- Email: [email protected]
77 poster Exclusive adjuvante high dose rate brachytherapy for intermediate risk endometrial carcinoma completely resected
Posers
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brachytherapy technique. Forty five patients with different Iocalisation were treated (t7 gynaecological malignancies). Classical technique (ICRU 38 rules) with vaginal moulds (Chassagne's technique) was used. The major problem encountered was adapting the tubes to the very small PDR catheter, which cannot be placed directly into moulding resin. Aims of the study: to preserve the advantages of Chassagne vaginal moulds (personalised and adapted) and to incorporate the technical advantages of PDR brachytherapy (optimisation). Material and methods: the mould was produced in the same way as for the low dose rate. The Chassagne tube was cut open and an adapter for urethral catheter with two rubber joints was inserted. The Nucletron catheter was then put into the Chassagne's tube and the adapter was screwed into place. The whole system was held together by a thermo-retractable outer covering. Results: since the beginning of 2000, the Oscar Lambret Centre has been equipped with three PDR peojectors and routine treatments have been performed with personalised moulds adapted to this technique• Forty patients were treated without any technical problems. All treatments were achieved as initially planned. Conclusion: it is possible to keep the advantages of vaginal mould combined with PDR brachytherapy in gynaecological malignancies. A commercial prototype of our system is currently being developed• 74
poster
Post operative irradiation with high dose rate vaginal brachytherapy alone and combined with external beam radiation in endometrial carcinoma. M.d.M. Sanchez Araoon, M. Jorge, M. Ortiz Monterrey, I. Monteiro Grille Santa Maria - University Hospital, Radiotherapy, Lisboa, Portugal Introduction: In April 1997 our lnstituition implemented the high dose rate intracavitary brachytherapy for gynecological carcinoma treatment . The goal of this paper is to report our 4 years experience in postoperative high dose rate brachytherapy in endometrial carcinoma. Methods and materials -Between April 1997 and April 2001 ,we treated 145 patients (pts) ,with a median age of 65 years (range37-85), staged according FIGO classification as (IB 64;IC 30;IIA 18;11B 5;ILIA 19; IIIC 9). Adenocarcinoma was the histology in 90% of the cases. 51 pts received adjuvant postoperative HDR vaginal brachytherapy alone and 94 pts combined with external beam radiation (EBRT). The HDR vaginal brachytherapy was performed in two fractionation sched• ules 2x7.5Gy (39pts) and 4x6Gy(106pts),at an interval of one week. Dose was prescribed to 5mm depth from the applicator surface, 3 cm in length to treat vaginal vault and upper vagina. When EBRT was combined, the delivered dose was 30-40Gy/15-20f with a parametrial boost of 20-10Gy. Results - With a median follow-up of 26 mths(5-59),3pts were lost to followup,118pts are alive without evidence of disease, 14pts have died (13 with endometriat carcinoma and 1 without evidence of disease) and 9 are alive with disease. A total of 22 recurrences were observed, 3 were local,4 were local and distant and 15 with distant recurrences.The median time to local and distant failure was 8 and 10 months respectively. The probability of five years overall survival and the probability of five years disease free survival was 87.1% and 79.5% respectively. According EORTC/RTOG score no severe acute complication had been found• Late morbidity had been observed in 3 pts with Grade3 G-I, 9 pts with vaginal stenose and 2 pts with vaginal colapse. Conclusion -The adjuvant postoperative irradiation in endometrial carcinoma with HDR BT give a high local control 95% with a tow incidence of moderate or severe complication 75
poster
MRI markers applied in MRI based treatment planning for cervical carcinoma, P. Bouma 1, A. van 't Riet 1, C. Hoekstra 1, K. Kostet2, J. Immerzeel 1 1RISO. Institute for Radiotherapy, Deventer, the Netherlands, 2Dep. of Radiology, Deventer Hospital, Deventer, the Netherlands Introduction: Superior tissue contrast makes MRI an ideal modality for imaging normal pelvic tissues and delineating cervical carcinoma. Therefore MRI images are used for treatment planning for intracavitary radiation of cervical neoplasms. An applicator imaged in-situ can avoid discrepancies between the anatomy during MRt and treatment Since the standard stainless steel applicator interferes with the MRI-signal a special disigned MRI compatible applicator can be used, consisting of an intra-uterine tube and two ovoids.
