Evaluation of the role of radiotherapy in the management of dermatofibrosarcoma protuberans.

PURPOSE: The aim of this study was to evaluate the role of radiotherapy (RT) in the management of dermatofibrosarcoma protuberans (DFSP). METHODS: Twenty-eight patients treated with RT for DFSP between 1974 and 2012 at Gulhane Military Medical Academy (GMMA) Radiation Oncology Department were retrospectively evaluated. Twenty-five out of 28 patients (89%) received postoperative RT and 3 received definitive RT alone. In the 25 patients receiving postoperative RT, the type of surgical excision was limited excision in 5 patients and wide excision in the remaining 20. Median RT dose was 63.21±3.7 Gy (range 50-70). RESULTS: At a median follow-up of 5 years, 5-year overall survival (OS) for the whole patient group was 93%. No relationship was determined between the total delivered RT dose and OS. The 5-year OS of the 10 female patients was 90% whereas it was 94% for the 18 male patients (p>0.05). Five-year disease-free survival (DFS) for the patients undergoing wide excision with RT vs. those undergoing limited excision with RT was significantly superior (p <0.05) in patients treated with wide excision and RT. CONCLUSION: RT is an effective treatment option for DFSP patients with positive postoperative margins, recurrent disease and selected inoperable cases.

Evaluation of stereotactic body radiotherapy (SBRT) boost in the management of endometrial cancer.

The purpose of this study is to evaluate the use of linear accelerator (LINAC)-based stereotactic body radiotherapy (SBRT) boost with multileaf collimator technique after pelvic radiotherapy (RT) in patients with endometrial cancer. Consecutive patients with endometrial cancer treated using LINAC-based SBRT boost after pelvic RT were enrolled in the study. All patients had undergone surgery including total abdominal hysterectomy and bilateral salpingo-oophorectomy ± pelvic/paraortic lymphadenectomy before RT. Prescribed external pelvic RT dose was 45 Gray (Gy) in 1.8 Gy daily fractions. All patients were treated with SBRT boost after pelvic RT. The prescribed SBRT boost dose to the upper two thirds of the vagina including the vaginal vault was 18 Gy delivered in 3 fractions with 1-week intervals. Gastrointestinal and genitourinary toxicity was assessed using the Common Terminology Criteria for Adverse Events version 3 (CTCAE v3).Between April 2010 and May 2011, 18 patients with stage I-III endometrial cancer were treated with LINAC-based SBRT boost after pelvic RT. At a median follow-up of 24 (8-26) months with magnetic resonance imaging (MRI) and gynecological examination, local control rate of the study group was 100 % with negligible acute and late toxicity.LINAC-based SBRT boost to the vaginal cuff is a feasible gynecological cancer treatment modality with excellent local control and minimal toxicity that may replace traditional brachytherapy boost in the management of endometrial cancer.

Evaluation of active breathing control-moderate deep inspiration breath-hold in definitive non-small cell lung cancer radiotherapy.

The purpose of this study is to evaluate the effect of Active Breathing Control-moderate deep inspiration breath-hold (ABC-mDIBH) on tumor motion and critical organ doses in non-small cell lung cancer (NSCLC) radiotherapy. 23 patients with locally advanced NSCLC were included in the study. All patients were scanned at free breathing and ABC-mDIBH for radiation treatment planning. 3 separate treatment plans were generated for each patient including one plan with ABC-mDIBH and uniform margins, one plan with free breathing and uniform margins, and one plan with free breathing and 3-dimensional non-uniform margins determined by Cone Beam Computed Tomography (CBCT) and XVI Motion View (X-ray Volume Imaging, Elekta, UK). Critical organ dose-volumes and physical lung parameters were comparatively evaluated on 3 separate dose-volume histograms of each patient acquired from planning software. Individual tumor motion of each patient with and without ABC-mDIBH was documented and compared. Use of ABC-mDIBH resulted in statistically significant improvement in physical lung parameters of V20 (lung volume receiving ≥ 20 Gy) and mean lung dose (MLD) which are predictors of radiation pneumonitis (p<0.001). Reduction in spinal cord dose and tumor motion with ABC-mDIBH was also statistically significant (p<0.001). ABC-mDIBH increases normal lung tissue sparing in definitive NSCLC radiotherapy by improving physical lung parameters along with spinal cord dose reduction through exact tumor immobilization. The incorporation of ABC-mDIBH into NSCLC radiotherapy may have implications for potential margin reduction and dose escalation to improve treatment outcomes.

Retinoic acid and intestinal wound healing in intra-operatively irradiated rat.

AIM: This study was undertaken to assess the effect of intra-operative radiotherapy on intestinal wound healing and prevention of its side effects by retinoic acid. MATERIALS AND METHODS: Thirty Spraque-Dawley rats were divided into 3 groups of (n = 10). All the groups had laparatomies and terminal ileum exteriorization. Group I was the control group with no irradiation and no anastomosis; group II had both irradiation and anastomosis and group III rats had peroral retinoic acid conditioning and irradiation + anastomosis. On the seventh postoperative day, tensile strength and intestinal elongation measurements were to evaluate the effect of retinoic acid on wound healing. RESULTS: Compared to the non-retinoic acid conditioned group, the retinoic acid conditioned group had statistically significant higher tensile strength and lower intestinal elongation values, revealing better wound healing. CONCLUSION: Peroral retinoic acid supplement administration has a preventive effect on radiation-induced wound-healing inhibition in intra-operative abdominopelvic irradiation and anastomoses.

