RESUMO
Despite aggressive multimodal therapy for pediatric glioblastoma multiforme (GBM), patient survival remains poor. This retrospective review of patients with GBM aims to evaluate the patterns of failure after radiation therapy (RT). The study included 14 pediatric patients treated with RT at the Children's Hospital of Philadelphia from 2007 to 2015. With a median follow-up of 16.9 months, 13 (92.9%) developed recurrent disease. Of recurrences, nine (69.2%) were in-field, three (23.1%) were marginal, and one (7.7%) was distant. The majority of patients treated with adjuvant radiation failed in the region of high-dose RT, indicating the need for improvements in local therapy.
Assuntos
Glioblastoma/mortalidade , Glioblastoma/radioterapia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/radioterapia , Adolescente , Adulto , Criança , Pré-Escolar , Intervalo Livre de Doença , Glioblastoma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Radioterapia Adjuvante , Estudos Retrospectivos , Falha de Tratamento , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: To quantify intra-treatment vaginal motion in women treated with daily endorectal balloon (ERB) placement and external beam radiotherapy for gynecologic cancers. MATERIALS AND METHODS: Eighteen post-hysterectomy women with gynecologic cancers underwent computed tomography (CT) simulation scans and daily treatment with ERB. Fiducial markers were placed at the vaginal apex prior to simulation and patients were counseled on a pre-treatment bladder filling protocol. Weekly to biweekly verification CT scans were used to calculate the intra-treatment change in bladder volumes, rectal volumes, and fiducial coordinates along all axes. The planning target volume (PTV) margins required to encompass 95% of intra-treatment fiducial movement were calculated using the van Herk margin recipe. RESULTS: The median bladder volume was 223 (range, 29-879)cc for verification CT scans. Mean intra-treatment fiducial displacements were 1.7 (range, 0-9.1)mm, 2.9 (range, 0-15.5)mm, and 2.5 (range, 0-11.8)mm along the left-right (L/R), superior-inferior (S/I), and anterior-posterior (A/P) axes, respectively. The van Herk PTV margins were 3mm (L/R), 10mm (S/I) and 7mm (A/P). CONCLUSION: When compared to existing studies, the use of daily ERB with post-hysterectomy radiotherapy reduces vaginal motion along the A/P axis. The impact of variable bladder filling on vaginal motion is most evident along the S/I axis.