- Email: [email protected]
P2.114. Short-term effects of a randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiation
Material and methods: Sixty patients with squamous cell carcinoma (stage: T1-3, N0-2b) were treated definitively on a prospective protocol with conformal techniques using standardized contouring guidelines. The recurrent or persistent tumor volume (Vf) was defined using imaging and surgical-pathologic findings, and analyzed using dose-volume histograms. The failure was considered marginal when 20–95% of Vf was within 95% isodose line. Results: At median follow-up of 12 months (range, 4–30) the 3year actuarial local control, loco-regional control, disease-free survival, and overall survival Kaplan–Meier estimates were 86.4%, 80.5%, 62.6%, and 46.4%, respectively. Of 12 (19.3%) patients with disease related events, 10 have loco-regional failures with a median time of 4 months (range, 0–22). Of 10 patients, 8 had in-field, one had marginal and one had failures of both patterns. Of seven (11.3%) local failure events, two were isolated and one had marginal failure. Of seven regional failure events, two were marginal including one with failure at peri-parotid contra-lateral neck. Another one had bilateral multiple nodal levels with supraclavicular recurrence. The remaining events were in-field were ‘‘true failures” with no apparent technical cause, none had out-field failures. Two patients were detected to have distant metastases and two developed second malignancies, one out-field and other with upper esophagus carcinoma was marginal at gradient zone of previous radiation. Conclusions: Conformal radiotherapy does not compromise locoregional control as compared to historical controls treated with conventional techniques. The majority of recurrences were ‘‘in-field” motivate studies of dose escalation to the highest risk regions and marginal failures in the high-dose gradient region highlight the potential hazard of high precision techniques and warrants careful consideration. doi:10.1016/j.oos.2009.06.515
P2.112. Hypofractionated concurrent chemoradiation in T3-4 squmous cell carcinoma of the buccal mucosa A. Jamshed*, R. Hussain, H. Iqbal, K. Rehman Shaukat Khanum Memorial Cancer Hospital, Pakistan Introduction: The results of standard treatment in locally advanced squamous cell carcinoma of the buccal mucosa (SCCBM) are poor. Hypofractionated concurrent chemoradiation (HCCRT) is infrequently used in these patients. The aim of this study was to assess response and determine survival in T3-4 SCCBM treated with HCCRT in our institution. Methods: Between January 2005 and July 2008, 52 patients with T3-4 SCCBM were treated with HCCRT. AJCC stage T3 N0 2 pts (4%), T3 N+ 6 pts (11%), T4 N0 14 pts (27%) and T4 N+ 30 pts (58%). Primary tumour and nodal metastases were irradiated with 2.75 Gy once a day, 5 days a week to a median tumour dose of 55 Gy with concurrent cisplatin 75 mg/m2 on day 1 and 22. Spinal cord dose was limited to 30.2 Gy. Thirty eight pts (73%) received induction chemotherapy with gemcitabine 1000 mg/m2 day 1 and 8 and cisplatin 75 mg/m2 on day 1 2cycles was used. Response was assessed at 6 weeks following completion of treatment. Results: Thirty four pts (66%) had complete response at 6 weeks post completion of chemoradiation. Among complete responders 13/ 34 (38%) patients have recurred; local 8 pts (23%), regional 3 pts (9%) and loco-regional 2 pts (6%). Surgical salvage was successful in 5/13 pts (38%). 3 Year disease free survival (DFS) was 49%. The median disease free survival was 1.13 years. Discussion: DFS with HCCRT is comparable with conventional treatments and provides an alternative treatment option to morbid surgery and prolonged conventional chemoradiation schedules.
