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403C Hodgkins Disease — part II: Management of advanced — stage disease, relapsed disease and long-term complications of treatment
128
I. J. Radiation OncologyeBiology*Physics 401 Brachytherapy Boost Techniques Alvaro A. Martinez, M.D. William Beaumont Hospital, Royal
for Locally
Advanced
Prostate
Volume 39, Number 2, Supplement, 1997
Cancer
Oak, Ml
While external beam remains the gold standard for the non-surgical treatment of patients with prostate cancer, the results for patients with locally advanced disease remains suboptimal. Specifically, the treatment for patients with clinical Stage TZb or greater, Gleason 6 or higher and pretreatment PSAs z 10 rig/ml remain a therapeutic challenge. Several strategies have been designed for these patients. They include pretreatment with hormones, conformal external beam treatment, mixed beam of photons and neutrons, and the utilization of a brachytherapy boost either with conformal high dose rate or with a permanent seed implantation. This course will address the brachytherapy boost techniques. Emphasis will be made on the ultrasound guided brachytherapy techniques for conformal high dose rate and for permanent seed implantation. DOS and don’@ will be discussed. A comparison of the two techniques including cost analysis will also be presented. Implant evaluation tools including definition of Brachytherapy Clinical Target Volume (B-CTV) Brachytherapy Planning Target Volume (B-PTV), Dose Volume Hystogram (DVHs), as well as assessment and dosimetric effect of post-implant edema, etc., will be presented. The on-line interactive conformal treatment planning for outpatient high dose rate template implants will be illustrated with clinical cases. A review of treatment results of prostate brachytherapy boost using local control, survival, biochemical control and cause specific survival will be presented. In addition, type and frequency of long term complications will be addressed.
402 Lower Gastrointestinal Malignancies Joel E. Tepper, M.D. Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC A great deal of new information has been generated in the past decade regarding the prevention, diagnosis, etiology, biology and treatment of cancers of the colon and rectum. Screening strategies have been demonstrated to be effective in preventing the occurence of these tumors by finding and removing neoplasms in their premalignant state. If widely implemented this should result in an overall decrease in mortality from these diseases. Genetic predisposition syndromes and the molecular abnormalities associated with them have been defined. A large number of molecular abnormalities have been elucidated which are associated with the development of sporadic tumors of the colon and rectum. These issues will be discussed including the relevance to the practicing oncologist. In addition to the enormous changes in our basic understanding of the biology of these tumors, there have also been substantial changes in the management of rectal cancer and there is a gradually changing role of radiation therapy. Radiation therapy is now standardly combined with chemotherapy in the manangement of patients with tumors that are through the bowel wall or with nodal positivity. The integration of the two modalities is in evolution, and issues of radiation enhancement by 5-fluoruracil is important in design of these strategies. At the present time the relative value of preoperative vs postoperative radiation therapy is not defined, and there is disagreement as to whether a short course of preoperative radiation therapy may be as effective as the more standard longer courses. The use of preoperative radiation therapy and chemotherapy to enhance the incidence of sphincter preservation has gained more widespread acceptance, but needs to be combined with surgeons experienced in these surgical approaches. For patients with early stage disease, there is more general acceptance of the use of sphincter preserving surgery and radiation therapy, but the criteria for which patients can be appropriately treated with this approach while important, is not fully defined. Management of patients with locally advanced disease remains a substantial problem, but the use of preoperative radiation therapy and chemotherapy apppears to improve local control and probably survival. Radiation therapy does not yet have a major role in the treatment of patients with cancers of the c&m. There is still interest in the use of radiation therapy and chemotherapy in patients with locally advanced disease, but there are still no randomized trials demonstrating an advantage in this clinical situation.
403c Hodgkins Disease - Part II: Management of Advanced - Stage Disease, Relapsed Disease and Long-Term Complications of Treatment Joachim Yahalom, M.D.1 Peter M. Mauch, M. D.2 Memorial Sloan-Kettering Cancer Center, New York, NY 1 Joint Center for Radiation Therapy, Boston, MA2 Part II of the refresher course on Hodgkin’s disease (HD) will: 1. Update chemotherapy principles and new regimens for HD. 2. Discuss the role and practice of radiation therapy in the management of stage III-IV disease. 3. Review the treatment of relapsed Hodgkin’s disease after radiotherapy alone and the salvage approach to failures of primary chemotherapy and combined modality therapy. 4. Examine the role of radiation therapy in high-dose salvage programs with stem cell rescue. 5. Review the long-term complications of all modalities with an emphasis on secondary breast cancer and coronary heart disease.
404c
Intravascular Brachytherapy - Part III: Preventing Coronary Artery Restenosis Vincent Massullo, M.D. Scripps Clinic & Research Foundation, La Jolla, CA Intravascular brachytherapy is proving to be the most effective tool to date to prevent coronary artery restenosis after cardiologic or surgical interventions. This exciting new interdisciplinary application of brachytheraphy may prove a paradigm shift in the therapy of vascular restenosis. This course will review the basic science background and early clinical studies of intravascular brachytherapy. Results of completed trials will be reviewed. New trials to assess efficacy as well as innovative new technologies will be described. The interaction and roles of the attendant medical and technical specialties in this fast-growing field will be discusssed.
