Does pelvic lymph nodes irradiation using intensity modulated radiation therapy increase rectal and bladder toxicities in patients with prostate carcinoma?

PURPOSE: this study compared the radiation-related rectal (R) and bladder (B) toxicities in prostate carcinoma patients receiving additional pelvic lymph nodes (PLN) irradiation with those receiving prostate (P) and seminal vesicle (SV) irradiation only. METHODS: thirty-three patients treated with intensity modulated radiation therapy (IMRT) were included. RT doses ranged between 60- 66.6 Gy to SV, 74-77.7 Gy to P and 50.4- 60 Gy to PLN. Max acute R toxicity was graded by a physician according to the RTOG side effect criteria during the period from the initiation of therapy until the end of the third month. Max late R and B toxicities were graded 3 months after the completion of RT by a physician using the RTOG GI and urogenital toxicity score and by patients using EORTC QLQ - PR25 self questionnaire separately. The effects of R and B doses and additional PLN irradiation on acute and late R and B toxicities and compatibility of patient- and physician-graded toxicity scores were investigated. RTOG GI and urogenital toxicity scores and EORTC QLQ - PR25 self questionnaire results were correlated. RESULTS: significant factors for acute R toxicity were: max R; R volume receiving ≥ 68 Gy; and PLN irradiation. PLN irradiation was marginally significant for late R toxicity; the mean B dose was a significant factor for late B toxicity. CONCLUSION: the results of this study suggest that although PLN irradiation increased acute R toxicity, it has no effect on late R and B toxicity. Patient- and physician-evaluated late R and B toxicity scores were concordant.

Impact of percent positive random biopsies on biochemical outcome in prostate cancer patients treated with external beam radiotherapy with or without androgen deprivation.

PURPOSE: To identify the prognostic factors for biochemical outcome in patients with localized prostatic adenocarcinoma treated with external beam radiotherapy (EBRT) with or without androgen deprivation (AD) and to investigate the impact of percent positive prostate core biopsies (PCB%). METHODS: From 1998 through 2003, 333 patients with newly diagnosed localized prostate cancer were retrospectively analyzed. The patients were treated in two institutions with definitive EBRT to a median dose of 72 Gy and 80% of them received short- or long-term AD. Biochemical failure was defined using ASTRO criteria with 3 consecutive rises in prostate specific antigen (PSA). RESULTS: Median follow up was 36 months. Gleason score, initial PSA, risk grouping, PCB%, AD and total duration of AD were found to be significant predictors for biochemical outcome in univariate analysis. Independent predictors for PSA failure on multivariate analysis were PCB% and duration of AD. Among 3 risk groups, in the intermediate risk group the biochemical control was significantly better in patients with < 67% positive core biopsies. In the subgroup analysis of patients who received a prostatic dose or= 67% positive core biopsies. These significant differences did not exist in patients receiving > 70.2 Gy and long-term hormonal therapy. CONCLUSION: Our results suggest that high PCB% could be a predictor of biochemical relapse, especially in the intermediate risk group. The role of PCB% in prostate cancer should be investigated in further trials.

Toxicity and feasibility analysis for cisplatin-based concomitant chemoradiotherapy in locally advanced nasopharyngeal carcinoma.

PURPOSE: To assess the side effects of cisplatin-based concurrent chemoradiotherapy (CRT) for locally advanced nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: From 2001 through 2007, 34 (27 males; 7 females) patients received a median of 70 Gy curative radiotherapy (RT) with conventional fractionation. Twenty-one (62%) patients received induction chemotherapy (CT): 8 of them received 2 courses of cisplatin (75 mg/m(2), day 1) and 5-fluorouracil (5-FU) (750 mg/m(2), days 1-5) every 3 weeks and 13 patients received 3 courses of cisplatin (75 mg/m(2), day 1) and docetaxel (75 mg/m(2), day 1) every 3 weeks. Concomitant cisplatin was administered either 40 mg/m(2) weekly (n=8) or 75-80 mg/m(2) every 3 weeks (n=26) during RT. Median Karnofsky performance status (KPS) prior to RT was 80 (range 70-90). Patient, disease and treatment-related factors were analysed in relation to termination of concurrent CT. RESULTS: Concurrent CT was administered to 13 (38.2%) patients without cisplatin termination, whereas 10 (29.4%) patients received 2 cycles of the 3-weekly schedule. Grade 3 oral mucositis (47.1%), grade 2-3 weight loss (44.2%) and grade 2 fatigue (44.1%) were the most frequently dose-limiting side effects during concurrent therapy. The rate of receiving cisplatin cycles as planned was 85% for patients with KPS >80, whilst it was 15% only for patients with KPS < or = 80 (p=0.006). None of the patients suffering of grade 2 fatigue could complete all cycles compared to 68% of patients with < grade 2 fatigue who completed all cycles (p <0.001). The severity of mucositis was significantly related to initial haemoglobin level (p=0.02) and weight loss during RT (p=0.04). Median follow-up was 20 months (range 5-65). Three-year locoregional relapse free (LRRFS), disease free (DFS) and overall survival (OS) rates were 79.3%, 68.8% and 79.2%, respectively. CONCLUSION: Concurrent administration of CT during RT reveals better outcome but requires careful consideration for toxicity. Initial performance status prior to CRT might be a predictor for unplanned CT stopping due to side effects.

