Late Radiation Reactions Research Articles

Postoperative Intensity Modulated Radiotherapy for Acinic Cell Parotid Carcinoma in Childhood- A Clinical Case from our Practice with Literature Review

Malignant parotid tumors in childhood are extremely rarely diagnosed diseases. Due to the rare incidence, there is no consensus on their complex treatment, as well as on the application of postoperative radiation therapy (RT). We present a clinical case of acinic cell parotid carcinoma in a 12-year-old girl, against the background of which we emphasize the optimal complex therapeutic approach. Despite radical facial nerve-sparing parotidectomy in pT2N0 acinic cell parotid carcinoma, due to the two pathohistological negative factors/two foci with vascular tumor invasion and the close proximity of the resection line to the preserved facial nerve, we conducted postoperative adjuvant RT. Due to the risk of late radiation reactions of normal tissues and organs after RT in childhood, intensity modulated radiation therapy (IMRT) with lower radiation doses in the target volumes was performed. Active surveillance and follow-up imaging studies are required for early diagnosis of possible recurrence or distant metastases.

NI-8 LATE-DELAYED MRI FINDINGS AFTER RADIOTHERAPY: DOT-LIKE ENHANCED LESION

Abstract Introduction Late-delayed radiation reactions after radiotherapy include brain atrophy, leukoencephalopathy, radiation necrosis, and cerebrovascular disease. We will discuss the contrast-enhanced SPGR to detect dot-like enhanced lesions that are considered to be late late-delayed radiation reactions. Material and Methods One hundred eleven patients (62 males and 49 females; median age at irradiation: 49 years) who had received radiotherapy since 1994 and were alive since 2010, had dot-like lesions by contrast-enhanced SPGR, and had a PFS OS of at least 24 months were included in the study. Of these, 64 had high-grade glioma, 4 had low-grade glioma, 15 had PCNSL, 7 had metastatic brain tumors, 9 had germ cell tumors, 5 had medulloblastoma, and 7 had other tumors, with a mean follow-up of 89. Results Contrast-enhanced SPGR showed dot-like or rod-like findings in 23/111 patients (20.7%). Contrast-enhanced FIESTA and Flair-Cube were also detectable in some cases. However, it was difficult to detect by contrast SE-T1WI, SE-T2WI, or contrast SE-Flair. The lesions appeared a median of 49 months after irradiation (IQR 34, 103. Range 25-298). There were no lesions that increased in size, and multiple lesions appeared during the course of the study in 8/23 (34.8%) of the patients. All lesions occurred within the irradiated field and were seen in patients receiving a total dose of 50 Gy or more, but not in patients receiving whole-brain irradiation alone or whole-brain irradiation plus boost at 50 Gy or less. Discussion and Conclusion It is difficult to elucidate the pathogenesis without pathological evidence, but it is one of the late-delayed radiation reactions that occur more than 2 years later, and it is presumed to be vasculopathy or granulation reaction in the Virchow-Robin space. It tends to increase over time and is not considered to be a condition that causes sudden clinical manifestations.

