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45 Peroperative interstitial HDR brachytherapy as a boost in breast conserving therapy
s33 46
45 PEROPERATIVE AS
A BOOST
INTERSTITIAL IN
BREAST
HDR
CONSERVING
BRACHYTHERAPY
PAOLO MUTO MD,VINCENZO D'AVERSA MD. Isti'cuto di RAVO MD, LUCIA Scienze Radiologiche I^CATTEDRA.Universita II"POLICLINICO.NAPOLI di Napoli FedricoII". In January 1993 we started a pilot study to investigate whether a peroperative inter_ stitial HDR boost dose is effective in the treatment of breast cancer in terms of local control and cosmetic rsults. From the period we treated 11 patients with to October 1993, breast cancer TlNOMO. After lumpectomy 5-7 mostly in a double plane, were pla_ needles, ted throught the tumor bed with open wound. Treatment started soon after surgery with Three fractions of 300cGy at brachytherapy. interval, were delivered. 1 cm, with 6 hours The first one started soon after surgery. After three weeks patients started a radio_ therapy treatment with tangential fields A dose of 44 Gy was and 2 Gy per fraction. delivered in 22 fractions. No electron boost was used. The cosmetic outcome during the follow up time was generally good or excel_ lent. At the moment we have not observed any relapse in these patients. We hope to inspi_ re a cooperative group trial to investigate perioperative brachytherapy plus radiotherapy as a treatment for early stage breast cancer.
47 Intraoperative
HDR-Brachytherapy
PEROPERATIVE
BRACHYTHERAPY
IN SARCOMA TREATMENT
THERAPY.
for Gynaecological
Cancer.
M.Nechushkin, L.Maryina, M.Sushchikhina, Cancer Research Centre, Moscow, Russia.
A. RIGON, M.L. FRISO, S. BELFONTALI, F. BERTI, C. 'BOSO, Divisione di Radioterapia e Medicina F. CALZAVARA. Nucleare - U.L.S.S. N. 21 - PADOVA - ITALY Between 6/91 and 12/93, 11 pts affect by sarcoma were treated with peroperative ihterstitiai.brachytherapy associated or not with external radiotherapy. 5 females and 6 males were treated; their age ranged between 19 and 78 years. Histologically there were: 3 cases of malignant fibrous histiocytoma, 3 schwannm , 3 myxoid liposarcomas, 2 leiomyosarcomas, 1 mixoid fibrosarcoma. 7 pts were treated after surgery for recurrence and 4 after primary surgery with incomplete excision. Areas treated were: shoulder (3 cases), arm (3),leg (31, trunk (11, inguino-crural (1). Peroperative brachytherapy was performed with afterloading plastic tubes placed immediately after gross surgl cal removal. The target area was always marked with clips for dosime tric study. After 8-15 days the IR192 wires were inserted. The dose given by brachytherapy was between 15 and 63 GY, 10 Gy per day, with low dose rate; in 8 cases it was associated with external radiotherapy to a total dose ranging between 60 and 70 Gy. The follow-up period is of 3-30 mts with a median of 19 mts. Up to day only one local recurrence has been obser ved, at 3 mts from treatment. All the other pts are ali ve and disease free. Peroperative brachytherapy my be an useful treatment for local control of sarcomas, alone or associated with external radiotherapy.
48 INTERSTITIAL RADIOTHERAPY ICAL CARCINOMAS
FOR GENEACOLOG-
L.Maryina, M.Niechushkin, M.Sushchikhina Cancer Research Centre,Moscow,
R.Likhovetskaya,
N.Zinoviev
The new intraoperative HDR-brachytherapy program was started in November 1993 for the patients with stage I and II cervical and endometrial cancer. All 9 patients were suitable for radical surgery-extend extirpation of uterus Removable implant was formed during surgery progedure: two flexible 5 mm diameter catheters were plased in the high risk recurrence parametrium area with inner ends being on the first lumbar vertebra level and outer ends outplaced through the vagina. Brachytherapy was performed one-two days after surgery procedure with “microSelectron-HDR”. Two thin 1.1 mm diameter catheters suitable for high-active ls21r source were placed into the previously inserted ones. Two films with dummy sources, contrast bladder and rectun, were made for implant reconstruction in relation to anatomic structures and neigbouring organs, an additional information was obtained from CT-scans. Treatment volume was made in form of two cylinders along the catheters in the upper part of implants, wherein the distance between them was 30-80 mm, and in form of one cylinder in the paracervical triangle area, in which the catheter axes distance did not exeed 10 mm. Dose prescribed points were placed 10 mm from the catheter axis, dose point optimization for volume implant was used for dosimetry treatment planning. As a result we formed treatment volume with extention of 110-120 mm and diameter of 20 mm and 30 mm in the upper and lower parts respectively. Patients received 4 fractions daily, 400 cGy per fraction. The external irradiation program was formed after gistological examination of tumor and determination of the disease spreading. AU patients underwent treatment well without complications.