197
HCCRT merits further evaluation in controlled clinical trials to define its role in the treatment of locally advanced SCCBM. doi:10.1016/j.oos.2009.06.516
P2.113. Post operative radiation with and without concurrent chemotherapy in node positive oral cancer A. Jamshed*, R. Hussain, H. Iqbal, K. Rehman Shaukat Khanum Memorial Cancer Hospital, Pakistan Introduction: In oral cancer adjuvant post operative radiotherapy has an established role in reducing locoregional recurrence and improving survival in N+ disease. In recent years concurrent chemoradiation has been employed to further improve these results. The aim of our study was to determine survival in patients with N+ oral cancer treated with radiation with or without concurrent chemotherapy in our institution. Methods: Between November 2003 and July 2008, 77 patients with biopsy proven squamous cell oral cancer completed post operative radiotherapy or concurrent chemoradiation. Data was collected prospectively on the head and neck unit database. M:F ratio was 65%:35% with a median age of 52 years (range 32–77). Site of disease was oral tongue 62%, buccal mucosa 16%, Alveolus and gingival 19%, hard palate 1% and lips 1%. According to AJCC staging 30% (23) had stage III and 70% (54) had stage IVa/IVb disease. Post operative radiotherapy alone was used in 67% (52) and concurrent chemoradiation in 33% (25). Radiation therapy was administered as 2 Gy/day, 5 days/ week, up to a dose of 55–70 Gy (median dose 60 Gy). In patients treated with concurrent chemoradiation Cisplatin 75 mg/m2 was given on day 1, 22 and 43 with radiation therapy. Results: Kaplan Meier estimate for relapse free survival (RFS) at 3 years for the whole group was 43%, median 1.5 years (SE 0.63, 95% CI 0.30–2.78). Thirty three patients 43% failed treatment. Site of failure; local 17%, locoregional 18%, distant 4%, other causes 4%. In patients treated with post operative radiation alone and concurrent chemoradiation RFS was 33% and 77% (p = 0.01), respectively. Discussion: Relapse free survival with post operative concurrent chemoradiation is superior to radiotherapy alone in N+ oral cancer and should be considered the standard of care in these patients. doi:10.1016/j.oos.2009.06.517
P2.114. Short-term effects of a randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiation L. van der Molen a,*, M.A. van Rossum b, L.M. Burkhead c, L.E. Smeele a, C.R.N. Rasch a, F.J.M. Hilgers a,d,e a
The Netherlands Cancer Institute, Netherlands University Medical Centre Leiden, Netherlands c Medical College of Georgia, United States d Institute of Phonetic Sciences, University of Amsterdam, Netherlands e Academic Medical Centre, University of Amsterdam, Netherlands b
Introduction: Functional problems and abnormalities before and after chemoradiation (CRT) for advanced head and neck cancer can be considerable. Standard swallowing exercises are supposedly improving swallowing function, but evidence-based (experimental) rehabilitation options are lacking. This randomized preventive rehabilitation trial evaluates the short-term effects of pretreatment exercises (Standard versus Experimental) on early-posttreatment outcomes like swallowing, mouth opening, and oral intake.
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
198
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Methods: Forty-nine patients with advanced head and neck cancer of the oral cavity, oropharynx, hypopharynx, larynx or nasopharynx treated with CRT were included. All patients received pretreatment exercises. Twenty-four received regular swallowing exercises (Standard group) and 25 used a simplified swallowing exercise regime based on the Therabite Jaw Motion Rehabilitation System (Experimental group). Before and approximately 10 weeks after CRT, all patients were assessed by means of a structured, multidimensional protocol (i.e. videofluoroscopy, mouth opening measurement, and oral intake and pain assessments). Results: Comparing the two exercise groups the Therabite group showed significant less residue above or below the valleculae swallowing Omnipaque coated cake (P = .021) compared with the Standard group. The Therabite group also scored significant less pain than the Standard group (p = .016). Comparing the pre and post measurements an average decrease in mouth opening