejewskz~, J. Wierzgon3, T. Rutkowskf, K. Skladowskf ~lnstitute of Oncology MSC Memorial Hospital, Gfiwi, Brachytherapy Department, Gfiwice, Poland 2Institute of Oncology , I Radiotherapy Clinic, Gliwice, Poland 3Institute of Oncology , Surgery Department, Gfiwice, Poland Aim: Aim of this study was to present treatment results and acute side effects of interstitial HDR-brachytherapy in patients with oral cavity and oropharyngeal cancers. Material and methods: Data charts of 25 - 17 (68%) male and 8 (32%) female patients treated between October 1999 and November 2003 in Brachytherapy Department of institue of Oncology In Gliwice were evaluated. Median age was 62 years. There were 17 (58,3%) patients with lip cancer, 5 (20 %) with oral cavity cancer. In 12 (48%) patients HDR-brachytherapy was performed after primary surgery; in 5 (20%) cases after teleradiotherapy to deliver the "boost" dose. In all cases interstitial radiotherapy was performed using flexible, afterloading catheters - in patients with oral cavity or floor of the mouth cancer with the "loop" technique. Applications were