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777One-year follow-up of the first three patients treated with boron neutron capture therapy using epithermal neutrons
SI97 775
774 SOME
ODD
EARLY MUCOSAL REACTIONS O B S E R V E D IN B U L G A R I A N
LATE REACTIONS AFTER HALF-BODY IRRADIATION
CHABT
7". Hadficva,* J. Todorov, * K Famev, ~ To. Rousscva1 t R ~ i o t h ~ D ~ Z Ertr D ~ u~e,=~ Hk,~t~" ~ Cao,,~aa', Sofia. Bulsatia Since April 1995 a protocol for Bulgarian modification of CHART has been worked out. THI December 1995 16 stage III and IV phatyax and oral cavity squamous cell cancer patients were enrolled in the study. No siguificant difference in time for mucosal picA. reactions compared to British CHART was observed. In 15% of cases mucosRis started early on the day 11-12 from the irrattiation start. During days 15 to 29 patients are not able to drink liquids or even to swallow tbe saliva for 10-12 days. One patient with turnout in hypoplugTax died on the first posttreatmast week from bilateral lobar pleuropneuaonia showing an reactivity, feber, coph. He developed signs of cerebral hypoxia and behave violently. We wroosly interpreted this as abstinention" because his ws.s heavy alcoholic. Two more patients with large hypopharyngel cancer felt into comma after being sleepy in the morning of first posttreatment week. One was treated by Lv. corticosteroids and became censcious af'ler 15 minutes. Most dramatic was third hypopharyngeal cancer patients' reaction, lntubation was difficult to perform because of laryngeal oedema and rec~aulation of respiratory tract was realised after 45 lninutes comma. NO cerehrral ctqm,~e was registered. Both patients were put on intensive care. Now they are turnout free 5 and 6 mounts after CHART. Obsereved severe obstruction of upper respiratory tract, somnolence and comma may have multiple reasons: large tumm~ur of an hypopharyngeal subsides with larynx rtxation" thick mucus production, radiation oedema of peritumour ti~ues, severe pain which StOpS normal rrmcus eliminzlJon. Metabolic dist~trbance due to --.-lnutrition starts several month because of deaease and expands ia period of n ~ i m a l reactions. Progr~mm~ for prevention and treatment of severe mucositis is proposed.
,\L;IH(.), ~ :, , L. Gotceva. J. Todorov. K. Ivanova. A. Jgnatov State University Hospata] "Qween G~ovanna". S o f , a . Bulgaria In the period 1989-1995 40 patients with operable locally advanced Ira-east carcinoma (LABC) received a :high dose half-body i r r a d i a t i o n as systemic radiation ~therapy alterrmtive to high dc6e chemotherspy with ,or without AEMT. The ~ of this study is to evaluate the 3,years survival and late tissue reactions after half.body irradiation; to assess the effectiveness of a .large single dose of irradiation on occult bone .metastasis; to estimate the v a l u e of therapeutic gain. F ~ the period under observation no hepatic, kidney .or heart late complications were found out. Only ,one p~tient developed radiation pnetm~onitis.
The I-mlf-lxx:ly i r r a d i a t i o n w i t h l a z u e d c e e s o f f e r s t h e p o s s i b i l i t y t o be a p p l i e d a s a s y s t e m i c r e d ' i n . t h e r a p y being a f i r s t line treatment in high r i s k LABC. ,With i t s good tolerance systemic chemotherapy s t i l l can be used as a second line treatment.