of 6% was shown. Analyzing the tube dependency 78% (38/49; measured immediately after CRT) and 37% (18/49; 10 weeks after CRT) of the patients were tube dependent after treatment. These results shows a major significant progress (P = .004) compared with the results (90%; 83/92 and 70%; 64/92) of a comparable study by Ackerstaff et al. (2008). Conclusion: Pretreatment exercises in head and neck cancer patients treated with chemoradiation seems to be effective for reducing the amount and/or severity of various functional outcomes pre – and early-posttreatment. Part of the study is supported by an unrestricted research grant from Atos Medical, Hörby, Sweden. doi:10.1016/j.oos.2009.06.518
P2.115. Definitive accelerated radiotherapy for head and neck cancer patients – The results of organ preservation and prognostic-factor analysis of CAIR-2 phase III trial K. Skladowski*, A. Wygoda, A. Maciejewski, T. Rutkowski, S. Poltorak, B. Maciejewski Institute of Oncology – Maria Sklodowska-Curie Memorial Cancer Center, Poland Introduction: Since two years there is the EBM altered fractionations have offered small, but significant advantage in survival of head and neck cancer patients. Accelerated radiotherapy (ART) without total dose reduction presents the subgroup of those fractionations which were given most frequently and were brought the lowest risk of loco-regional recurrence. In Gliwice Institute of Oncology, between 1998 and 2006, phase III trial on such two definitive ART schedules having identical overall treatment times but different timing of dose-delivery - weekend-in or weekend-off – has been undergoing. Methods: In CAIR arm fraction-dose was given once-a-day, regularly at 24 h interval, including Saturdays and Sundays. In concomitant boost (CB) arm the dose was delivered once-a-day at Mondays, Wednesdays and Thursdays and twice-a-day with 8 h interval at Tuesdays and Fridays. Patients with moderate advanced SQCC were stratified per tumour site (larynx 48%, oropharynx 34%, oral cavity 9%, hypopharynx 9%) and stage (T2N0 31%, T2N1 10%, T3N0 22%, T3N1 13%, T4N0 12%, T4N1 12%). 3DRT technique and fractionation parameters remained within the ranges: 66.6–72Gy of total dose, 37–40 fractions and 37–40 days. Results: Median follow-up is 70 months. Generally, for all trial end-points similar rates for both schedules were noted - at 5 years LC was 67% in the CAIR and 68% in CB arm, DFS and OS rates were respectively 38% vs. 44% and 50 vs. 55% and come of, among others, the second primary tumours (36 pts) and the distant metastases (11
pts). Mucositis was the main acute toxicity with the same incidence in the arms. Actuarial 5-year grade 3–4 morbidity-free survival was 95% for both treatments. In 24 out of 104 T-failures (23% pts) and in 10 out of 35 N-failures (29% pts) salvage surgery was performed, including planned neck dissection. Thus, the overall rate of pts who survive 5-year with LC and organ preservation was 65%. Clinical T stage has been the only prognostic factor for both LC and OS (p = 0.00011). Conclusions: Gliwice CAIR-2 study has yielded the EBM that weekend-off in ART with no compromise of total dose has no impact on tumour cure for head and neck cancer patients. For moderate advanced head and neck cancer patients the probability of long-term local control with organ preservation and no serious toxicity is pretty high and the risk of distant metastases is low, what suggests that such ART could be worthy of use instead of more toxic concurrent chemo-radiation. doi:10.1016/j.oos.2009.06.519
P2.116. Daily concurrent preoperative chemoradiotherapy using NewSuperselectiveIntra-arterial infusion via superficial temporal artery for oral cancer – Cervical lymphnode metastasis N. Yamamoto*, T. Shigetomi, M. Nishikawa, D. Mizuno, H. Furue, F. Sato Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Japan Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicin, Japan Patients with head and neck squamous cell cancers (HNSC) of stages III and IV have a poor outcome, often losing important functions such as swallowing and speech despite combined surgery and radiotherapy. Two-thirds of such patients die of local recurrence and disseminated metastasis in spite of salvage therapy. Conventional adjuvant chemotherapy is often difficult for HNSC patients, since many