[The effect of tumour bed boost on local control after breast conserving surgery. First results of the randomized boost trial of the National Institute of Oncology] / A tumorágy kiegészítô besugárzásának hatása a lokális daganatmentességre emlômegtartó mûtét után. First results of the randomized boost trial of the National Institute of Oncology.

PURPOSE: To evaluate the effect of tumour bed boost on local tumour control (LTC) after breast conserving surgery in a prospective study. METHODS: Between 1995 and 1998, 207 women with early invasive breast cancer who underwent conservative operation were treated by 50 Gy irradiation to the whole breast and then randomly assigned to receive either no further radiotherapy (n=103) or a boost to the tumour bed (n=104) with either 16 Gy electron (n=52) or 12-14.25 Gy high dose rate brachytherapy (n=52). RESULTS: At a median follow-up of 4.25 years the crude rate of local recurrence was 6.7% with and 13.6% without boost. The respective rates of tumour bed relapse were 3.8% vs. 10.7%. The 4 year probability of LTC, relapse-free survival and breast cancer-specific survival was 94.2% vs. 85.1% (p=0.1176), 82.3% vs. 67.2% (p=0.0438) and 84.8% vs. 90.9% (p=0.1111), respectively, in favour of the boost group. Systemic treatments had no significant impact on LTC (88.9% with and 89.6% without systemic treatment, p=0.8858). CONCLUSION: Tumour bed boost decreased the incidence of local and tumor bed relapses with a reduction of 50% and 64%, respectively. Relapse-free survival was improved significantly with boost. However, the influence of boost treatment on breast cancer-specific survival should be tested in further studies. In spite of the higher incidence of late radiation side effects in the boost arm, boost dose is strongly recommended for patients at high risk for local recurrence. The final results of the EORTC trial and other ongoing studies will help to clarify the indication of boost dose according to prognostic subgroups.

[Radiotherapy of childhood brain stem tumours] / Agytörzsi daganatok sugárkezelése gyermekkorban.

STUDY OBJECTIVE: Description and evaluation of radiotherapy of inoperable brain stem tumours. Possibilities of improving therapeutic results. MATERIALS AND METHODS: Between 1987 and 2000 43 patients (23 boys and 20 girls, mean age 8.5+/-4.4 years) with brain stem tumours were treated with 6 MV and 9 MV X-ray. The doses administered ranged from 30 to 66 Gy; mean 50.41+/-7.67 Gy. Treatment in each case was performed according to CT- and /or MR-based radiotherapy plan. Since 2000 3D conformal radiotherapy plans have been prepared by using image fusion. RESULTS: All patients were followed. The mean follow-up period was 19.4 months (range: 1 to 112 months). For survival statistics the 2 to 3-year overall and symptom-free survivals were taken into account, the former ones in the function of tumour localisations. The gender of children did not affect the survival (p>0.74). No significant difference was found as to survival in the function of tumour localisation either (p>0.87). CONCLUSION: According to the literature data the results expected were not achieved by hyperfractionation and by delivering an overall focal dose of 72 to 78 Gy. Results can be improved by precise patient fixation and the routine application of 3D conformal radiotherapy plans prepared by CT- and MR-based image fusion. These together can result the correctly reproducible patient fixation, the homogenous radiation delivery in the target volume and the reduction of injury in the surrounding tissues. Irradiation should be performed also in histologically not verified tumours since a 24.6 month transitory improvement could be achieved in 60.5% of our patients.

[Radiotherapy of early breast cancer. More than loco-regional tumor control] / A korai emlôrák sugárkezelése: Több, mint loko-regionális daganatkontroll. Osszefoglaló közlemény. More than loco-regional tumor control.

The authors review the value of radiotherapy in the multidisciplinary treatment of early (stage 0-II) breast cancer and describe past achievements, current scientific evidences and possible future prospects of clinical research. Results of randomized studies proved that conservative surgery with radiotherapy is equally effective to mastectomy for the treatment of in situ and invasive breast cancer, both in terms of local control and overall survival. In the nineties, findings of prospective clinical trials indicate that the use of irradiation in high-risk patients provides both a significant improvement in loco-regional control and survival rate. The magnitude of survival benefit with appropriate patient selection and radiotherapy technique is similar to that seen with adjuvant systemic therapy. Radiotherapy of early breast cancer is based on level I scientific evidences in the vast majority of cases. Remaining controversial issues are subjects of several ongoing international and Hungarian prospective randomized studies.

[Importance of 3D conformal percutan and brachytherapy treatment planning based on CT and MRI examinations in treatment of oral cavity tumors] / A CT- és MRT-vizsgálatokon alapuló háromdimenziós besugárzás jelentôsége szájüregi daganatoknál.

AIM: The importance of 3D conformal percutan and brachytherapy treatment planning based on CT and MRI examinations in treatment of oral cavity tumors. Introducing of the planning procedure and the selection aspects. METHOD: We present the treatment planning based on CT and MRI slices of an oral cavity tumor. The percutan or interstitial boost follow the percutan irradiation of the involved regions and lymph nodes, regarding to the target volume and the critical organs. RESULT: Our ADAC 3D planning system gives us the possibility to add the first line and the boost treatment plans, to determine and compare the dose distribution within the planned target volume and the radiation load of the critical organs. CONCLUSION: The comparative 3D radiation planning system allows higher local dose escalation required for the effective radiation treatment of oral cavity tumors with maximal protection of the surrounding healthy tissues.

[Conformal radiotherapy of maxilla tumors] / Maxillatumorok konformális sugárkezelése.