ВОЗМОЖНОСТИ СОВРЕМЕННОЙ ЛУЧЕВОЙ ТЕРАПИИ У БОЛЬНЫХ РАКОМ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ

Introduction: Until now, malignant neoplasms of the pancreas remain a very important oncological problem, which is determined by the long subclinical course of the disease, the primary diagnosis of most tumors already at advanced stages, as well as the pronounced effect of this pathology on the functional status and overall quality of life of patients. No more than a quarter of patients with pancreatic cancer can be operated on. The remaining significant part of patients receive palliative anticancer treatment and/or symptomatic therapy. Purpose: The purpose of this work is to analyze the possibilities of modern methods of radiation therapy in patients with pancreatic cancer based on the analysis of scientific sources of the Internet resource National Center for Biotechnology Information. Sections: This article describes the role of preoperative chemoradiotherapy using 3D-conformal techniques in patients with localized and borderline resectable pancreatic cancer, the effectiveness of chemoradiotherapy as an adjuvant component, and the possibilities of this method in patients with locally advanced disease. The advantages of modern radiotherapy regimens are demonstrated: with modulated intensity or volume intensity modulation by arches, stereotaxic technique, proton and adaptive MR-guided radiation therapy. The international experience of brachytherapy in patients with pancreatic cancer was analyzed. Conclusion: Modern methods of radiotherapy are widely used in clinical practice for the treatment of patients with adenogenic pancreatic cancer. The implementation of various options for radiation or chemoradiation therapy can significantly increase the survival rates of patients with localized, borderline resectable and locally advanced process, the frequency of achieving local tumor control and its duration, as well as improve the quality of life of patients by reducing the severity of abdominal pain syndrome. Constant improvement in the technique of radiation treatment contributes to a natural decrease in the frequency of early and late radiation reactions.

Radiation injuries during combined radiation treatment of locally distributed cervical cancer: A literary review

Radiation therapy is one of the leading methods of treating malignant tumors of female genital organs. However, modern radiotherapeutic equipment technical capacity does not exclude the possibility of radiation complications from healthy organs and tissues in the radiation zone. During radiation treatment (administered independently or in combination with other methods), patients develop local radiation reactions of different intensity from related organs, such as the bladder, rectum, and vagina, which significantly deteriorate patients’ quality of life. This also leads to involuntary interruptions in treatment and, finally, worsens the treatment outcome.
 Purpose: To describe radiation injuries to pelvic organs in cervical cancer radiation treatment. It analyzes the frequency and evidence of early and late radiation reactions from the affected organs.
 Results: Radiation injuries to the pelvic organs form the basis of radiation pathology in patients with cervical cancer and largely determine cured patients’ quality of life. Radiation complications of grade II-III, less often IV, are frequent after radiation treatment for pelvic cancer, especially cervical cancer.
 Conclusions: Despite the improvements in radiation treatment methods, there is still no unified system for preventing radiation reactions that would include algorithms for diagnosing and treating early and late radiation reactions using modern medications and non-pharmacological options. The development and implementation of an algorithm for the correction of radiation reactions after radiation and complex treatment for cervical cancer would timely prevent radiation and combined complications from target organs and improve patients’ quality of life.

Radiation injuries during combined radiation treatment of locally distributed cervical cancer: A literary review

Relevance: Radiation therapy is one of the leading methods of treating malignant tumors of female genital organs. However, modern radiotherapeutic equipment technical capacity does not exclude the possibility of radiation complications from
 healthy organs and tissues in the radiation zone. During radiation treatment (administered independently or in combination
 with other methods), patients develop local radiation reactions of different intensity from related organs, such as the bladder,
 rectum, and vagina, which significantly deteriorate patients’ quality of life. This also leads to involuntary interruptions in treatment and, finally, worsens the treatment outcome.
 Purpose: To describe radiation injuries to pelvic organs in cervical cancer radiation treatment. It analyzes the frequency
 and evidence of early and late radiation reactions from the affected organs.
 Results: Radiation injuries to the pelvic organs form the basis of radiation pathology in patients with cervical cancer and
 largely determine cured patients’ quality of life. Radiation complications of grade II-III, less often IV, are frequent after radiation
 treatment for pelvic cancer, especially cervical cancer.
 Conclusions: Despite the improvements in radiation treatment methods, there is still no unified system for preventing radiation reactions that would include algorithms for diagnosing and treating early and late radiation reactions using modern
 medications and non-pharmacological options. The development and implementation of an algorithm for the correction of
 radiation reactions after radiation and complex treatment for cervical cancer would timely prevent radiation and combined
 complications from target organs and improve patients’ quality of life.

