3D Conformal External Beam Radiotherapy Research Articles

Assessment of the safety and feasibility of neoadjuvant chemotherapy (2 cycles of FLOT chemotherapy + chemoradiotherapy) followed by surgery in the treatment of locally advanced gastric cancer

The aim of the study was to analyze of the safety and feasibility of neoadjuvant chemotherapy (2 cycles of FLOT chemotherapy + chemoradiotherapy) followed by surgery in the treatment of locally advanced gastric cancer. Material and Methods. The phase II clinical trial included 47 patients with histologically verified locally advanced gastric cancer (cT3/T4a-b: 26/21 and cN0/N1–3: 20/27) treated at the A.F. Tsyba MRRC from 2018 to 2021. Lesion location was: upper third in 19 patients (esophageal invasion in 9 patients), middle third in 13 patients, lower third in 14 patients, and entire stomach in 1 patient. The tumor grade was G3 in 23 patients, G2 in 13 patients and G1 in 7 patients. Signet ring cell carcinoma was revealed in 4 patients. The patients received 2 cycles of induction chemotherapy with FLOT regimen (85 mg/m2 oxaliplatin + 200 mg/m2 calcium folinate + 50 mg/m2 docetaxel on day 1 + 2600 mg/m2 fluorouracil as 24-hour infusion from day 1; every 2 weeks) followed by 3d-conformal external beam radiotherapy (46 Gy in daily fractions of 2 Gy) combined with chemotherapy with capecitabine and oxaliplatin). The patients then underwent follow-up examination to exclude disease progression and to plan surgery. Postoperative complications were analyzed using the Clavien-dindo classification. Results. Induction chemotherapy followed by concurrent chemoradiotherapy was well tolerated. Forty-five (95.7 %) patients underwent surgery, 97.7 % of them underwent radical surgery. Postoperative complications were observed in 11 (23.4 %) patients. Grade III and more severe complications were observed in 3 (6.4 %) patients. It should be noted that postoperative mortality rate was low, amounting to 2.2 % (1 patient). Conclusion. Induction FLOT polychemotherapy followed by concurrent chemoradiotherapy was shown to be safe, feasible, and tolerable. Moreover, this treatment regimen did not reduce the frequency of R0 surgeries and did not increase incidence and severity of postoperative complications.

Impact of Androgen Deprivation Therapy Associated to Conformal Radiotherapy in the Treatment of D'Amico Intermediate-/High-Risk Prostate Cancer in Older Patients.

Simple SummaryAndrogen Deprivation Therapy (ADT) combined with radiotherapy is recommended for a duration of 6 months in unfavorable D’Amico intermediate-risk (IR) prostate cancer and a duration of 18 to 36 months in D’Amico high-risk (HR) prostate cancer. However, as patients ≥80 years are excluded from phase III trials combining radiotherapy and ADT, there is no consensus in this population regarding the combination of these treatments. So, we aimed to report the oncological results and morbidity radiotherapy +ADT in 101 ≥ 80 years patients with IR/HR localized prostate cancers in Marseille University Hospital. The tolerance of ADT in association to radiotherapy was acceptable in this study. There was no increase in the incidence of cardiovascular events compared to the general population, whatever the duration of ADT. The absence of significant difference in biochemical recurrence-free survival or distant metastasis-free survival between 6 and 15 months of ADT in the HR group of patients raise the question of the optimal duration of ADT in this older population. However cardio-vascular evaluation and surveillance are mandatory, especially for men over 82 years old.Purpose/objective: The association of 3D Conformal External Beam Radiotherapy (3D-CEBRT) with adjuvant Androgen Deprivation Therapy (ADT) proved to treat patients with intermediate- and high-risk localized prostate cancer (IR and HR). However, older patients were underrepresented in literature. We aimed to report the oncological results and morbidity 3D-CEBRT +ADT in ≥80 years patients. Material and Methods: From June 1998 to July 2017, 101 patients ≥80 years were included in a tertiary center. The median age was 82 years. ADT was initiated 3 months prior 3D-CEBRT in all patients, with a total duration of 6 months for IR prostate cancer (group A; n = 41) and 15 months for HR prostate cancer (group B; n = 60). Endpoints included overall survival (OS), metastasis-free survival (DMFS), biochemical recurrence-free survival (BRFS) and toxicity. Results: Five years-OS was 95% and 86.7% in groups A and B, respectively. Cardiovascular events occurred in 22.8% of ≥80 years patients with no impact on OS. In the multivariate analysis, age <82 years, Karnofsky index and normalization of testosterone levels were significantly associated with better OS. Conclusion: Age ≥80 years should not be a limitation for the treatment of IR and HR prostate cancer patients with 3D-CEBRT and ADT, but cardiovascular monitoring and prevention are mandatory.