On MRI images, the lumen of the applicator tubes are not well visible making reconstruction on the basis of MRI images difficult. Especially the channels within the ovoids are hardly recognieed. In this paper a MRI marker is presented which makes it possible to visualise the channels within the MRI compatible applicator. Material and Methods: A coronary dilatation balloon (3.5 mm in diameter and 20 mm length) filled with a Gadolinium containing solution is applied as MRI marker. Magnevista, 200 times diluted in a physiologic salt solution, is injected in the balloon lumen. Just before MRI, a balloon is inserted in each of the channels of the applicator and inflated to a pressure of 2 arm. MRI images are imported in the Plato system for treatment planning. Target volume is delineated and the markers are reconstructed representing possible dwell positions. Applicator configuration was not affected by MRI related deformations. On the base of these data a conformal dose distribution for treatment is planned. Results: In the figure the visibility of the channel within the ovoid is demonstrated on a sagittal view (T2-weighted FSE, 1.5 T Signa High Speed, General Etectrics). Conclusion: A coronary dilatation balloon, filled with a solution containing Gadolinium, improves the identification of intracavitary applicator channels on MRI images, making it possible to reliably reconstruct the applicator volume and interior for cervical cancer treatment planning. 76
poster
The role of neoadjuvant brachytherapy in stage i endometrial carcinoma K. L.Szluha, R. P6ka, H. Urbancsek, E. Pintye, A. Horvath University of Debrecen Medical and Health Science, Radiotherapy, Debrecen, Hungary Introduction It is still questionable whether there is any survival advantage attributable to preoperative intrauterine brachytherapy in early stage endometrial cancer. The prognostic tumor biological factors can be used in the indication of the neo adjuvant brachytherapy. Material and methods Retrospective analysis 1019 endometrial cancer was performed. 5 year disease-free survival of stage I patients with and without preoperative brachytherapy was analyzed according to the grade and depths of myometrial invasion in the Radiotherapy and Gynaecological Department of Debrecen University between 1978-1993. 526 patients received 3 times 6 Gy intrauterine MDR treatments before Hysterectomy, while in 291 cases neo adjuvant treatment was not performed. 91.5 % of the irradiated patients underwent 50 Gy adjuvant external beam irradiation, while 70.1% of them received 3x6 Gy vaginal application as well. 93,1% of previously not irradiated cases got postoperative irradiation, 77.3% was treated with combined postoperative radiotherapy modalities. The life table method was used for survival analysis. Cumulative disease-free survival probabilities were calculated and survival curves were compared by longrank test. Discussion The frequency of sterilized operative specimens was 10 % in the neo adjuvant group. There was no significant difference between the preoperatively irradiated and not irradiated patients survival in poorly differentiated (G1) and well-differentiated tumors (G3). Patients with moderately differentiated tumors (G2) treated with neo adjuvant brachytherapy had significantly better disease-free survival than those without preoperative radiotherapy. Conclusion Our results demonstrate important role of the tumour grading in radiosensitivity of early stage endometriat tumors. 77
poster
Exclusive adjuvante high dose rate brachytherapy for intermediate risk endometrial carcinoma completely resected A.C. Pellizzon 1,2, M. Miziara 1, H. Baraldi 1, C. Soares 1, R. Fogaroli 1, J. Miziara 1 llnstituto Arnaldo Vieira de Carvalho, Radiation Oncology, Sao Paulo, Brasfl 2Hospital A C Camargo, Radiation Oncology, Sao Paulo, Brasil Objective: to evaluate the outcome of patients with low to intermediate risk endometrial adenocarcinoma submitted to total abdominal hysterectomy and bilateral salpingo-ooforectomy, without lynphadenectomy and high dose rate vault brachytherapy as sole adjuvant treatment. Material and Methods: from 1995 to 1998 a total of 87 patients were treated. The length of treatment was 20ram in all patients and the dose specified at the vaginal surface, ranging from 30 to 50Gy given in two fractions per week, to a total of 4 to 5 fractions of 6 to 10Gy. The biological effective dose was calculated for the tumor (Gyl0) using the linear quadratic model• Re~ult~: Mean and median BED for tumor was 80 Gyl0 and 100 Gyl0.