The influence of nitric oxide synthases inhibitor Т1023 on the development of radiation pneumofibrosis in rats

The purpose of the work was to study the ability of the NOS inhibitor T1023 to prevent late radiation injuries. Methods: the effects of T1023 (75 mg / kg, once i.p. 30 minutes before the irradiation) on the development of post-radiation pulmonitis and pneumofibrosis in rats with thoracic exposure to g-radiation at a dose of 12.5 Gy were studied histopathologically and morphometrically. The results of the studies showed that there wasn’t a significant objective effect of T1023 on the development of early radiation-induced lung injuries (9 weeks after irradiation). But it prevented late radiation induced lung injuaries (26 weeks after irradiation) – there were a significant lesser pathomorphological manifestations of post-radiation pulmonitis, proliferation of connective tissue and the development of fibrotic changes in the lung parenchyma. At this stage, the action of T1023 clearly contributed to the preservation of the normal histostructure of the lungs, reducing by 40% the content of compaction zones in the parenchyma. The ability of the NOS inhibitor T1023 to significantly limit the development of lungs late radiation reaction confirms the promise of further development of this compound as a means for prevention radiation therapy complications.

LATE RADIATION TOXICITY AFTER RADICAL RADIOTHERAPY FOR GENITAL CANCER.

Radiation therapy for malignant tumors of the female genital area, even with the use of modern radiotherapy equipment and dosimetric planning, causes the development of local radiation changes. An approach involving methodsof general and local exposure is used in their treatment. One of the most promising directions is the creation of optimal combinations of medicines (in the form of ointments, gels, aerosols, suppositories, etc.), which have a therapeutic effect on the inflammatory process. The article reflects the clinical course and stage of occurrence of late radiation reactions of the skin, vaginal/cervix mucosa, bladder, and intestines, as well as the features of their treatment.Literary data and own practical experience in the treatment of radiation complications are presented. Whenreviewing the topic under study, it could be concluded that the leading cause of the development of local radiationdamage is the errors in the planning and implementation of radiation therapy, when high absorbed doses thatexceed the tolerance of healthy tissues are used. Another reason for this is the poor accounting for dose distribution of ionizing radiation in tissues, the presence of concomitant diseases in patients, and the underestimation ofthe long-term effects of radiation.

Comet assay is not useful to predict normal tissue response after radiochemotherapy in cervical and larynx cancer patients.

Normal tissues reactions after radiotherapy vary considerably even between patients receiving the same treatment. The ability to predict the differences in radiosensitivity before radiotherapy would have important implication. Patients with squamous cell carcinoma of the: (i) cervix (38 patients) and (ii) larynx (19 patients) were studied. Control group consisted of 9 healthy women. To assess individual radiosensitivity/chemoradiosensitivity alkaline version of comet assay was performed using isolated peripheral blood lymphocytes from cancer patients and healthy donors. The level of endogenous (0Gy), initial (immediately after 6Gy irradiation) and residual (after irradiation and 1h of repair) DNA damage was investigated. The mean value of endogenous damage was similar in control and cervical cancer (CCU) groups and significantly lower than in larynx cancer patients. Cancer patients showed slower DNA repair. For CCU and larynx patients, comet assay parameters were not helpful for unequivocal prediction of appearance of acute and late radiation reaction effects. Comet assay seems to be unable to predict normal tissue reaction after radiochemotherapy. Therefore, there is still need for developing predictive assays, however, due to complicated mechanism of chemoradiosensitivity, only assays assessing not one but many molecular pathways might gives us reliable score.

In vitro prediction of breast cancer therapy toxicity.

