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588 poster 3-D conformal radiotherapy in children with low-grade brain tumours
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36 Gy. The median interval between surgery and the start of RT was 28 days (range 10-40).Chemotherapy was used on only four patients (% 29). The median follow-up was 31 months (6-52 months)
Conclusion: Medulloblastoma is a highly malignant cerebellar tumor of children and less frequently seen at adults. The prognosis has improved significantly in recent decades, in parallel with the improvement in neurosurgical techniques and the use of postoperative radiotherapy. Although chemotherapy may be useful and well tolerated, radiotherapy remains the mainstay adjuvant treatment. 587 poster Clinical results of proton beam therapy for skull base chordoma
~ , K. Tokuuye ~, T. Okumura 2, S. Sugahara 3, K. Kagei , M. Hata 1, K. Ohara 3, K. Tsubol-4, T. Hashimoto I , Y. Akine ~ I University of Tsukuba, Proton Medical Research Center, Ibaraki, Japan 21baraki Prefectural Central Hospital, Department of Radiology, Ibaraki, Japan 3University of Tsukuba, Department of Radiation Oncology, Ibaraki, Japan 4University of Tsukuba, Department of Neurosurgery, Ibaraki, Japan Background: Proton beam therapy can deliver higher dose to the tumor because of better dose distribution compared with conventional radiotherapy. The aim of this study was to evaluate clinical results of proton beam therapy for patients with skull base chordoma.
Methods and Materials: Thirteen patients with pathologically confirmed chordoma in the skull base who were treated using proton beams with or without X-rays at the University of Tsukuba between 1989 and 2000 were analyzed. The patients' ages ranged from 14 to 74 years (median 61 years). The median preoperative tumor volume was 27.4 mL (range 3.3-88.4 mL). The median total tumor dose of 72.0 Gy (range 63.0-95.0 Gy) was delivered in 20-38 fractions (median 33 fractions). Five patients of the 13 were irradiated combining 6.0-24.0 Gy of X-rays in 2.0 Gy per fraction. The patients were followed-up for a median period of 69.3 months (range 14.6-123.4 months). Results: Of the 13 patients, 6 suffered from recurrence; all of them had Ioco-regional recurrence and none had disseminated or metastatic diseases. Seven patients died: 3 by chordoma, 1 by radiation-induced brain necrosis, and 3 by intercurrent diseases. The 5-year local control rate was 46.0%. Cause-specific, overall, and disease-free survival rates at 5 years were 72.2%, 66.7%, and 42.2%, respectively. The local control rate was higher, without statistical significance, for those with preoperative tumors less than 30 mL (60.0% vs. 0% at 5 years). The local control rate for the patients who underwent partial or subtotal tumor removal as the latest surgery was not better than that for those who underwent biopsy only. Local control rate for the seven patients who had tumors less than 30 mL with no prior treatment was 83.3% at 5 years. Conclusions: Proton beam therapy is an effective modality for patients with skull base chordoma, especially for those with small tumors. For a patient having a tumor less than 30 mL with no prior treatment, biopsy without tumor removal appears appropriate before proton beam therapy.
