The purpose of this study was to evaluate the treatment results of preoperative brachytherapy and the prognostic value of pathologic complete remission after preoperative intracavitary irradiation in patients with stage Ib and IIa cervical carcinoma in relation to recurrence rate and survival. The clinical records of 185 patients with stage Ib (129 patients) and IIa (56 patients) cervical carcinoma, consecutively admitted to Radiumhemmet from January 1989 to December 1991 were reviewed. The median follow-up time was 71 months. In 121 patients the treatment consisted of uterovaginal intracavitary irradiation, according to the Stockholm technique, followed by surgery. Tumor remission assessed in the surgical specimen was classified as pathologic complete remission (pCR) if no microscopic tumor was found or incomplete pathologic remission (non-pCR) if microscopic residual tumor was found. Postoperative external beam radiation was added to cases with metastases in pelvic nodes or residual tumor in the resection margins. The disease-specific 5-year survival was 87% and 75% for stage Ib and IIa, respectively, for the patient population treated with preoperative intracavitary radiotherapy and surgery. After intracavitary radiation, 79% of the patients obtained pCR of the primary tumor. Five-year survival in those with pCR was 95%, compared with 46% in those with non-pCR (P < 0.0001). Patients with pCR and no lymph node metastases had a 98% 5-year survival as compared to a 5-year survival of 64% in patients with non-pCR and node negativity (P < 0.0001). Locoregional relapses were diagnosed in 2% of the patients with pCR compared to 54% in patients with non-pCR (P < 0.0001). Multivariate analysis revealed non-pCR (RR = 6.42) and node positivity (RR = 4.59) as nonfavorable factors for survival, while tumor size was not found to be of independent significance for survival. Pathologic complete remission after intracavitary irradiation is a strong favorable prognostic factor in node-negative patients. The combination of preoperative intracavitary radiotherapy and surgery results in a high cure rate and aids in identifying patients at risk for relapse who might be subject to adjuvant therapy.

PurposeThis study aims to retrospectively evaluate dosimetric parameters calculated as biological effective dose in relation to outcome in patients with cervical cancer treated with various treatment approaches, including radiotherapy with and without surgery.Material and methodsCalculations of biological effective dose (BED) were performed on data from a retrospective analysis of 171 patients with cervical carcinoma stages IB-IIB treated with curative intent, between January 1989 and December 1991. 43 patients were treated only with radiotherapy and 128 patients were treated with a combination of radiotherapy and surgery. External beam radiotherapy was delivered with 6-21 MV photons from linear accelerators. Brachytherapy was delivered either with a manual radium technique or with a remote afterloading technique. The treatment outcome was evaluated at 5 years.ResultsThe disease-specific survival rate was 87% for stage IB, 75% for stage IIA and 54% for stage IIB, while the overall survival rates were 84% for stage IB, 68% for stage IIA and 43% for stage IIB. Patients treated only with radiotherapy had a local control rate of 77% which was comparable to that for radiotherapy and surgery patients (78%). Late complications were recorded in 25 patients (15%). Among patients treated with radiotherapy and surgery, differences in radiation dose calculated as BED10 did not seem to influence survival. For patients treated with radiotherapy only, a higher BED10 was correlated to a higher overall survival (p = 0.0075). The dose response parameters found based on biological effective dose calculations were D50 = 85.2 Gy10 and the normalized to total dose slope of the dose response curve γ = 1.62 for survival and D50 = 61.6 Gy10 and γ = 0.92, respectively for local control.ConclusionsThe outcome correlates with biological effective dose for patients treated with radiation therapy alone, but not for patients treated with radiotherapy and surgery. No correlations were found between BED and late toxicity from bladder and rectum.

No abstract

No abstract

17059 Background: To determine if lung cancer irradiation (RT) induces myocardial damage. Methods: Patients undergoing definitive RT with > 10% incidental cardiac RT (>30 Gy) were evaluated pre-RT and at 2 and 6 mos post-RT FUs. They underwent gadolinium enhanced cardiac MRI and rest-SPECT. The mean cardiac (MCD) and left ventricular (MLVD) doses were calculated on the dose planning CT. Data on confounding factors, e.g. diabetes, smoking, and levels of TGF-B, plasma glucose/fats were collected. The MRIs were analyzed for reductions in stroke volume (SV), ejection fraction (EF), left ventricular mass (LVM), and for visual signs of myocardial fibrosis/damage. The severity of SPECT-changes were analyzed with the semiquantitative summed rest score (SRS)-method (16-segments) and the extent was further quantified with the Bull’s-eye-view technique as volume-% (cutoff level for 1.5 SD below the mean). The Wilcoxon Matched Pairs test was used to study changes in repeated measurements. To test variable relation the Pearson’s Correlation Coefficient was calculated. Results: Presently, 13/30 patients are evaluated after their first FU. There was a limited decrease in LVM at first FU compared to pre-RT (median change: −6 g; P = 0.02), but no changes in SV or EF. The correlation coefficient for MCD (range: 2–32 Gy) (MLVD: 1–36 Gy) and MRI-reductions in SV, EF, and LVM at 2 mos were −0.46 (−0.27), −0.22 (−0.1), −0.30 (−0.12), respectively (P-values > 0.05). On rest-SPECT, a clinically significant SRS-increase was evident in one patient (SRS: +13; extent of defect 19%) at 2 mos. A new, extra cardial mass was, however, evident in this patient which would cause attenuation. No myocardial fibrosis/damage was detected on visual inspection of the MRIs. There was no increase in S-troponin levels at the first FU. Conclusions: At this stage of our study, no cardiac changes were evident following lung RT. This contrasts against studies in breast cancer RT were SPECT-defects corresponding to the tangential beams have been reported. RT-induced chest wall damage could in our series explain new SPECT-defects in one patient, who had no structural changes on MRI. Our entire cohort should be evaluated after both planned post-RT FUs before definitive conclusions can be drawn concerning cardiac damage and lung cancer RT. No significant financial relationships to disclose.