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Posters
The local control was observed in 85 (97.7%) patients. Failures were one in the vaginal cuff, treated with BED 80 Gyl0 to the vaginal surface and one pelvic failure, treated with 100 Gyl0 to the vagina. Actuarial disease free survival at 5 years is 91,3%. Conclusion: modest dose fraction schedules of HDR-B can yield a high local control for patients with low to intermediate risk endometrial cancer. 78
poster
Brachytherapy of cervical cancer O.A. Kravetz 1, L.A. Marjina 1, V.N. Chekhonadsk~2, A.O. Rusanov2 1Moscow Cancer Research Center, Radiosurgery clinic, Moscow, Russian Federation 2Moscow Cancer Research Center, Department of Medical Physics, Moscow, Russian Federation The clinics of the N. N Blokhin Cancer Research Center, RAMS, have accumulated a large amount of clinical experience in the treatment of patients with the cancer of uterine cervix using various ionizing sources: 60Co, 137Cs,1921r. The clinical base for the study formed 322 cases undergoing associated radiotherapy for stage II, III and IV cervical cancer at the Radiosurgery Department, during 1982 - 2001. The clinical material was divided into three groups. Group I consisted of 180 patients with stage II-III cervical cancer who underwent associated radiotherapy using a 60Co source for intracavitary radiotherapy. Group II consisted of 85 patients with stage II-lll cervical cancer who underwent associated radiotherapy using a 137Cs source for intracavitary radiotherapy. Group III consisted of 57 patients with stage II-IV cervical cancer who underwent associated radiotherapy using a 1921r source for intracavitary radiotherapy. In our study we use external gamma-therapy (external irradiation with a high activity 60Co source) or photon-therapy with a 15 MeV linear accelerator. The intracavitary radiotherapy was performed in three modalities: 60Co - dose per fraction p.A - 10 Gy, Total dose - 40 Gy. 137Cs - dose per fraction p.A - 10-12 Gy, Total dose - 40-50 Gy. 1921r - dose per fraction p.A - 7,5 Gy, Total dose - 30 Gy. 5- and 10-year survival for patients with cancer of uterine cervix are in three groups, accordingly: II stage - 67,5+4,0%, 65±5,2%; Ill stage - 42,6:L'6,8%, 42,0+8,8% (60Co); II stage - 61,0±8,5%, 46,5±8,7%; III stage - 57,7±9,6%, 51,3±9,9% (137Cs). 2-year survival for patients that were treated with 1921r since 1999 is II stage - 100%, III stage - 68,6%, 1- year survival for patients with IV stage is 50%. 79
poster
Acute and late morbidity of exclusive adjuvant HDR brachytherapy for early stage endometrial cancer A.C. Pellizzonl,2 M. Miziara 1, C. Soares 1, H. Baraldi 1, R. Fogaroli 1,2, A. Ataide 1, L. Paula 1 l lnstituto Amaldo Vieira de Carvalho, Radiotherapy, Sao Paulo, Brasil 2Hospital ACcamargo, Radiation Oncology, Sao Paulo, Brasil Objectives: to evaluate the incidence of bowel and urinary, acute and late morbidity in patients with low to intermediate risk endometrial adenocarcinoma Who underwent to total abdominal hysterectomy and bilateral salpingoooforectomy, without lynphadenectomy and high dose rate vault brachytherapy (HDR-B) as sole adjuvant treatment. Material and methods: from 01/95 to 06/98 a total of 87 patients with endometrial cancer were treated with HDR-B as sole treatment. Patients were treated through a micro-Selectron HDR unit, in an outpatient basis, with two fractions per week. Doses were specified at the vaginal surface, to a total of 4 to 5 fractions of 6 to 10Gy. The biological effective dose was calculated for both late responding tissues (Gy3), bladder and bowel, using the linear quadratic model. Results: Moderate to severe complications using the RTOG / EORTC criteria for bladder and bowel were 0% and 3.4%, respectively. Bowel complications grade 3 and 4 occurred in 2 and 1 patient, respectively, been the last one a severe rectal bleeding. Actuarial 5-year complication free survival was 96,8%. Conclusions: Modest dose fraction schedules of HDR-B yields very high local control rates and low morbidity rates.