Rectal volume variations and estimated rectal dose during 8 weeks of image-guided radical 3D conformal external beam radiotherapy for prostate cancer

•Modern IGRT has given new insight regarding organ motion in radiotherapy.•Rectal volume variation may increase the risk of biochemical and local failure.•Rectal volume decreased significantly during eight weeks of radiotherapy.•The percentage of irradiated rectal volume did not change statistically significant.•Our study shows that IGRT ensures a close to stable dose to the rectum.

Results from chemoradiotherapy for squamous cell cervical cancer with or without intracavitary brachytherapy.

PurposeThe aim of this study is to compare the outcomes of intracavitary high-dose-rate brachytherapy (BT-IC) boost and external beam radiotherapy (EBRT) boost in patients treated with concomitant chemoradiotherapy for squamous cell carcinoma of the cervix.Material and methodsIt is a retrospective review of 92 patients with stage IB1-IVA cervical cancer treated with concomitant chemoradiotherapy between 2008 and 2013. All patients received pelvic 3D conformal EBRT (range, 45-50.4 Gy) concomitant with weekly cisplatin (40 mg/m2), and a BT-IC boost (37 patients: 4 fractions of 6 Gy prescribed to a point A) to the tumor or a 3D conformal EBRT boost (55 patients: 16.2 Gy), if the former was not technically feasible.ResultsThe 5-year overall survival and recurrence-free survival rates for both groups were 68% and 55%, respectively. The 5-year overall survival and recurrence-free survival were better and statistically significant in the BT-IC group with 82% and 79%, respectively, as compared to the EBRT group with 58% and 38%, respectively. In multivariate analysis controlling for maximum tumor dimension, lymph node status, and FIGO stage, EBRT boost was associated with a statistical significant increase in the risk of recurrence (HR: 3.56; 95% CI: 1.27-10.02; p = 0.016) and a trend towards an increase in the risk of death (HR: 3.14; 95% CI: 0.97-10.17; p = 0.056). Lymph node status was also significantly associated with a greater risk of recurrence.ConclusionsBT-IC boost was associated with a lower recurrence rate and better overall survival and recurrence-free survival. EBRT boost patients had a three-fold increase in the risk of recurrence. Brachytherapy is essential in the treatment of cervical cancer and improved alternatives are needed for patients who are not candidates for standard brachytherapy applicators.

Organ at risk dose comparison between gynaecological cancers of the endometrium and cervix using a combined external beam and brachytherapy boost treatment

