Search

Objective: Today, respiratory movement can be monitored and recorded with different methods during a simulation on a four-dimensional (4D) computed tomography (CT) device to be used in radiotherapy planning. A synchronized respiratory monitoring system (RPM) with an externally equipped device is one of these methods. Another method is to create 4D images of the patient's breathing phases without the need for extra equipment, with an anatomy-based software program integrated into the CT device. Our aim is to compare the RPM system and the software system (Deviceless) which are two different respiratory monitoring methods used in tracking moving targets during 4D-CT imaging and to assess their clinical usability., Methods: Ten patients who underwent paraaortic nodal irradiation were enrolled. The simulation was performed using intravenous contrast material on a 4D-CT device with both respiratory monitoring methods. The right/left kidneys and renal arteries were chosen as references to evaluate abdominal organ movement. It was then manually contoured one by one on both sets of images. The images were compared volumetrically and geometrically after rigid reconstruction. The similarity between the contours was determined by the Dice index. Wilcoxon test was used for statistical comparisons., Results: The motion of the kidneys in all three directions was found to be 0.0 cm in both methods. The shifts in the right/left renal arteries were submillimetric. The Dice index showed a high similarity in both kidney and renal artery contours., Conclusion: In our study, no difference was found between RPM and Deviceless systems used for tracking and detection of moving targets during simulation in 4D-CT. Both methods can be used safely for radiotherapy planning according to the available possibilities in the clinic., Competing Interests: No conflict of interest was declared by the authors., (© Copyright 2024 by Istanbul Provincial Directorate of Health.)

Objective: There are a limited number of studies supporting vaginal brachytherapy boost to external beam radiotherapy in the adjuvant treatment of cervical cancer. The aim of this study was to assess the impact of the addition of vaginal brachytherapy boost to adjuvant external beam radiotherapy on oncological outcomes and toxicity in patients with cervical cancer., Methods: Patients treated with post-operative external beam radiotherapy ± chemotherapy ± vaginal brachytherapy between January 2001 and January 2019 were retrospectively evaluated. The treatment outcomes and prognostic factors were analyzed in patients treated with external beam radiotherapy with or without vaginal brachytherapy., Results: A total of 480 patients were included in the analysis. The median age was 51 years (range 42-60). At least two intermediate risk factors were observed in 51% of patients, while 49% had at least one high-risk factor. The patients in the external beam radiotherapy + vaginal brachytherapy group had worse prognostic factors than the external beam radiotherapy alone group. With a median follow-up time of 56 months (range 33-90), the 5-year overall survival rate was 82%. There was no difference in 5-year overall survival (87% vs 79%, p=0.11), recurrence-free survival (74% vs 71%, p=0.49), local recurrence-free survival (78% vs 76%, p=0.16), and distant metastasis-free survival (85% vs 76%, p=0.09) rates between treatment groups. There was no benefit of addition of vaginal brachytherapy to external beam radiotherapy in patients with positive surgical margins. In multivariate analysis, stage (overall survival and local recurrence-free survival), tumor histology (recurrence-free survival, local recurrence-free survival and distant metastasis-free survival), parametrial invasion (recurrence-free survival and distant metastasis-free survival), lymphovascular space invasion (recurrence-free survival), and lymph node metastasis (distant metastasis-free survival) were found as negative prognostic factors., Conclusion: Adding vaginal brachytherapy boost to external beam radiotherapy did not provide any benefit in local control or survival in patients with cervical cancer., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Ganglioneuroblastomas (GNBs) are rare embryonic neoplasms in the spectrum of neuroblastic tumours and 80% of cases occur in the first decade. In adults, GNBs are usually located in the retroperitoneum, mediastinum and neck but intracranial GNBs are extremely rare., Case Report: A 34-year-old male applied to the Department of Neurology outpatient clinic with a two month history of headache and numbness in his legs. Detailed examinations and cranial CT were performed and showed a mass with a 5 cm diameter running from the third to the fourth ventricle. Referral to a neurosurgeon was performed for partial removal of the tumour, as the histological and immunohistochemical studies defined the diagnosis of GNB. Three months later, when the patient experienced dizziness, an MRI was performed, which showed a 4×3 cm ventricular mass, with hypointense characterisation in T1-weighted and hyperintense characteristics in T2-weighted and flair sequences. Afterwards, fractioned radiotherapy (54 Gy/30 fx) was chosen as the appropriate therapy. In the follow-up period, MRI was performed 3 months and 1 year after treatment, and revealed shrinkage of the tumour by at least 50%. Meanwhile the patient's post-irradiation course was favourable., Conclusion: Data following the use of radiotherapy as treatment for intracranial GNB showing favourable results has been reported.