776
777
COMPARISON OF DIFFERENT MEASUREMENT SYSTEMS USED FOR DATA ACQUISITION OF A STEREOTACTIC SYSTEM
ONE-YEAR FOLLOW-UP OF THE FIRST THREE PATIENTS TREATEO WITH BORONNEUTRON CAPTURE THERAPY USING EPITHERMAL NEUTRONS
Hartl, R. F. E.l'2," A~ginger, H. ': P6tter R. 2 L Atominstitute of the Austrian Universities Dept. of Radiotherapy and Radiobiology, University of Vienna Purpose: All available dosimetric measurement systems should be tested for their suitability for data acquisition in small fiekls produced by a commercially available stereotactie system (BrainLAB}. The results should be compared taking the charactaristics of each system into account. Method: OARs (Off Axis Ratios), TIqR-values (Tissue Maximum Ratio) and Scatter Factors were acquired using a silicon diode, fihndensitometry, TLDs, an ionisation chamber (IC) and a flat chamber. The semiconductor detector was fixed oil the sledge of a Wellh6fer water phantom, films and TLDs were exposed at isocenter level with 75ram Solid Water T. M. build up material and the IC was connected to the couch mount and positioned by hand. The T M R values were acquired with Solid Water v" M. as build up. Results: OARs measured showed excellent correspondence. All acquired TMR-values matched within 1% beyond the dose maximum, before this point the various effects due to the characteristics of each system could be observed. Scatter Factors differed especially for small fields due to the lack of secondary particle equilibrium. The results were compared taking the energy dependent sensibility and the effect of not given Bragg-Gray conditions into account. Conclusion: Among the tested measuremeut systems the silicon diode provides the best system for data acquisition in small irradiation "file(Is.
H. Madoc-Jones, G. Solares, R. Zamenhof, and O. Harling Tufts University School of Medicine and the Massachusetts I n s t i t u t e of Technology, Boston, USA The f i r s t three patients to enter a phase 1 t r i a l of boron neutron capture therapy to treat recurrent subcutaneous melanomata of the extremities have now been followed for one f u l l year. All three patients were given boronated phenylalanine by mouth as a test dose followed by serial blood samples and punch biopsies of normal skin and of melanoma nodules in order to establish the preferential uptake of the BPA by the tumor. They were then exposed to a total epithermal neutron dose of 1,000 RBE-cGy in four fractions a f t e r receiving the same oral dose of BPA and with repeat blood and tissue measurements for the concentration of BPA. None of the three patients had any acute reaction of the skin. All three had a partial response of the tumor. At one year no late effect on normal skin or soft tissue was observed. I t appears that at this low dose of epithermal neutrons boron neutron capture therapy is feasible and is without acute or late t o x i c i t y of normal skin and soft tissue. Photographs of the tumor response will be shown including one patient who is s t i l l controlled l o c a l l y at one year despite the fact that this was a low neutron dose.
774 SOME
ODD
EARLY MUCOSAL REACTIONS O B S E R V E D IN B U L G A R I A N
LATE REACTIONS AFTER HALF-BODY IRRADIATION
CHABT
7". Hadficva,* J. Todorov, * K Famev, ~ To. Rousscva1 t R ~ i o t h ~ D ~ Z Ertr D ~ u~e,=~ Hk,~t~" ~ Cao,,~aa', Sofia. Bulsatia Since April 1995 a protocol for Bulgarian modification of CHART has been worked out. THI December 1995 16 stage III and IV phatyax and oral cavity squamous cell cancer patients were enrolled in the study. No siguificant difference in time for mucosal picA. reactions compared to British CHART was observed. In 15% of cases mucosRis started early on the day 11-12 from the irrattiation start. During days 15 to 29 patients are not able to drink liquids or even to swallow tbe saliva for 10-12 days. One patient with turnout in hypoplugTax died on the first posttreatmast week from bilateral lobar pleuropneuaonia showing an reactivity, feber, coph. He developed signs of cerebral hypoxia and behave violently. We wroosly interpreted this as abstinention" because his ws.s heavy alcoholic. Two more patients with large hypopharyngel cancer felt into comma after being sleepy in the morning of first posttreatment week. One was treated by Lv. corticosteroids and became censcious af'ler 15 minutes. Most dramatic was third hypopharyngeal cancer patients' reaction, lntubation was difficult to perform because of laryngeal oedema and rec~aulation of respiratory tract was realised after 45 lninutes comma. NO cerehrral ctqm,~e was registered. Both patients were put on intensive care. Now they are turnout free 5 and 6 mounts after CHART. Obsereved severe obstruction of upper respiratory tract, somnolence and comma may have multiple reasons: large tumm~ur of an hypopharyngeal subsides with larynx rtxation" thick mucus production, radiation oedema of peritumour ti~ues, severe pain which StOpS normal rrmcus eliminzlJon. Metabolic dist~trbance due to --.-lnutrition starts several month because of deaease and expands ia period of n ~ i m a l reactions. Progr~mm~ for prevention and treatment of severe mucositis is proposed.
