Contribution of low-molecular weight heparin addition to concomitant chemoradiotherapy in the treatment of glioblastoma multiforme.

PURPOSE: Glioblastoma multiforme (GBM) is the most common brain tumor in adults and has a very aggressive course. Median survival is as short as 2 years with standard treatment (chemoradiotherapy followed by adjuvant temozolomide). The purpose of this study was to determine the contribution of low molecular weight heparin (LMWH) addition to concomitant chemoradiotherapy in the treatment of GBM. METHODS: All patients with newly diagnosed GBM between March 2004-May 2009 were evaluated. After surgical intervention (total, subtotal resection or only biopsy) all of them were treated with concomitant chemoradiotherapy (2 Gy daily, 5 days a week, 30 fractions, total tumor dose 60 Gy; and 75 mg/m² temozolomide, 7 days a week), followed by adjuvant temozolomide (6 cycles, 150-200 mg/m², 5 days every 28 days), with or without LMWH (4000 IU/day, 7 days a week, concomitant with radiotherapy) because of risk of thrombosis. The primary endpoint was the determination of progression-free survival (PFS) and overall survival (OS); secondary endpoints were 1- and 2-year OS survival. RESULTS: 30 patients (13 patients in the group non receiving LMWH (LMWH-) and 17 patients in the group receiving LMWH (LMWH+)) were included in the study. Median age was 54 years (range 24-75). Median PFS was 57 and 38 weeks in LMWH+ and LMWH- groups, respectively (p=0.068). Median OS was 69 and 44 weeks (p=0.095), 1-year OS survival 84.6 and 41.2% (p=0.016), and 2-year OS survival 38.5 and 5.9% in LMWH+ and LMWH-, respectively (p=0.061). No significant difference was noted between the two groups for grade 3-4 toxicity (p>0.05). CONCLUSION: Better PFS, OS and 2-year OS survival were obtained in present study with the addition of LMWH to concomitant chemoradiation for GBM but without statistical significance. One-year OS survival was statistically significant favoring the LMWH group. The addition of LMWH did not increase temozolomide toxicity.

Reduction of irradiated small bowel volume with Trendelenburg position in gynecologic pelvic radiotherapy.

The aim of this study was to assess the effect of Trendelenburg position in comparison to prone position on small bowel volume and treatment dose in gynecologic pelvic external beam radiotherapy using three-dimensional conformal treatment plans. Eight patients with gynecologic cancers, treated with definitive or postoperative pelvic radiotherapy were investigated. Pelvic computerized tomography (CT) scans for treatment planning were performed in prone and 25 degree Trendelenburg positions for each patient. The dose-volume histograms of small bowel within the treatment fields were obtained and compared for both positions. The clinical target volume (CTV) and the planning target volume (PTV) were also defined and evaluated in the subjects. Treatment dose was 5040 cGy to PTV with 180 cGy daily fraction doses in both techniques for all patients. The average irradiated small bowel volume was 726 cc for prone position and 458 cc for the Trendelenburg position. The average irradiated small bowel volume reduction in the Trendelenburg position was 38.0% (95% CI 19.5 +/- 38%) compared with the prone position. The average small bowel percent dose was 25.4% (1280 cGy) for Trendelenburg position and 39.9% (2010 cGy) for prone position. PTV doses were similar in both techniques. The results of this dosimetric study suggest that gynecologic pelvic radiotherapy in the Trendelenburg position decreases the volume of irradiated small bowel compared to prone position and may decrease treatment related small bowel morbidity. Clinical benefit of this position should be evaluated in further clinical studies.

Dosimetric comparison of conventional helmet-field whole-brain irradiation with three-dimensional conformal radiotherapy: dose homogeneity and retro-orbital area coverage.

The aim of this study was to compare the dosimetric data from conventional two-dimensional (2D) helmet-field whole-brain irradiation (WBI) with those from three-dimensional conformal radiotherapy (3D-CRT), and to investigate the potential benefits of 3D-CRT as regards both dose coverage of the brain and retro-orbital (RO) area and ocular lens protection. Simulation CT scans of 30 patients were used. In 3D-CRT planning, the brain, optic nerves, ocular lenses and RO areas were contoured. Two opposed lateral fields were used and matched non-divergently behind the ocular lenses. The nominal prescribed photon beam dose was 1800 cGy in 10 fractions using 6 MV photons. Brain and RO areas were covered by at least 95% and 90% of the prescribed dose, respectively, and the maximum doses were limited to 110% of prescribed dose. In conventional 2D planning, the same field centre and angles were used as for the 3D-CRT plans. Fields were created using digital reconstructed radiographs and bony reference marks without information on the contour of structures. Brain, ocular lens and RO area doses were compared using cumulative dose-volume histograms. The mean value of minimum brain doses was significantly higher (p = 0.008) for 3D-CRT plans: all patients received a minimum of 95% of the prescribed dose. Mean doses of the left (p = 0.004) and right (p = 0.003) RO areas were also higher for 3D-CRT plans than for conventional 2D plans: all patients received a minimum of 90% of the prescribed dose. Furthermore, the mean values of minimum doses for both RO areas were statistically higher for 3D-CRT (p<0.001). 3D-CRT planning significantly improved the coverage of the RO areas and the dose homogeneity in WBI while protecting the ocular lenses.

Characteristics and prognosis of breast cancer in younger women.

PURPOSE: Women under 40 years of age comprise a small proportion of patients with breast cancer. Clinical and pathological features of the disease in these patients are different from those in older patients with this type of cancer. In the present study we investigated the clinicopathological characteristics and prognostic factors in young patients with breast cancer. METHODS: We retrospectively reviewed the medical records of 249 consecutive breast cancer patients who were admitted to our department between August 2001 and December 2005. Clinicopathological features were determined both in patients under and over 40 years of age. RESULTS: 106 (42.5%) patients were under and 143 (57.5%) were over 40 years. The mean age was 35.2 years for those under 40 years and 54 for those older than 40 years. At diagnosis, 10.4% of the patients in the younger age group and 7.0% in the older age group had metastasis (p=0.500). Patients in the younger age group exhibited higher estrogen receptor (ER) negativity (48.1 vs. 37.1%) (p=0.425) and a higher percentage of family history of breast cancer (4.7 vs. 2.8%) (p=0.651). Breast cancer in younger women was more frequently associated with other poor prognostic factors such as perineural and/or lymphovascular invasion. The 5-year overall survival was 6.3% for the younger patients and 22.2% for the older ones (p=0.004). CONCLUSION: This study demonstrates that breast cancer in younger patients has significantly more poor prognostic features compared to older ones.

The effect of vitamin E on acute skin reaction caused by radiotherapy.

Ionizing radiation affects healthy organs and tissues as well as diseased tissues during radiation therapy. Skin reactions varying from acute erythema to necrosis can be seen. It has been found that vitamin E can prevent mutagenic and/or carcinogenic effects of ionizing radiation in both animals and cell cultures. This study investigated the preventative effect of antioxidant vitamin E on irradiation-induced acute skin reactions. No protective effect of vitamin E was demonstrated. It is possible that the vehicle induced free radical exposure in the irradiated skin.