Purpose: To evaluate the role of postoperative radiotherapy (RT) in local control and survival and to identify treatment-related prognostic factors in uterine sarcomas., Methods: Sixty patients with uterine sarcomas treated with postoperative RT were retrospectively analyzed. Median age was 49.5 years (range 24-78). The stage distribution was as follows: stage I: 60%, II: 11.7%, and III: 28.3%. All patients were treated with pelvic irradiation (dose range 45.6-54.6 Gy). Pelvic control (PC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were calculated. Age, stage, histology, tumor size, type of surgery, residual disease, time interval between surgery and RT were selected as possible prognostic factors for PC and OS. Age, total treatment time, pelvic dose, dose per fraction, and acute side effects were analyzed as probable prognostic factors for late complications., Results: Median follow-up was 84 months. The 10-year PC, DMFS, DFS and OS rates were 84, 67.3, 64 and 61.5%, respectively. Univariate analysis showed that age, residual disease, type of surgery and stage were significant factors for PC; residual disease, type of surgery and stage were significant factors for DMFS; stage was found as the only significant factor for DFS and OS. Total treatment time, pelvic dose, dose per fraction, and acute side effects were significant factors for late complications., Conclusion: Although our results suggest improved PC, the role of postoperative RT should be tested in prospective randomized trials.

Objective: To evaluate the impact of the presence of laryngeal edema on outcome and the other potential prognostic factors in patients with supraglottic larynx carcinoma treated with radiotherapy after partial laryngectomy., Design: A retrospective analysis., Setting: Cerrahpaşa Medical Faculty, Istanbul University., Methods: Seventy-nine patients with supraglottic carcinoma of the larynx were treated with radiotherapy after partial laryngectomy between January 1980 and July 2003. Neck dissection was not performed in 46 patients. The median follow-up time was 64 months., Main Outcome Measures: The effect of laryngeal edema grade on local control, disease-free, and actuarial survival rates., Results: The 5-year locoregional progression-free and overall survival rates were 86% and 75%, respectively. In univariate analysis, histologically positive neck disease reduced regional (p = .0045) and disease-free survival (p = .01). Patients with edema grade III-IV had lower local control (p = .0004), disease-free (p = .0034), and actuarial survival (p = .0041) rates. In the multivariate analysis, a significant negative association of laryngeal edema with local control (p = .012), disease-free survival (p = .002), and actuarial survival (p = .003) was found. Nodal status was a significant prognostic factor for disease-free survival (p = .027). Grade III-IV laryngeal edema was observed in 17 patients. Owing to laryngeal edema, tracheostomy dependence and total laryngectomy were required in three patients and one patient, respectively., Conclusion: Radiotherapy after partial laryngectomy can be performed in patients with poor prognostic factors with reasonable complication rates. However, in the presence of grade III-IV laryngeal edema, tumour recurrence should be suspected, and these patients have to be managed with close follow-up and further evaluation to improve outcome.