80
poster
Combined External Beam & Interstitial Brachytherapy For Vaginal & Vulval Cancer. A.M..M..L.A. Rvabtseva. M.I. Nechushkin N.N. Blochin, s Cancer Research Center, Moscow, Russia The development of interstitial brachytherapy remote afterloading techniques has provided a progress for performing radiotherapy of lower gynecological tract malignancies. Materials and Methods. From September, 1991 to April, 2001 a total of 88 patients with lower gynecological tract cancer have been treated with a combination of external irradiation followed by interstitial brachytherapy. 41 of these patients had a local/regional recurrent, 4 primary vaginal tumors and 43 patients had vulval cancer. Vaginal recurrent tumors consisted of 17 adenocarcinomas of the uterine body, 23 squamous cell carcinomas of the uterine cervix, 1 ovarian adenocarcinoma. The age range of these patients was from 31 to 76 years, the median- 53 years. The age of the patients with squamous cell vulval carcinomas ranged from 24 to 84 years wiht a median age of 58 years. The stage distributions of 29 primary vulval cancer cases were: stage I-4, stage I1-11, stage 111-13, stage IV-1 patient; 14 patients had a recurrent/residual carcinoma. The external radiotherapy was delivered by telecobalt unit gamma rays or a liner accelerator of photons, at 2 Gy/fraction, five times a week, total 30-50 Gy in 15-25 fractions. Interstitial implants were performed under general anaesthesia using the Martinez Universal Perineal Interstitial Template. After implantation all patients were CT-scanned and an optimization of programme was used for treatment planning. Interstitial brachytherapy was performed using the microSelectron-HDR and the microSelectron-LDR. The total dose applied by brachytherapy at the reference isodose surface was 10-50 Gy according individual parameters. Results. All patients underwent the implantation and removal of interstitial template without serious complJcations and tolerated the procedure well for their treatment periods. 31 complete responses, 12 partial responses, 2 no changes were observed as initial responses of the vaginal tumors. In the cases of vulval carcinomas there were 21 complete responses, 14 partial responses, 8 no changers. Conclusions. The use of interstitial brachytherapy to boost the dose to the tumor after external beam radiation therapy for lower gynecological tract cancer gives a high local tumor control and is an effective and preferable modelity, maintains satisfactory cure rates for such patients. 81
poster
Relapse frequency decreasing of a cervix cancer by means of complex chemotherapy treatment E.R. Backshinvan, A.G. Khangeldyan Oncological Scientific Center, Department of Radiotherapy & Radiogynecology, Yerevan, Armenia Introduction: basic causes of cervix cancer (CC) retreatment are residual infiltrates, resulting to process progress in a small pelvis region, and metastasis in remote organs. With the purpose of possible decrease of a relapses after the treatment protocol of CC based on combined radiotherapy (CRT) conjoined with the monochemotherapy (MT) or on a split course with polychemotherapy (SCPT) was developed. Materials and methods: 486 women with CC (481 - squamous cell CC, 5 adenocarcinoma) were distinguished on 3 groups by treatment types. CRT have received in I group (235). The II (83) have accepted the CRT conjunct with MT (CRMT). The III (168) was treated by SCPT. The CRT was conducted by alternation remote (RRT) and intracavitary irradiations (IRT). 1 stage: RRT was carried out by 2 opposite figure form fields (FFF), with total dose in center of pelvis (TD) =12-18Gy. 2 stage: the 4-fields irradiation by FFF (another dimensions) with 2Gy to point B was applied (TD=22-28Gy). IRT was spent by a remote afterloading method with Cs-137 and Co-60. HDR corresponded to two fractions per one week (w.) on 5Gy (TD=50Gy) and one LDR fraction per 1 w with 15Gy (TD=60Gy). The duration of CRT by HDR and LDR were 6 and 5 w., respectively. For CRT TD were 75-85Gy to point A and 55-58Gy to point B. The combination with MT was used for 6 day of w. (3w.) on 50mg/m2 (150 rag). The SCT was conducted in 2 stages: the CRT (TD= 5-60Gy) and after 3-w. of a break - radiotherapy (TD=25-28Gy) shared with polychemotherapy. Results and discussion: after treatment course were registered: tumor's full lysis, strongly marked beam pathomorphosis, restoration of the cervix uteri form, regeneration of mucosa. The use of IRT (TD=50-60Gy) lead to primary treatment of tumor process: in 80% of cases. After CRT tumor cells (PAP-test etc.) did not revealed, and in 20% expressed beam pathomorphosis was observed. Conclusion: analysis of post-treatment results (P<0.001) identity of those three types has shown, but the 3-year survival rate of patients on III groups
