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60 Initial experience with novel brachytherapy device for early stage breast cancer treatment
Posters
S19
calculated by the 3-D treatment planning system with in vivo measurements in selected points on the breast surface. Materials and methods: since 1998 in the Brachytherapy Department of the Centre of Oncology in Warsaw the HDR brachytherapy is used as the boost after the external beam radiotherapy in conservative treatment of breast cancer. After tumourectomy the whole breast is external beam radiotherapy the patients receive a 10-12 Gy HDR brachytherapy boost to the tumour bed. The position of the tumour bed is established on the basis of postoperative mammography. The treatment planning is based on the surgeon's reporl and mammograms. The number of brachytherapy needles and distances between them and also the rantge and length of Ir-192 source path (GAMMAMED from Sauerwein Gmbh) in the needles is established on the basis of the tumour bed volume and on its distance from the skin surface. The close distribution calculation and optimization is performed by the 3-D treatment planning system (ABACUS from Sauerwein Gmbh). The preliminary measurements were carried out on the Alderson phantom with mosfet dosimeters and TLD. The doses to the specific points markes on the patient's skin were measured with the thermoluminescent dosimeters (Harshaw JTLD pellets). Results and conclusions: in our group of patients the doses to the points in the skin ranged between 2-40% of the prescribed dose far less than commonly accepted value of 60%. The value of the dose to the skin has a great impact on the overall cosmetic effect of the treatment. The comparison of the doses measured in vivo and calculated allowed for the modification of the brachytherapy technique and optimization of the active length of the catheters and of the distance between the skin base and the distal and proximal dwell positions of the source.
or LDR brachytherapy sources. It is designed for intracavitary (intralum-pectomy cavity) implantation. Our team has implanted the spherical device (4 cm diameter) in 4 patients of the group enrolled nationally. Ages ranged from 65 to 84 years. Axial CT images of the patients with the applicator were taken at 3 mm intervals and imported into the 3 D treatment planning system, TPS, (BrachyVision 6.0 TPS, Varian Medical Systems Inc.). CT based planning allowed 3dimensional positioning of the breast tissue which varied from the 2-dimensional views available from orthogonal views on the simulator. A single position of the HDR source, in the center of the balloon, allowed good coverage of a concentric volume 1 cm around the implanted device by the 340 cGy isodose line. Results: All our patients tolerated the procedure well and had no complications during the 5 days of treatment, with 2 treatments a day given 6 hours apart. The only patient complaint was a sensation of pressure at the balloon site during the 5 day course. The device itself functioned well, with only 1 mm variation from concentric expansion of the balloon. After treatment, the device deflated well, with recovery of all but - 2 cc of the saline used for inflation of the balloon at the time of insertion. The device did deflate with redundant material making sedation at the time of removal a reasonable measure for patient comfort. One patient developed an abscess 5 days post removal necessitating surgical drainage but not debridement. The other patients were treated with prophylactic antibiotics at the time of removal and developed no evidence of infection. Conclusions: The MammoSite device performs well for brachytherapy treatment for early stage breast cancer patients. Complications to date have been low with this procedure and patient tolerance has been good.
59 poster B r a c h y t h e r a p y b o o s t in b r e a s t c a n c e r : d o s e , v o l u m e , fractionation relationships9 F. Piro, P. Guerrieri, A. Destito, I. Ziccarefli, C. Bianco, P. Ziccarelli, A. Molinaro. R. Mole, P. Montemaggi Radiotherapy, Mariano Santo, Cosenza, Italy Aims and background: In breast cancer the boost of tumor bed after conservative surgery is a widely accepted clinical practice, even if not completely clarified in its theoretic aspects. In this work we will analize our experience in out patients base. Methods: From April 1999 to December 2000, 75 consecutive patients with breast cancer were enrolled in this perspective study: Conservative surgery, Whole Breast Radiotherapy (50 Gy/5 weeks), 3-6 days after the completion of these. Brachytherapy (BRT) High Dose Rate (HDR) implant consisting of 3 fractions of 350 cGy each, 6 hour apart, over 24 hours; if intraoperative BRT was used, external radiotherapy was done 1-2 weeks after the reverse boost. Patients N received chemotherapy /- hormones. BRT boost was generally done as a multiplanes implant (MI) to provide the maximum