Malignant mixed müllerian tumors (MMMT) are highly aggressive tumors, usually diagnosed in advanced stage. Cases of MMMT derive from either ovary or uterus. In our study, we investigated the role of carcinomatous and sarcomatous component on response to chemotherapy and disease outcome. We retrospectively analyzed 25 patients with MMMT who were treated in our outpatient clinic from 1998 to 2003. All the paraffin specimens were reevaluated according to the histopathologic features (primary site and percentages of carcinomatous and sarcomatous component) and the effect of predominant histologic type on response to treatment. Primary tumor sites were ovary and endometrium in 36% and 64% of patients, respectively. Ten of 25 patients (40%) were treated with a combination chemotherapy regimen of cisplatin-ifosfamide (PI) and 7 patients (28%) were treated with paclitaxel-carboplatin (PC) protocol. Despite chemotherapy, 17.6% of patients had progressive disease. The remaining 13 patients (54.2%) responded to chemotherapy. Response rates of patients treated with PC (100%) were remarkably higher than the response rates of patients treated with PI (66.6%). Moreover, patients with predominating carcinomatous component had a higher response rate (87.5%) than patients with predominating sarcomatous component (66.6%). MMMT are highly chemoresponsive tumors, irrespective of primary site. One of the best predictors to response is the histologic pattern. Predominating histopathologic feature (carcinoma or sarcoma) should be taken into consideration in predicting the response and planning the chemotherapy regimen.

We report the case of a patient who underwent laparoscopic removal of a retained surgical spatula two months after a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. The foreign body was detected on a routine radiograph while the patient was been prepared for radiotherapy. Laparoscopy allowed us to explore the entire abdominal cavity for any potential complications of the retained instrument, and the procedure was completed successfully. This case demonstrates the feasibility of using a minimally invasive technique in the removal of a retained foreign body.

Background: Paranasal sinus metastasis following endometrial carcinoma is extremely rare and a reflection of disseminated disease., Case: We report a case of a 72-year-old woman who presented ethmoid and sphenoid sinus metastasis, 14 months after total abdominal hysterectomy and bilateral salpingo-oophorectomy due to an endometrial clear cell carcinoma., Conclusion: One should recognize the possibility of a metastatic disease to the sinuses in patients presenting with associated symptoms.

Purpose: Intrauterine tandem placement can be difficult in brachytherapy for cervical cancer. A prospective study was planned to investigate transvaginal ultrasound (TVU) guidance for intrauterine tandem insertions in the treatment of cervix cancer., Methods and Materials: Between January 1997 and January 2002, TVU was used after pelvic external beam radiotherapy in 48 cervical cancer patients with a high complication risk because the cervical canal orifice could not be identified and/or the patients could not undergo hysterometry. The TVU findings were graded as 1-4, with a higher number indicating greater difficulty in implantation. The tandem was inserted using the guidance of the TVU findings. Tandem application difficulties were graded in accordance with the number of implantation trials. The relations between tandem applicability and possible factors were analyzed., Results: By TVU, the difficulties in tandem insertion were graded as Grade 1 in 5 cases, Grade 2 in 23 cases, Grade 3 in 17 cases, and Grade 4 in 3 cases. The tandem was inserted in 19 patients on the first try, 12 patients on the second try, 12 patients on the third try, and 2 patients on the fourth try. However, the cervical canal could not be opened in 3 patients. Factors such as median age, stage, chemotherapy, diameter of the tandem applicators, time between external beam radiotherapy and brachytherapy, and the rate of tumor regression were not statistically significant. The ultrasound grade (p = 0.02) and diameter of the tandem applicator (p = 0.007) were statistically significant. Perforation and sepsis were not observed., Conclusion: TVU guidance before brachytherapy has a positive contributory effect in reducing the morbidity rate of patients considered high risk.