Gynaecological cancers (GCs) treated using external beam radiotherapy (EBRT) followed by a boost of brachytherapy (BT) reduces the overall treatment dose and gives a better treatment of the tumour compared to using EBRT or BT alone. However, with this combined treatment, there is growing concern for the increased dose to the Organs at Risk (OAR) as it increases the possibility of late toxicity effects and potentially reduces the patient’s quality of life (QoL). Using statistical analysis, the differences in dose delivered to the OAR for two GCs (endometrial and cervical) was investigated as well as other dose influencing factors (i.e. applicator insertion angle and size). This project involved 19 cervical patients: EBRT = 50.4 Gy, 28 fractions followed by BT = 21 Gy, 3 fractions; and 17 endometrial patients: EBRT = 45/46 Gy, 28 fractions and BT = 18 Gy 3 fractions. All patients had been treated with 3D-Conformal EBRT using 15 MV photon beams and BT with a Ir-192 GammaMed Plus system. Statistically significant differences (p-value < 0.05) between the OAR doses for the two GC treatments identified that cervical patients receive a higher dose to the bladder, sigmoid and small intestines, with a reduction in rectum dose due to the use of a rectum retractor in BT treatments. Total Reference Air KERMA (TRAK), a potential predictive factor for the biological effect of radiation on tissues, also showed that cervical treatments exhibited much higher TRAK values than when compared with endometrial treatments (p-value < 0.0001). Gynaecological cancers (GCs) treated using external beam radiotherapy (EBRT) followed by a boost of brachytherapy (BT) reduces the overall treatment dose and gives a better treatment of the tumour compared to using EBRT or BT alone. However, with this combined treatment, there is growing concern for the increased dose to the Organs at Risk (OAR) as it increases the possibility of late toxicity effects and potentially reduces the patient’s quality of life (QoL). Using statistical analysis, the differences in dose delivered to the OAR for two GCs (endometrial and cervical) was investigated as well as other dose influencing factors (i.e. applicator insertion angle and size). This project involved 19 cervical patients: EBRT = 50.4 Gy, 28 fractions followed by BT = 21 Gy, 3 fractions; and 17 endometrial patients: EBRT = 45/46 Gy, 28 fractions and BT = 18 Gy 3 fractions. All patients had been treated with 3D-Conformal EBRT using 15 MV photon beams and BT with a Ir-192 GammaMed Plus system. Statistically significant differences (p-value < 0.05) between the OAR doses for the two GC treatments identified that cervical patients receive a higher dose to the bladder, sigmoid and small intestines, with a reduction in rectum dose due to the use of a rectum retractor in BT treatments. Total Reference Air KERMA (TRAK), a potential predictive factor for the biological effect of radiation on tissues, also showed that cervical treatments exhibited much higher TRAK values than when compared with endometrial treatments (p-value < 0.0001).

Organ at risk dose comparison between gynaecological cancers of the endometrium and cervix using a combined external beam and brachytherapy boost treatment

Gynaecological cancers (GCs) treated using external beam radiotherapy (EBRT) followed by a boost of brachytherapy (BT) reduces the overall treatment dose and gives a better treatment of the tumour compared to using EBRT or BT alone. However, with this combined treatment, there is growing concern for the increased dose to the Organs at Risk (OAR) as it increases the possibility of late toxicity effects and potentially reduces the patient’s quality of life (QoL). Using statistical analysis, the differences in dose delivered to the OAR for two GCs (endometrial and cervical) was investigated as well as other dose influencing factors (i.e. applicator insertion angle and size). This project involved 19 cervical patients: EBRT = 50.4 Gy, 28 fractions followed by BT = 21 Gy, 3 fractions; and 17 endometrial patients: EBRT = 45/46 Gy, 28 fractions and BT = 18 Gy 3 fractions. All patients had been treated with 3D-Conformal EBRT using 15 MV photon beams and BT with a Ir-192 GammaMed Plus system. Statistically significant differences (p-value

Abstract P2-11-12: Prospective comparison of late toxicity and cosmetic outcome after accelerated partial breast irradiation with conformal external beam radiotherapy or single-entry multi-lumen intracavitary brachytherapy