coverage of the tumor bed, singleplane (SI) was performed in very small breast, in clearly identifiable tumor bed and in anatomic configuration of the breast not suitable for a MI. Results: 75 patients treated with BRT boost: 36 (48%) MI (4 intraoperative, 32 as out patients). The Volume Reference Isodose (350 cGy/fraction) was: median 106.2cc (range 13-516); the High Dose Volume (700 cGy/fraction): median 29.5cc (range 5-130); the Dose Homogeneity Index: median 0.74 (range 0.24-1 ); the 350/700 Volumes Ratio: median 3.8 (range 1.32-16.61 ); only 7 patients (9.3 %) of SI group did not receive an adequate treatment (normal ratio 2); cosmetics results, as variation of the surgical cosmetic results, were excellent in 65% of cases evaluated by the patients, 60% by the physicians. Only 5 patients had moderate infectious complication (no hospitalisation), no further toxicities has been observed. Conclusions: BRT is an effective method to boost tumor bed, MI seem to be more reliable, HDR can be used in out patients, complications and cosmetics results are similar to Low Dose Implants. Key words: Brachytherapy, breast cancer, high dose rate
61 poster F o u r - y e a r s e x p e r i e n c e in t h e t u m o u r b e d I o c a l i s a t i o n f o r HDR brachytherapy during BCT procedure. J. Lyczek, A. Kulik. M. Kawczynska, W. Bulski Cancer Center Institute of Oncology, Warsaw, Poland From 1996 almost 150 pts were treated with BCT procedure in brachytherapy department in cancer center in Warsaw. In all cases cancer was previously biopsy proven. T1-2NOM0 patients were qualified to the procedure with tumorectomy, external beam irradiation up to 50 Gy in conventional regime and then selected to electron boost or when the turnout was deeper than 1 cm under the skin to HDR boost. HDR therapy was given 5-10 days (m. 7 d) after external irradiation. In all cases 10 Gy was given in a single fraction in out-patient regime. "Bridge" applicator was used as a routine way of steel needle immobilisation. As a treatment unit Gammamed 12i was used. For planning ABACUS 1.6 Treatment Planning System with 3D reconstruction was used. Primary tumour bed was defined by titanium clips located during operation. Before HDR session mammography and CT exam was done. In 15% cas~'s tumour bed was unclear because of clips migration. Secondly ultrasound and mammography was done just before HDR therapy. In both groups no clear evidence of tumour bed margin gave an effect to implant 10 to 16 needles to be sure that prescribed isodose covered tumour bed with 1 cm margin. Now ultrasound and mammographyl is done before external irradiation in treatment position. In that way tumour bed is well defined and number of needles decrease to 5 to 8 always in rain 2 planes. In all groups there is difference in local recurrence and overall survival. Strongly differences are cosmetic results depending from number of insert neeldes.
60 poster Initial e x p e r i e n c e w i t h n o v e l b r a c h y t h e r a p y d e v i c e f o r e a r l y stage breast cancer t r e a t m e n t M. Hebert, R. Alecu, M. Alecu US Oncology. Texas Cancer Center. Sherman, TX. USA Purpose: To discuss our initial clinical experience with a novel brachytherapy applicator (The MammoSiteTM RTS, Proxima Therapeutics, Inc.) used for Ir-192 HDR intracavitary radiation treatment in the breast cancer. Problems encountered in meeting the national protocol's requirements due to variations in patients'; breast size and tissue firmness will be presented along with our solutions and clinical outcome. Materials and Methods: A novel brachytherapy device, MammoSite, is under trial for FDA approval. The MammoSite device is an inflatable spherical balloon catheter with a central lumen that may be used with either HDR
GYNAECOLOGICAL 62
TUMOURS
poster
Radical r a d i o t h e r a p y o f c a r c i n o m a of t h e e n d o m e t r i u m u s i n g e x t e r n a l b e a m r a d i o t h e r a p y a n d o p t i m i s e d s i n g l e line s o u r c e brachytherapy
B. Jones 1 M. Churn 2 1imperial College School of Medicine, Hammersmith Hospital, London W12 OHS & 2New Cross Hospital, Wolverhampton, UK Introduction: concurrent medical conditions, gross obesity or advanced stage confer inoperability in a small proportion of patients with adenocarcinoma of the endometrium. These patients can be treated with primary radiotherapy with either curative or palliative intent. Methods: we report 37 such patients treated at Clatterbridge Centre for Oncology (Liverpool) by a combination of external beam radiotherapy and intracavitary brachytherapy using a single line source technique. Optimisation of the dose distribution of the brachytherapy by means of variation of treatment length, radioactive source positions and prescription point (e.g. the use of the uterine serosal surface rather than point A) according to tumour bulk and individual anatomy were achieved in most patients studied.
