Evaluation of margins in pelvic lymph nodes and prostate radiotherapy and the impact of bladder and rectum on prostate position.

PURPOSE: The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. PATIENTS AND METHODS: This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. RESULTS: Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. CONCLUSIONS: We recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume.

Factors influencing diagnosis delay of advanced breast cancer in Moroccan women.

BACKGROUND: Delay in the diagnosis of breast cancer in symptomatic women of 3 months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women. METHODS: A group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records. RESULTS: In all, 137 patients were interviewed. The mean age of women was 48.3 ± 10.4 years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1 %) patients and to a medical reason in 19 (13.9 %) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9 %) patients; traditional therapy was applied in 15 (12.7 %) patients and fear of cancer diagnosis and/or treatment in 14 (11.9 %) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (p = 0.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (p < 0.001). Also, a significantly higher risk of more than 6 months delay was found among rural women (P = 0.035) and women who live far away from specialized care center (P = 0.001). CONCLUSIONS: Diagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by promoting early detection.

[Combined radiation therapy and androgen deprivation in the management of prostate cancer: Where do we stand?]. / Association de radiothérapie et d'hormonothérapie dans la prise en charge des cancers localisés de la prostate: où en est-on?

Radiotherapy and androgen deprivation therapy play a major role in the management of prostate cancer. Indeed, radiotherapy and hormone therapy are combined in a neoadjuvant and concomitant setting for intermediate risk cancers but also in an adjuvant setting in high risk or locally advanced prostate cancer. The benefice of this association was suggested by preclinical studies and demonstrated later by several randomized trials. However, as these trials were conducted before the era of dose escalation the role of androgen deprivation therapy in this case is less clear. Moreover, as hormonal therapy can lead to a significant morbidity and a decrement in quality of life its indications must be carefully weighed especially in case of intermediate risk cancer witch represent a heterogeneous group with distinct prognostic subgroups.

RapidArc for centrally recurrent cervical cancer in the vaginal cuff following primary surgical therapy: a case report.

BACKGROUND: Pelvic recurrences of cervical cancer after primary surgical treatment can be potentially cured with radical hysterectomy or chemoradiation therapy. Combined radio-chemotherapy is believed to improve results compared to other option. Currently, RapidArc radiotherapy is considered an excellent technological advance that shows great potential for producing highly conformal doses to treatment volumes. CASE PRESENTATION: We present a case of a 67-year-old woman with history of early cervical cancer initially treated by radical laparoscopic hysterectomy. More than 5 years later, the patient presented with a central pelvic vaginal cuff recurrence that is histologically confirmed. Salvage radiotherapy using RapidArc with concurrent cisplatin-based chemotherapy was indicated. A high dose of 70 Gy was delivered to the gross recurrent disease with simultaneous integrated boost (SIB) to the subclinical disease and good sparing of organs at risk especially the rectum and sigmoid. CONCLUSIONS: This case clearly demonstrates a large benefit for salvage RapidArc radiotherapy to central pelvic recurrences of gynecological cancers with an excellent rate of local control and less rate of toxicity.