Concurrent chemotherapy and intensity-modulated radiation therapy for anal carcinoma--clinical outcomes in a large National Cancer Institute-designated integrated cancer centre network.

AIMS: To report the clinical outcomes of patients with anal carcinoma treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy in a large integrated academic-community cancer centre network. MATERIALS AND METHODS: Seventy-eight patients were treated with IMRT for anal carcinoma at 13 community cancer centres. IMRT planning for all centres was carried out at one central location. Sixty-five patients (83%) were T1-T2, 64% were N0, 9% were M1; five patients were HIV positive. All but one patient received concurrent chemotherapy. The median dose to the pelvis including inguinal nodes was 45 Gy. The primary site and involved nodes were boosted to a median dose of 55.8 Gy. All acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 3.0. RESULTS: The median follow-up for the entire cohort was 16 months (range 0-72 months). Acute grade ≥3 toxicity included 27.7% gastrointestinal and 29.0% dermatological. Acute grade 4 haematological toxicity occurred in 12.9% of patients. Sixty-four (88.9%) patients experienced a complete response. The 2 year colostomy-free survival, overall survival, freedom from local failure and freedom from distant failure rates were 81.2, 86.9, 83.6 and 81.8%, respectively. CONCLUSIONS: Early results seem to confirm that IMRT used concurrently with chemotherapy for treatment of anal carcinoma is effective and well tolerated. This complex treatment can be safely and effectively carried out in a large integrated healthcare network.

Radiotherapy for malignancies associated with lupus: case reports of acute and late reactions.

Six patients with lupus (five with systemic lupus erythematosus and one with discoid lupus) were treated with moderate-dose to high-dose standard radiation treatment for breast cancer (four patients), Hodgkin's disease (one patient), and thymoma (one patient). None of the patients had severe acute or late radiation complications in the skin or subcutaneous tissues treated, with a follow-up of 7-121 months. Systemic lupus erythematosus is not an absolute contraindication to radiotherapy, which can be offered to patients with malignant disease that can be appropriately treated with this modality.

Low-grade astrocytomas of childhood.

Low-grade astrocytomas are the single most common form of pediatric brain tumor, representing 28% of the total. Prolonged survival and even cures can be expected in a substantial proportion of patients who present with these tumors. For a variety of reasons, the overall oncologic management of children with low-grade astrocytomas is extremely controversial. This article analyzes the available information related to the management of various forms of low-grade astrocytoma in childhood while awaiting the performance of a long-term national cooperative study on the natural history and management of this common pediatric brain tumor.

The dosimetric properties of an intraoperative radiation therapy applicator system for a Mevatron-80.

An applicator system for intraoperative radiation therapy has been fabricated which does not require physical docking with the accelerator. A dosimetric study has been completed which documents the properties of this system for a variety of electron beam energies, applicator sizes, collimator settings, both primary and secondary, and source-surface distance (SSD) settings. Sensitivity of the system to common misalignment errors was also determined. Results indicate (a) applicator leakage of less than 5%, (b) beam flatness to within plus or minus 5% at the dMAX with a single primary collimator setting, (c) smooth changes in output with cone size, beam energy and SSD, and (d) negligible changes in dose distributions within alignment errors permitted by the system.