ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer.

BACKGROUND AND PURPOSE: Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS: During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. RESULTS: Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. CONCLUSION: The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.

[Impact of age and comorbidity on survival and toxicity of irradiated prostate cancer patients]. / Impacto de la edad y de la comorbilidad en la supervivencia y toxicidad del paciente con cáncer de próstata irradiado.

BACKGROUND AND OBJECTIVE: We intended to assess the impact of age on radiation outcome in patients treated for prostate cancer with 2D planning radiation therapy in clinical practice at the Hospital Clínic of Barcelona Radiation Oncology Department. PATIENTS AND METHOD: One hundred eighty three patients, treated from November 1993 to April 1999, were included. Median follow-up was 41.8 months and median age was 70 years old. Median dose to prostate was 70 Gy. Univariate (Kaplan-Meier with log rank test comparison) and multivariate analysis (Cox's regression models) were done to assess the effect of age on toxicity and to study prognostic factors for disease control, survival and radiation treatment toxicity. RESULTS: Five years disease free survival probability was 61.94%, with an overall survival probability of 82.83%. Although comorbidity increased significantly with age, reduced overall survival by a factor of 0.4, from 94.85% to 78.55% at 5 years. No differences were seen with regard to age in acute or late toxicity. Five years toxicity free probability was 66.46%. CONCLUSIONS: Comorbidities decrease life expectancy in prostate cancer patients treated with radiation. Age does not necessarily suppose an increased risk of late toxicity for selected patients.