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Stereotactic radiotherapy: Its role in a multidisciplinary approach to brain arteriovenous malformations
262
Radiation Oncology, Biology, Physics
Volume 24, Supplement
1
subacute and late toxicities have been acceptable with little difference in skin, mucosal or GI toxicity between HEBI and CFI patients. Weight change has ranged between -2.4 Kg and +4.2 Kg. Two patients developed fistulae following surgery and CFI. A single patient developed grade II (RTOG) renal toxicity.
Conclusion: The promising early local tumor control and lack of differential toxicity between HEBI and CFI patients support further study of HEBI in RMS.
1037 HYPERFRACTIONATED-ACCELERATED
RADIOTHERAPY
FOR
CHILDHOOD
L. Gandola, F. Fossatl-Bellanl, M Gaspannl. M C Glannl, M. Massimlno, P Navarrta, Departments of Radlatlon Therapy and Pediatric Oncology, lstituto Nazlonale Tumon
RHABDOMYOSARCOMA
F Lombardi 20133 Milan. Italy
Purpose. Hyperfractlonated-accelerated radlotherapy (HART) was adopted for children with either unresectable or partially resected rhabdomyosarcoma (RMSA), following a 2-month intensive chemotherapy. This irradiation modality was used, Instead of a conventlonal one, with the aim to increase local control of the disease, due to a better treatment compliance, and to reduce late sequelae Materials and methods 18 consecutive children (10 boys, 8 girls. median age 7 yrs, range 3-18 yrs, embryonal RMSA 12. alveolar 5, unclassified 1) entered the study Primary tumor sites were head and neck 12 (paramemngeal 6). pelvis 3, paratesticular 2. retropentoneum 1 Patients, after biopsy alone (13) or partial resectlon (5), received primary CT (ADM. DACT, CTX. VCR alternated for 8 weeks), followed by HART, and then by 9 mos of maintenance CT with the same four drugs administered monthly HART consisted of 3 daily fractions (1 5 Gy/fractlon) at 5-hr intervals, to a total dose of 49.5 Gy, administered in 11 days excluding weekend treatments. Results Primary CT induced a CR in 3/18 pts, and a PR in 15 HART Induced a CR in 8/13 evaluable pts, and Improved PR in 3, while in 2 pts the disease remained stable Eight of 18 pts (44%) are alive In CCR after a median time of 18 mos (8-32 mos); 5 (28%) relapsed at prrmary site after 5,15,17.19,24 mos from HART, 4 developed distant metastases after 4.6,lO. 15 mos, and 1 pt died in PR for a suspected brain-stem radionecrosis (+ 8 mos) Acute toxicrty from HART consisted mainly of severe necrotizmg oropharyngeal mucosrtis in the pts with head and neck primary, requiring a treatment interruption (13 days) in 1 pt only. The observed late sequelae were one suspected brain-stem radlonecrosis and one severe soft-tissue fibrosis (gluteus) developing 7 and 12 mos. respectively, after HART Results of the HART study were compared with those of a histoncal senes of 33 consecutive patients with unresected or partially resected RMSA (median age 8 yrs. median follow-up 60 mos) who received the same primary and maintenance CT along with a conventlonal high-dose radiotherapy (55-60 Gy). Conclusions: HART IS feasible after a 2-month Intensive CT A toxlclty-related temporary Interruption of radiotherapy was necessary in 5% of the pts in the HART study, as compared with 51% in the hIstorIcal series Local relapse rate is not reduced by HART (28%) as compared with conventional radlotherapy (27%), while delayed toxicity appears to be ltmited and probably reduced in the HART study A more aggressive CT and a higher total HART dose are probably required to improve local as well as distant control of the disease in children with unresectable or partially resected RMSA
1038 STEREOTACTIC RADIOTHERAPY: MALFORMATIONS.
ITS ROLE IN A MULTIDISCIPLINARY
APPROACH TO BRAIN ARTERIOVENOUS
C. Young, M.C. Wallace, I. Daramola, F. Gentili, M. Schwartz, K. TerBrugge, R. Willinsky. University of Toronto Brain Vascular Malformation Study Group; Toronto-Bayview Regional Cancer Centre, Toronto, Ontario, Canada M4N 3M5 Purpose: Treatment regarding patterns. feasibility
Brain arteriovenous malformations can be treated by stereotactic radiotherapy, embolization or surgery, or observed. must be individualized, comparing the relative risks of the various therapies versus future hemorrhage. Education treatment options is of paramount importance to avoid therapy recommendation according to specialty or referral With stereotactic radiotherapy joining the therapeutic armamentarium comparatively recently, we explored the of integrating the three modalities in a planned approach to AVM patients.
Material and Methods: Our multidisciplinary group, with one radiation oncologist, two interventional neuroradiologists and three neurosurgeons, sees patients in a common clinic. All referrals are discussed by the group in separate case conferences. We have developed treatment algorithms incorporating patient, lesional and treatment factors. These will be presented.