of them suffer from associated chronic oral, respiratory and gastrointestinal diseases due to tobacco and alcohol in addition to having poor nutritional and oral hygienic conditions. We developed a new method of superselective intra-arterial infusion via the superficial temporal artery. Forty six advanced head and neck cancer patients with cervical lymph node metastasis were treated by superselective intra-arterial chemotherapy using docetaxel (DOC) and ciplatin (CDDP) from 2000 to 2008. Radiotherapy (total dose: 40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using DOC (total dose: 60 mg/m2,15 mg/m2/week) and CDDP (total dose: 100 mg/m2, 5 mg/m2/day) were performed, followed by surgery. The pathological effects of lymph node metastasis after surgery were grade III, IV (Oboshi- Shimosato classification) in level I, II. This method promises to be the strategy of oral cancer with cervical lymph node metastasis. doi:10.1016/j.oos.2009.06.520
P2.117. The pattern evaluation of healing processess of acute mucosal reactions in irradiated patients with oral and oropharyngeal cancer A. Wygoda*, K. Skladowski, T. Rutkowski, M. Hutnik, B. Pilecki, M. Golen Ist Department of Radiation Oncology, Cancer Center and Institute of Oncology, Maria Sklodowska-Curie Memorial, Gliwice Branch, Poland
P2.112. Hypofractionated concurrent chemoradiation in T3-4 squmous cell carcinoma of the buccal mucosa A. Jamshed*, R. Hussain, H. Iqbal, K. Rehman Shaukat Khanum Memorial Cancer Hospital, Pakistan Introduction: The results of standard treatment in locally advanced squamous cell carcinoma of the buccal mucosa (SCCBM) are poor. Hypofractionated concurrent chemoradiation (HCCRT) is infrequently used in these patients. The aim of this study was to assess response and determine survival in T3-4 SCCBM treated with HCCRT in our institution. Methods: Between January 2005 and July 2008, 52 patients with T3-4 SCCBM were treated with HCCRT. AJCC stage T3 N0 2 pts (4%), T3 N+ 6 pts (11%), T4 N0 14 pts (27%) and T4 N+ 30 pts (58%). Primary tumour and nodal metastases were irradiated with 2.75 Gy once a day, 5 days a week to a median tumour dose of 55 Gy with concurrent cisplatin 75 mg/m2 on day 1 and 22. Spinal cord dose was limited to 30.2 Gy. Thirty eight pts (73%) received induction chemotherapy with gemcitabine 1000 mg/m2 day 1 and 8 and cisplatin 75 mg/m2 on day 1 2cycles was used. Response was assessed at 6 weeks following completion of treatment. Results: Thirty four pts (66%) had complete response at 6 weeks post completion of chemoradiation. Among complete responders 13/ 34 (38%) patients have recurred; local 8 pts (23%), regional 3 pts (9%) and loco-regional 2 pts (6%). Surgical salvage was successful in 5/13 pts (38%). 3 Year disease free survival (DFS) was 49%. The median disease free survival was 1.13 years. Discussion: DFS with HCCRT is comparable with conventional treatments and provides an alternative treatment option to morbid surgery and prolonged conventional chemoradiation schedules.
197
HCCRT merits further evaluation in controlled clinical trials to define its role in the treatment of locally advanced SCCBM. doi:10.1016/j.oos.2009.06.516
P2.113. Post operative radiation with and without concurrent chemotherapy in node positive oral cancer A. Jamshed*, R. Hussain, H. Iqbal, K. Rehman Shaukat Khanum Memorial Cancer Hospital, Pakistan Introduction: In oral cancer adjuvant post operative radiotherapy has an established role in reducing locoregional recurrence and improving survival in N+ disease. In recent years concurrent chemoradiation has been employed to further improve these results. The aim of our study was to determine survival in patients with N+ oral cancer treated with radiation with or without concurrent chemotherapy in our institution. Methods: Between November 2003 and July 2008, 77 patients with biopsy proven squamous cell oral cancer completed post operative radiotherapy or concurrent chemoradiation. Data was collected prospectively on the head and neck unit database. M:F ratio was 65%:35% with a median age of 52 years (range 32–77). Site of disease was oral tongue 62%, buccal mucosa 16%, Alveolus and gingival 19%, hard palate 1% and lips 1%. According to AJCC staging 30% (23) had stage III and 70% (54) had stage IVa/IVb disease. Post operative radiotherapy