Efficacy of gamma-knife surgery for treating meningiomas that involve the superior sagittal sinus.

BACKGROUND: Meningiomas involving the superior sagittal sinus (SSS) are among the most challenging tumors to treat. Authors of some recent series have advocated total removal with SSS reconstruction. However gamma-knife surgery is a reasonable choice for these tumors. PATIENTS: This study focused on 43 cases of meningioma invading the SSS that were treated with gamma-knife therapy. Twenty-eight patients had undergone previous resection. The follow-up period after radiosurgery ranged from 24 to 86 months (median, 46 months). The median marginal dose was 15 Gy. RESULTS: During follow-up, 22 (51%) tumors decreased in size, 16 (37%) remained unchanged, and 5 (12%) expanded. The overall rate of tumor control with radiosurgery was 89%. CONCLUSION: When a small meningioma involves the SSS and the sinus is patent, the first-line treatment should be radiosurgery. If the tumor is large and the sinus is patent, we recommend gross total resection with no removal of SSS. If postoperative or follow-up MR imaging demonstrates residual tumor or recurrence, gamma-knife surgery should be performed. If a large meningioma has completely obliterated the SSS, our policy is to remove the tumor and all sinus tissue without reconstructing the SSS.

Concomitant administration of uracil-tegafur and leucovorin during adjuvant radiotherapy for locally advanced rectal cancer.

PURPOSE: We report the feasibility and toxicity profile, and the impact on local control, disease-free survival and overall survival rates of our study which consisted of postoperative concurrent chemoradiotherapy, followed by adjuvant chemotherapy using uracil-tegafur (UFT)/leukovorin (LV) in locally advanced rectal cancer patients. PATIENTS AND METHODS: Thirty-one patients operated for rectal adenocarcinoma (pT3/4 or N+) were enrolled onto the study. Twenty-three patients were males and 8 females with median age 62 years (range 21-85). Radiotherapy (RT) to the pelvis with conformal technique and individual blocks was delivered within 8 weeks following surgery. Total RT dose was 50.4 Gy and was given in a conventional single fraction of 1.8 Gy per day. Chemotherapy was administered concomitantly and consisted of UFT (300 mg/m(2)/day) and LV (30 mg/day) during RT-days. Following chemoradiotherapy, chemotherapy alone was administered for 4 cycles in the same dose for 28 days every 35 days. RESULTS: No lethal toxicity occurred. All patients completed the scheduled RT. Concurrent chemotherapy continued in 22 (70.9%) patients until the end of RT. Seventeen (54.8%) patients completed the whole concurrent chemoradiotherapy and adjuvant chemotherapy as planned. No grade 3-4 stomatitis/mucositis or haematological toxicities were observed during the whole treatment period. During concomitant therapy grade 1-2 toxicities were: nausea/vomiting 60%, dyspepsia/gastric pain 39%, diarrhea 39% and dysuria 10%, whereas grade 3 nausea and diarrhea occurred in 6% and 19%, respectively. Median follow-up was 22 months. Two-year local control, disease-free survival and overall survival rates were 96.3%, 72.3% and 83.2%, respectively. CONCLUSION: The acute toxicity profile of UFT/LV, local control, disease-free survival and overall survival in the concurrent chemoradiotherapy setting for operated, locally advanced rectal cancer seem comparable with the standard 5-fluorouracil (5-FU)-based therapies.

Determination of output factors for the Leksell gamma knife using ion chamber, thermoluminescence detectors and films.

