Skin-sparing helical tomotherapy vs 3D-conformal radiotherapy for adjuvant breast radiotherapy: in vivo skin dosimetry study.

PURPOSE: We investigated whether treatment-planning system (TPS)-calculated dose accurately reflects skin dose received for patients receiving adjuvant breast radiotherapy (RT) with standard three-dimensional conformal RT (3D-CRT) or skin-sparing helical tomotherapy (HT). METHODS AND MATERIALS: Fifty patients enrolled in a randomized controlled trial investigating acute skin toxicity from adjuvant breast RT with 3D-CRT compared to skin-sparing HT, where a 5-mm strip of ipsilateral breast skin was spared. Thermoluminescent dosimetry or optically stimulated luminescence measurements were made in multiple locations and were compared to TPS-calculated doses. Skin dosimetric parameters and acute skin toxicity were recorded in these patients. RESULTS: With HT there was a significant correlation between calculated and measured dose in the medial and lateral ipsilateral breast (r = 0.67, P<.001; r = 0.44, P=.03, respectively) and the medial and central contralateral breast (r = 0.73, P<.001; r = 0.88, P<.001, respectively). With 3D-CRT there was a significant correlation in the medial and lateral ipsilateral breast (r = 0.45, P=.03; r = 0.68, P<.001, respectively); the medial and central contralateral breast (r = 0.62, P=.001; r = 0.86, P<.001, respectively); and the mid neck (r = 0.42, P=.04, respectively). On average, HT-calculated dose overestimated the measured dose by 14%; 3D-CRT underestimated the dose by 0.4%. There was a borderline association between highest measured skin dose and moist desquamation (P=.05). Skin-sparing HT had greater skin homogeneity (homogeneity index of 1.39 vs 1.65, respectively; P=.005) than 3D-CRT plans. HT plans had a lower skin(V50) (1.4% vs 5.9%, respectively; P=.001) but higher skin(V40) and skin(V30) (71.7% vs 64.0%, P=.02; and 99.0% vs 93.8%, P=.001, respectively) than 3D-CRT plans. CONCLUSION: The 3D-CRT TPS more accurately reflected skin dose than the HT TPS, which tended to overestimate dose received by 14% in patients receiving adjuvant breast RT.

Management pathway for patients with cervical cancer in the Auckland region 2003-2007.

INTRODUCTION: This review was performed to describe the patient pathway and timelines involved in the treatment of FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IVA cervical cancer in a New Zealand cancer centre. METHODS: Retrospective audit of women with a new diagnosis of FIGO Stage IB1-IVA cervical cancer in the Auckland/Northland regions between 2003 and 2007. RESULTS: Two hundred and seven patients were identified. Median time from referral to first specialist assessment (FSA) was 10days, from FSA to decision to treat (DTT) 50days and from DTT to start of treatment 26days. Overall median time from referral to start of treatment was 97days. There was no difference in median time from referral to DTT for patients treated with primary surgery (48days) or radiotherapy (47days). On univariate analysis, factors associated with reduced time from referral to start of treatment were less socioeconomic deprivation (P=0.001), shorter time to completion of radiological investigations (P<0.0005) and private FSA (P<0.0005). Only private FSA remained significant on multivariate analysis. The greatest delay in the pathway was between FSA and DTT, encompassing presentation at multidisciplinary meeting, examination under anaesthetic and obtaining radiological investigations. Median overall treatment time (OTT) for patients treated with definitive radiotherapy was 56days and was increased by a median of 3days where there were delays accessing operating theatre time for brachytherapy insertions. CONCLUSION: Overall patient pathway and radiotherapy OTT were longer than optimal, and areas of delay potentially amenable to modification were identified.

Patterns of care for cervical cancer in Auckland, New Zealand, 2003-2007.

INTRODUCTION: The purpose of this review is to document current patterns of care for the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 to IVA cervical cancer in a New Zealand cancer centre. METHODS: This is a retrospective review of women with newly diagnosed FIGO Stage IB1-IVA cervical cancer in the Auckland/Northland regions between 2003 and 2007. RESULTS: Two hundred seven patients were identified. Fifty-three percent were stage IB, 24% stage II, 19% stage III and 3% stage IVA. Factors associated with stage ≥ IIB were age >50, lack of participation in cervical screening and public first specialist assessment. Ninety percent (90/100) of stage IB1 patients and 73% (8/11) of stage IB2 patients were treated with primary surgery. Thirty-eight percent of surgically treated stage IB1 and 100% of surgically treated stage IB2 tumours had indications for adjuvant radiotherapy. Radiotherapy utilisation rates were: stage IB 49% (IB1 44%, IB2 91%); stage II 93%; stage III 90%; and stage IVA 71%. Brachytherapy utilisation rate (BTU) for stages IIB to IVA was 64% overall and 75% in definitively treated patients. Seventy-five percent of patients treated with definitive radiotherapy received concurrent cisplatin chemotherapy. CONCLUSION: Both radiotherapy and brachytherapy utilization rates were below optimal and are being addressed. No formal surgical or chemotherapy utilisation estimates exist for comparison; however, the use of concurrent cisplatin chemotherapy was similar to other groups. A high rate of adjuvant (chemo)radiotherapy was noted in surgically treated Stage IB patients, suggesting a need for an increased consideration of primary chemoradiotherapy in these patients to avoid the unnecessary toxicity of trimodality therapy. Future outcome analysis is planned.