Post-chemotherapy Residual Disease Research Articles

SEOM guidelines: non-seminomatous germ cell cancer (NSGCC)

Non-seminomatous germ cell cancer (NSGCC) is a curable disease; its treatment has not essentially changed since the 1980s. BEP (bleomycin, etoposide, cisplatin) chemotherapy remains the standard of care. NSGCC's management can be summarised by three trees of decision, which contemplate staging, treatment with chemotherapy and management of postchemotherapy residual disease. The role of high-dose chemotherapy remains to be established. TIP (paclitaxel, iposfamide, cisplatin) chemotherapy is still the standard salvage treatment for patients progressing after BEP chemotherapy. Surgical removal of any residual disease is mandatory. For patients with poor prognosis, consultation with a centre of expertise is strongly recommended.

Factors affecting long-term outcomes after postchemotherapy surgery in patients with nonseminomatous germ cell tumors of the mediastinum.

e15019 Background: To identify factors that affect long-term survival after postchemotherapy resection of residual disease in patients with nonseminomatous germ cell tumors arising from the mediastinum (NSGCTM). Methods: Between 1983 and 2009, 52 patients (49 males and 3 females) with NSGCTM underwent surgical resection of postchemotherapy residual disease in our institution. Serum tumor markers (STM) were elevated in 49 patients at diagnosis and remained increased preoperatively in 14 of them despite a second line chemotherapy. Uni and multivariate analyses were performed. Results: A complete resection was achieved in 49 patients with on histology viable germ cell tumor in 23 patients, sarcoma in 3, only teratoma in 10 and only necrosis in 16 patients. Postoperatively, STM level was normal in 44 patients. Adjuvant chemotherapy was given to 20 patients. Two patients died postoperatively and 20 other patients died during follow-up (14 from tumor recurrence, 5 from leukaemia and one from pulmonary fibrosis)...

3073 POSTER Optimisation of radiotherapy planning for rectal cancer: a comparison of supine CT and MRI defined target and normal tissue dose volume data

To compare volumetric-modulated arc therapy (VMAT) with 3D-conformal radiation therapy (3D-CRT) mediastinal irradiation for stage I–II supra-diaphragmatic Hodgkin’s Lymphoma (HL).Eleven patients were planned for RT after 4–6 cycles of ABVD chemotherapy: conventional 3D-CRT (AP/PA) and VMAT plans were conformed to the same PTV. Objective was to choose the best PTV coverage plan with the least OAR dose. The 2 plans were compared for: PTV coverage, mean dose and V5,V20lung, mean dose and V30heart, V5, V10, V15breast (female patients), and the integral body dose.Both techniques achieved adequate PTV coverage. Mean lung and heart dose was consistently lower in VMAT plans. The lung V20 dose was acceptable for VMAT, but exceeded the tolerance threshold in 6 cases with 3DCRT plans. A mean difference of 15.9% for both lungs V20 favored VMAT plans; average MLD difference was 2.3 Gy less for VMAT plans. Similarly, lower maximum and mean heart doses with a 3.3 Gy dose reduction and a 9.4% difference in V30 favored VMAT plans. Mean V5lung/female breast and integral dose were invariably higher in VMAT plans because of the low-dose spread.VMAT is a valuable technique for treatment of large mediastinal HL. VMAT spares the lung and heart compared to 3DCRT using ISRT in select HL cases. VMAT allows dose escalation for post-chemotherapy residual disease with minimal dose to OARs. VMAT low radiation dose (V5) to the normal tissues, and the increased integral dose should be considered.