PURPOSE: In stereotactic radiosurgery by the Leksell gamma knife, small fields of 4-18 mm in diameter are used. The difficulties associated with the dosimetry of small radiosurgical beams are well known. The output factors for small field sizes show a strong field size dependence, with rapidly decreasing output factors as the diameter of the field decreases. The main purpose of this study was to determine output factors of 18, 14, 8 and 4 mm collimators for Leksell gamma knife and to compare them with the values given by the manufacturer. MATERIALS AND METHODS: The relative output factors of the 18, 14 8 and 4 mm collimators for model B Leksell gamma knife were measured. The output factor measurements were prformed using a PTW 0.125 cc ion chamber, G200 thermoluminescence detectors (TLDs), KodakXV and Kodak ERD2 films. RESULTS: For 14 mm collimator, output measurements used with an ion chamber, TLD, Kodak XV film and Kodak ERD2 film were in agreement with the manufacturer's estimates within 1%. For 8 and 4 mm collimators, the best agreement with values given by the manufacturer were obtained by Kodak EDR2 films (2% and 5%, respectively). CONCLUSION: The measured output factors are in good agreement with the values recommended by the manufacturer for 18, 14 and 8 mm collimators. No good agreement was found for 4 mm collimator.

Radiosurgical treatment of cavernous sinus cavernous haemangiomas.

BACKGROUND: The objective of this report is to evaluate the effects of radiosurgery on cavernous sinus cavernous haemangiomas (CSCHs). METHOD: Five cases of CSCHs are presented in this report. One of them was diagnosed only neuroradiologically. Other patients underwent surgery and were then referred to Gamma Knife radiosurgery for residual tumours. The cohort consisted of 3 male and 2 female patients with median age of 42 (37-60). The volume of the tumours ranged between 3.8-6.5 cc. They were treated with a marginal dose of 14 to 16 Gy (mean 15 Gy). Findings. In the mean follow-up period of 32 months (6-52 months) all of the tumours decreased in size. There were no complications related to radiosurgery. CONCLUSION: Gamma Knife radiosurgery is an effective method in the treatment of CSCH, over the period of follow-up described.

Outcome of rectal and sigmoid carcinoma patients receiving adjuvant chemoradiotherapy in Marmara University Hospital.

Adjuvant chemoradiotherapy is the standard treatment in resected stage II/III rectosigmoid carcinoma. We report a retrospective analysis of 33 patients who received adjuvant chemoradiotherapy. Patients received 5-fluorouracil (375mg/m2/day x 5days) and calcium leucovorin (20mg/m2/day x 5days), q4weeks, two courses before and two courses after radiotherapy. The 5-fluorouracil dose was reduced to 225mg/m2/day given continuously as protracted short-term infusion on the first and last 3 days during radiotherapy. Radiotherapy was started at 7th week and 45-50.4 Gy was given to pelvic region. Median age was 63 years. Median follow-up was 38 months starting from the operation date. Four-year local and distant control rates were 78% and 69%, respectively. Four-year disease-free survival and overall survival were 60% and 62%, respectively. Protracted short-term infusion of 5-fluorouracil during pelvic irradiation is a safe treatment modality. Further studies are needed to improve the local control of high-risk rectal and sigmoid carcinomas.

Neoplastic diseases prevalence in a turkish university hospital.

PURPOSE: The purpose of this study was to register the different cancer cases diagnosed in our hospital with an aim to define the most common and treatable cancer types and help define accurate targets for the allocation of the already limited resources of the Ministry of Health. MATERIALS AND METHODS: We surveyed 12 months of the hospital's pathology records to determine the prevalence of various cancer types. RESULTS: Out of 9720 biopsy and cytology samples, 662 were cancer cases. Breast and gastric cancers were higher and colorectal cancers were lower than the series reported from the United States. Of the pulmonary malignancies, lung cancer in general was not particularly higher in proportion to other cases, something interesting for a country with smoking rates exceeding 60% of the adult population. Squamous cell lung cancer was more common compared to the rates reported in the western world statistics. CONCLUSION: Although biases may exist, as certain cancers are more amenable to surgical intervention and physician groups may have special interest toward a particular cancer, distribution of cancer cases in Turkey is probably similar to the western world.

Determination of dose distributions and dose rates in the gamma knife.

PURPOSE: To measure the dose parameters of the Leksell gamma knife unit and compare them with the treatment planning data. MATERIALS AND METHODS: The dose distributions taken from treatment planning computer were confirmed with film dosimetry using a spherical uniform density polystyrene phantom. The dose rate measurements were made by using a 0.125 cc ion chamber and the spherical phantom for 4, 8, 14 and 18 mm helmets. The dose rate measurements were compared with the estimates given by the manufacturer. RESULTS: The dose distributions obtained by film dosimetry were in agreement with those taken from the treatment planning computer only for the 70% and 50% isodose line. The results of dose rate measurement showed that the 0.125 cc ion chamber was suitable only for 18 and 14 mm helmets. Conversely, it was not suitable for 8 and 4 mm helmets. CONCLUSION: This study showed that both computergenerated treatment plans and film densitometry estimates provided similar dose distributions without special beam blocking.