Abstract Purpose/Objective(s): To prospectively compare late toxicity after accelerated partial breast irradiation (APBI) with 3D-conformal external beam radiotherapy (3D-CRT) or single-entry multi-lumen intracavitary brachytherapy. Patients/Methods: Two hundred eighty-one patients with pTis or pT2N0 (≤3.0 cm) breast cancer treated with segmental mastectomy were prospectively enrolled on a multi-institution observational protocol from 12/2008 – 8/2014. Patients were enrolled and treated at primary, satellite, and affiliated academic institutions. APBI was delivered using 3D-CRT or with a Contura®, MammoSite®, or SAVI® brachytherapy catheter. 3D-CRT patients were treated to 34.0 Gy (7%) or 38.5 Gy (93%) at 3.4-3.85 Gy/fx BID and brachytherapy patients were treated to 34.0 Gy at 3.4 Gy/fx BID. Per protocol, patients were clinically evaluated at 2, 6, 12, 18, and 24 months and then annually. At each clinical evaluation the radiation oncologist scored cosmetic outcome (excellent/good/fair/poor according to the Harvard Cosmesis Scale), toxicity (seroma/infection/fat necrosis/pain/telangiectasia/radiation dermatitis/hyperpigmentation/hypopigmentation/fibrosis/induration/edema/other according to CTCAE v3.0) and recurrence status. Results: The median age was 61 years. Of 281 patients, 211 (75%) had invasive breast cancer and 70 (25%) had in situ disease. Among patients with invasive disease, 90% were HR+/HER2-, and among patients with in situ disease, 83% were HR+. APBI was delivered with 3D-CRT in 29 (10%) patients and with single-entry multi-lumen intracavitary brachytherapy in 252 (90%) patients. Among the brachytherapy patients, APBI was delivered with the SAVI®, Contura®, and MammoSite® devices in 176 (70%), 56 (22%), and 20 (8%) patients, respectively. With a median follow-up of 49 months, rates of Grade 1 (G1) and Grade 2-3 (G2-3) toxicity are: 3D-CRTBrachytherapy G1G2-3G1G2-3G1G2-3 N (%)N (%)N (%)N (%) Fibrosis13 (46%)1 (4%)176 (72%)6 (2%)p=0.008p=0.54Fat Necrosis0 (0%)0 (0%)0 (0%)4 (2%)p=1.00p=1.00Telangiectasia6 (21%)1 (4%)44 (18%)5 (2%)p=0.61p=0.48Seroma2 (7%)1 (4%)135 (55%)12 (5%)p&amp;lt;0.0001p=1.00 Mean skin dose of the maximally-irradiated 0.1 cc (D0.1cc) of skin was significantly higher in patients who developed telangiectasia (103.4% ± 16.1% compared to 96.5% ± 18.6% of prescription dose, p=0.007) and fibrosis (100.1% ± 15.5% compared to 92.8% ± 23.0% of prescription dose, p=0.02). Crude rates of fair or poor cosmetic outcome at 2-4 and 4-6 years were 6.9% and 14.8%, respectively, for 3D-CRT and 14.8% and 21.3%, respectively, for brachytherapy (p&amp;gt;0.05 at both timepoints). Five-year recurrence-free survival was 96.3% with 3D-CRT and 96.1% for brachytherapy (p&amp;gt;0.05). Conclusion: APBI with single-entry multi-lumen intracavitary brachytherapy is associated with increased rates of grade 1 fibrosis and seroma than APBI with 3D-CRT. Higher mean skin D0.1cc is associated with increased risk of telangiectasia and fibrosis. Despite increased low-grade fibrosis, there is no significant difference in radiation oncologist-reported fair or poor cosmetic outcome out to six years, or rate of five-year ipsilateral breast recurrence. Citation Format: Stecklein SR, Babiera GV, Bedrosian I, Shaitelman SF, Ballo MT, Tereffe W, Arzu IY, Perkins GH, Strom EA, Reed VK, Dvorak T, Smith BD, Woodward WA, Hoffman KE, Schlembach PJ, Chronowski GM, Shah SJ, Kirsner SM, Nelson CL, Guerra W, Dibaj SS, Bloom ES. Prospective comparison of late toxicity and cosmetic outcome after accelerated partial breast irradiation with conformal external beam radiotherapy or single-entry multi-lumen intracavitary brachytherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-12.