Radiation Oncology, Biology, Physics
Volume 24, Supplement
1
subacute and late toxicities have been acceptable with little difference in skin, mucosal or GI toxicity between HEBI and CFI patients. Weight change has ranged between -2.4 Kg and +4.2 Kg. Two patients developed fistulae following surgery and CFI. A single patient developed grade II (RTOG) renal toxicity.
Conclusion: The promising early local tumor control and lack of differential toxicity between HEBI and CFI patients support further study of HEBI in RMS.
1037 HYPERFRACTIONATED-ACCELERATED
RADIOTHERAPY
FOR
CHILDHOOD
L. Gandola, F. Fossatl-Bellanl, M Gaspannl. M C Glannl, M. Massimlno, P Navarrta, Departments of Radlatlon Therapy and Pediatric Oncology, lstituto Nazlonale Tumon
RHABDOMYOSARCOMA
F Lombardi 20133 Milan. Italy
Purpose. Hyperfractlonated-accelerated radlotherapy (HART) was adopted for children with either unresectable or partially resected rhabdomyosarcoma (RMSA), following a 2-month intensive chemotherapy. This irradiation modality was used, Instead of a conventlonal one, with the aim to increase local control of the disease, due to a better treatment compliance, and to reduce late sequelae Materials and methods 18 consecutive children (10 boys, 8 girls. median age 7 yrs, range 3-18 yrs, embryonal RMSA 12. alveolar 5, unclassified 1) entered the study Primary tumor sites were head and neck 12 (paramemngeal 6). pelvis 3, paratesticular 2. retropentoneum 1 Patients, after biopsy alone (13) or partial resectlon (5), received primary CT (ADM. DACT, CTX. VCR alternated for 8 weeks), followed by HART, and then by 9 mos of maintenance CT with the same four drugs administered monthly HART consisted of 3 daily fractions (1 5 Gy/fractlon) at 5-hr intervals, to a total dose of 49.5 Gy, administered in 11 days excluding weekend treatments. Results Primary CT induced a CR in 3/18 pts, and a PR in 15 HART Induced a CR in 8/13 evaluable pts, and Improved PR in 3, while in 2 pts the disease remained stable Eight of 18 pts (44%) are alive In CCR after a median time of 18 mos (8-32 mos); 5 (28%) relapsed at prrmary site after 5,15,17.19,24 mos from HART, 4 developed distant metastases after 4.6,lO. 15 mos, and 1 pt died in PR for a suspected brain-stem radionecrosis (+ 8 mos) Acute toxicrty from HART consisted mainly of severe necrotizmg oropharyngeal mucosrtis in the pts with head and neck primary, requiring a treatment interruption (13 days) in 1 pt only. The observed late sequelae were one suspected brain-stem radlonecrosis and one severe soft-tissue fibrosis (gluteus) developing 7 and 12 mos. respectively, after HART Results of the HART study were compared with those of a histoncal senes of 33 consecutive patients with unresected or partially resected RMSA (median age 8 yrs. median follow-up 60 mos) who received the same primary and maintenance CT along with a conventlonal high-dose radiotherapy (55-60 Gy). Conclusions: HART IS feasible after a 2-month Intensive CT A toxlclty-related temporary Interruption of radiotherapy was necessary in 5% of the pts in the HART study, as compared with 51% in the hIstorIcal series Local relapse rate is not reduced by HART (28%) as compared with conventional radlotherapy (27%), while delayed toxicity appears to be ltmited and probably reduced in the HART study A more aggressive CT and a higher total HART dose are probably required to improve local as well as distant control of the disease in children with unresectable or partially resected RMSA
1038 STEREOTACTIC RADIOTHERAPY: MALFORMATIONS.
ITS ROLE IN A MULTIDISCIPLINARY
APPROACH TO BRAIN ARTERIOVENOUS
C. Young, M.C. Wallace, I. Daramola, F. Gentili, M. Schwartz, K. TerBrugge, R. Willinsky. University of Toronto Brain Vascular Malformation Study Group; Toronto-Bayview Regional Cancer Centre, Toronto, Ontario, Canada M4N 3M5 Purpose: Treatment regarding patterns. feasibility
Brain arteriovenous malformations can be treated by stereotactic radiotherapy, embolization or surgery, or observed. must be individualized, comparing the relative risks of the various therapies versus future hemorrhage. Education treatment options is of paramount importance to avoid therapy recommendation according to specialty or referral With stereotactic radiotherapy joining the therapeutic armamentarium comparatively recently, we explored the of integrating the three modalities in a planned approach to AVM patients.
Material and Methods: Our multidisciplinary group, with one radiation oncologist, two interventional neuroradiologists and three neurosurgeons, sees patients in a common clinic. All referrals are discussed by the group in separate case conferences. We have developed treatment algorithms incorporating patient, lesional and treatment factors. These will be presented.