S19
calculated by the 3-D treatment planning system with in vivo measurements in selected points on the breast surface. Materials and methods: since 1998 in the Brachytherapy Department of the Centre of Oncology in Warsaw the HDR brachytherapy is used as the boost after the external beam radiotherapy in conservative treatment of breast cancer. After tumourectomy the whole breast is external beam radiotherapy the patients receive a 10-12 Gy HDR brachytherapy boost to the tumour bed. The position of the tumour bed is established on the basis of postoperative mammography. The treatment planning is based on the surgeon's reporl and mammograms. The number of brachytherapy needles and distances between them and also the rantge and length of Ir-192 source path (GAMMAMED from Sauerwein Gmbh) in the needles is established on the basis of the tumour bed volume and on its distance from the skin surface. The close distribution calculation and optimization is performed by the 3-D treatment planning system (ABACUS from Sauerwein Gmbh). The preliminary measurements were carried out on the Alderson phantom with mosfet dosimeters and TLD. The doses to the specific points markes on the patient's skin were measured with the thermoluminescent dosimeters (Harshaw JTLD pellets). Results and conclusions: in our group of patients the doses to the points in the skin ranged between 2-40% of the prescribed dose far less than commonly accepted value of 60%. The value of the dose to the skin has a great impact on the overall cosmetic effect of the treatment. The comparison of the doses measured in vivo and calculated allowed for the modification of the brachytherapy technique and optimization of the active length of the catheters and of the distance between the skin base and the distal and proximal dwell positions of the source.
or LDR brachytherapy sources. It is designed for intracavitary (intralum-pectomy cavity) implantation. Our team has implanted the spherical device (4 cm diameter) in 4 patients of the group enrolled nationally. Ages ranged from 65 to 84 years. Axial CT images of the patients with the applicator were taken at 3 mm intervals and imported into the 3 D treatment planning system, TPS, (BrachyVision 6.0 TPS, Varian Medical Systems Inc.). CT based planning allowed 3dimensional positioning of the breast tissue which varied from the 2-dimensional views available from orthogonal views on the simulator. A single position of the HDR source, in the center of the balloon, allowed good coverage of a concentric volume 1 cm around the implanted device by the 340 cGy isodose line. Results: All our patients tolerated the procedure well and had no complications during the 5 days of treatment, with 2 treatments a day given 6 hours apart. The only patient complaint was a sensation of pressure at the balloon site during the 5 day course. The device itself functioned well, with only 1 mm variation from concentric expansion of the balloon. After treatment, the device deflated well, with recovery of all but - 2 cc of the saline used for inflation of the balloon at the time of insertion. The device did deflate with redundant material making sedation at the time of removal a reasonable measure for patient comfort. One patient developed an abscess 5 days post removal necessitating surgical drainage but not debridement. The other patients were treated with prophylactic antibiotics at the time of removal and developed no evidence of infection. Conclusions: The MammoSite device performs well for brachytherapy treatment for early stage breast cancer patients. Complications to date have been low with this procedure and patient tolerance has been good.
59 poster B r a c h y t h e r a p y b o o s t in b r e a s t c a n c e r : d o s e , v o l u m e , fractionation relationships9 F. Piro, P. Guerrieri, A. Destito, I. Ziccarefli, C. Bianco, P. Ziccarelli, A. Molinaro. R. Mole, P. Montemaggi Radiotherapy, Mariano Santo, Cosenza, Italy Aims and background: In breast cancer the boost of tumor bed after conservative surgery is a widely accepted clinical practice, even if not completely clarified in its theoretic aspects. In this work we will analize our experience in out patients base. Methods: From April 1999 to December 2000, 75 consecutive patients with breast cancer were enrolled in this perspective study: Conservative surgery, Whole Breast Radiotherapy (50 Gy/5 weeks), 3-6 days after the completion of these. Brachytherapy (BRT) High Dose Rate (HDR) implant consisting of 3 fractions of 350 cGy each, 6 hour apart, over 24 hours; if intraoperative BRT was used, external radiotherapy was done 1-2 weeks after the reverse boost. Patients N received chemotherapy /- hormones. BRT boost was generally done as a multiplanes implant (MI) to provide the maximum coverage of the tumor bed, singleplane (SI) was performed in very small breast, in