MRI-guided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective

Background. The first Nordic protocol for three-dimensional (3D) planned radiotherapy in locally advanced cervical cancer was the prospective NOCECA study (1994–2000). NOCECA consisted of computed tomography (CT)-based 3D conformal external beam radiotherapy (EBRT) with a simultaneous integrated boost (SIB) to the primary tumour combined with brachytherapy (BT) based on x-ray imaging. In NOCECA the planning aim was to achieve 80 Gy at point A from EBRT and BT combined. However, the balance of dose between EBRT and BT was determined by tumour size at diagnosis with more EBRT dose given to point A and less by BT in more advanced stages. In 2005 image-guided adaptive brachytherapy (IGABT) based on magnetic resonance imaging (MRI) and optimisation of the BT dose distribution to the remaining tumour and cervix at time of BT (HR CTV) was introduced in Aarhus. EBRT remained like in NOCECA until 2008 when the SIB to the primary tumour was abandoned and IMRT was introduced as routine technique. In this study, we report outcome of our first five-year experience with IGABT using our NOCECA cohort as reference. Material and methods. The NOCECA cohort comprising 99 patients was compared with 140 consecutive patients treated by IGABT. Patients with para-aortic nodes were excluded in NOCECA but were present in 9% of the patients treated with IGABT. No patient in NOCECA received chemotherapy whereas concomitant cisplatin was given to 79% of the IGABT patients. Results. With IGABT actuarial local control was 91% at three years. When comparing NOCECA with IGABT overall survival was significantly improved from 63% to 79% (p = 0.005). In parallel, both moderate and severe late morbidity were reduced by about 50% (p = 0.02). Conclusion. Introduction of IGABT reduced morbidity and generated a very high rate of local control, which likely has improved survival by at least as much as concomitant chemotherapy.

Evaluation of acute/late toxicity and local recurrence in Τ1-Τ2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT)

BackgroundThe aim of the study was to evaluate the efficacy, as well as the acute and late toxicity of an accelerated hypofractionated 3DCRT schedule as radical treatment in patients with organ confined glottic cancer cT1-2N0.Patients and methods.Between June of 2004 and September 2010, 47 retrospectively selected patients (29 males, 18 females) diagnosed with organ confined T1 or T2 glottic cancer, were treated with external 3DCRT in an accelerated hypofractionation schedule. The median age was 70 years. A dose of 64.4 Gy in 28 daily fractions was prescribed. The primary study endpoints were to assess the acute and late effects of radiation toxicity, according to the EORTC/ RTOG scale, as well as the therapeutic impact of this schedule in terms of local recurrence.ResultsThe median follow up was 36 months. At the end of radiotherapy, grade I, II and III acute toxicity was observed in 34, 9 and4 patients, respectively. Late grade I and II toxicity was observed in 25 and in 8 patients respectively. Only two local recurrences were observed, 15 and 24 months post 3DCRT respectively.ConclusionsOur radiotherapy schedule achieves a high locoregional control rate with the advantage of voice preservation. The proposed hypofractionated schedule can be recommended as a standard radiotherapy treatment, since these results are comparable with those of conventional fractionation schedules.

Preoperative chemoradiotherapy in patients with rectal cancer - 3D conformal external beam radiotherapy (EBRT)

Aim — Background In local advanced rectal cancer at clinical stages IIa-IIIc, chemoradiotherapy precedes total mesorectal resection. If there is a high risk of local recurrence or an attempt to convert a transabdominal resection to intervention for sphincter preservation, preoperative combined chemoradiotherapy with 3D conformal external beam radiotherapy and concurrent chemotherapy is recommended; this can downstage an unresectable cancer to one that is resectable.

Intraoperative radiotherapy of the breast - really a valide option or "only" comfortable.

Intraoperative radiotherapy (IORT) of the breast is an innovative treatment option for early breast cancer and has rapidly entered clinical practice in the last years. There are several indications using a breast IORT. Generally accepted because of excellent long-term results is the intraoperative tumorbed boost followed by an external whole breast irradiation (WBI) (1,2). Considering that most in-breast tumor recurrences are seen in or near to the initial tumor site (3-7) partial breast irradiation (PBI) as the sole radiotherapy treatment modality is of large interest. Different PBI techniques, such as an IORT with electrons or 50 kV X-rays (Intrabeam © ), the interstitial multicatheter or balloncatheter (Mammosite © ) brachytherapy or also the 3D conformal external beam radiotherapy are in clinical use [overview in (8,9)], whereby no superiority could be shown for one of them.

Case 4: Cervical Cancer Stage IB1 Treated with 3D Conformal External Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Tandem/Ovoid High Dose Rate Brachytherapy.