Understanding the basis of clinical radiosensitivity is a key goal of radiation research. In this study, we used the limiting dilution assay (LDA) to analyze in vitro radiosensitivity of cell lines from individuals with breast and other cancers, who had been treated with ionizing radiation, and who either had a non-radiosensitive (RS) radiation response or who were clinically RS. Lymphoblastoid cell lines (LCLs) were created from 29 cancer patients including 19 RS patients, 10 controls who had not developed severe normal tissue reactions, and 1 ataxia telangiectasia RS control cell line. The clinically RS patients had grade 3 or grade 4 reactions; one had a grade 2 reaction. All cells were exposed to graded doses of gamma-radiation in vitro and cell survival assessed via LDA. Cell survival was expressed on non-linear regression analysis-fitted survival curves and also as the surviving fraction at 2 Gray (Gy) (SF2). Our LDA analysis yielded two notable positive results. Firstly, it could distinguish control cells from cells from pooled breast cancer cases with severe reactions of all types (acute reactors, consequential late reactors and late reactors). Secondly, two radiosensitivity outliers were detected on the fitted curves, corresponding clinically to grade 3 and 4 late radiation reactions in breast and head and neck cancer cases respectively. The assay showed considerable cell survival heterogeneity. The LDA as used here may provide unique clinical utility in detecting potential RS breast cancer patients prior to radiotherapy (RT), a form of personalized medicine. The assay may be especially useful in situations where its results can be temporally available prior to therapy initiation (e.g., those patients not undergoing RT until some months after surgery, typically those having adjuvant chemotherapy prior to RT). Two LCLs from RS outliers could potentially yield insight into the cellular and/or genetic basis of radiosensitivity, for example by undertaking genomic analyses on these cell lines.

Clinical value of stereotactic body radiotherapy for the treatment of metastatic pancreatic cancer

Objective To discuss the clinical value of stereotactic radiotherapy for the treatment of metastatic pancreatic cancer. Methods Data of 17 patients with metastatic pancreatic cancer were retrospectively studied. All patients were admitted to Air Force General Hospital from January 2006 to December 2014. Lung carcinoma was the most common primary tumor (n=7), followed by cystic carcinoma (n=3), esophageal cancer (n=1), gastric carcinoma (n=1), renal carcinoma (n=1), colon carcinoma (n=1), acute myeloid leukemia (n=1), left chest fibrous histiocytoma (n=1), and upper extremity synovial sarcoma (n=1). There were 8 patients choosing the therapy of body gamma knife, 5 choosing the therapy of IMRT, 3 choosing the therapy of 3DCRT and 1 choosing the therapy of TOMO. Metastases median maximum diameter was 3.6 cm (range, 1.6-1.7 cm), median target volume was 37.1 mm3 (range, 11.1-72.1 mm3) and median GTV dose was 50 Gy (range, 40-70 Gy). Patients treatment time was 14 to 22 days, 5 fractions/week and median single dose was 3 Gy. Results Of all the patients of this group, 4 patients qualified as complete remission (CR), 8 patients reached the standard of partial remission (PR), and 2 patients maintained the situation of stable disease (SD). The total percentage of therapeutic efficiency was 70.1 % (12/17). As for the analgesic therapy, 3 patients qualified as CR, 5 patients reached the standard of PR, and 1 patient maintained the situation of MR (minimal response). The total percentage of analgesic therapeutic efficiency was 100 %. The local control rates for six-month and 1 year were both 100 %, and the overall survival rates for 1 year and 2 years were 35.3 % and 5.9 %. No Grade 3 or more acute and late radiation reaction was observed. Conclusion The majority of patients with pancreatic metastatic carcinoma have lost the opportunity to have surgery, but the stereotactic radiation therapy can improve the quality of life and local control rate with small toxicity and acceptable complications. Key words: Pancreatic neoplasms; Metastatic/Stereotactic; Radiotherapy; Prognosis

Combined external and intracavitary irradiation in treatment of advanced cervical carcinomas: predictive factors for treatment outcome and early and late radiation reactions.

