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400 poster Treatment result of the primary orbital lymphoma
Posters
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policy has been changed: in the 1st period (until 1980) most, 31/38, paients were treated by radiotherapy alone. Since 1981, the 2nd period, chemotherapy was added to 84% (59/70) of the pts, and 36 (52%) of them recieved it alone. Results: CR was equal (89%) in both periods of study. However, distant failure was higher and 10y survival was significantly lower in pts treated in 1st period compared to those treated in the 2nd period (59% vs. 4% and 35% vs. 60%, respectively p<0.002). In pts with aggressive lymphoma chemotherapy alone was as effective as combined radio-chemotherapy treatment (CR 83% vs. 85%, relapse 8% vs. 20% and long term survival 63% vs. 45%, respectively). Radiotherapy alone was mainly effective in low grade (LG) histology (CR 100% and 10y survival 83%). Conclusions: 1. Instituting chemotherapy in the last two decades dramatically improved the outcome of the patients. 2. The role of radiotherapy in ENHN lymphoma is questionable particularly in the face of potential severe radiation side effects at that location. 3. Radiotherapy alone may remain optimal for localized LG ENHN lymphoma. 398
poster
Total body irradiation: dose determination accuracy. J. Malicki1, G. Kosieka 1, G. Stryezynska2, J. Wachowiak3 1Greatpoland Cancer Centre, Medical Physics, Poznan, Poland 2Greatpoland Cancer Centre, Radiotherapy, Poznan, Poland 3Medical University, BMT, Poznan, Poland Purpose: The aim of this paper was: (I) to estimate the error in preliminary dose calculations in some chosen cross-sections of the body; (2) to check accordance between the calculated doses and those measured in-vivo in a group of thirty patients. Methods: A total dose of 12.6 Gy (below 10 Gy in lungs) was prescribed in the body midline in the central axis (CAX). A dose of 8.2 Gy was delivered from 6 lateral fields (with 7 cGy/min) and 4.4 Gy from AP/PA fields (with 17 cGy/min). Lungs were shielded during AP/PA fields. A group of thirty consecutive patients, children aged from 5 to 12 years was taken for dose compadsion. Doses were calculated and measured (by thermoluminescent and semiconductor detectors) in ten chosen CT-made cross-sections. The error in the calculations was determined by a total differential method. For measured doses their average percent deviations from the calculations and the respective standard deviations were determined for all fields and sections. Accordance of measured doses to those calculated was tested with Student's test for the whole group of patients. Results: Dose calculation error for the points on the beam to the body entry was below 5% except for the neck (<10%, lateral fields) and the lungs (<10%, AP/PA fields). On the beam exits error exceeded 5% in more points: neck, shoulders,lungs,elbows,wrists,knees,feet(< 10%, lateral); wrists, knees, feet (<10%, AP/PA) and lungs (<15%, AP/PA) respectively. The standard .deviations (in per cents on entry/exit)for the whole group of patients for lateral fields were: 4.6/7.1 for head; 5.7/17.0 for the neck and 5.9/18.5 for the lungs. For AP/PA fields respectively: 4.2/6.5 for head; 5.2/7.2 for the neck and 9.3/24.3 for the lungs. The measured doses did not fit to those calculated for head and neck exits at lateral fields and for the lungs at AP/PA fields only (p=0.05). Conclusions: The neck and the lungs were critical sections in dose determination, however achieved discrepancies did not exceed 10% on entry and 15% on exits respectively. 399
poster
Long-term side effects of radiotherapy and chemotherapy for Hodgkin's disease A. Dimitrovska Institute of Radiotherapy and Oncology, Skopje, Macedonia Purpose: To assess the degree of late complications of radiotherapy (RT) and chemotherapy (CT) in patients successfully/treated for Hodgkin's disease. • Patients and methods: Long-term side effects were evaluated jn 78 patients who were in a complete remission for 3 years:or more after having received tumor dose between 35 Gy and 45 Gy and/or minimum three courses of CT (32 patients). The following investigations were performed: clinical examination, pulmonary function tests, chest X-ray, cardiological investigations including echocardiography, haematological investigations, bone marrow cytology and thyroid function tests. Results: Reduced performance status and deteriorated general condition was found in 40%, mediastinal or paramediastinal fibrosis in82% (severe in 8% and moderate in 48%), slight (20%) and moderate (8%) fibrosis of the apical parts of the lung, ventilation disorder in 76%, mostly of the restrictive type, ventricular function disorder in 18%, cardiac insufficiency in 5%, pericarditis in 5%, granulocytopenia in 11%, lymphocytopenia in 26%, slight anemia in 20%, aplasia in 60% and hypoplasia in 27% on ster-
