[PET/CT based radiotherapy treatment planning in head and neck cancers]. / PET/CT alapú besugárzástervezéssel szerzett tapasztalatok fej-nyaki tumorokban.

The purpose of this study was to evaluate the experiences of PET/CT based radiation planning in patients suffering from head and neck cancer. PET/CT based 3D-conformal irradiation was used in eleven patients between March 2008 and February 2009. In six of the eleven cases the therapeutic plan was modified after PET/CT examination, as the previously determined lymph node negative state proved to be lymph node positive. For that reason, the treatment needed to be completed by chemotherapy and in some cases clinical target volume and planning target volume have been also modified. PET/CT examination has a decisive influence on therapeutic planning and on the planning process in patients with head and neck cancer.

Perioperative brachytherapy for pretreated chest wall recurrence of breast cancer.

PURPOSE: To demonstrate the technical aspects of high-dose-rate afterloading (HDR-AL) brachytherapy for isolated local chest wall recurrence of breast cancer pretreated with mastectomy and axillary node dissection plus postoperative radiotherapy. CASE REPORT: A 63-year-old female patient with left ductal breast cancer, pT2pN1biM0, was reoperated for an isolated local chest wall recurrence 13 years after primary treatment (mastectomy, axillary dissection, and 50 Gy postoperative irradiation). Radical surgery would have involved extreme mutilation. Reoperative surgical margins of 3 mm width were involved, and four parallel afterloading catheters were placed intraoperatively in this histologically positive margin site. Perioperative HDR-AL (Ir-192 stepping source, 370 GBq activity, dose rate: reference air kerma rate at 1 m 40.84 mGy/h kg) was performed. Dose per fraction: 6 Gy to the reference line, two fractions per week, total dose 30 Gy. Follow-up after secondary treatment: 5 years. RESULTS: Firm local control and 5-year disease-free survival were obtained with perioperative HDR-AL therapy; staging procedures (clinical exam, MRI, abdominal ultrasound, and bone scan) showed no evidence of disease. The development of radiodermatitis did not exceed grade 2 level and healed spontaneously within 6 weeks. CONCLUSIONS: Isolated local chest wall relapse can be effectively controlled by wide surgical excision and perioperative reirradiation with HDR-AL. This technique may represent a treatment alternative to ultraradical surgery, with equal healing probability and a better quality of life. Small-volume irradiation of the postoperative scar can be performed with HDR-AL brachytherapy, and long-term local control can be achieved with a total dose of 30 Gy.