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János Fodor

Publications and source records attributed to János Fodor.

At least 19 recordsLinked to original sources
PubMed2006

Dosimetric comparisons between high dose rate interstitial and MammoSite balloon brachytherapy for breast cancer.

BACKGROUND AND PURPOSE: To make a quantitative dosimetric comparison between treatment plans of multicatheter-based interstitial brachytherapy (IB) and MammoSite brachytherapy (MSB) for breast cancer. PATIENTS AND METHODS: Seventeen patients treated with IB and twenty-four with MSB were selected for the study. The irradiations for IB patients were planned using conventional two-film reconstruction technique. Following the implantation each patient was CT scanned, then the planning target volume (PTV) was retrospectively defined on the CT data set, and the original plan was reconstructed (CONV plans). Furthermore, conformal plans were also created by dose optimization on target (CONF plans). The planning for MammoSite applicator was based on CT imaging. The dose distributions were evaluated with dose-volume histograms. The following parameters were calculated and compared: volume of the PTV and its percentage receiving 90, 100, 150 and 200% of the prescribed dose (V90, V100, V150 and V200, respectively), percentage dose covering 90% of the PTV (D90), minimum dose in the PTV (D(min)), maximum dose in the PTV (D(max)) for MSB only, dose homogeneity index (DHI), and conformal index (COIN). To assess the dose to organs at risk maximum point dose to skin, lung and heart was used. RESULTS: The median number of implanted catheters for IB was 11 (range: 6-13), the average balloon volume for MSB was 59.1cm(3) (range: 43.4-75.3 cm(3)). The average volume of PTV was 63.4 and 109.6 cm(3) for IB and MSB patients, respectively. The average V90, V100, V150, V200 were 76, 70, 26 and 9% for IB(CONV); 92, 87, 55 and 32% for IB(CONF) and 96, 88, 27 and 3% for MSB, respectively. The average D90 was 72, 94 and 99%, the D(min) was 47, 58 and 67%, respectively. The mean D(max) was 258% for MSB. The average DHI was 0.63, 0.37 and 0.70 for IB(CONV), IB(CONF) and MSB, respectively. D(max) to skin, lung and heart were 45, 54 and 31% for IB(CONV), 50, 55 and 29% for IB(CONF,) 97, 66 and 27% for MSB, respectively. CONCLUSIONS: Target volume coverage was better for MSB than conventional IB, and it was comparable to conformal IB. The suboptimal coverage for IB patients is due to radiography based planning, which is unable to provide 3D information of the target. Dose homogeneity was somewhat better for MSB than IB(CONV), but the dose to skin and lung was higher for MSB. The MSB provides dosimetrically acceptable dose plans. The quality of interstitial implants can be improved with image-guided catheter insertions regarding both homogeneity and conformality.

Brachytherapy↗
PubMed2006

[Interactions between radiation and hormonal therapy in breast cancer: simultaneous or sequential treatment].

BACKGROUND: Combining radiation and hormone therapy (administration of selective estrogen receptor modulators) has become common clinical practice in recent years for receptor positive breast cancer. Little is known about a possible interaction of both treatment modalities if they are given simultaneously. Tamoxifen (antiestrogen molecule, triphenylethylene derivative) may theoretically render cancer cells less responsive to radiotherapy arresting hormone-receptor-positive cells in G0/G1 phase and increase the risk of breast and lung fibrosis stimulating the secretion of transforming growth factor beta in human fibroblasts. PURPOSE: This article reviews the published data to assess the impact of sequencing of hormonal and radiation therapy on outcomes in breast cancer. METHODS: Computerised searches for publications debating the sequencing of hormonal therapy relative to radiation therapy were done using MEDLINE data. RESULTS: Results of tamoxifen experiments with cell culture regarding radioprotection of tumour clonogens are conflicting. In contrast to in vitro results, in animal studies no protective effect of tamoxifen was observed. In one in vitro study, letrozole (non-steroid selective aromatase inhibitor) had a radiosensitizing effect on breast-cancer lines. No randomised clinical trials to date have studied sequencing of tamoxifen or other selective estrogen receptor modulators and radiotherapy. Results from retrospective clinical studies which included treatment arms with and without tamoxifen showed reduction in tumour recurrence with tamoxifen. Some of these studies have noted increased risk of lung and breast fibrosis with tamoxifen with radiotherapy. Results of three articles examined the effect of tamoxifen sequence showed no adverse effect on local control or survival in sequential versus concurrent tamoxifen and radiation patients. One of the three studies also assessed the risk of complications with respect to the timing of tamoxifen with radiotherapy. There was no difference in the rates of complications between the two groups. The association of radiation and selective aromatase inhibitors or aromatase inactivators has not been addressed in clinical studies. CONCLUSIONS: Combined application of tamoxifen and radiotherapy improves survival and local control in breast cancer. Available clinical studies do not indicate that the simultaneous application of tamoxifen and radiotherapy is disadvantageous, as was suggested by some of the in vitro studies. The risk of subcutaneous breast and lung fibrosis might be slightly increased if tamoxifen is given simultaneously with radiotherapy. Both treatment modalities should be started early after surgery. There is no sufficient evidence to withhold tamoxifen administration during irradiation of breast cancer. The issue of optimal sequencing of hormonal and radiotherapy should be addressed in randomised clinical trials.

