Comparing ultrasound with computerized tomography images to choose electron energy for radiotherapy boost field in breast cancer patients with breast conserving surgery.

PURPOSE: To compare ultrasonographic (US) with computerized tomographic (CT) images in order to choose electron energy for radiotherapy (RT) boost field in patients with breast conserving surgery (BCS). METHODS: Thirty-seven consecutive patients with breast cancer treated by BCS and RT in our department were evaluated. Median age was 49 years (range 32-82). According to the Dokuz Eylul Breast Tumor Group Protocol (DEBTG), in patients with BCS, RT (5000 cGy to the whole breast ± lymphatic area) and boost with electron energy to the primary tumor bed (1000 cGy if surgical margin negative, or 1600 cGy if surgical margin positive was delivered. Before January 2003, the distances between skin-the deepest point of tumor bed (STD), skin-clips (SCD), and skin-fascia (SFD) were measured with US to choose electron energy in boost field. Since then, CT simulation images were used to this purpose. These two imaging systems were compared in this study. Electron energy was selected after measurement of the deepest metallic clips in CT simulation images (90%) or measurement of the STD if no clips were present (10%). RESULTS: Median measurements with US and CT were as follows: STD: US 12 mm (range 4-35), CT 28 mm (range 2-54); SFD: US 25 mm (range 6-57), CT 31 mm (range 2-93); SCD: US 14 mm (range 7-26), CT 29 mm (range 2-68). The median electron energy was 9 MeV é (range 6-12) for US and 12 MeV é (range 6-21) for CT. Concordance in US and CT measurements was 27%. CONCLUSION: This preliminary study reveals that CT-based SCD measurements are deeper than US measurements, and selected electron energy with CT is 3 MeV higher than US. These two factors can affect local control and side effects. We noticed only one local recurrence in 37 patients. We did not evaluate side effects in this study. These could be a subject of a future study.

Is re-irradiation effective in symptomatic local recurrence of non small cell lung cancer patients? A single institution experience and review of the literature.

PURPOSE: To determine reirradiation results of patients with recurrent non-metastatic non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: 38 NSCLC patients who showed clinical and/or radiological progression and were retreated with hypofractionated irradiation (RT) were retrospectively evaluated. Two parallel or oblique opposed fields were used for reirradiation of the recurrent tumor while excluding the spinal cord. "Improvement" and "complete or near complete response" were defined as > or = 50% and 75-100% regression of symptoms, respectively. Log-rank test, chi-square test and Cox regression analysis were used for statistical analyses. RESULTS: Median age was 58 years (range 33-80) and only 3 patients were females. Median follow-up was 13.5 months (range 4-65). In the initial and second course of RT the total dose was 30 Gy (range 28.8-67.2) and 25 Gy (range 5-30) and the number of fractions was 10 (range 9-33) and 10 (range 1-10), respectively. The median interval between the two RT courses was 35 weeks (range 4-189). After reirradiation improvement was observed in 86% of the patients assessable for hemoptysis, in 77% with cough, in 69% with dyspnea, and in 60% with thoracic pain. After reirradiation, the median survival time was 3 months (range 0-55). Two-year survival rates from diagnosis were 28.8% and from reirradiation 5.8%. An interval more than 35 weeks between the end of initial RT and the start of reirradiation was found as the only independent prognostic factor affecting survival. No grade III-IV RTOG late side effects were observed. CONCLUSION: In initially non-metastatic NSCLC patients, reirradiation can be a safe and effective treatment for palliation after recurrence. Large prospective studies are needed to confirm the safety, effectiveness and economical advantages of this modality.