Case 4: Cervical Cancer Stage IB1 Treated with 3D Conformal External Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Tandem/Ovoid High Dose Rate Brachytherapy.

Case 4: Cervical Cancer Stage IB1 Treated with 3D Conformal External Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Tandem/Ovoid High Dose Rate Brachytherapy

Case 4: Cervical Cancer Stage IB1 Treated with 3D Conformal External Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Tandem/Ovoid High Dose Rate Brachytherapy

Case 9: Cervical Cancer Stage IIA2 Treated with 3D Conformal External-Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Low Dose-Rate Brachytherapy with Tandem and Ovoids

Case 9: Cervical Cancer Stage IIA2 Treated with 3D Conformal External-Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Low Dose-Rate Brachytherapy with Tandem and Ovoids

Case 9: Cervical Cancer Stage IIA2 Treated with 3D Conformal External-Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Low Dose-Rate Brachytherapy with Tandem and Ovoids.

Case 9: Cervical Cancer Stage IIA2 Treated with 3D Conformal External-Beam Irradiation, Concomitant Chemotherapy, and Radiograph-Based Intracavitary Low Dose-Rate Brachytherapy with Tandem and Ovoids.

P-0102 Postoperative Radiochemotherapy for Adenocarcinomas of The Gastroesophageal Junction

IntroductionAdenocarcinomas of gastroesophageal junction (GEJ) represent a heterogenic group of tumors with poor prognosis. The principal treatment of nonmetastatic GEJ is surgical resection with 5-year survival rate of approximately 20%. It is clear that the patients with T2, T3 and/or N+ disease need additional treatment. In our institution, nowadays preoperative chemoradiotherapy (RCT) is the treatment of choice. However, there are still patients with locoregionally advanced disease who first undergo surgical resection followed by postoperative RCT. MethodsIn the period from January 2005 to November 2011, 72 patients (56 males and 16 females; aged 33-77 years, mean age 60 years) were treated for non-metastatic adenocarcinoma of GEJ (stage IIa- IIIc) with postoperative RCT. Proximal subtotal resection of the stomach, total resection of the stomach, transhiatal esophagogastrectomy and transthoracal esophagogastrectomy were performed in 4.2%, 69.4%, 19.5% and 6.9% of patients, respectively. Radical resection was performed in 58 (80.6%) patients and in the remaining 14 (19.4%) patients non-radical surgery was performed. Most frequently (in 47.3%), the primary tumor originated in the subcardial stomach (Siewert III). The tumor was staged as pT2 in 33.3%, as pT3 in 58.4% and as pT4 in 8.3% of pateints. Sixty-five patients (92.9%) had N+ disease. Planned treatment schedule consisted of 3D conformal external beam radiotherapy (45 Gy in 25 fractions), with six cycles of chemotherapy (CT) with 5-FU (1000 mg/m2) through 96 hours and cisplatin (75 mg/m2) in bolus on day 2 of each cycle. Radiotherapy was started concomitantly with the second cycle of CT. The main endpoints of this study were as follows: locoregional control (LRC); disease-free survival (DFS); disease-specific survival (DSS) and overall survival (OS) and the rates of acute side-effects were estimated. ResultsTwenty-eight patients (38.9%) completed the treatment according to the protocol. Sixty-three patients (87.5%) reached the total radiation dose of 45 Gy. In six patients (8.3%) the total dose was lower (9-27 Gy) and three (4.2%) patients did not even start with the radiotherapy because of the side effects during the first cycle of CT. All six cycles of CT could be administered in only 28 patients (38.9%). No death occurred due to therapy. Acute toxicity grade 3 or more, such as stomatitis, dysphagia, nausea and vomiting, and infection, occurred in 2.9 %, 34.3%, 38.6% and 41.5% of patients, respectively. The median follow-up time of all 72 patients was 16 months (range: 4-64 months). On the close-out date, 29 (40.3%) patients were still alive, 22 (30.6%) of them being with no signs of disease. Thirty-nine (54.2%) patients died from GEJ adenocarcinoma. After adjuvant RCT, local and/or regional recurrence developed in two (2.8%) patients, locoregional and systemic disease was observed in five (6.9%) patients, and systemic disease alone developed in 39 (54.2%) patients. The 3-year LRC, DFS, DSS and OS were 78.3%, 25.5%, 35.9%, and 33.9%, respectively. ConclusionPostoperative RCT with 5-FU and cisplatin is feasible, although with high toxicity and therefore should be reserved only for selected group of patients, who first underwent surgery due to different reasons.

Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer

BackgroundTo analyse the overall clinical outcome and benefits by applying protocol based image guided adaptive brachytherapy combined with 3D conformal external beam radiotherapy (EBRT)±chemotherapy (ChT). MethodsTreatment schedule was EBRT with 45–50.4Gy±concomitant cisplatin chemotherapy plus 4×7Gy High Dose Rate (HDR) brachytherapy. Patients were treated in the “protocol period” (2001–2008) with the prospective application of the High Risk CTV concept (D90) and dose volume constraints for organs at risk including biological modelling. Dose volume adaptation was performed with the aim of dose escalation in large tumours (prescribed D90>85Gy), often with inserting additional interstitial needles. Dose volume constraints (D2cc) were 70–75Gy for rectum and sigmoid and 90Gy for bladder.Late morbidity was prospectively scored, using LENT/SOMA Score. Disease outcome and treatment related late morbidity were evaluated and compared using actuarial analysis. FindingsOne hundred and fifty-six consecutive patients (median age 58years) with cervix cancer FIGO stages IB–IVA were treated with definitive radiotherapy in curative intent. Histology was squamous cell cancer in 134 patients (86%), tumour size was >5cm in 103 patients (66%), lymph node involvement in 75 patients (48%). Median follow-up was 42months for all patients.Interstitial techniques were used in addition to intracavitary brachytherapy in 69/156 (44%) patients. Total prescribed mean dose (D90) was 93±13Gy, D2cc 86±17Gy for bladder, 65±9Gy for rectum and 64±9Gy for sigmoid.Complete remission was achieved in 151/156 patients (97%). Overall local control at 3years was 95%; 98% for tumours 2–5cm, and 92% for tumours >5cm (p=0.04), 100% for IB, 96% for IIB, 86% for IIIB. Cancer specific survival at 3years was overall 74%, 83% for tumours 2–5cm, 70% for tumours >5cm, 83% for IB, 84% for IIB, 52% for IIIB. Overall survival at 3years was in total 68%, 72% for tumours 2–5cm, 65% for tumours >5cm, 74% for IB, 78% for IIB, 45% for IIIB.In regard to late morbidity in total 188 grade 1+2 and 11 grade 3+4 late events were observed in 143 patients. G1+2/G3+4 events for bladder were n=32/3, for rectum n=14/5, for bowel (including sigmoid) n=3/0, for vagina n=128/2, respectively. Interpretation3D conformal radiotherapy±chemotherapy plus image (MRI) guided adaptive intracavitary brachytherapy including needle insertion in advanced disease results in local control rates of 95–100% at 3years in limited/favourable (IB/IIB) and 85–90% in large/poor response (IIB/III/IV) cervix cancer patients associated with a moderate rate of treatment related morbidity. Compared to the historical Vienna series there is relative reduction in pelvic recurrence by 65–70% and reduction in major morbidity. The local control improvement seems to have impact on CSS and OS. Prospective clinical multi-centre studies are mandatory to evaluate these challenging mono-institutional findings.

Avoiding Mastectomy: Accelerated Partial Breast Irradiation for Breast Cancer Patients with Pacemakers or Defibrillators