Animals↗
PubMed2006

Angiosarcoma after conservation treatment for breast carcinoma: our experience and a review of the literature.

The development of angiosarcoma of the breast is a recognized complication of breast conservation therapy (BCT), but the evolution, prevalence, and outcome have not been accurately established. We sought to evaluate and review the clinicopathologic, prognostic, and treatment attributes of angiosarcoma arising in the irradiated breast after BCT. We conducted a retrospective chart and slide review of 8 patients seen between 1996 and 2004 with a diagnosis of secondary angiosarcoma. All were treated with mastectomy. Clinical and histopathologic findings were studied and previously reported cases were reviewed. Primary surgery-related breast edema and cellulitis was observed in 7 and 5 patients of the 8 patients studied, respectively. Postirradiation breast edema and grade 2/3 fibrosis occurred in 5 and 8 patients, respectively. The mean age of the patients at onset of the breast cancer and angiosarcoma was 65 and 72 years, respectively. The mean latency period between the treatment of the breast cancer and the diagnosis of angiosarcoma was 75 months. The actuarial rate of 2-year survival for patients presented with single (n = 4) compared with multiple (n = 4) skin lesions was 50% and 0%, respectively (P = .0233). The estimated incidence of angiosarcoma after BCT was found to be 0.14 %. BCT-associated angiosarcoma arises after a relatively brief interval, and breast edema-fibrosis can possibly contribute to its development. Special attention should be paid to skin changes occurring after BCT. The extent of skin lesions is predictive of survival. As shown by a review of the literature, angiosarcomas are often resistant to surgery, chemotherapy, and radiotherapy, and targeted therapy against tumor biological properties may be a new approach to angiosarcoma treatment.

Aged↗
PubMed2005

[Local relapse in young (< or = 40 years) women with breast cancer after mastectomy or breast conserving surgery: 15-year results].

PURPOSE: Data from various sources indicate that after breast conserving surgery (BCS), younger patients have a high risk of local relapse, but there is insufficient evidence about the risk of post-mastectomy local recurrence. This study investigates the risk of local recurrence for young (< or = 40 years) patients treated with either conservative or radical surgery, with or without radiotherapy (RT). METHODS: 148 young (< or = 40 years) women with early invasive breast cancer underwent axillary dissection and mastectomy (n = 92) or BCS (n = 56) between January 1983 and December 1997. When adjuvant RT was given, the median dose was 50 Gy. The risk factors of local recurrence were estimated by uni- and multivariate analysis. RESULTS: At a median follow-up time of 199 months 60 (40.5%) women died of breast cancer. The type of surgery (mastectomy vs. wide tumour excision) had no significant impact on breast cancer-specific survival. The crude rate of local relapse for nonirradiated mastectomy and BCS patients was 24% and 75% (p = 0.0041), and for irradiated patients 4% and 23%, respectively (p = 0.0091). After mastectomy in univariate analysis nodal status (negative vs. positive) and RT (no vs. yes) were significant predictors of local control, but tumour size (T1 vs. T2) and histological grade (1-2 vs. 3) were not. In multivariate analysis both nodal involvement and omission of RT remained independent significant negative predictors of local control. After BCS in univariate analysis extensive intraductal component (EIC, negative vs. positive) and RT (no vs. yes) were significant predictors of local control, but tumour size (T1 vs. T2), nodal status (N0 vs. N1) and histological grade (1-2 vs. 3) were not. In multivariate analysis omission of RT and presence of EIC remained independent significant negative predictors of local control. The 15-year actuarial rate of local relapse was 29% for irradiated, and 75% for nonirradiated BCS patients (RR, 0.21; 95% CI, 0.07-0.55; p = 0.0052). The 15-year actuarial rate of local recurrence was 6% for irradiated, and 46% for nonirradiated node-positive mastectomy patients (RR, 0.12; 95% CI, 0.06-0.96; p = 0.0095). CONCLUSION: The incidence of local recurrence is high for young patients treated either with BCS or mastectomy, and RT significantly reduces the risk. The use of postmastectomy RT in node-positive patients gives a good local control. The efficacy of BCS and RT as a treatment modality for young patients needs further investigations.