I. J. Radiation OncologyeBiology*Physics 401 Brachytherapy Boost Techniques Alvaro A. Martinez, M.D. William Beaumont Hospital, Royal
for Locally
Advanced
Prostate
Volume 39, Number 2, Supplement, 1997
Cancer
Oak, Ml
While external beam remains the gold standard for the non-surgical treatment of patients with prostate cancer, the results for patients with locally advanced disease remains suboptimal. Specifically, the treatment for patients with clinical Stage TZb or greater, Gleason 6 or higher and pretreatment PSAs z 10 rig/ml remain a therapeutic challenge. Several strategies have been designed for these patients. They include pretreatment with hormones, conformal external beam treatment, mixed beam of photons and neutrons, and the utilization of a brachytherapy boost either with conformal high dose rate or with a permanent seed implantation. This course will address the brachytherapy boost techniques. Emphasis will be made on the ultrasound guided brachytherapy techniques for conformal high dose rate and for permanent seed implantation. DOS and don’@ will be discussed. A comparison of the two techniques including cost analysis will also be presented. Implant evaluation tools including definition of Brachytherapy Clinical Target Volume (B-CTV) Brachytherapy Planning Target Volume (B-PTV), Dose Volume Hystogram (DVHs), as well as assessment and dosimetric effect of post-implant edema, etc., will be presented. The on-line interactive conformal treatment planning for outpatient high dose rate template implants will be illustrated with clinical cases. A review of treatment results of prostate brachytherapy boost using local control, survival, biochemical control and cause specific survival will be presented. In addition, type and frequency of long term complications will be addressed.
402 Lower Gastrointestinal Malignancies Joel E. Tepper, M.D. Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC A great deal of new information has been generated in the past decade regarding the prevention, diagnosis, etiology, biology and treatment of cancers of the colon and rectum. Screening strategies have been demonstrated to be effective in preventing the occurence of these tumors by finding and removing neoplasms in their premalignant state. If widely implemented this should result in an overall decrease in mortality from these diseases. Genetic predisposition syndromes and the molecular abnormalities associated with them have been defined. A large number of molecular abnormalities have been elucidated which are associated with the development of sporadic tumors of the colon and rectum. These issues will be discussed including the relevance to the practicing oncologist. In addition to the enormous changes in our basic understanding of the biology of these tumors, there have also been substantial changes in the management of rectal cancer and there is a gradually changing role of radiation therapy. Radiation therapy is now standardly combined with chemotherapy in the manangement of patients with tumors that are through the bowel wall or with nodal positivity. The integration of the two modalities is in evolution, and issues of radiation enhancement by 5-fluoruracil is important in design of these strategies. At the present time the relative value of preoperative vs postoperative radiation therapy is not defined, and there is disagreement as to whether a short course of preoperative radiation therapy may be as effective as the more standard longer courses. The use of preoperative radiation therapy and chemotherapy to enhance the incidence of sphincter preservation has gained more widespread acceptance, but needs to be combined with surgeons experienced in these surgical approaches. For patients with early stage disease, there is more general acceptance of the use of sphincter preserving surgery and radiation therapy, but the criteria for which patients can be appropriately treated with this approach while important, is not fully defined. Management of patients with locally advanced disease remains a substantial problem, but the use of preoperative radiation therapy and chemotherapy apppears to improve local control and probably survival. Radiation therapy does not yet have a major role in the treatment of patients with cancers of the c&m. There is still interest in the use of radiation therapy and chemotherapy in patients with locally advanced disease, but there are still no randomized trials demonstrating an advantage in this clinical situation.
403c Hodgkins Disease - Part II: Management of Advanced - Stage Disease, Relapsed Disease and Long-Term Complications of Treatment Joachim Yahalom, M.D.1 Peter M. Mauch, M. D.2 Memorial Sloan-Kettering Cancer Center, New York, NY 1 Joint Center for Radiation Therapy, Boston, MA2 Part II of the refresher course on Hodgkin’s disease (HD) will: 1. Update chemotherapy principles and new regimens for HD. 2. Discuss the role and practice of radiation therapy in the management of stage III-IV disease. 3. Review the treatment of relapsed Hodgkin’s disease after radiotherapy alone and the salvage approach to failures of primary chemotherapy and combined modality therapy. 4. Examine the role of radiation therapy in high-dose salvage programs with stem cell rescue. 5. Review the long-term complications of all modalities with an emphasis on secondary breast cancer and coronary heart disease.
404c
Intravascular Brachytherapy - Part III: Preventing Coronary Artery Restenosis Vincent Massullo, M.D. Scripps Clinic & Research Foundation, La Jolla, CA Intravascular brachytherapy is proving to be the most effective tool to date to prevent coronary artery restenosis after cardiologic or surgical interventions. This exciting new interdisciplinary application of brachytheraphy may prove a paradigm shift in the therapy of vascular restenosis. This course will review the basic science background and early clinical studies of intravascular brachytherapy. Results of completed trials will be reviewed. New trials to assess efficacy as well as innovative new technologies will be described. The interaction and roles of the attendant medical and technical specialties in this fast-growing field will be discusssed.