The objective of this study was to evaluate the safety, toxicity, and planning concerns involved in accelerated partial breast irradiation (APBI) for patients with breast cancer who have a pacemaker or an automatic implantable cardioverter-defibrillator (AICD) and who desire breast conservation. We performed a review of prospectively obtained data for patients with early-stage breast cancer with a pacemaker or AICD treated between April 2007 and July 2010. Patients were treated with either 3D conformal external beam irradiation (3D-CRT) or high-dose rate balloon brachytherapy (HDRBB) as performed in the National Surgical Adjuvant Breast and Nowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 protocol. Device interrogation was performed after the first and last radiation treatment, with comparative cardiac monitoring performed before and after the first three treatments. Eight patients were treated and have a mean follow-up of 6months. Three patients received HDRBB delivering 34Gy in 10 fractions. Mean planning target volume for evaluation (PTV_EVAL) coverage was 93.6%. The maximum radiation dose delivered to any device was 1.03Gy, with a mean pacemaker distance to lumpectomy cavity (DLC) of 9.1cm. Five patients received 3D-CRT consisting of 38.5Gy in 10 fractions. The mean 90% PTV_EVAL coverage was 97.3%. Maximum dose delivered to any device was 1.68Gy at a DLC of 9cm. Local toxicity did not exceed grade 1, and no adverse device events were noted. APBI in patients with pacemakers or AICDs who desire breast preservation seems to be a technically safe and reasonable application of targeted radiation therapy.

Results of high dose-rate brachytherapy boost before 2D or 3D external beam irradiation for prostate cancer

Background and purposeTo evaluate biochemical control and treatment related toxicity of patients with localized adenocarcinoma of the prostate treated with high dose-rate brachytherapy (HDRB) combined with conventional 2D or 3D-conformal external beam irradiation (EBI). Material and methodsFour-hundred and three patients treated between December 2000 and March 2004. HDRB was delivered with three fractions of 5.5–7Gy with a single implant, followed by 45Gy delivered with 2D or 3D conformal EBI. ResultsThe median follow-up was 48.4months. Biochemical failure (BF) occurred in 9.6% according to both ASTRO and Phoenix consensus criteria. Mean time to relapse was 13 and 26months, respectively. The 5-year BF free survival using the ASTRO criteria was 94.3%, 86.9% and 86.6% for the low, intermediate and high risk groups, respectively; using Phoenix criteria, 92.4%, 88.0% and 85.3%, respectively. The only predictive factor of BF in the multivariate analysis by both ASTRO and Phoenix criteria was the presence of prostate nodules detected by digital palpation, and patients younger than 60years presented a higher chance of failure using Phoenix criteria only. ConclusionsTreatment scheme is feasible and safe with good efficacy.

9097 Conformal radiotherapy in radical treatment of stage III non-small cell lung cancer (nsclc)

Objective: We evaluated the safety and efficacy of high dose rate (HDR) brachytherapy using Iridium-192 (Ir 192) and 3D conformal external beam radiotherapy in patients with localized prostate cancer.Methods: A total of 444 patients with localized prostate cancer underwent combined radiotherapy with interstitial Ir 192 and 3D conformal external beam radiotherapy between December 1992 and March 2001. The 230 patients, treated between December 1992 and December 1997 were analyzed. All patients underwent laparoscopic pelvic lymph node dissection to exclude patients with lymphatic involvement. Ir 192 was delivered twice with a 1-week interval in HDR remote control technique. The interstitial dose from December 1992 to December 1993 was 10 Gy, after December 1993 the dose was reduced to 9 Gy per treatment session. The interstitial application was followed by external beam radiation of 45 Gy for cT1–cT2 and 50.4 Gy for cT3 tumor (40 Gy from December 1992 to December 1993). Progression was defined as biochemical failure according to ASTRO criteria, e.g. three consecutive PSA rises following the PSA nadir.Results: The median PSA value decreased from 12.8 to 0.93 ng/ml 12 months after treatment. Median PSA value was 0.47 after 24 months, 0.30 ng/ml after 36 months and 0.18 ng/ml after 60 months. 68% of the biopsies were negative 24 months after therapy. Progression-free rate was 100% for cT1 tumors, 75% for cT2 and 60% for stage-cT3 on 5-year follow-up. Five-year overall survival was 93%, 5-year disease-specific survival was 98%. Initial PSA value <10 ng/ml, low stage and low grade were significantly related to 5-year progression-free survival.Conclusions: Combined HDR brachytherapy with Ir 192 is an alternative treatment option especially for patients with cT3 prostate cancer. Initial PSA value, stage and grade, are important prognostic factors.