The objective of this study was to find out predictive factors of tumor control as well as acute and late radiation reactions in treatment of advanced cervical carcinomas. In a series of 134 primary cervical carcinomas in International Federation of Gynecology and Obstetrics stages I to IV treated with combined external pelvic and intraluminal cervical-vaginal brachytherapy, predictive and prognostic factors were analyzed with regard to tumor control, recurrences, survival data, and adverse effects. Concomitant chemotherapy was given to 48 patients (35.8%). The external beam therapy was given with a 4-field technique (50-60 Gy) and brachytherapy was given with a high-dose rate (iridium-192) afterloading technique using a ring applicator set. A computed tomographically based 3-dimensional dose-planning system was used for the external beam therapy and for the brachytherapy planning. The mean age of the patients was 65 years. A total of 110 tumors were squamous cell carcinomas and 24 were adenocarcinomas or adenosquamous carcinomas. A total of 111 tumors were in International Federation of Gynecology and Obstetrics stages I to II; 23 tumors, in stages III to IV. The primary control rate of the complete series was 92.5%. Tumor size, the brachytherapy dose, the combined external and brachytherapy dose, as well as the number of days of interruption (delay) of irradiation were all significant predictive factors for local tumor control. Forty recurrences (30%) were recorded. Early radiation reactions were recorded in 67% (mostly grade 1) and were associated with the widths of the anterior-posterior and lateral pelvic fields. Serious late radiations reactions (grade 3-4) were noted in 11%. The width of the lateral pelvic fields, left point A and B doses, dose to the rectal reference point, as well as asymmetry of the dose distribution were associated with late severe reactions. Prior abdominal and pelvic surgery was also a high-risk factor for late tissue reactions. Concomitant chemotherapy did not increase the risk for acute or late toxicity.

Effectiveness and Toxicity of Intraoperative Radiation Therapy (IORT) Given as a Boost During Breast-Conserving Surgery (BCS) Followed by Adjuvant Whole Breast Radiation Therapy (WBRT)

The aim of the study was to report four years of a single-center experience of intraoperative radiation therapy (IORT) during breast-conserving surgery (BCS) as a tumor bed boost using high energy electrons and to evaluate effectiveness of treatment, analyze early and late radiation reactions, cosmetic effect and quality of life.

Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group

Radiation dermatitis (RD) results from radiotherapy and often occurs within the first 4 weeks of treatment, although late effects also occur. While RD may resolve over time, it can have a profound effect on patients' quality of life and lead to dose modifications. A study group of international, interdisciplinary experts convened to develop RD prevention and treatment guidelines based on evidence from randomized, controlled trials. Evidence-based recommendations were developed after an extensive literature review. Randomized, controlled trials with standardized measurement of outcomes were considered the best evidence, and a majority of the recommendations were formulated from this literature. The adoption of washing with water, with or without a mild soap, and allowing the use of antiperspirants is supported by randomized trials. Use of topical prophylactic corticosteroids (mometasone) is recommended to reduce discomfort and itching. There is some evidence that silver sulfadiazine cream can reduce dermatitis score. There is insufficient evidence to support, and therefore the panel recommends against the use of trolamine, topical sulcrate, hyaluronic acid, ascorbic acid, silver leaf dressing, light-emitting diode lasers, Theta cream, dexpanthenol, calendula, proteolytic enzymes, sulcralfate, oral zinc, and pentoxifylline. Moreover, there is no evidence to support the superiority for any specific intervention in a reactive fashion. For patients with established radiation-induced telangiectasia and fibrosis, the panel suggests the use of pulse dye laser for visual appearance, and the use of pentoxifylline and vitamin E for the reduction of fibrosis.

Incidence of radiation toxicity in cervical cancer and endometrial cancer patients treated with radiotherapy alone versus adjuvant radiotherapy