,\L;IH(.), ~ :, , L. Gotceva. J. Todorov. K. Ivanova. A. Jgnatov State University Hospata] "Qween G~ovanna". S o f , a . Bulgaria In the period 1989-1995 40 patients with operable locally advanced Ira-east carcinoma (LABC) received a :high dose half-body i r r a d i a t i o n as systemic radiation ~therapy alterrmtive to high dc6e chemotherspy with ,or without AEMT. The ~ of this study is to evaluate the 3,years survival and late tissue reactions after half.body irradiation; to assess the effectiveness of a .large single dose of irradiation on occult bone .metastasis; to estimate the v a l u e of therapeutic gain. F ~ the period under observation no hepatic, kidney .or heart late complications were found out. Only ,one p~tient developed radiation pnetm~onitis.
The I-mlf-lxx:ly i r r a d i a t i o n w i t h l a z u e d c e e s o f f e r s t h e p o s s i b i l i t y t o be a p p l i e d a s a s y s t e m i c r e d ' i n . t h e r a p y being a f i r s t line treatment in high r i s k LABC. ,With i t s good tolerance systemic chemotherapy s t i l l can be used as a second line treatment.
776
777
COMPARISON OF DIFFERENT MEASUREMENT SYSTEMS USED FOR DATA ACQUISITION OF A STEREOTACTIC SYSTEM
ONE-YEAR FOLLOW-UP OF THE FIRST THREE PATIENTS TREATEO WITH BORONNEUTRON CAPTURE THERAPY USING EPITHERMAL NEUTRONS
Hartl, R. F. E.l'2," A~ginger, H. ': P6tter R. 2 L Atominstitute of the Austrian Universities Dept. of Radiotherapy and Radiobiology, University of Vienna Purpose: All available dosimetric measurement systems should be tested for their suitability for data acquisition in small fiekls produced by a commercially available stereotactie system (BrainLAB}. The results should be compared taking the charactaristics of each system into account. Method: OARs (Off Axis Ratios), TIqR-values (Tissue Maximum Ratio) and Scatter Factors were acquired using a silicon diode, fihndensitometry, TLDs, an ionisation chamber (IC) and a flat chamber. The semiconductor detector was fixed oil the sledge of a Wellh6fer water phantom, films and TLDs were exposed at isocenter level with 75ram Solid Water T. M. build up material and the IC was connected to the couch mount and positioned by hand. The T M R values were acquired with Solid Water v" M. as build up. Results: OARs measured showed excellent correspondence. All acquired TMR-values matched within 1% beyond the dose maximum, before this point the various effects due to the characteristics of each system could be observed. Scatter Factors differed especially for small fields due to the lack of secondary particle equilibrium. The results were compared taking the energy dependent sensibility and the effect of not given Bragg-Gray conditions into account. Conclusion: Among the tested measuremeut systems the silicon diode provides the best system for data acquisition in small irradiation "file(Is.
H. Madoc-Jones, G. Solares, R. Zamenhof, and O. Harling Tufts University School of Medicine and the Massachusetts I n s t i t u t e of Technology, Boston, USA The f i r s t three patients to enter a phase 1 t r i a l of boron neutron capture therapy to treat recurrent subcutaneous melanomata of the extremities have now been followed for one f u l l year. All three patients were given boronated phenylalanine by mouth as a test dose followed by serial blood samples and punch biopsies of normal skin and of melanoma nodules in order to establish the preferential uptake of the BPA by the tumor. They were then exposed to a total epithermal neutron dose of 1,000 RBE-cGy in four fractions a f t e r receiving the same oral dose of BPA and with repeat blood and tissue measurements for the concentration of BPA. None of the three patients had any acute reaction of the skin. All three had a partial response of the tumor. At one year no late effect on normal skin or soft tissue was observed. I t appears that at this low dose of epithermal neutrons boron neutron capture therapy is feasible and is without acute or late t o x i c i t y of normal skin and soft tissue. Photographs of the tumor response will be shown including one patient who is s t i l l controlled l o c a l l y at one year despite the fact that this was a low neutron dose.