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brachytherapy technique. Forty five patients with different Iocalisation were treated (t7 gynaecological malignancies). Classical technique (ICRU 38 rules) with vaginal moulds (Chassagne's technique) was used. The major problem encountered was adapting the tubes to the very small PDR catheter, which cannot be placed directly into moulding resin. Aims of the study: to preserve the advantages of Chassagne vaginal moulds (personalised and adapted) and to incorporate the technical advantages of PDR brachytherapy (optimisation). Material and methods: the mould was produced in the same way as for the low dose rate. The Chassagne tube was cut open and an adapter for urethral catheter with two rubber joints was inserted. The Nucletron catheter was then put into the Chassagne's tube and the adapter was screwed into place. The whole system was held together by a thermo-retractable outer covering. Results: since the beginning of 2000, the Oscar Lambret Centre has been equipped with three PDR peojectors and routine treatments have been performed with personalised moulds adapted to this technique• Forty patients were treated without any technical problems. All treatments were achieved as initially planned. Conclusion: it is possible to keep the advantages of vaginal mould combined with PDR brachytherapy in gynaecological malignancies. A commercial prototype of our system is currently being developed• 74
poster
Post operative irradiation with high dose rate vaginal brachytherapy alone and combined with external beam radiation in endometrial carcinoma. M.d.M. Sanchez Araoon, M. Jorge, M. Ortiz Monterrey, I. Monteiro Grille Santa Maria - University Hospital, Radiotherapy, Lisboa, Portugal Introduction: In April 1997 our lnstituition implemented the high dose rate intracavitary brachytherapy for gynecological carcinoma treatment . The goal of this paper is to report our 4 years experience in postoperative high dose rate brachytherapy in endometrial carcinoma. Methods and materials -Between April 1997 and April 2001 ,we treated 145 patients (pts) ,with a median age of 65 years (range37-85), staged according FIGO classification as (IB 64;IC 30;IIA 18;11B 5;ILIA 19; IIIC 9). Adenocarcinoma was the histology in 90% of the cases. 51 pts received adjuvant postoperative HDR vaginal brachytherapy alone and 94 pts combined with external beam radiation (EBRT). The HDR vaginal brachytherapy was performed in two fractionation sched• ules 2x7.5Gy (39pts) and 4x6Gy(106pts),at an interval of one week. Dose was prescribed to 5mm depth from the applicator surface, 3 cm in length to treat vaginal vault and upper vagina. When EBRT was combined, the delivered dose was 30-40Gy/15-20f with a parametrial boost of 20-10Gy. Results - With a median follow-up of 26 mths(5-59),3pts were lost to followup,118pts are alive without evidence of disease, 14pts have died (13 with endometriat carcinoma and 1 without evidence of disease) and 9 are alive with disease. A total of 22 recurrences were observed, 3 were local,4 were local and distant and 15 with distant recurrences.The median time to local and distant failure was 8 and 10 months respectively. The probability of five years overall survival and the probability of five years disease free survival was 87.1% and 79.5% respectively. According EORTC/RTOG score no severe acute complication had been found• Late morbidity had been observed in 3 pts with Grade3 G-I, 9 pts with vaginal stenose and 2 pts with vaginal colapse. Conclusion -The adjuvant postoperative irradiation in endometrial carcinoma with HDR BT give a high local control 95% with a tow incidence of moderate or severe complication 75
poster
MRI markers applied in MRI based treatment planning for cervical carcinoma, P. Bouma 1, A. van 't Riet 1, C. Hoekstra 1, K. Kostet2, J. Immerzeel 1 1RISO. Institute for Radiotherapy, Deventer, the Netherlands, 2Dep. of Radiology, Deventer Hospital, Deventer, the Netherlands Introduction: Superior tissue contrast makes MRI an ideal modality for imaging normal pelvic tissues and delineating cervical carcinoma. Therefore MRI images are used for treatment planning for intracavitary radiation of cervical neoplasms. An applicator imaged in-situ can avoid discrepancies between the anatomy during MRt and treatment Since the standard stainless steel applicator interferes with the MRI-signal a special disigned MRI compatible applicator can be used, consisting of an intra-uterine tube and two ovoids.