clearly identifiable tumor bed and in anatomic configuration of the breast not suitable for a MI. Results: 75 patients treated with BRT boost: 36 (48%) MI (4 intraoperative, 32 as out patients). The Volume Reference Isodose (350 cGy/fraction) was: median 106.2cc (range 13-516); the High Dose Volume (700 cGy/fraction): median 29.5cc (range 5-130); the Dose Homogeneity Index: median 0.74 (range 0.24-1 ); the 350/700 Volumes Ratio: median 3.8 (range 1.32-16.61 ); only 7 patients (9.3 %) of SI group did not receive an adequate treatment (normal ratio 2); cosmetics results, as variation of the surgical cosmetic results, were excellent in 65% of cases evaluated by the patients, 60% by the physicians. Only 5 patients had moderate infectious complication (no hospitalisation), no further toxicities has been observed. Conclusions: BRT is an effective method to boost tumor bed, MI seem to be more reliable, HDR can be used in out patients, complications and cosmetics results are similar to Low Dose Implants. Key words: Brachytherapy, breast cancer, high dose rate
61 poster F o u r - y e a r s e x p e r i e n c e in t h e t u m o u r b e d I o c a l i s a t i o n f o r HDR brachytherapy during BCT procedure. J. Lyczek, A. Kulik. M. Kawczynska, W. Bulski Cancer Center Institute of Oncology, Warsaw, Poland From 1996 almost 150 pts were treated with BCT procedure in brachytherapy department in cancer center in Warsaw. In all cases cancer was previously biopsy proven. T1-2NOM0 patients were qualified to the procedure with tumorectomy, external beam irradiation up to 50 Gy in conventional regime and then selected to electron boost or when the turnout was deeper than 1 cm under the skin to HDR boost. HDR therapy was given 5-10 days (m. 7 d) after external irradiation. In all cases 10 Gy was given in a single fraction in out-patient regime. "Bridge" applicator was used as a routine way of steel needle immobilisation. As a treatment unit Gammamed 12i was used. For planning ABACUS 1.6 Treatment Planning System with 3D reconstruction was used. Primary tumour bed was defined by titanium clips located during operation. Before HDR session mammography and CT exam was done. In 15% cas~'s tumour bed was unclear because of clips migration. Secondly ultrasound and mammography was done just before HDR therapy. In both groups no clear evidence of tumour bed margin gave an effect to implant 10 to 16 needles to be sure that prescribed isodose covered tumour bed with 1 cm margin. Now ultrasound and mammographyl is done before external irradiation in treatment position. In that way tumour bed is well defined and number of needles decrease to 5 to 8 always in rain 2 planes. In all groups there is difference in local recurrence and overall survival. Strongly differences are cosmetic results depending from number of insert neeldes.
60 poster Initial e x p e r i e n c e w i t h n o v e l b r a c h y t h e r a p y d e v i c e f o r e a r l y stage breast cancer t r e a t m e n t M. Hebert, R. Alecu, M. Alecu US Oncology. Texas Cancer Center. Sherman, TX. USA Purpose: To discuss our initial clinical experience with a novel brachytherapy applicator (The MammoSiteTM RTS, Proxima Therapeutics, Inc.) used for Ir-192 HDR intracavitary radiation treatment in the breast cancer. Problems encountered in meeting the national protocol's requirements due to variations in patients'; breast size and tissue firmness will be presented along with our solutions and clinical outcome. Materials and Methods: A novel brachytherapy device, MammoSite, is under trial for FDA approval. The MammoSite device is an inflatable spherical balloon catheter with a central lumen that may be used with either HDR
GYNAECOLOGICAL 62
TUMOURS
poster
Radical r a d i o t h e r a p y o f c a r c i n o m a of t h e e n d o m e t r i u m u s i n g e x t e r n a l b e a m r a d i o t h e r a p y a n d o p t i m i s e d s i n g l e line s o u r c e brachytherapy
B. Jones 1 M. Churn 2 1imperial College School of Medicine, Hammersmith Hospital, London W12 OHS & 2New Cross Hospital, Wolverhampton, UK Introduction: concurrent medical conditions, gross obesity or advanced stage confer inoperability in a small proportion of patients with adenocarcinoma of the endometrium. These patients can be treated with primary radiotherapy with either curative or palliative intent. Methods: we report 37 such patients treated at Clatterbridge Centre for Oncology (Liverpool) by a combination of external beam radiotherapy and intracavitary brachytherapy using a single line source technique. Optimisation of the dose distribution of the brachytherapy by means of variation of treatment length, radioactive source positions and prescription point (e.g. the use of the uterine serosal surface rather than point A) according to tumour bulk and individual anatomy were achieved in most patients studied.