alone was used in 67% (52) and concurrent chemoradiation in 33% (25). Radiation therapy was administered as 2 Gy/day, 5 days/ week, up to a dose of 55–70 Gy (median dose 60 Gy). In patients treated with concurrent chemoradiation Cisplatin 75 mg/m2 was given on day 1, 22 and 43 with radiation therapy. Results: Kaplan Meier estimate for relapse free survival (RFS) at 3 years for the whole group was 43%, median 1.5 years (SE 0.63, 95% CI 0.30–2.78). Thirty three patients 43% failed treatment. Site of failure; local 17%, locoregional 18%, distant 4%, other causes 4%. In patients treated with post operative radiation alone and concurrent chemoradiation RFS was 33% and 77% (p = 0.01), respectively. Discussion: Relapse free survival with post operative concurrent chemoradiation is superior to radiotherapy alone in N+ oral cancer and should be considered the standard of care in these patients. doi:10.1016/j.oos.2009.06.517
P2.114. Short-term effects of a randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiation L. van der Molen a,*, M.A. van Rossum b, L.M. Burkhead c, L.E. Smeele a, C.R.N. Rasch a, F.J.M. Hilgers a,d,e a
The Netherlands Cancer Institute, Netherlands University Medical Centre Leiden, Netherlands c Medical College of Georgia, United States d Institute of Phonetic Sciences, University of Amsterdam, Netherlands e Academic Medical Centre, University of Amsterdam, Netherlands b
Introduction: Functional problems and abnormalities before and after chemoradiation (CRT) for advanced head and neck cancer can be considerable. Standard swallowing exercises are supposedly improving swallowing function, but evidence-based (experimental) rehabilitation options are lacking. This randomized preventive rehabilitation trial evaluates the short-term effects of pretreatment exercises (Standard versus Experimental) on early-posttreatment outcomes like swallowing, mouth opening, and oral intake.
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
198
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Methods: Forty-nine patients with advanced head and neck cancer of the oral cavity, oropharynx, hypopharynx, larynx or nasopharynx treated with CRT were included. All patients received pretreatment exercises. Twenty-four received regular swallowing exercises (Standard group) and 25 used a simplified swallowing exercise regime based on the Therabite Jaw Motion Rehabilitation System (Experimental group). Before and approximately 10 weeks after CRT, all patients were assessed by means of a structured, multidimensional protocol (i.e. videofluoroscopy, mouth opening measurement, and oral intake and pain assessments). Results: Comparing the two exercise groups the Therabite group showed significant less residue above or below the valleculae swallowing Omnipaque coated cake (P = .021) compared with the Standard group. The Therabite group also scored significant less pain than the Standard group (p = .016). Comparing the pre and post measurements an average decrease in mouth opening of 6% was shown. Analyzing the tube dependency 78% (38/49; measured immediately after CRT) and 37% (18/49; 10 weeks after CRT) of the patients were tube dependent after treatment. These results shows a major significant progress (P = .004) compared with the results (90%; 83/92 and 70%; 64/92) of a comparable study by Ackerstaff et al. (2008). Conclusion: Pretreatment exercises in head and neck cancer patients treated with chemoradiation seems to be effective for reducing the amount and/or severity of various functional outcomes pre – and early-posttreatment. Part of the study is supported by an unrestricted research grant from Atos Medical, Hörby, Sweden. doi:10.1016/j.oos.2009.06.518