On MRI images, the lumen of the applicator tubes are not well visible making reconstruction on the basis of MRI images difficult. Especially the channels within the ovoids are hardly recognieed. In this paper a MRI marker is presented which makes it possible to visualise the channels within the MRI compatible applicator. Material and Methods: A coronary dilatation balloon (3.5 mm in diameter and 20 mm length) filled with a Gadolinium containing solution is applied as MRI marker. Magnevista, 200 times diluted in a physiologic salt solution, is injected in the balloon lumen. Just before MRI, a balloon is inserted in each of the channels of the applicator and inflated to a pressure of 2 arm. MRI images are imported in the Plato system for treatment planning. Target volume is delineated and the markers are reconstructed representing possible dwell positions. Applicator configuration was not affected by MRI related deformations. On the base of these data a conformal dose distribution for treatment is planned. Results: In the figure the visibility of the channel within the ovoid is demonstrated on a sagittal view (T2-weighted FSE, 1.5 T Signa High Speed, General Etectrics). Conclusion: A coronary dilatation balloon, filled with a solution containing Gadolinium, improves the identification of intracavitary applicator channels on MRI images, making it possible to reliably reconstruct the applicator volume and interior for cervical cancer treatment planning. 76
poster
The role of neoadjuvant brachytherapy in stage i endometrial carcinoma K. L.Szluha, R. P6ka, H. Urbancsek, E. Pintye, A. Horvath University of Debrecen Medical and Health Science, Radiotherapy, Debrecen, Hungary Introduction It is still questionable whether there is any survival advantage attributable to preoperative intrauterine brachytherapy in early stage endometrial cancer. The prognostic tumor biological factors can be used in the indication of the neo adjuvant brachytherapy. Material and methods Retrospective analysis 1019 endometrial cancer was performed. 5 year disease-free survival of stage I patients with and without preoperative brachytherapy was analyzed according to the grade and depths of myometrial invasion in the Radiotherapy and Gynaecological Department of Debrecen University between 1978-1993. 526 patients received 3 times 6 Gy intrauterine MDR treatments before Hysterectomy, while in 291 cases neo adjuvant treatment was not performed. 91.5 % of the irradiated patients underwent 50 Gy adjuvant external beam irradiation, while 70.1% of them received 3x6 Gy vaginal application as well. 93,1% of previously not irradiated cases got postoperative irradiation, 77.3% was treated with combined postoperative radiotherapy modalities. The life table method was used for survival analysis. Cumulative disease-free survival probabilities were calculated and survival curves were compared by longrank test. Discussion The frequency of sterilized operative specimens was 10 % in the neo adjuvant group. There was no significant difference between the preoperatively irradiated and not irradiated patients survival in poorly differentiated (G1) and well-differentiated tumors (G3). Patients with moderately differentiated tumors (G2) treated with neo adjuvant brachytherapy had significantly better disease-free survival than those without preoperative radiotherapy. Conclusion Our results demonstrate important role of the tumour grading in radiosensitivity of early stage endometriat tumors. 77
poster
Exclusive adjuvante high dose rate brachytherapy for intermediate risk endometrial carcinoma completely resected A.C. Pellizzon 1,2, M. Miziara 1, H. Baraldi 1, C. Soares 1, R. Fogaroli 1, J. Miziara 1 llnstituto Arnaldo Vieira de Carvalho, Radiation Oncology, Sao Paulo, Brasfl 2Hospital A C Camargo, Radiation Oncology, Sao Paulo, Brasil Objective: to evaluate the outcome of patients with low to intermediate risk endometrial adenocarcinoma submitted to total abdominal hysterectomy and bilateral salpingo-ooforectomy, without lynphadenectomy and high dose rate vault brachytherapy as sole adjuvant treatment. Material and Methods: from 1995 to 1998 a total of 87 patients were treated. The length of treatment was 20ram in all patients and the dose specified at the vaginal surface, ranging from 30 to 50Gy given in two fractions per week, to a total of 4 to 5 fractions of 6 to 10Gy. The biological effective dose was calculated for the tumor (Gyl0) using the linear quadratic model• Re~ult~: Mean and median BED for tumor was 80 Gyl0 and 100 Gyl0.