nal marrow cytology (previously irradiated) and hypoplasia in 16% on lilac crest cytology (not irradiated), clinically manifested hypothyroidism in one patient, elevated serum thyrotropin stimulating hormone in 35% and abnormal test of thyrotropin-releasing hormone in 18%. Conclusion: The fact that more than 50% of patients showed pathological findings signals the need for further detection of long-term side effects of RT and CT and the need for administration of symptomatic therapy in patients with proven complications. 400
poster
Treatment result of the primary orbital lymphoma A. Nishikawa N. Shikama, S. Sasaki, A. Shinoda, M. Oguchi Nagano Red Cross Hospital, Radiology, Nagano, Japan Purpose: To analysis the treatment results and adverse effects of orbital lymphomas (stage I) after radiotherapy and/or chemotherapy. Material and Methods: We reviewed 22 patients with primary orbital lymphomas (stage I), who were treated from 1990 through 1999 at our institute. Twenty-one patients had B-lineage, and one had T-lineage. The male to female ratio was 14: 8, and median age was 61 years (range: 3382 years). The primary sites were retrobulbar space in 11 patients, con: junctiva in 10, and lacrimal gland in one. Biopsy was performed in 17 patients, and total removal in 5. All patients received conventional radialtherapy, and the median radiation dose was 40 Gy/20 fx. (range: 30-60 Gy). Twelve patients received chemotherapy before or after radiotherapy. The median follow-up time was 40 months (range: 1-113 months). Results: The 5-year overall and disease-free survival rates of all patients were 88% and 93%, respectively. The 5-year local control rate was 100%. Chemotherapy di d not contribute to increase the survival rates. The evaluation of Quality of Life (QOL) was performed in 20 patients. The level of QOL after treatment was worse than that before treatment in 10 patients because of disorder of visual activity or initiation. All 5 patients with total removal demonstrated the low QOL, but only 5 in 15 patients with biopsy demonstrated the low QOL (p=0.03). We could evaluate the visual activity in 18 patients. Nine patients disclosed the disorder of visual activity after radiotherapy. Conclusion: The local control rate of orbital lymphomas was good, but half of all patients disclosed the disorder of visual activity. We should decrease the total radiation dose less than 40 Gy. The total removal leads to low QOL due to the disorder of initiation 40I
poster
The danger of mantle-field technique in radiotherapy of Hodgkin's disease J. Zamecnik 1, P. Vitek 1, D. Feltl1, V. Stahalova 1, Z. Dienstbief2 1institute of Radiation Oneology, Prague, Czech republic 2League Against Cancer, Prague, Czech republic Purpose: Of 283 patients with Hodgkin's disease treated with "classic" mantle-field technique 6 patients younger than 40 years developed breast cancer (1 patient bilateral). A modified mantle-field technique has been developed to prevent this radiation induced cancer. Methods: At 60Co unit or 6 MeV Linac the patients are treated with anterior mantle-field. The breast glands are shielded or fixed under the lung blocks. Employing CT slides the daily dose 200 cGy is calculated at axillary nodes. The dose at mid-plain (mediastinum) is daily saturated to 200 cGy from a posterior field covering the mediastinum. The spinal cord does not need to be shielded in a m&jority of patients. Results: Of 323 patients none younger than 40 years has developed breast cancer since 1973. 402
poster
Radiation treatment in patients with intraorbital lymphoma 7-. Inomata. Y. Ogawa, A. Nishioka, M. Terashima, S. Kariya, S. Yoshida, I. Narabayashi Department of Radiology, Kochi Medical School, Japan Department of Radiology, Osaka Medical College, Japan Purpose: to evaluate the response rate, survival rate, improvement in symptoms, and late toxicity of intraocular lymphoma by radiation therapy. Materials and methods: 22 patients with intraorbital lymphoma were treated between April 1982 and March 2000 by 4-15 MeV electron beam or 4 MV photon beam with one or two radiation portals. The delivered dose ranged from 36 Gy to 48 Gy. Lens and cornea were shielded if possible. Results: response rate was CR 9 (41%), PR 12 (55%), and NC 1 (4%). Only one patient with PR had died at six months after treatment. There was no local recurrence, though two patients experienced relapse at other sites. The incidence of cataract in patients whose lens was included in the radiation portals was 54% without Ct simulator. The ratio was decreased to 22% when CT simulator was evailable.
