Intraoperative electron beam radiotherapy (ELIOT) to the breast: a need for a quality assurance programme.

Intraoperative radiotherapy (IORT) is a technique in which a high, single-fraction radiation dose is delivered directly to the tumour bed during a surgical intervention, after the removal of a neoplastic mass. IORT has been recently used in early stage cancer as an exclusive radiation modality, rather than as a boost, especially for breast tumours, in particular at the European Institute of Oncology in Milan, where the technique has been called electron intraoperative therapy (ELIOT). Our studies on more than 1000 patients have demonstrated the feasibility of the technique and it is expected that its application will become more widespread in the immediate future. It is important to emphasise that ELIOT relies not only on new technological developments, but also on a multidisciplinary team with clear roles and responsibilities, the establishment of a programme of quality assurance with appropriate guidelines and a comprehensive staff development programme.

Irradiation with standard tangential breast fields in patients treated with conservative surgery and sentinel node biopsy: using a three-dimensional tool to evaluate the first level coverage of the axillary nodes.

Recent data show that axillary coverage can be obtained, but only through a selective CT-based treatment planning, as standard tangential fields are inadequate to deliver therapeutic doses. Currently, the replacement of axillary dissection with new techniques, such as sentinel node (SN) biopsy, makes it necessary to re-address the question about the real role of axillary irradiation, complicated by the differences in the anatomy of dissected and undissected axillary regions. The purpose of this paper is the dosimetric analysis of first axillary level coverage in standard irradiation of 15 breast-cancer patients treated with quadrantectomy and SN biopsy (negative finding). During surgery a clip on the site of the SN was positioned, marking the caudal margin of first axillary level. After the breast treatment plan was completed, the first axillary level was contoured on CT scans, from the site of the surgical clip up to the sternal manubrium, for coverage analysis with dose-volume histograms (DVHs) and three-dimensional isodose visualization. The maximum dose mean ranged from 5% to 80% of the prescribed dose (mean value 48.7%). The mean total dose received by the volume of interest was lower than 40 Gy in all but one patient. No patient had total irradiation of first nodal level; only one patient had 35% of the volume enclosed in the 100% isodose. Our analysis lead to the conclusion that therapeutic doses are not really delivered to first level axillary level nodes by a standard tangential field technique, and that specific treatment planning and beam arrangement are required when adequate coverage is necessary.

Body iron reserves of rural and urban Guatemalan women of reproductive age.

Body iron reserves (using serum ferritin as an index), hematological status, and other indicators of iron nutrition were evaluated in three groups of non-pregnant nulliparous women with ages comprised between 14 and 29 years (mean = 19 years). The first group (n = 33) included residents of the rural coastal area (less than 750 m above sea level) (group RCG); the second (n = 32) from the rural highlands (751-1,500 m) (group RHG); and the third group (n = 104) from urban Guatemala City (1,500 m) (group UG). The women in the UG group belonged to the middle or high socioeconomic stratum. Median values in serum ferritin levels (ng/ml) for each group were: RCG = 11.5 (undetectable 50.6); RHG = 17.2 (1.9-83.1) and UG = 20.2 (3.9-56.7). The difference between RCG and UG was statistically significant (P less than 0.05). The percentage of women with serum ferritin levels less than or equal to 9 ng/ml (iron deficiency) was 45 in the RCG, 25 in the RHG and 12 in the UG group. In addition, the prevalence of subnormal hemoglobin levels (below mean - 1 SD) was 46% in the RCG, 12% in the RHG and 8% in the UG. There were no cases of subnormal blood folate levels. As results indicate, the women studied had low iron reserves, the rural coastal group being the most affected. They also evidenced the high prevalence of iron deficiency in the region and the need for public health actions to overcome this nutrition problem.