Quality of life after radiation therapy of cerebral low-grade gliomas of the adult: results of a randomised phase III trial on dose response (EORTC trial 22844). EORTC Radiotherapy Co-operative Group.

In 1985, the EORTC Radiotherapy Co-operative Group launched a randomised phase III study comparing high-dose (59.4 Gy in 6.5 weeks) versus low-dose (45 Gy in 5 weeks) radiotherapy with conventional techniques in patients diagnosed with low-grade cerebral glioma. The primary endpoint of the study was survival. No difference in survival was observed between the two treatment strategies. A quality of life (QoL) questionnaire consisting of 47 items assessing a range of physical, psychological, social, and symptom domains was included in the trial to measure the impact of treatment over time. Patients who received high-dose radiotherapy tended to report lower levels of functioning and more symptom burden following completion of radiotherapy. These group differences were statistically significant for fatigue/malaise and insomnia immediately after radiotherapy and in leisure time and emotional functioning at 7-15 months after randomisation. These findings suggest that for conventional radiotherapy for low-grade cerebral glioma, a schedule of 45 Gy in 5 weeks not only saves valuable resources, but also spares patients a prolonged treatment at no loss of clinical efficacy.

Radiation therapy in the unresectable cavernous hemangioma of the liver.

Hemangioma is the most common benign neoplasm of the liver, for which a 'wait and see' policy has been advised when it is small or without symptoms. Surgery is the treatment of choice of these tumors when marked symptomatology is present. However, some of these lesions cannot be excised due to their size, multiplicity, location or medical conditions. In these patients, radiotherapy has been reported to give good results with minor morbidity, suspending the tumor growth and decreasing the symptomatology. Seven symptomatic patients were treated with radiotherapy with a dose of 15-30 Gray in 15-22 fractions. Improvement of the quality of life was observed in all patients and the regression of the tumor volume was confirmed by computed tomography in five, with a follow-up ranging from 40 to 67 months.

[Conservative treatment of breast cancer. Experience of the Consultation Group of Breast Oncology of the Santa Maria Hospital]. / O tratamento conservador do cancro da mama. Experiência da Consulta de Grupo da Mama Oncológica do H.S.M.

Since 1983, the Oncology Breast Group Consultation of the H.S.M. has been practicing a Conservative Treatment in women with early stage breast carcinoma. So far, 61 women stages I and II, were submitted to Conservative Treatment, which consists of limited Surgery, followed by Radiotherapy. 20 patients had performed associated systemic therapy, because they presented axillary positive lymphnodes. 10 of there were pre-menopause and they had performed Chemotherapy and the other 10 were post-menopause receiving Hormonotherapy. Of the 61 patients that constitute this series, two had local failure; two had hepatic metastasis and another two had secondary neoplasms. The remaining 55 are in good condition. In 54 patients with follow-up superior to 3 month oesthetical evaluation revealed excellent results in 26 cases, good in 24, medium (fair) in 6, middling in one and bad in 4. Follow-up varies between 3 months and 6 years, and it is not possible to present results of 5 years survival because almost all patients have a follow-up of less than 2 years.

[Effectiveness of radiotherapy in non-resectable cavernous hemangioma of the liver]. / A efficácia radioterapia no hemangioma cavernoso irressecável do fígado.

In the management of the unresectable cavernous hemangioma of the liver, the Radiotherapy has an important role. This paper reports the experience of Radiotherapy department of Hospital Santa Maria. The authors review retrospectively the literature concerning techniques, results and complications of this therapy and analyse other possible attitudes in treatment of these lesions.

Acute secondary effects in the esophagus in patients undergoing radiotherapy for carcinoma of the lung.

The incidence and nature of acute secondary irradiation esophagitis was studied in a series of 38 patients undergoing 60Co teletherapy for carcinoma of the lung. Thirty-four patients were male and four female, with ages ranging from 38 to 78 years. The mediastinum being irradiated in the process, all the patients underwent endoscopy for signs of esophagitis and/or gastritis after a dose of 30-40 Gy was delivered to the esophagus. Eighteen patients complained of dysphagia, but only in 12 of them did endoscopy show esophagitis. Of the remaining patients without complaints five had endoscopic signs of esophagitis. Gastritis was found in 18 cases and confirmed histologically in 14. In 17 cases, esophagitis and/or gastritis were confirmed histologically. It is believed that there is a fairly close correlation among clinical, endoscopic, and histological findings to support the claim that esophagitis in these patients is radiation induced. However, the cause of gastritis is not well understood. Data in the literature suggest that nonsteroid anti-inflammatory agents can act as prophylactic means of preventing radiation esophagitis.

Direct multiplanar computed tomography in planning radiotherapy for malignant tumours of the nasopharynx.

A method of direct computed tomography (CT) scanning for planning radiotherapy of malignant nasopharyngeal tumours is described. Direct multiplanar CT scanning is the imaging method of choice for the diagnosis and definition of the target volume of these tumours. The patient is positioned for treatment precisely as for direct axial model CT. By integrating the information generated by high-definition scout views, direct axial mode, and, occasionally, direct coronal mode CT, the anatomical points of reference are identified. These are then translated to the surface anatomy of the patient to define the fields accurately prior to radiotherapy treatment.

The value of three-dimensional CT-scanning in head pathology.

The A. A. present five patients with intracerebral pathology in which three-dimensional CT-scanning has been performed. The coordinates and the range of volume of the processes can be given by this technique allowing for accurate surgical and/or radiotherapy management. Sagittal reconstructions add to completeness of spatial imaging of the relationship of the tumours to topographic landmarks. Holographic imaging can be derived from both axial and coronal cuts as well as from reconstruction modes. The A. A. indicate the fields of application of three-dimensional modes and maintain that three-dimensional isoattenuation coefficient curves could be very helpful for optimal radiotherapy treatment planning. Further, CT-scanning is a non-invasive way of assessment of the patients during treatment, after treatment and longterm follow-up.