S 105
policy has been changed: in the 1st period (until 1980) most, 31/38, paients were treated by radiotherapy alone. Since 1981, the 2nd period, chemotherapy was added to 84% (59/70) of the pts, and 36 (52%) of them recieved it alone. Results: CR was equal (89%) in both periods of study. However, distant failure was higher and 10y survival was significantly lower in pts treated in 1st period compared to those treated in the 2nd period (59% vs. 4% and 35% vs. 60%, respectively p<0.002). In pts with aggressive lymphoma chemotherapy alone was as effective as combined radio-chemotherapy treatment (CR 83% vs. 85%, relapse 8% vs. 20% and long term survival 63% vs. 45%, respectively). Radiotherapy alone was mainly effective in low grade (LG) histology (CR 100% and 10y survival 83%). Conclusions: 1. Instituting chemotherapy in the last two decades dramatically improved the outcome of the patients. 2. The role of radiotherapy in ENHN lymphoma is questionable particularly in the face of potential severe radiation side effects at that location. 3. Radiotherapy alone may remain optimal for localized LG ENHN lymphoma. 398
poster
Total body irradiation: dose determination accuracy. J. Malicki1, G. Kosieka 1, G. Stryezynska2, J. Wachowiak3 1Greatpoland Cancer Centre, Medical Physics, Poznan, Poland 2Greatpoland Cancer Centre, Radiotherapy, Poznan, Poland 3Medical University, BMT, Poznan, Poland Purpose: The aim of this paper was: (I) to estimate the error in preliminary dose calculations in some chosen cross-sections of the body; (2) to check accordance between the calculated doses and those measured in-vivo in a group of thirty patients. Methods: A total dose of 12.6 Gy (below 10 Gy in lungs) was prescribed in the body midline in the central axis (CAX). A dose of 8.2 Gy was delivered from 6 lateral fields (with 7 cGy/min) and 4.4 Gy from AP/PA fields (with 17 cGy/min). Lungs were shielded during AP/PA fields. A group of thirty consecutive patients, children aged from 5 to 12 years was taken for dose compadsion. Doses were calculated and measured (by thermoluminescent and semiconductor detectors) in ten chosen CT-made cross-sections. The error in the calculations was determined by a total differential method. For measured doses their average percent deviations from the calculations and the respective standard deviations were determined for all fields and sections. Accordance of measured doses to those calculated was tested with Student's test for the whole group of patients. Results: Dose calculation error for the points on the beam to the body entry was below 5% except for the neck (<10%, lateral fields) and the lungs (<10%, AP/PA fields). On the beam exits error exceeded 5% in more points: neck, shoulders,lungs,elbows,wrists,knees,feet(< 10%, lateral); wrists, knees, feet (<10%, AP/PA) and lungs (<15%, AP/PA) respectively. The standard .deviations (in per cents on entry/exit)for the whole group of patients for lateral fields were: 4.6/7.1 for head; 5.7/17.0 for the neck and 5.9/18.5 for the lungs. For AP/PA fields respectively: 4.2/6.5 for head; 5.2/7.2 for the neck and 9.3/24.3 for the lungs. The measured doses did not fit to those calculated for head and neck exits at lateral fields and for the lungs at AP/PA fields only (p=0.05). Conclusions: The neck and the lungs were critical sections in dose determination, however achieved discrepancies did not exceed 10% on entry and 15% on exits respectively. 399
poster
Long-term side effects of radiotherapy and chemotherapy for Hodgkin's disease A. Dimitrovska Institute of Radiotherapy and Oncology, Skopje, Macedonia Purpose: To assess the degree of late complications of radiotherapy (RT) and chemotherapy (CT) in patients successfully/treated for Hodgkin's disease. • Patients and methods: Long-term side effects were evaluated jn 78 patients who were in a complete remission for 3 years:or more after having received tumor dose between 35 Gy and 45 Gy and/or minimum three courses of CT (32 patients). The following investigations were performed: clinical examination, pulmonary function tests, chest X-ray, cardiological investigations including echocardiography, haematological investigations, bone marrow cytology and thyroid function tests. Results: Reduced performance status and deteriorated general condition was found in 40%, mediastinal or paramediastinal fibrosis in82% (severe in 8% and moderate in 48%), slight (20%) and moderate (8%) fibrosis of the apical parts of the lung, ventilation disorder in 76%, mostly of the restrictive type, ventricular function disorder in 18%, cardiac insufficiency in 5%, pericarditis in 5%, granulocytopenia in 11%, lymphocytopenia in 26%, slight anemia in 20%, aplasia in 60% and hypoplasia in 27% on ster-