Russia
Between September 1981 and december 1993 Department of Radiosurgery, Cancer Research Center, delivered interstitial radiation therapy to 92 patients. 9,7 70 (9 patients) had primary vulva tumours; 67,370 (62 patients) - metastases of uterus cancer into vagina; 10,8a/o (10 patients) - metastases of rectum cancer; 11,970 (11 patients) - metastases of cancer in parametrium. Dosimetry planning for irradiating vagina and vulva tumours (Microselectron-LDR and - HDR) was performed using Nucletron Planning System. For LDR unit, planning Orton protracted irradiation model was used, the planned dose of 35-45 Gy being delivered in one fraction, while for HDR unit planning, Orton-Ellis fractionated model applied, the same dose being delivered in 2-3 fractions. 45 patients were treated with low-energy B°Co(simple afterloading), 47 - with 13?Csand lszIr (Microselectron - LDR and - HDR). The follow-up periods varied from 1 to 10 years. The treatment delivery resulted in clinical cure of the primaries and overall survival for 3, 5 and 10 years. The data available through the analysis allow to conclude that interstitial radiotherapy with B°Co, 13’Cs and lg21r is well applicable for the foregoing group of patients and may be used both independently and in combination with other techniques. The use of Microselectron LDR and HDR units and Nucletron Planning System for radiotherapy and treatment planning is yet another extention of brachytherapy potentials and efficacy. The advantages of these units were displayed in good performance properties, ease of handling and applicability for interstitial irradiation of variuos geneacological localizations.
45 PEROPERATIVE AS
A BOOST
INTERSTITIAL IN
BREAST
HDR
CONSERVING
BRACHYTHERAPY
PAOLO MUTO MD,VINCENZO D'AVERSA MD. Isti'cuto di RAVO MD, LUCIA Scienze Radiologiche I^CATTEDRA.Universita II"POLICLINICO.NAPOLI di Napoli FedricoII". In January 1993 we started a pilot study to investigate whether a peroperative inter_ stitial HDR boost dose is effective in the treatment of breast cancer in terms of local control and cosmetic rsults. From the period we treated 11 patients with to October 1993, breast cancer TlNOMO. After lumpectomy 5-7 mostly in a double plane, were pla_ needles, ted throught the tumor bed with open wound. Treatment started soon after surgery with Three fractions of 300cGy at brachytherapy. interval, were delivered. 1 cm, with 6 hours The first one started soon after surgery. After three weeks patients started a radio_ therapy treatment with tangential fields A dose of 44 Gy was and 2 Gy per fraction. delivered in 22 fractions. No electron boost was used. The cosmetic outcome during the follow up time was generally good or excel_ lent. At the moment we have not observed any relapse in these patients. We hope to inspi_ re a cooperative group trial to investigate perioperative brachytherapy plus radiotherapy as a treatment for early stage breast cancer.
47 Intraoperative
HDR-Brachytherapy
PEROPERATIVE
BRACHYTHERAPY
IN SARCOMA TREATMENT
THERAPY.
for Gynaecological
Cancer.
M.Nechushkin, L.Maryina, M.Sushchikhina, Cancer Research Centre, Moscow, Russia.