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Posters
The local control was observed in 85 (97.7%) patients. Failures were one in the vaginal cuff, treated with BED 80 Gyl0 to the vaginal surface and one pelvic failure, treated with 100 Gyl0 to the vagina. Actuarial disease free survival at 5 years is 91,3%. Conclusion: modest dose fraction schedules of HDR-B can yield a high local control for patients with low to intermediate risk endometrial cancer. 78
poster
Brachytherapy of cervical cancer O.A. Kravetz 1, L.A. Marjina 1, V.N. Chekhonadsk~2, A.O. Rusanov2 1Moscow Cancer Research Center, Radiosurgery clinic, Moscow, Russian Federation 2Moscow Cancer Research Center, Department of Medical Physics, Moscow, Russian Federation The clinics of the N. N Blokhin Cancer Research Center, RAMS, have accumulated a large amount of clinical experience in the treatment of patients with the cancer of uterine cervix using various ionizing sources: 60Co, 137Cs,1921r. The clinical base for the study formed 322 cases undergoing associated radiotherapy for stage II, III and IV cervical cancer at the Radiosurgery Department, during 1982 - 2001. The clinical material was divided into three groups. Group I consisted of 180 patients with stage II-III cervical cancer who underwent associated radiotherapy using a 60Co source for intracavitary radiotherapy. Group II consisted of 85 patients with stage II-lll cervical cancer who underwent associated radiotherapy using a 137Cs source for intracavitary radiotherapy. Group III consisted of 57 patients with stage II-IV cervical cancer who underwent associated radiotherapy using a 1921r source for intracavitary radiotherapy. In our study we use external gamma-therapy (external irradiation with a high activity 60Co source) or photon-therapy with a 15 MeV linear accelerator. The intracavitary radiotherapy was performed in three modalities: 60Co - dose per fraction p.A - 10 Gy, Total dose - 40 Gy. 137Cs - dose per fraction p.A - 10-12 Gy, Total dose - 40-50 Gy. 1921r - dose per fraction p.A - 7,5 Gy, Total dose - 30 Gy. 5- and 10-year survival for patients with cancer of uterine cervix are in three groups, accordingly: II stage - 67,5+4,0%, 65±5,2%; Ill stage - 42,6:L'6,8%, 42,0+8,8% (60Co); II stage - 61,0±8,5%, 46,5±8,7%; III stage - 57,7±9,6%, 51,3±9,9% (137Cs). 2-year survival for patients that were treated with 1921r since 1999 is II stage - 100%, III stage - 68,6%, 1- year survival for patients with IV stage is 50%. 79
poster
Acute and late morbidity of exclusive adjuvant HDR brachytherapy for early stage endometrial cancer A.C. Pellizzonl,2 M. Miziara 1, C. Soares 1, H. Baraldi 1, R. Fogaroli 1,2, A. Ataide 1, L. Paula 1 l lnstituto Amaldo Vieira de Carvalho, Radiotherapy, Sao Paulo, Brasil 2Hospital ACcamargo, Radiation Oncology, Sao Paulo, Brasil Objectives: to evaluate the incidence of bowel and urinary, acute and late morbidity in patients with low to intermediate risk endometrial adenocarcinoma Who underwent to total abdominal hysterectomy and bilateral salpingoooforectomy, without lynphadenectomy and high dose rate vault brachytherapy (HDR-B) as sole adjuvant treatment. Material and methods: from 01/95 to 06/98 a total of 87 patients with endometrial cancer were treated with HDR-B as sole treatment. Patients were treated through a micro-Selectron HDR unit, in an outpatient basis, with two fractions per week. Doses were specified at the vaginal surface, to a total of 4 to 5 fractions of 6 to 10Gy. The biological effective dose was calculated for both late responding tissues (Gy3), bladder and bowel, using the linear quadratic model. Results: Moderate to severe complications using the RTOG / EORTC criteria for bladder and bowel were 0% and 3.4%, respectively. Bowel complications grade 3 and 4 occurred in 2 and 1 patient, respectively, been the last one a severe rectal bleeding. Actuarial 5-year complication free survival was 96,8%. Conclusions: Modest dose fraction schedules of HDR-B yields very high local control rates and low morbidity rates.