nal marrow cytology (previously irradiated) and hypoplasia in 16% on lilac crest cytology (not irradiated), clinically manifested hypothyroidism in one patient, elevated serum thyrotropin stimulating hormone in 35% and abnormal test of thyrotropin-releasing hormone in 18%. Conclusion: The fact that more than 50% of patients showed pathological findings signals the need for further detection of long-term side effects of RT and CT and the need for administration of symptomatic therapy in patients with proven complications. 400
poster
Treatment result of the primary orbital lymphoma A. Nishikawa N. Shikama, S. Sasaki, A. Shinoda, M. Oguchi Nagano Red Cross Hospital, Radiology, Nagano, Japan Purpose: To analysis the treatment results and adverse effects of orbital lymphomas (stage I) after radiotherapy and/or chemotherapy. Material and Methods: We reviewed 22 patients with primary orbital lymphomas (stage I), who were treated from 1990 through 1999 at our institute. Twenty-one patients had B-lineage, and one had T-lineage. The male to female ratio was 14: 8, and median age was 61 years (range: 3382 years). The primary sites were retrobulbar space in 11 patients, con: junctiva in 10, and lacrimal gland in one. Biopsy was performed in 17 patients, and total removal in 5. All patients received conventional radialtherapy, and the median radiation dose was 40 Gy/20 fx. (range: 30-60 Gy). Twelve patients received chemotherapy before or after radiotherapy. The median follow-up time was 40 months (range: 1-113 months). Results: The 5-year overall and disease-free survival rates of all patients were 88% and 93%, respectively. The 5-year local control rate was 100%. Chemotherapy di d not contribute to increase the survival rates. The evaluation of Quality of Life (QOL) was performed in 20 patients. The level of QOL after treatment was worse than that before treatment in 10 patients because of disorder of visual activity or initiation. All 5 patients with total removal demonstrated the low QOL, but only 5 in 15 patients with biopsy demonstrated the low QOL (p=0.03). We could evaluate the visual activity in 18 patients. Nine patients disclosed the disorder of visual activity after radiotherapy. Conclusion: The local control rate of orbital lymphomas was good, but half of all patients disclosed the disorder of visual activity. We should decrease the total radiation dose less than 40 Gy. The total removal leads to low QOL due to the disorder of initiation 40I
poster
The danger of mantle-field technique in radiotherapy of Hodgkin's disease J. Zamecnik 1, P. Vitek 1, D. Feltl1, V. Stahalova 1, Z. Dienstbief2 1institute of Radiation Oneology, Prague, Czech republic 2League Against Cancer, Prague, Czech republic Purpose: Of 283 patients with Hodgkin's disease treated with "classic" mantle-field technique 6 patients younger than 40 years developed breast cancer (1 patient bilateral). A modified mantle-field technique has been developed to prevent this radiation induced cancer. Methods: At 60Co unit or 6 MeV Linac the patients are treated with anterior mantle-field. The breast glands are shielded or fixed under the lung blocks. Employing CT slides the daily dose 200 cGy is calculated at axillary nodes. The dose at mid-plain (mediastinum) is daily saturated to 200 cGy from a posterior field covering the mediastinum. The spinal cord does not need to be shielded in a m&jority of patients. Results: Of 323 patients none younger than 40 years has developed breast cancer since 1973. 402
poster
Radiation treatment in patients with intraorbital lymphoma 7-. Inomata. Y. Ogawa, A. Nishioka, M. Terashima, S. Kariya, S. Yoshida, I. Narabayashi Department of Radiology, Kochi Medical School, Japan Department of Radiology, Osaka Medical College, Japan Purpose: to evaluate the response rate, survival rate, improvement in symptoms, and late toxicity of intraocular lymphoma by radiation therapy. Materials and methods: 22 patients with intraorbital lymphoma were treated between April 1982 and March 2000 by 4-15 MeV electron beam or 4 MV photon beam with one or two radiation portals. The delivered dose ranged from 36 Gy to 48 Gy. Lens and cornea were shielded if possible. Results: response rate was CR 9 (41%), PR 12 (55%), and NC 1 (4%). Only one patient with PR had died at six months after treatment. There was no local recurrence, though two patients experienced relapse at other sites. The incidence of cataract in patients whose lens was included in the radiation portals was 54% without Ct simulator. The ratio was decreased to 22% when CT simulator was evailable.