A. RIGON, M.L. FRISO, S. BELFONTALI, F. BERTI, C. 'BOSO, Divisione di Radioterapia e Medicina F. CALZAVARA. Nucleare - U.L.S.S. N. 21 - PADOVA - ITALY Between 6/91 and 12/93, 11 pts affect by sarcoma were treated with peroperative ihterstitiai.brachytherapy associated or not with external radiotherapy. 5 females and 6 males were treated; their age ranged between 19 and 78 years. Histologically there were: 3 cases of malignant fibrous histiocytoma, 3 schwannm , 3 myxoid liposarcomas, 2 leiomyosarcomas, 1 mixoid fibrosarcoma. 7 pts were treated after surgery for recurrence and 4 after primary surgery with incomplete excision. Areas treated were: shoulder (3 cases), arm (3),leg (31, trunk (11, inguino-crural (1). Peroperative brachytherapy was performed with afterloading plastic tubes placed immediately after gross surgl cal removal. The target area was always marked with clips for dosime tric study. After 8-15 days the IR192 wires were inserted. The dose given by brachytherapy was between 15 and 63 GY, 10 Gy per day, with low dose rate; in 8 cases it was associated with external radiotherapy to a total dose ranging between 60 and 70 Gy. The follow-up period is of 3-30 mts with a median of 19 mts. Up to day only one local recurrence has been obser ved, at 3 mts from treatment. All the other pts are ali ve and disease free. Peroperative brachytherapy my be an useful treatment for local control of sarcomas, alone or associated with external radiotherapy.
48 INTERSTITIAL RADIOTHERAPY ICAL CARCINOMAS
FOR GENEACOLOG-
L.Maryina, M.Niechushkin, M.Sushchikhina Cancer Research Centre,Moscow,
R.Likhovetskaya,
N.Zinoviev
The new intraoperative HDR-brachytherapy program was started in November 1993 for the patients with stage I and II cervical and endometrial cancer. All 9 patients were suitable for radical surgery-extend extirpation of uterus Removable implant was formed during surgery progedure: two flexible 5 mm diameter catheters were plased in the high risk recurrence parametrium area with inner ends being on the first lumbar vertebra level and outer ends outplaced through the vagina. Brachytherapy was performed one-two days after surgery procedure with “microSelectron-HDR”. Two thin 1.1 mm diameter catheters suitable for high-active ls21r source were placed into the previously inserted ones. Two films with dummy sources, contrast bladder and rectun, were made for implant reconstruction in relation to anatomic structures and neigbouring organs, an additional information was obtained from CT-scans. Treatment volume was made in form of two cylinders along the catheters in the upper part of implants, wherein the distance between them was 30-80 mm, and in form of one cylinder in the paracervical triangle area, in which the catheter axes distance did not exeed 10 mm. Dose prescribed points were placed 10 mm from the catheter axis, dose point optimization for volume implant was used for dosimetry treatment planning. As a result we formed treatment volume with extention of 110-120 mm and diameter of 20 mm and 30 mm in the upper and lower parts respectively. Patients received 4 fractions daily, 400 cGy per fraction. The external irradiation program was formed after gistological examination of tumor and determination of the disease spreading. AU patients underwent treatment well without complications.
Russia
Between September 1981 and december 1993 Department of Radiosurgery, Cancer Research Center, delivered interstitial radiation therapy to 92 patients. 9,7 70 (9 patients) had primary vulva tumours; 67,370 (62 patients) - metastases of uterus cancer into vagina; 10,8a/o (10 patients) - metastases of rectum cancer; 11,970 (11 patients) - metastases of cancer in parametrium. Dosimetry planning for irradiating vagina and vulva tumours (Microselectron-LDR and - HDR) was performed using Nucletron Planning System. For LDR unit, planning Orton protracted irradiation model was used, the planned dose of 35-45 Gy being delivered in one fraction, while for HDR unit planning, Orton-Ellis fractionated model applied, the same dose being delivered in 2-3 fractions. 45 patients were treated with low-energy B°Co(simple afterloading), 47 - with 13?Csand lszIr (Microselectron - LDR and - HDR). The follow-up periods varied from 1 to 10 years. The treatment delivery resulted in clinical cure of the primaries and overall survival for 3, 5 and 10 years. The data available through the analysis allow to conclude that interstitial radiotherapy with B°Co, 13’Cs and lg21r is well applicable for the foregoing group of patients and may be used both independently and in combination with other techniques. The use of Microselectron LDR and HDR units and Nucletron Planning System for radiotherapy and treatment planning is yet another extention of brachytherapy potentials and efficacy. The advantages of these units were displayed in good performance properties, ease of handling and applicability for interstitial irradiation of variuos geneacological localizations.