Experimental lens-sparing optimization in therapeutic orbital irradiation with electron beams.

There has been a number of approaches in the literature for therapeutic malignant and benign orbital irradiation. All techniques intend to deliver a homogenous dose to the orbital and retroorbital target volume while sparing the lens of excessive dose. In this experimental lens-sparing study, 4 MeV and 12 MeV anterior electron irradiation has been used with cerrobend shielding circular blocks of varying diameter and thickness placed on a thin Mylar at the distal tip of the electron applicator to spare the lens. The first phase of the study in water phantom has been designed to determine the shield thickness and diameter constant for 4 MeV and 12 MeV electron beams. After optimizing the lens dose by water phantom, the second phase of our study has been designed to measure doses at lens and other specific localizations in randophantom under same conditions with 4 MeV and 12 MeV electron beams. By this technique lens accumulated 18.56% of prescribed dose and lateral aspects of the lens received 44.59% of the prescribed dose in 4 MeV electron irradiation, whereas this was 13.86% and 44.80%, respectively in 12 MeV electron irradiation. The technique used is found to be an extremely simple and effective technique allowing an easier setup with excellent dose distribution characteristics with lens sparing applicable to orbital irradiation practice.

Evaluation of dose homogenization and radiation carcinogenesis risk in total body irradiation for bone marrow transplantation.

The purpose of this study is to report on the dose homogeneity in total body irradiated patients undergoing Bone Marrow Transplantation (BMT), and carcinogenic risk in surviving patients. Between 1987 and 2001, 105 patients received hyperfractionated (6 fractions in 3 days) 12 Gy Total Body Irradiation (TBI) in our institution with lateral opposed fields. All the patients had measurements with thermoluminiscence dosimetry (TLD100) placed on seven bilateral body sites in vivo, controlled by the randophantom measurements to verify reasonable dose homogeneity achievement. The comorbid effects in the whole TBI conditioning group with at least three months post BMT follow-up were noted and surviving patients who had a minimum 5-year and maximum 14-year follow-up (median 7.8 years) have been evaluated for carcinogenic radiation risk on the basis of tissue weighting factors as defined by ICRP 60. Reasonable dose homogeneity by lateral opposed beam TBI has been obtained in all 105 patients in whom lateral TLD100 measurement means were within +5% of the planned doses. Calculated carcinogenesis risk factor was 11.34% for males and 12.40% for females, and no second-cancer has been detected whilst radiation-induced 5 cataracts and 10 interstitial pneumonia comorbidities were noted. Dose homogenization can be well achieved for hyperfractionated lateral-beam TBI with acceptable comorbidities and estimated second-cancer risk is significant but relatively low compared to the risk from the clinical indications for TBI.

Evaluation of radiation carcinogenesis risk in vertebral hemangioma treated by radiotherapy.

The purpose of this study is to report carcinogenesis risk factor evaluation in vertebral hemangioma patients treated by radiotherapy. Between 1975 and 1995, 29 patients received 20-30 Gy total irradiation dose using conventional fractionation scheme. All the patients had measurements with thermoluminescent dosimeters (TLD 100 ), placed on multiple randophantom sites in vivo within the irradiated volume, to verify irradiation accuracy and calculate carcinogenesis risk factor. Twenty nine still-alive patients who had a minimum 6-year and maximum 26-year follow-up (median 14.34 years) have been evaluated by carcinogenic radiation risk factor on the basis of tissue weighting factors as defined by International Commission on Radiological Protection Publication 60. Reasonable pain relief has been obtained in all 29 patients. Calculated mean carcinogenesis risk factor is 0.6% for single irradiation portals and 0.9% for double irradiation portals in the whole group, whilst no secondary cancer has been detected. Radiotherapy is an effective treatment modality in relieving pain of vertebral hemangioma patients. Estimated secondary cancer risk factor for this benign neoplasm irradiation is not as high as can be feared.

Split-course radiotherapy with or without concurrent or sequential chemotherapy in non-small cell lung cancer.

In our department we designed a three-armed study to compare the effects of sequential and concurrent chemoradiotherapy in locally advanced non-small cell lung cancer. Each treatment arm consisted of 15 patients with histologically confirmed stage III non-small cell lung cancer. In group 1, the main treatment approach was split-course radiotherapy alone. In group 2, 6 mg/m2 of cisplatin was applied daily and concurrently with split-course radiotherapy. In group 3, two cycles of etoposide, ifosfamide, and cisplatin chemotherapy, which ended three weeks before split-course radiotherapy, was applied. Overall response rates were 40%, 66%, and 53% in groups 1, 2, and 3, respectively. Median survival was 10, 11, and 10 months for groups 1, 2, and 3 respectively. Results are discussed in the light of the literature.

Fifteen cases of male breast carcinoma treated between 1980 and 1995.

Male breast carcinoma is a rare malignity. In Turkey, as in other countries, there are insufficient studies on male breast cancer. In the Radiation Oncology Department, Gülhane Military Medical Academy, we treated 15 cases of male breast cancer versus 1393 female breast cancer. Two of the cases had stage I, nine had stage II, and the remaining four had stage III disease. Median age was 52. All patients had definitive external beam radiation therapy with daily 200 cGy fractionation, following surgery. Median follow-up was 227 months. Five year survival rate was found to be 60% for all stages. Our evaluations of the pathologic findings, management, and treatment outcome were compared with literature.