[Image-guided radiotherapy for muscle invasive bladder cancer with intravesical lipiodol injection. A new option for bladder sparing treatment]. / Izominvazív hólyagrák képvezérelt sugárkezelése intravesicalisan befecskendezett lipiodolos jelöléssel. A hólyagmegtartó kezelés új lehetosége.

INTRODUCTION AND AIM: To implement lipiodol as a fiducial marker of the tumor bed for image-guided radiotherapy with simultaneous integrated boost technique as part of radiochemotherapy for muscle invasive bladder tumors. METHOD: Since April 2016, radiochemotherapy was performed in 3 male patients with muscle invasive, transitional cell bladder carcinoma. Prior to radiochemotherapy, tumor bed resection was performed for each patient, at the same time 10 ml of lipiodol solution was injected submucosally into the resection site, thus marking the tumor bed for escalated dose irradiation. During radiochemotherapy 51 Gy (1.7 Gy/die) to the pelvis, 57 Gy (1.9 Gy/die) to the whole bladder, and 63 Gy (2.1 Gy/die) to the lipiodol-labeled tumor bed was delivered with simultaneous integrated boost technique. The accuracy of the irradiation was controlled by daily kilovoltage CT. Early radiogenic urogenital and gastrointestinal side effects were recorded according to Radiation Therapy Oncology Group side-effects grading recommendation. RESULTS: Substantial perioperative side effect or toxicity were not observed during and after the injection of lipiodol. The prescribed dose was successfully delivered in all patients. Radiotherapy duration was 6 weeks. The lipiodol-labeled tumor bed was clearly visible on daily kilovoltage cone beam CT. In one patient grade II cystitis and proctitis was observed, another patient experienced only grade I cystitis. These complaints improved with symptomatic medication. In the third patient no significant side effect occurred. CONCLUSIONS: The injection of lipiodol into the bladder wall is a safe technique, without any perioperative toxicity or complication. The tumor bed demarcated by lipiodol was visible both on treatment planning and kilovoltage CTs. The total treatment time was shortened by 4 days. The treatment was well tolerated, early side effects were moderate, or slight. Orv Hetil. 2017; 158(51): 2041-2047.

[Radiotherapy of soft tissue sarcomas of the extremities and superficial trunk]. / A végtag és a törzsfelszín lágyrészszarkómáinak sugárkezelése.

Soft tissue sarcomas represent a histopathologically and clinically heterogeneous group of tumors that make up around 1% of malignancies, in which soft tissue sarcomas of the extremities and superficial trunk (STSET) are treated with more or less the same strategy. Over the past 30 years, there has been a migration away from amputation and radical ablative surgical procedures for localized STSET toward more conservative, function-preserving surgery combined with radiotherapy +/- chemotherapy. The latter complex treatment ensures equal local control to radical surgery. This multidisciplinary management includes organ sparing surgery as the main procedure but also radiotherapy of different types applied before, during or after the surgery, chemotherapy depending of the stadium of the tumor and plastic, reconstructive surgery, and last but not least rehabilitation of the patient after treatment. In this publication we overview the practical guidelines for the treatment of STSET based on the available literature from the last decades. Indication and timing of radiotherapy of STSET as well as available external beam and brachytherapy techniques are summarized. The prescribed radiation dose, the role of alternative fractionations, the combination of radiotherapy and systemic chemotherapy, hyperthermia or limb perfusion regards to STSET are also discussed. Practical considerations of radiotherapy, the target volumes and the role of newer radiotherapy technology in STSET treatment are overviewed.