AimThe study was made to evaluate early and late toxicity in a diversified group of patients receiving definitive or adjuvant radiotherapy in terms of clinical diagnosis and treatment methods. BackgroundRadiotherapy is a standard way of treatment in cervical and endometrial cancer patients, both as definitive and adjuvant therapy. But every radiation treatment may be involved with toxicity. Materials and methodsA detailed analysis was performed of 263 patients with gynaecological cancer treated with definitive (90 patients with cervical cancer received radiochemotherapy or radiotherapy exclusively) and adjuvant radiotherapy (38 with cervical and 135 with endometrial cancer). ResultsAcute reactions were found in 51.3% and late reactions were found in 14.8% of patients. It was stated that early (p<0.007) and late (p<0.003) post radiation reaction appear more frequently in women treated with definitive than adjuvant radiotherapy. The analysis of the whole group revealed higher rate of toxicity, both early and late, in the gastrointestinal tract than in the urinary system (p<0.004). Comparing the subgroups, it was found that intestinal reactions occurred more frequently in the definitive radiotherapy group than in the adjuvant one.The occurrence of side effects was associated with the prolongation of total irradiation time due to necessary interruptions of radiotherapy. The comparison of the subgroups showed that interruptions occurred more frequently in patients receiving definitive rather than adjuvant radiotherapy (17.7–2.9%). ConclusionsDefinitive radiotherapy compared with adjuvant treatment may by associated with higher percentage of side effects caused by dose of therapy and correlation with chemotherapy.

Severe reaction to radiotherapy for breast cancer as the presenting feature of ataxia telangiectasia

Background:Severe early and late radiation reaction to radiotherapy is extremely rare in breast cancer patients. Such a reaction prompted an investigation into a 44-year-old mother (patient A-T213).Methods:A neurological examination was performed and blood lymphocytes and skin fibroblasts were assessed for radiosensitivity chromosomally and by colony-forming assay. The ATM gene was sequenced and ATM mutations modelled by site-directed mutagenesis. The ATM kinase activity was also assessed.Results:Patient A-T213 was normally ambulant with no ataxia and minimal other neurological features. T lymphocytes and skin fibroblasts were unusually radiosensitive, although less sensitive than in classical ataxia telangiectasia (A-T). A lymphoblastoid cell line and skin fibroblasts expressed ATM protein with some retained kinase activity. One missense ATM mutation c.8672G>A (p.Gly2891Asp) and a c.1A>G substitution were identified. In the modelling system, the p.Gly2891Asp mutant protein was expressed and shown to have residual ATM kinase activity.Conclusion:Patient A-T213 has a milder form of A-T with biallelic ATM mutations, which may have contributed to breast cancer development, and certainly caused the severe radiation reaction. Ataxia telangiectasia should be investigated as a potential cause of untoward severe early and late radiation reactions in breast cancer patients.

Feasibility of Involved-Field Conformal Radiotherapy for Cervical and Upper-Thoracic Esophageal Cancer

Background: The aim of this study was to investigate the feasibility of involved-field irradiation (IFI) for the treatment of cervical and upper-thoracic esophageal cancer with concurrent chemoradiation. Patients and Methods: 102 eligible patients with cervical or upper-thoracic esophageal cancer were treated with concurrent chemoradiation and randomized to either an IFI or elective nodal irradiation (ENI) group. Results: Adverse events included infection (27.4 vs. 64.7%) and nausea (25.4 vs. 54.9%), with a statistically significant difference between the IFI and the ENI group (p = 0.008 and 0.028, respectively). No difference was seen for late radiation reaction. The cumulative incidence of local/regional failure (13.7 vs. 17.6%) and regional lymph failure (7.8 vs. 9.8%) showed no statistically significant difference between the IFI versus the ENI group (p = 0.837 and 0.837, respectively). A nodal out-field relapse rate of only 2% was seen in the IFI group. 3-year survival rates for the ENI and IFI group were 41.3 and 32.0%, respectively (p = 0.58), and 3-year local control rates were 85.7 and 80.1%, respectively (p = 0.34). Conclusion: IFI was acceptable for cervical and upper-thoracic esophageal cancer with a decrease in acute toxicities and no increase in lymph node failure.