Actuarial Analysis↗
PubMed2005

[Lens-sparing external beam radiotherapy of periocular lymphomas].

PURPOSE: The presentation of techniques and results of lens-sparing external beam radiotherapy of patients with ophthalmologic lymphomas. MATERIAL AND METHODS: From 1991 to 2001, at the Department of Radiotherapy of the National Institute of Oncology, Budapest, 92 patients with periocular lymphomas were treated by photon and/or electron beam irradiation depending on the localization. Mean age was 63 years (range: 26-89 years) and the male/female ratio was 1.3. According to the Ann Arbor classification, 72% were in stage I.E. Histologically 85 patients (92.4%) were Grade I while 7 patients (7.6%) presented with higher grade disease. In case of low-grade lymphoma, a dose of 24-32 Gy was delivered, and for higher grade of malignancy we applied 34-40 Gy total dose, using 1.8-2 Gy daily fractions. RESULTS: The local remission rate was 94.4% (CR: 78.8% and PR: 15.6%). There was no change in 2.3%, and 3.3% showed progression. Mild and intermediate acute side effects occurred in 28%, and the incidence of chronic late complications was 3%. CONCLUSION: External beam radiotherapy applying lens-sparing methods is safe and effective in the treatment of periocular lymphomas.

Adult↗
PubMed2005

[Dosimetric assessment of external treatment plans for breast cancer: the significance of dose prescription selection].

PURPOSE: To analyze the treatment plans of breast irradiation performed with two tangential beams, to discuss the importance of dose prescription, and to estimate the differences in delivered dose due to various dose prescription methods. MATERIAL AND METHODS: A survey was performed between the Hungarian radiotherapy centers in order to compare the dose prescription methods. Then, treatment plans of 125 breast cancer patients treated in our department were evaluated. The irradiations were performed with cobalt unit, and with 6 and 9 MV photon beams of linear accelerators. The dose distributions were normalized to izocenter, then dose values in five points in central plane; local medial, lateral and central maximums (D(med), D(lat) and D(cent)); volumetric maximum and its location were determined. To characterize the dose to lung and to heart at left-sided tumors the central lung distance (CLD) and maximum heart distance (MHD) were used. Based on the results, estimation was made to assess the differences between delivered dose due to various dose prescriptions applied at the institutions. RESULTS: Four types of dose prescription are currently used in our country, and most frequently the isocenter is selected as a reference point. In the central plane the calculated dose in all but one points differed only a little from the dose to isocenter. The mean D(med), D(lat) and D(cent) were 107%, 107% and 101%, respectively. The volumetric maximum was on average 13% higher than the dose to isocenter. Regarding the beam qualities, this value was 16%, 13% and 11% for cobalt unit, 6 MV and 9 MV photon beams, respectively. The mean CLD and MHD were 1.9 and 0.8 cm, respectively. The difference between delivered doses at the institutions was 6% on average, but in extreme cases it can be as high as 20%. CONCLUSIONS: Three-dimensional treatment planning and plan evaluation are recommended at breast irradiation, especially for large breasts. Since the various dose prescriptions may result in significant differences in the delivered doses, use of a standard dose prescription protocol is recommended.

Adult↗
PubMed2005

[Teletherapy versus teletherapy and "boost" brachytherapy in the treatment of base of tongue tumors: 5-year results].