P2.115. Definitive accelerated radiotherapy for head and neck cancer patients – The results of organ preservation and prognostic-factor analysis of CAIR-2 phase III trial K. Skladowski*, A. Wygoda, A. Maciejewski, T. Rutkowski, S. Poltorak, B. Maciejewski Institute of Oncology – Maria Sklodowska-Curie Memorial Cancer Center, Poland Introduction: Since two years there is the EBM altered fractionations have offered small, but significant advantage in survival of head and neck cancer patients. Accelerated radiotherapy (ART) without total dose reduction presents the subgroup of those fractionations which were given most frequently and were brought the lowest risk of loco-regional recurrence. In Gliwice Institute of Oncology, between 1998 and 2006, phase III trial on such two definitive ART schedules having identical overall treatment times but different timing of dose-delivery - weekend-in or weekend-off – has been undergoing. Methods: In CAIR arm fraction-dose was given once-a-day, regularly at 24 h interval, including Saturdays and Sundays. In concomitant boost (CB) arm the dose was delivered once-a-day at Mondays, Wednesdays and Thursdays and twice-a-day with 8 h interval at Tuesdays and Fridays. Patients with moderate advanced SQCC were stratified per tumour site (larynx 48%, oropharynx 34%, oral cavity 9%, hypopharynx 9%) and stage (T2N0 31%, T2N1 10%, T3N0 22%, T3N1 13%, T4N0 12%, T4N1 12%). 3DRT technique and fractionation parameters remained within the ranges: 66.6–72Gy of total dose, 37–40 fractions and 37–40 days. Results: Median follow-up is 70 months. Generally, for all trial end-points similar rates for both schedules were noted - at 5 years LC was 67% in the CAIR and 68% in CB arm, DFS and OS rates were respectively 38% vs. 44% and 50 vs. 55% and come of, among others, the second primary tumours (36 pts) and the distant metastases (11
pts). Mucositis was the main acute toxicity with the same incidence in the arms. Actuarial 5-year grade 3–4 morbidity-free survival was 95% for both treatments. In 24 out of 104 T-failures (23% pts) and in 10 out of 35 N-failures (29% pts) salvage surgery was performed, including planned neck dissection. Thus, the overall rate of pts who survive 5-year with LC and organ preservation was 65%. Clinical T stage has been the only prognostic factor for both LC and OS (p = 0.00011). Conclusions: Gliwice CAIR-2 study has yielded the EBM that weekend-off in ART with no compromise of total dose has no impact on tumour cure for head and neck cancer patients. For moderate advanced head and neck cancer patients the probability of long-term local control with organ preservation and no serious toxicity is pretty high and the risk of distant metastases is low, what suggests that such ART could be worthy of use instead of more toxic concurrent chemo-radiation. doi:10.1016/j.oos.2009.06.519
P2.116. Daily concurrent preoperative chemoradiotherapy using NewSuperselectiveIntra-arterial infusion via superficial temporal artery for oral cancer – Cervical lymphnode metastasis N. Yamamoto*, T. Shigetomi, M. Nishikawa, D. Mizuno, H. Furue, F. Sato Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Japan Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicin, Japan Patients with head and neck squamous cell cancers (HNSC) of stages III and IV have a poor outcome, often losing important functions such as swallowing and speech despite combined surgery and radiotherapy. Two-thirds of such patients die of local recurrence and disseminated metastasis in spite of salvage therapy. Conventional adjuvant chemotherapy is often difficult for HNSC patients, since many of them suffer from associated chronic oral, respiratory and gastrointestinal diseases due to tobacco and alcohol in addition to having poor nutritional and oral hygienic conditions. We developed a new method of superselective intra-arterial infusion via the superficial temporal artery. Forty six advanced head and neck cancer patients with cervical lymph node metastasis were treated by superselective intra-arterial chemotherapy using docetaxel (DOC) and ciplatin (CDDP) from 2000 to 2008. Radiotherapy (total dose: 40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using DOC (total dose: 60 mg/m2,15 mg/m2/week) and CDDP (total dose: 100 mg/m2, 5 mg/m2/day) were performed, followed by surgery. The pathological effects of lymph node metastasis after surgery were grade III, IV (Oboshi- Shimosato classification) in level I, II. This method promises to be the strategy of oral cancer with cervical lymph node metastasis. doi:10.1016/j.oos.2009.06.520
P2.117. The pattern evaluation of healing processess of acute mucosal reactions in irradiated patients with oral and oropharyngeal cancer A. Wygoda*, K. Skladowski, T. Rutkowski, M. Hutnik, B. Pilecki, M. Golen Ist Department of Radiation Oncology, Cancer Center and Institute of Oncology, Maria Sklodowska-Curie Memorial, Gliwice Branch, Poland