Zastosowanie techniki SIB-IMRT w leczeniu skojarzonym z jednoczesną chemioterapią u chorych na nowotwory głowy i szyi w III i IVa stopniu zaawansowania. Ocena wczesnych wyników i tolerancji leczenia

Concomitant radiochemotherapy become the treatment of choice for locally advanced SCHNC. This strategy of treatment has a limitation, which is an acute and late toxicity. The IMRT technique provides the possibility of better sparing of healthy tissue. Radiobiological and clinical data also suggest that accelerated fractionation and higher dose per fraction given in GTV may produce better locoregional control. Therefore it might be expected that concomitant chemotherapy and SIB-IMRT radiotherapy could increase locoregional control and reduce acute and late radiation reactions. The evaluation of early results and toxicity of this treatment modality is presented. The evaluation of the early results and toxicity of SIB-IMRT radiotherapy given concomitantly with cisplatin for locally advanced squamous cell head and neck cancer (SCHNC). SIB-IMRT technique was applied. The boost volume was limited to the GTV + 3mm margin (macroscopic tumor extension was defined on the basis of CT and/or MRI examinations). Dose per fraction given to this volume was 2.25 Gy up to 67.5 Gy of total dose. The PTV-CTV + 3mm - was defined as an area of increased risk of microscopic spread. Dose per fraction given to this volume was 2 Gy up to 60 Gy. The PTV1-ETV+ 3mm (electively irradiated volume) received dose per fraction -1.8 Gy up to 54-56 Gy. Overall treatment time was 6 weeks (5 fractions per week, 30 fractions). Concomitant chemotherapy consisted of cisplatin in daily dose100mg/m2 given two times during irradiation (1 and 22 day of treatment). The evaluation of early tolerance was performed once weekly during the treatment than during the follow up every 2 months. The early reactions were scored according to the EORTC/RTOG scale. Between June 2006 and December 2009 99 patients diagnosed with III and IV clinical stage of SCHNC were treated with this method. 65 patients were diagnosed with oropharyngeal cancer, 18 with laryngeal cancer and 16 with hypopharyngeal cancer. PEG was performed at 65 patients before treatment for better alimentation during radiochemotherapy. No severe life risking complications were observed a no concequentional late effects were observed. Extended mucositis grade III according RTOG/EORTC scale were observed only in boost region in 80% patients just after treatment was completed. In 2 patients ulceration were observed in tumour side which have healed up spontaneously within two months after treatment. 55% patients were suffering for III xerostomia and 41% for middle after the treatment. Majority of side effects were cured within 4 months after irradiation. The PEG was removing in 92% patients 2 months after treatment. The median follow-up time is 28 months (ranged from 14 m to 58 m). Actuarial 2-years overall survival and disease-free survival is respectively 90% and 82%, probability of locoregional recurrence at 2-years is 14% and 5-years estimated is 17,5%. At the present moment it might be concluded that accelerated radiotherapy with SIB-IMRT given concomitantly with cisplatin produce excellent local control in patients treated of III-IV stage SCHNC without increasing toxicity.

THE ESTIMATION OF LATE RADIATION REACTION OF SALIVARY GLANDS IN PATIENTS WITH SQUAMOUS CELL CANCER IRRADIATED IN HEAD&NECK REGION – THE PROSPECTIVE STUDY

Purpose: The purpose of this study is to estimate the late radiation toxicity of salivary glands in patients with squamous cell cancer irradiated by conventional (3D CRT) or accelerated method (CAIR or CB).The special goal there is to analyse the influence of method of contouring the glands on the values of accumulated doses. Materials: In 65 patients with pharyngeal and laryngeal cancer irradiated to total dose in range 62.5-72,O Gy the estimation of late radiation toxicity of salivary glands was provided. All patients were irradiated by conventional (3D CRT) or accelerated method (CAIR or CB). There were used two methods of contouring parotids: whole organs and whole parotids including superficial part. The late radiation reaction was estimated after 3, 6 and every 6 months after final treatment with using CTC version 3.0 classification. The non parametric Mann-Whitney and Spearman test was used for the estimation of relationships. Results: We have observed the middle level of xerostomia connecting with change of amount and consistency of saliva after irradiation. The contouring of whole parotids including superficial part of organ had significant influence on decrease of mean, median and modal doses in whole organs. In our material we had: mean doses=29,93 Gy, median doses=29,18 Gy and modal doses =28,85 for whole parotids. Conclusions: Xerostomy is the most troublesome symptom in patients with squamous cell cancer in H&N region. The contouring of whole parotids including superficial part had significant influence on decrease of mean, median and modal doses in whole organ in the correlation to the group of patients with contouring only whole parotids.This prospective study is being continued.

