Three dimensional conformal postoperative radiotherapy for unilateral parotid gland cancer: a comparison of three different parotid gland irradiation techniques

Postoperative radiotherapy of the parotid gland could be achieved with various radiotherapy techniques. However they irradiate differently the surrounding organs at risk [OARs] in particular the cochlea, oral cavity and contralateral parotid causing significant increase in the risk of oral mucositis, xerostomia, and hearing deficits on the irradiated side. The aim of this study was to compare radiation doses received by target volume and different surrounding OARs using three different parotid irradiation techniques aiming to achieve the optimum technique which shows adequate target coverage and sparing of surrounding OARs during postoperative 3DCRT treatment of parotid gland cancer patients. Ten patients diagnosed as having parotid cancer were included in this study. They were subjected to CT simulation and scans were transferred to the treatment planning system. Target volumes and contralateral parotid, oral cavity, cochlea, spinal cord, brain stem, eyes, lenses and optic nerves were contoured. Three plans were done using [a] ipsilateral oblique wedged photon pair, [b] oblique wedged photon pair and direct lateral field, and [c] ipsilateral mixed photon electron beams. For three plans, the dose volume parameters [DVPs] for target volume and surrounding OARs were compared and analyzed statistically. Target dose coverage was adequate and comparable for techniques 1 and 2. Technique 2 showed the best dose homogeneity and conformity and lowest max dose to PTV and to the whole body and although the dose to OARs was higher compared to technique 1 it was far lower than OARs tolerance. On the other hand, technique 3 showed unaccepted underdose and dose inhomogeneity within the PTV, the highest doses to OARs and the highest PTV max and body max dose. The ipsilateral oblique wedged photon pair and direct lateral photon field technique is an optimal treatment technique for parotid cancer patients in comparison to other plans

Physical profile and clinical results of concurrent chemoradiotherapy or radiotherapy alone in the treatment of uterine cervix carcinoma using different dose rate brachytherapy

To evaluate physical profile, application techniques and clinical results of conventional external beam radiotherapy [EBRT] with different dose intracavitary brachytherapy [ICRT]. The role of concurrent cisplatin-based chemo-radiotherapy and HDR interstitial brachytherapy technique was also assessed. A total of 108 patients were prospectively studied, distributed into three treatment groups. Treatment was initiated with EBRT in all treatment groups. Groups I and II patients were divided into 2 subgroups [IA, IB], [IIA, IIB]. Both subgroups were treated by a conventional EBRT schedule, and concurrent cisplatin in group II. This was followed by ICRT either low dose rate [LDR] in subgroups IA, IIA or high dose rate [HDR] ICRT in subgroups IB, IIB. Group III patients received concurrent chemoradiotherapy followed by intertistial HDR brachytherapy. The mean age was 48 year. Vaginal bleeding was the most frequent symptom [84%, 80%, and 89% in groups I, II, and III respectively]. Exocervical lesions were the commonest presentation in groups I and II [70%]. Squamous cell carcinoma was dominant in all therapeutic groups. The clinical results showed complete response [CR] in 78% [group I] and 84% in group II, while in group III, only 61% achieved CR. Notably the associated early and late reactions were reported in group III more than the other two groups. Forty-two month actuarial pelvic/locoregional control rates were achieved in 66%, 77%, and 39% in groups I, II and III respectively [p=0.05]. The utilization of HDR ICRT compared to LDR produced a dramatically improved ability for dose distribution and optimization, not to mention patient convenience. The addition of cisplatinum with conventional EBRT and ICRT [LDR and/or HDR] demonstrated a clear positive impact on initial treatment results and subsequent progression-free and overall survival, with minimal differences in treatment related morbidities compared to radiotherapy alone. The utilization of interstitial rather than ICRT techniques, for patients with generally poor pelvic anatomy, producing more improved dose distribution/optimization, resulted in comparable actuarial 3.5-year cumulative overall survival rate

role of total body irradiation [TBI] in the management of low grade non-hodgkin's lymphomas: 5- year results

Twenty-five untreated patients with low grade lymphoma stages III and IV were the material of this study. All patients were treated by TBI, 15 cGy/day for ten doses twice weekly for five weeks with or without involved field irradiation 20 Gy/10 fractions to bulky tumour or residual disease. Treatment results were compared with historical control group of 35 cases treated with combination chemotherapy [CVP]. The overall response was 88% with 72% compete response, the mean duration of response was 32 months, compared to 94% and 77% in control group with mean duration of response of 35 months. The 5-year survival for the study group was 56% with 32% disease free survival at 5 years while in the control group it was 60% and 38% respectively. Treatment response and survival were correlated to some prognostic factors such as age, sex, tumour site, constitutional symptoms, histological types and stage of the disease