Clinicopathologic features of 21 patients with T-cell-rich B-cell lymphoma (TCRBCL) were reviewed and compared to 43 patients with diffuse large B-cell lymphoma (DLBCL) to determine if there were distinguishing clinical characteristics and differences in response or survival to CHOP therapy. For the diagnosis of TCRBCL, the current WHO criteria was used. In all of our cases, the majority of cells are non-neoplastic T cells and <10% large neoplastic B cells are present. The initial pathologic diagnosis was nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) in two cases. Patients with TCRBCL were significantly younger (median: 46 years) and had a significantly higher incidence of B symptoms (62%), hepatomegaly (33%) and marrow infiltration (33%) at presentation when compared to DLBCL (P<0.03). The CR rate after treatment was 48% for TCRBCL patients versus 79% for the DLBCL (P<0.003). Although the CR rates in between the two groups are significant, the difference in 3 years survival rates in each CR groups was insignificant (80% versus 77%). The overall survival time in the two groups was 17 months. Event-free survival time in TCRBCL was 12 months, compared with 17 months in the DLBCL (P>0.05). The frequency of patients with TCRBCL achieving CR was 52.6% whereas that of patients with DLBCL was 79% (P<0.003). The TCRBCL 3 years event-free survival 48% and overall survival 64% were 63 and 72% for DLBCL, respectively.

Purpose: To evaluate the results and complications of treatment with high dose rate (HDR) compared to low dose rate (LDR) brachytherapy in cervical carcinoma., Methods: Three hundred and seventy patients who were treated with external irradiation and intracavitary brachytherapy and followed for more than 2 years between 1978 and 1998 have been recently updated. The low dose rate group consisted of 77 cases treated between 1978 and 1982 and HDR group consisted of 293 cases treated between 1982 and 1998. All patients first received external irradiation with 60Co or 9-18 MV photons and a median dose of 54 Gy was given in 6 weeks. In the LDR group, intracavitary treatment was given with Manchester applicators loaded with radium (30 mg) in an intrauterine tube and 20 mg in vaginal ovoids. The dose delivered to point A was on average 32 Gy in one application. In the HDR group, a total dose of 24 Gy was given to point A in three insertions 1 week apart. The dose rate was 0.62 Gy at point A., Results: The 5-year pelvic control rate was found to be 73% in the HDR group, compared with 86% in the radium group for stage I cases. In stage IIB and IIIB cases, the rates were 68% and 45% for HDR and 65% and 53% for LDR, respectively. In all stages, there was no statistical difference in pelvic control and survival rates between the two groups. Overall incidence of late complications was found as 31.1% and 31.9% in HDR and LDR groups, respectively. The grade 2-4 late complication rate was 14% in the HDR group compared to 19% in the LDR group (P>0.05)., Conclusion: HDR brachytherapy in the management of the cervix appears to be a safe and efficacious approach. Pelvic control, survival and complications rates are quite similar when compared with LDR.

Background: Although metastasis to bone is common in solid tumors, it seldom occurs in endometrial carcinoma. It is usually seen together with abdominopelvic recurrences and/or other organ metastases. Furthermore, bone metastases involving only the lower limbs are seen extremely rare., Case: 67-year-old woman was referred for a vaginal recurrence from endometrial carcinoma. Pelvic irradiation and intracavitary brachytherapy failed to control the disease. Subsequently, she was presented with swelling of her left foot resembling an abscess, and bone scan revealed an increased uptake in both lower extremities below the knees. Furthermore, biopsy showed metastatic disease. She died 2 months after palliative irradiation with progressive disease., Conclusion: It should be remembered that bone metastasis at unusual sites might be seen in endometrial carcinoma., (Copyright 2001 Academic Press.)