Posters
588 poster
3-D conformal radiotherapy in children with low-grade brain tumours A. Skowronska-Gardas, M. Chojnacka, K. Pedziwiatr Centre of Oncology, Radiotherapy, Warszawa, Poland Purpose: 3-D CRT is a treatment of choice for children with partially resected or nonoperable low-grade tumours. In our department, due to neurosurgeons preference, the accepted policy was to deliver RT only to patients with recurrent craniopharyngioma or low-grade astrocytoma. Results of conformal RT in children with localised, low-grade brain tumours are presented. Material and methods: In 1997-2001, 20 children, age 3.518 years with low-grade brain tumours (8 craniopharyngioma and 12 astrocytoma) were treated with conformal radiotherapy techniques. In craniopharyngioma group, all patients were irradiated due to recurrent tumour, after multiples surgeries, and were seriously handicapped before RT onset. Patients with astrocytoma were treated after partial surgery (3) or biopsy only (9) and chemotherapy as well (7). Details of radiotherapy techniques will be presented. Results: All patients with craniopharyngioma are living with no recurrence (7) or with stable disease (1). We did not •observe radiotherapy-related complications. Four patients with astrocytoma died, due to progressive disease (3) or complications after chemotherapy (1). Two are living with dissemination, and 6 with stable disease. Late complications of radiotherapy were not observed. Conclusions: 3-D CRT for children with craniopharyngioma should be applied early in the treatment and follow limited surgical resection to diminish the severe toxicity of repeated surgery. For patients with astrocytoma conformal radiotherapy is treatment of choice when total or subtotal resection of tumour is not possible. The risk of complications related to RT is relatively low. 589 poster
Radiotherapy plus concomitant temozolomide in glioblastoma multiforme and anaplastic astrocytoma: preliminary data A. D'Amico I, V. Solarino 1, S. Maluta ~, L. Cristoforf, P. luzzolino 3, L. Vivenza 3
~HospitaI-University, Radiotherapy, Verona, Italy 2Hospital-University, Neurosurgery, Verona, Italy 3Hospital-University, Pathology, Verona, Italy Objectives: This phase II study, approved by the Ethical Committee of Azienda Ospedaliera of assess the response rate of the (RT+TMZ), the safety profile of the quality of life of patients undergoing this
Verona, is aimed to combined regimen association and the combined therapy.
Patients and Methods: The inclusion criteria were as follows: prior histologic confirmation of glioblastoma, gliosarcoma, anaplastic astrocytoma or anaplastic mixed oligoastrocytoma; all patients underwent macroscopic surgical resection; age > 18 years; Kamofsky Performance Status > 60%; ANC > 1500/mm 3, platelet > 100000/mm 3, hemoglobin > 8g/dl; life expectancy greater than 3 months; informed consent obtained. From June 2002 to November 2003, twenty patients have been enrolled at the Radiotherapy Dept. of Ospedale Maggiore of Verona. In the fase II study, 20 patients affected by GBM (19 pts = 95%) and AA (1 pt = 5%) received Temozolomide (75 mg/mq) daily for 6 weeks combined with synchronous postoperative radiotherapy (60 Gy, 2 Gy per fraction, 5 days a week).
36 Gy. The median interval between surgery and the start of RT was 28 days (range 10-40).Chemotherapy was used on only four patients (% 29). The median follow-up was 31 months (6-52 months)
Conclusion: Medulloblastoma is a highly malignant cerebellar tumor of children and less frequently seen at adults. The prognosis has improved significantly in recent decades, in parallel with the improvement in neurosurgical techniques and the use of postoperative radiotherapy. Although chemotherapy may be useful and well tolerated, radiotherapy remains the mainstay adjuvant treatment. 587 poster Clinical results of proton beam therapy for skull base chordoma
~ , K. Tokuuye ~, T. Okumura 2, S. Sugahara 3, K. Kagei , M. Hata 1, K. Ohara 3, K. Tsubol-4, T. Hashimoto I , Y. Akine ~ I University of Tsukuba, Proton Medical Research Center, Ibaraki, Japan 21baraki Prefectural Central Hospital, Department of Radiology, Ibaraki, Japan 3University of Tsukuba, Department of Radiation Oncology, Ibaraki, Japan 4University of Tsukuba, Department of Neurosurgery, Ibaraki, Japan Background: Proton beam therapy can deliver higher dose to the tumor because of better dose distribution compared with conventional radiotherapy. The aim of this study was to evaluate clinical results of proton beam therapy for patients with skull base chordoma.