PURPOSE: To demonstrate a conventional and a new therapeutic method of 3D treatment planning in maxilla tumors, the process of 3D treatment planning and its significance and to compare these two methods. METHOD: We performed 2D and 3D treatment plans. The ADAC planning system was used in the 3D treatment planning. CT and MRI scans were taken on the target volume and on each scan we demarcated the target volume and the critical organs. The irregular fields were obtained by 3D graphic reconstruction provided by the treatment planning programme. RESULTS: Compared to the conventional treatment planning more favourable dose distribution was obtained within the target volume and the radiation burden of the critical organs was kept under their tolerance doses. CONCLUSION: In conformal 3D treatment planning the shape and size of the irradiated volume are in good conformity with those of the target volume. In this way the radiation burden of the critical organs and adjacent intact tissues can be reduced.

[Modern radiotherapy techniques in the treatment of tumour of the base of tongue] / Nyelvgyöktumor korszerû sugárkezelése.

AIM: To demonstrate the role, the execution and the importance of the computed tomography (CT) based three-dimensional brachytherapy and conformal percutan radiotherapy in the treatment of the advanced tumour of the base of tongue. METHODS: Between January 1993 and June 2000, 27 patients with stage III-IV squamous cell cancers of the base of tongue were treated after 60 Gy percutan irradiation with interstitial, high dose rate brachytherapy (23 patients) or conformal, multi-fields radiotherapy (4 patients) as a boost. The dose of the boost irradiation varied between 12 and 24 Gy. RESULTS: Boost irradiation was well tolerated by the patients. The local tumour control at the mean follow-up period (39 months) was 52%. Using this two treatment methods in case of percutan conformal irradiation 6%, in case of brachytherapy 1.5% of the mandible received the prescribed boost dose. The spinal cord received a maximum of 15%, and 8% of the boost dose, respectively, depending on the two treatment types. CONCLUSION: With the help of these two radiotherapeutic modalities locally higher cumulative dose and better tumour control can be achieved without the higher risk of radiation injury of the surrounding normal tissues and the two most critical organs (medulla, mandible).

[Low-dose Taxol radiosensitization in locally advanced head and neck cancers] / Alacsony dózisú Taxol-sugárérzékenyítés helyileg elôrehaladott fej-nyaki daganatokban.

INTRODUCTION: Combined modality treatment with chemotherapy and radiotherapy in locally advanced head and neck cancers is an effective and often the only treatment with a chance of cure. An alternative is to use chemotherapeutic agents at low doses as radiosensitizers. In this study we examined the radiosensitizing effect of low dose Taxol in locally advanced head and neck cancer. Patients and methods: 26 patients with locally advanced squamous cell carcinoma of the oral cavity and the oropharynx were treated with external beam radiotherapy up to doses of 66-70 Gy and received concomitantly 2 mg/m(2) Taxol intravenously three times a week. Response rates according to WHO criteria, side effects according to the National Cancer Institute Common Toxicity Criteria, overall and progression-free survival were evaluated. RESULTS: All patients completed the therapy. Median radiation dose was 66 Gy, Taxol dose 40 mg/m(2) and treatment duration 54 days. 8 weeks after completion of therapy complete response was 30.8%, partial response 34.6%, stable disease 11.5% and progressive disease 23.1%. The median follow-up time was 25 months (9-36). At the cloes- out date 12 (46,1%) of the patients were alive, 9 without evidence of disease. The estimated median overall survival was 22 months (CI 14.2-34.6), the median progression-free survival 12 months (CI 5.2-18.8). We observed four grade 4, fourteen grade 3 and numerous grade 1-2 side effects. There was no treatment related death. DISCUSSION: Our regimen resulted in a worse response rate than the aggressive chemoradiation protocols treating the same disease. However, the two-year survival was comparable with the results of other studies. The advantages of our schedule are that it is well tolerated, easy to perform on an outpatient basis, resource effective and does not deteriorate the general condition of the patients, therefore successive therapy can be carried out immediately if necessary. We intend to evaluate the effectivity of this treatment in a study comparing radiotherapy with Taxol sensitization versus radiotherapy alone.

[Combined modality treatment of locally advanced oral and oropharyngeal cancer following primary radiotherapy with and without taxol radiosenzitization] / Komplex onkoterápia eredményei elôrehaladott stádiumú fej-nyaki laphámrákos betegek Taxol-sugárérzékenyítéssel és anélkül végzett primer sugárkezelését követôen.

AIM: To determine the effect of radiosensitization with Taxol and multimodality treatments on the survival of advanced oral and oropharyngeal cancer. Patients, methods: 56 patients with St. III-IV oral or oropharyngeal cancer were treated with external beam radiotherapy; 26 of them were sensitized by low-dose paxlitaxel and 30 were irradiated traditionally. The median follow up was 23 months (17-36). Endpoints of the study were: response to radiotherapy, progression-free and overall survival and the results of surgery and chemotherapy following radiation. RESULTS: 73.3% (41/56) of treatments resulted in CR or PR with median 10 months (0-33) progression-free and 14 months (4-33) overall survival. There was no significant difference between the radiosensitized and traditional radiotherapy group (p=0.6). The survival was significantly influenced by the stage of tumor and the response to primary radiotherapy. Seven (38.9%) of 16 patients treated also by either surgery or chemotherapy for recurrent or residual disease are free of cancer, 6 (35%) alive with tumor and 5 (26.1%) died with median survivals of 21, 20.5 and 18 months, respectively. Those treated only with radiotherapy with or without sensitization are free of cancer in 31.6%, alive with cancer 5.3%, died 63.2%. CONCLUSION: There were significant correlation between tumor stage, response to radiotherapy and combined modality treatment, and surival. The radiosensitizing effect of Taxol was not obvious so far, it may be apparent in the future by analyzing the long term survival data.