Purpose: To evaluate treatment results and prognostic factors, pediatric patients with nasopharyngeal carcinoma were reviewed., Materials and Methods: Thirty-two patients at the age of 16 and younger were treated for nasopharyngeal carcinoma. One patient had WHO type I, 15 had WHO type II, and 14 had WHO type III histology. All patients were treated with radiotherapy, median dose to nasopharynx and involved nodes was 70 Gy (range 60-70.4 Gy), three patients received intracavitary booster dose of 24 Gy in three fractions, 12 patients were also given from two to four courses of platinum based neo-adjuvant chemotherapy., Results: Twenty-three patients are alive and well with a median follow-up of 107 months. Ten and 15 years loco-regional control (LRC) and overall survival (OS) rates were 82.5, 68.7 and 72.7, 62.4%, respectively. Patient age, size of the lymph node and prolongation of overall external radiotherapy time were found to be the prognostic factors in univariate analysis, however the only factor remained significant after multivariate analysis was the size of the lymph node on LRC. Almost all long-term survivors experienced moderate to severe complications yielding complication free survival rate of 10.9% at 15 years.

Introduction: The present study was planned to research the effects of fibrin glue on irradiated colonic anastomoses., Method: The effect of fibrin glue on irradiated colonic anastomoses was investigated in four identical groups of rats. In Group I (control group) colonic anastomoses were performed without radiotherapy; in Group II, colonic anastomoses were performed five days after radiotherapy; in Group III, fibrin glue was applied to anastomotic line without radiotherapy; in Group IV, fibrin glue was applied to anastomotic line with radiotherapy. The healing of left colonic anastomoses was evaluated through the bursting pressure of the anastomotic segment and the hydroxyproline contents of the anastomosis., Results: Measurements done on the fourth postoperative day revealed that anastomotic healing was impaired in rats that underwent radiotherapy (P < 0.001); fibrin glue had no effect on anastomotic healing in groups with or without radiotherapy., Conclusion: In the early phases of anastomotic healing, fibrin glue cannot help remove unwanted effects of preoperative radiotherapy.

This paper presents long-term results of a randomised study of ornidazole as a radiosensitiser in locally advanced carcinoma of the cervix. A total of 76 patients were randomised and followed-up with a median of 85 months. All patients were treated with external and intracavitary irradiation. The 10 year actuarial local control rate was 61% in patients receiving ornidazole, compared with 50% for placebo group. This difference was not statistically significant. Ten year actuarial overall and disease-free survival rates were also similar in the two treatment groups. Although, when analysed by stage, there was a significant advantage in the local control (54% vs 15%; P = 0.044) and disease-free survival rates (37% vs 8%; P = 0.047) in ornidazole group for stage IIIB cases, its implication is obscure because of the small number of patients. In this study moderate and severe complication rates were found to be 30%. These results suggest that ornidazole seems to have relatively weak sensitisation and it may show a possibility of a marginal benefit with unconventional irradiation using relatively large radiation doses. However, the results are insufficient for a real gain in the probability of local tumour control and survival.

In order to assess the role of postoperative radiotherapy and prognostic factors, 126 patients who were treated with radiotherapy after surgery for clinical early-stage carcinoma of the cervix were reviewed. All patients received external pelvic radiotherapy and 37 patients were treated with additional vaginal cuff irradiation. The 5-year overall survival, disease-free survival and locoregional control rates were 71.1, 69.9 and 78.1%, respectively. The 5-year disease-free survival rates were 40% for grade 3 vs. 75.4% for grade 1 tumours (p = 0.05), 76.5% for pathological stage IB versus 54.1% for pathological stage IIA (p = 0.04), 36.6% for node-positive patients versus 82.5% for node-negative patients (p = 0.0017), 54% for full thickness cervical invasion versus 100% superficial cervical invasion (p = 0.01), 34.8% for positive margins versus 78.1 for negative margins (p < 0.0001). After a multivariate analysis, tumour grade (p = 0.026) and presence of positive margins (p = 0.006) were found to independently influence the outcome. Grade II and III complication rate was 5.5% in all patients. In conclusion, postoperative radiotherapy should be used in patients treated with simple hysterectomy as well as those treated with radical hysterectomy with unfavorable pathological findings.