ABSTRACT
PURPOSE: This retrospective study evaluated the effectiveness of salivary gland radiotherapy for reducing sialorrhea in patients with amyotrophic lateral sclerosis (ALS). PATIENTS AND METHODS: From August 2001 to February 2008, 21 patients with amyotrophic lateral sclerosis (six men, 15 women; mean age 61.2 years, range 39-81) received external beam radiotherapy for sialorrhea (evaluation by the ALS Functional Rating Scale). All patients had previously received pharmacological treatments with unsatisfactory results or side effects. The mean dose was 19.1Gy (range 3-48), delivered in five fractions (range 1-16) on 17 days (range 1-77). Eight patients received 3D-conformal and 13 received 2D-conformal radiotherapy. Clinical target volumes included the parotids and submandibular glands (18 patients), submandibular glands and one parotid (one patient), or parotids (two patients). Thirteen patients were treated with 5.5-6MV photons and eight were treated with 6-15MeV electrons. A satisfactory salivary response was defined as complete or partial improvement. The median follow up was 10.4 months (range 0.4-26). One patient was lost to follow up. RESULTS: A positive response was observed in 65% of patients during a mean of 7 months (range 1-23). Four patients (20%) treated with photons and no patients treated with electrons experienced acute toxicity. Half (50%) the patients treated with photons and 87.5% of patients treated with electrons responded positively (P=0.09). Positive responses were more common with a high total dose (≥16Gy; 78.6%) than a low total dose (<16Gy; 33%; P=0.07). No differences were observed in tolerance (P=0.27). Age and sex did not impact the response. CONCLUSION: Salivary gland radiotherapy effectively reduced sialorrhea in patients with amyotrophic lateral sclerosis. An adequate compromise between toxicity and efficiency was achieved with 3D-conformal radiotherapy delivered with electrons to parotids and submandibular glands in a total dose of 16Gy or more (mean: 20Gy in five fractions).
Subject(s)
Amyotrophic Lateral Sclerosis/complications , Salivary Glands/radiation effects , Sialorrhea/radiotherapy , Adult , Aged , Aged, 80 and over , Amyotrophic Lateral Sclerosis/mortality , Dose Fractionation, Radiation , Electrons/therapeutic use , Female , Humans , Male , Middle Aged , Photons/therapeutic use , Radiotherapy, Conformal , Retrospective Studies , Sialorrhea/etiologyABSTRACT
This article describes the determination and the delineation of the target volumes for head-and-neck cancers treated with intensity-modulated radiotherapy (IMRT). The delineation of the clinical target volumes (CTV) on the computerized tomography scanner (CT scan) requires a rigorous methodology due to the complexity of head-and-neck anatomy. The clinical examination with a sketch of pretreatment tumour extension, the surgical and pathological reports and the adequate images (CT scan, magnetic resonance imaging and fluorodeoxyglucose positron emission tomography) are necessary for the delineation. The target volumes depend on the overall strategy: sequential IMRT or simultaneous integrated boost-IMRT (SIB-IMRT). The concept of selectivity of the potential subclinical disease near the primary tumor and the selection of neck nodal targets are described according to the recommendations and the litterature. The planing target volume (PTV), mainly reflecting setup errors (random and systematic), results from a uniform 4-5mm expansion around the CTV. We propose the successive delineation of: (1) the gross volume tumour (GTV); (2) the "high risk" CTV1 around the GTV or including the postoperative tumour bed in case of positive margins or nodal extracapsular spread (65-70 Gy in 30-35 fractions); (3) the CTV2 "intermediate risk" around the CTV1 for SIB-IMRT (59-63 Gy in 30-35 fractions); (4) the "low-risk" CTV3 (54-56 Gy in 30-35 fractions); (5) the PTVs.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Intensity-Modulated/methods , Antineoplastic Agents/therapeutic use , Combined Modality Therapy , Dose Fractionation, Radiation , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Magnetic Resonance Imaging , Organs at Risk , Positron-Emission Tomography , Radiography , Radiopharmaceuticals , Radiotherapy, Adjuvant , Tumor BurdenABSTRACT
Pulmonary artery sarcoma is a rare tumor. We present a case of intimal sarcoma arising from right pulmonary artery and left lower pulmonary vein observed in a 44-year-old man with a non-productive cough. Computed tomographic scans and magnetic resonance imaging showing filling defect enhancement contributed early, suggesting the diagnosis of primary vascular tumor, hypothesis confirmed by pathologist findings.