80
poster
Combined External Beam & Interstitial Brachytherapy For Vaginal & Vulval Cancer. A.M..M..L.A. Rvabtseva. M.I. Nechushkin N.N. Blochin, s Cancer Research Center, Moscow, Russia The development of interstitial brachytherapy remote afterloading techniques has provided a progress for performing radiotherapy of lower gynecological tract malignancies. Materials and Methods. From September, 1991 to April, 2001 a total of 88 patients with lower gynecological tract cancer have been treated with a combination of external irradiation followed by interstitial brachytherapy. 41 of these patients had a local/regional recurrent, 4 primary vaginal tumors and 43 patients had vulval cancer. Vaginal recurrent tumors consisted of 17 adenocarcinomas of the uterine body, 23 squamous cell carcinomas of the uterine cervix, 1 ovarian adenocarcinoma. The age range of these patients was from 31 to 76 years, the median- 53 years. The age of the patients with squamous cell vulval carcinomas ranged from 24 to 84 years wiht a median age of 58 years. The stage distributions of 29 primary vulval cancer cases were: stage I-4, stage I1-11, stage 111-13, stage IV-1 patient; 14 patients had a recurrent/residual carcinoma. The external radiotherapy was delivered by telecobalt unit gamma rays or a liner accelerator of photons, at 2 Gy/fraction, five times a week, total 30-50 Gy in 15-25 fractions. Interstitial implants were performed under general anaesthesia using the Martinez Universal Perineal Interstitial Template. After implantation all patients were CT-scanned and an optimization of programme was used for treatment planning. Interstitial brachytherapy was performed using the microSelectron-HDR and the microSelectron-LDR. The total dose applied by brachytherapy at the reference isodose surface was 10-50 Gy according individual parameters. Results. All patients underwent the implantation and removal of interstitial template without serious complJcations and tolerated the procedure well for their treatment periods. 31 complete responses, 12 partial responses, 2 no changes were observed as initial responses of the vaginal tumors. In the cases of vulval carcinomas there were 21 complete responses, 14 partial responses, 8 no changers. Conclusions. The use of interstitial brachytherapy to boost the dose to the tumor after external beam radiation therapy for lower gynecological tract cancer gives a high local tumor control and is an effective and preferable modelity, maintains satisfactory cure rates for such patients. 81
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Relapse frequency decreasing of a cervix cancer by means of complex chemotherapy treatment E.R. Backshinvan, A.G. Khangeldyan Oncological Scientific Center, Department of Radiotherapy & Radiogynecology, Yerevan, Armenia Introduction: basic causes of cervix cancer (CC) retreatment are residual infiltrates, resulting to process progress in a small pelvis region, and metastasis in remote organs. With the purpose of possible decrease of a relapses after the treatment protocol of CC based on combined radiotherapy (CRT) conjoined with the monochemotherapy (MT) or on a split course with polychemotherapy (SCPT) was developed. Materials and methods: 486 women with CC (481 - squamous cell CC, 5 adenocarcinoma) were distinguished on 3 groups by treatment types. CRT have received in I group (235). The II (83) have accepted the CRT conjunct with MT (CRMT). The III (168) was treated by SCPT. The CRT was conducted by alternation remote (RRT) and intracavitary irradiations (IRT). 1 stage: RRT was carried out by 2 opposite figure form fields (FFF), with total dose in center of pelvis (TD) =12-18Gy. 2 stage: the 4-fields irradiation by FFF (another dimensions) with 2Gy to point B was applied (TD=22-28Gy). IRT was spent by a remote afterloading method with Cs-137 and Co-60. HDR corresponded to two fractions per one week (w.) on 5Gy (TD=50Gy) and one LDR fraction per 1 w with 15Gy (TD=60Gy). The duration of CRT by HDR and LDR were 6 and 5 w., respectively. For CRT TD were 75-85Gy to point A and 55-58Gy to point B. The combination with MT was used for 6 day of w. (3w.) on 50mg/m2 (150 rag). The SCT was conducted in 2 stages: the CRT (TD= 5-60Gy) and after 3-w. of a break - radiotherapy (TD=25-28Gy) shared with polychemotherapy. Results and discussion: after treatment course were registered: tumor's full lysis, strongly marked beam pathomorphosis, restoration of the cervix uteri form, regeneration of mucosa. The use of IRT (TD=50-60Gy) lead to primary treatment of tumor process: in 80% of cases. After CRT tumor cells (PAP-test etc.) did not revealed, and in 20% expressed beam pathomorphosis was observed. Conclusion: analysis of post-treatment results (P<0.001) identity of those three types has shown, but the 3-year survival rate of patients on III groups