Radiotherapy for Glottic T1N0 Carcinoma with Slight Hypofractionation and Standard Overall Treatment Time: Importance of Overall Treatment Time

We retrospectively investigated treatment outcomes in patients with glottic T1 carcinoma treated with 65 Gy in 26 fractions four times a week and discuss the importance of the overall treatment time. Two hundred one patients with glottic T1 carcinoma were evaluated. Sixty-five Gray in 26 fractions were delivered for 200 patients, whereas 1 patient received 62.5 Gy in 25 fractions. We delivered radiotherapy once daily four times a week in this period, for a weekly dose of 10 Gy. Weekdays except Wednesday were treatment days. The overall survival rate was 96.8 ± 1.3% (standard error) at 3 years and 90.8 ± 2.2% at 5 years. The local control rate was 91.9 ± 2.0% at 3 years and 89.8 ± 2.3% at 5 years. In patients with an overall treatment time equal to or longer than 47 days, the local control rate was 82.6 ± 6.0% at both 3 and 5 years. In the patients with overall treatment time equal to or less than 46 days, the local control rate was 94.6 ± 1.9% at 3 years and 91.8 ± 2.4% at 5 years. There was a significant difference between these two groups (P = 0.0349). A severe late radiation reaction occurred in one patient. He experienced severe laryngeal edema that required tracheotomy at 6 months after the completion of radiotherapy. The tracheotomy was closed at 14 months after completion of radiotherapy. Overall treatment time seems to be an important factor for a good local control rate for glottic T1N0 carcinoma even when treated with slight hypofractionation.

Assessment of concomitant versus sequential aromatase inhibitor with radiotherapy for postmenopausal women with early-stage breast cancer.

667 Background: Combined radiation and hormone therapies have become common clinical practice in recent years for locally advanced prostate cancer. The use of such concomitant therapy in the treatment of breast disease has been infrequently reported in literature with few available published studies confirm the superiority of association of radiation with tamoxifen as opposed to radiation therapy alone in decreasing local recurrences. Toxicity associated with such concomitant therapy includes mainly subcutaneous and pulmonary fibroses. To our knowledge, no studies were done to address the outcome of association of radiotherapy and aromatase inhibitors. Methods: This is a prospective randomized trial on forty postmenopausal women with early stage breast cancer who proved to be hormone sensitive. Those patients were randomized into two groups: group I: patients received aromatase inhibitor anastrazole 1 mg daily after the last cycle of adjuvant chemotherapy and continue it during as well as after the end of radiotherapy for 3 years (or disease progression). Group II: patients received anastrazole three weeks after the end of radiotherapy. Toxicity profile and 3 year DFS were assessed. Results: Early radiation reactions in the form of grade III skin reactions were observed in 3 (15%) patients in group I and in 2 (10%) patients in group II (p > 0.05). Late radiation reactions in the form of grade II radiation pneumonitis or lung fibrosis were detected in 3 (15%) patients in group I and 2 (10%) patients in group II (p > 0.05). Local recurrence was observed in one patient in group II during the third year of follow up, no local recurrence was seen in group I (p > 0.05). Distant metastasis was detected in 5 (25%) patients in group I and in 6 (30%) patients in group 2 (p > 0.05). Conclusions: Starting aromatase inhibitors during radiotherapy appears to be safe and at least equally effective as its use after the end of radiotherapy. Although there was a trend toward better local control in the concurrent group, yet it did not reach a statistically significant value. Large number of patients and longer follow-up periods are recommended. No significant financial relationships to disclose.