Methods and Materials: Thirteen patients with pathologically confirmed chordoma in the skull base who were treated using proton beams with or without X-rays at the University of Tsukuba between 1989 and 2000 were analyzed. The patients' ages ranged from 14 to 74 years (median 61 years). The median preoperative tumor volume was 27.4 mL (range 3.3-88.4 mL). The median total tumor dose of 72.0 Gy (range 63.0-95.0 Gy) was delivered in 20-38 fractions (median 33 fractions). Five patients of the 13 were irradiated combining 6.0-24.0 Gy of X-rays in 2.0 Gy per fraction. The patients were followed-up for a median period of 69.3 months (range 14.6-123.4 months). Results: Of the 13 patients, 6 suffered from recurrence; all of them had Ioco-regional recurrence and none had disseminated or metastatic diseases. Seven patients died: 3 by chordoma, 1 by radiation-induced brain necrosis, and 3 by intercurrent diseases. The 5-year local control rate was 46.0%. Cause-specific, overall, and disease-free survival rates at 5 years were 72.2%, 66.7%, and 42.2%, respectively. The local control rate was higher, without statistical significance, for those with preoperative tumors less than 30 mL (60.0% vs. 0% at 5 years). The local control rate for the patients who underwent partial or subtotal tumor removal as the latest surgery was not better than that for those who underwent biopsy only. Local control rate for the seven patients who had tumors less than 30 mL with no prior treatment was 83.3% at 5 years. Conclusions: Proton beam therapy is an effective modality for patients with skull base chordoma, especially for those with small tumors. For a patient having a tumor less than 30 mL with no prior treatment, biopsy without tumor removal appears appropriate before proton beam therapy.
Posters
588 poster
3-D conformal radiotherapy in children with low-grade brain tumours A. Skowronska-Gardas, M. Chojnacka, K. Pedziwiatr Centre of Oncology, Radiotherapy, Warszawa, Poland Purpose: 3-D CRT is a treatment of choice for children with partially resected or nonoperable low-grade tumours. In our department, due to neurosurgeons preference, the accepted policy was to deliver RT only to patients with recurrent craniopharyngioma or low-grade astrocytoma. Results of conformal RT in children with localised, low-grade brain tumours are presented. Material and methods: In 1997-2001, 20 children, age 3.518 years with low-grade brain tumours (8 craniopharyngioma and 12 astrocytoma) were treated with conformal radiotherapy techniques. In craniopharyngioma group, all patients were irradiated due to recurrent tumour, after multiples surgeries, and were seriously handicapped before RT onset. Patients with astrocytoma were treated after partial surgery (3) or biopsy only (9) and chemotherapy as well (7). Details of radiotherapy techniques will be presented. Results: All patients with craniopharyngioma are living with no recurrence (7) or with stable disease (1). We did not •observe radiotherapy-related complications. Four patients with astrocytoma died, due to progressive disease (3) or complications after chemotherapy (1). Two are living with dissemination, and 6 with stable disease. Late complications of radiotherapy were not observed. Conclusions: 3-D CRT for children with craniopharyngioma should be applied early in the treatment and follow limited surgical resection to diminish the severe toxicity of repeated surgery. For patients with astrocytoma conformal radiotherapy is treatment of choice when total or subtotal resection of tumour is not possible. The risk of complications related to RT is relatively low. 589 poster
Radiotherapy plus concomitant temozolomide in glioblastoma multiforme and anaplastic astrocytoma: preliminary data A. D'Amico I, V. Solarino 1, S. Maluta ~, L. Cristoforf, P. luzzolino 3, L. Vivenza 3
~HospitaI-University, Radiotherapy, Verona, Italy 2Hospital-University, Neurosurgery, Verona, Italy 3Hospital-University, Pathology, Verona, Italy Objectives: This phase II study, approved by the Ethical Committee of Azienda Ospedaliera of assess the response rate of the (RT+TMZ), the safety profile of the quality of life of patients undergoing this
Verona, is aimed to combined regimen association and the combined therapy.
Patients and Methods: The inclusion criteria were as follows: prior histologic confirmation of glioblastoma, gliosarcoma, anaplastic astrocytoma or anaplastic mixed oligoastrocytoma; all patients underwent macroscopic surgical resection; age > 18 years; Kamofsky Performance Status > 60%; ANC > 1500/mm 3, platelet > 100000/mm 3, hemoglobin > 8g/dl; life expectancy greater than 3 months; informed consent obtained. From June 2002 to November 2003, twenty patients have been enrolled at the Radiotherapy Dept. of Ospedale Maggiore of Verona. In the fase II study, 20 patients affected by GBM (19 pts = 95%) and AA (1 pt = 5%) received Temozolomide (75 mg/mq) daily for 6 weeks combined with synchronous postoperative radiotherapy (60 Gy, 2 Gy per fraction, 5 days a week).