AIM: To study the importance of high-dose-rate (HDR) boost brachytherapy (BT) after percutaneous irradiation of base of tongue tumors. METHODS: Between 1992 and 2000 seventy patients with biopsy proven carcinoma of the base of tongue were treated with primary radiation therapy. Fourty patients received a mean dose of 61 Gy (range, 50-72 Gy) external beam irradiation, and afterwards 30 patients were treated with a mean dose of 18 Gy (range, 12-30 Gy) boost HDR BT. Prognostic factors were analyzed in uni- and multivariate model. RESULTS: At a median follow-up of 56 (16-108) months, boost BT increased the incidence of local tumor control (LTC) from 38% to 67% (p=0.0145). The 5-year probability of LTC was 60% vs. 36% (p=0.0188), the locoregional tumor control 52% vs. 34% (p=0.0753) and the overall survival (OS) 46% vs. 26% (p=0.0545), respectively, in favor of the boost group. Serious, grade 4 radiation toxicity occurred in 5% (2/40) and 13% (4/30) without or with boost treatment, respectively (p=0.2110). In multivariate analyses for LTC, tumor size (p=0.0042) and boost (p=0.0444), and for OS tumor size (p=0.0047) and nodal status (p=0.0163) had a significant effect. CONCLUSION: Boost BT after teletherapy improves LTC significantly without considerable increase in the risk of side-effects.

Adult↗
PubMed2005

Evaluation of HDR interstitial breast implants planned by conventional and optimized CT-based dosimetry systems with respect to dose homogeneity and conformality.

BACKGROUND AND PURPOSE: Recently, the use of brachytherapy for partial breast irradiation has increased significantly. The aim of this study was to make dosimetric comparisons between conventional (CONV) and CT-based optimized dosimetry systems applied to breast implants. PATIENTS AND METHODS: 17 patients treated with high-dose-rate (HDR) interstitial brachytherapy were selected for the study. Two patients had two-plane and 15 three-plane implants. Treatment planning was based on conventional two isocentric radiographs and dose point optimization (CONV). For each patient postimplant CT scans were taken, and the target volume (lumpectomy cavity with 1 cm margin) was outlined in all axial slices. The treatment planning was repeated using CT images. The dose distributions were analyzed by dose-volume histograms. To quantify the dose distributions, volume (V90, V100, V150, V200) and dose (D90, D(min), mean central dose [MCD]) parameters, along with the dose nonuniformity ratio (DNR), dose homogeneity index (DHI), external volume index (EI) and conformal index (COIN) were used. For each implant, three more virtual treatment plans were created using the Paris dosimetry system (PDS), geometrically optimized system (GOS) and conformal system (CONF). Dose and volume parameters were calculated and compared. RESULTS: The median number of catheters amounted to ten (range: 6 to 13) and the average volume of planning target volume to 63.4 cm(3) (range: 17.7-122 cm(3)). The mean target coverage was 70%, 61%, 57% and 87%; the D90 72%, 64%, 60% and 94%; the DNR 0.35, 0.25, 0.25 and 0.55; the EI 0.62, 0.54, 0.08 and 0.15; the COIN 0.40, 0.34, 0.50 and 0.74 for the CONV, PDS, GOS and CONF systems, respectively. CONCLUSION: With CT-based optimized dose planning the target coverage can be significantly increased compared to the conventional dosimetry systems, but the target dose distribution will be more inhomogeneous. To improve the quality of brachytherapy implants, the image-based three-dimensional information should be used not only for dose plan evaluation, but also previously, for planning the geometry of the catheter positions and performing the insertions.

Brachytherapy↗
PubMed2004

High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: seven-year results of a comparative study.

PURPOSE: To report the 7-year results of a prospective study of accelerated partial breast irradiation (APBI) using interstitial high-dose-rate brachytherapy and compare the treatment results with those achieved by standard, whole breast radiotherapy (WBRT), with or without a tumor bed boost (TBB). METHODS AND MATERIALS: Between 1996 and 1998, 45 prospectively selected patients with T1N0-N1mi (single nodal micrometastasis), nonlobular breast cancer without the presence of an extensive intraductal component and with negative surgical margins were treated with APBI using interstitial high-dose-rate implants. A total dose of 30.3 Gy (n = 8) and 36.4 Gy (n = 37) in seven fractions within 4 days was delivered to the tumor bed plus a 1-2-cm margin. During the same period, 80 patients, who met the eligibility criteria for APBI but who were treated with 50 Gy WBRT with (n = 36) or without (n = 44) a 10-16-Gy TBB, were selected as controls. The median follow-up for the APBI and control groups was 81 and 83 months, respectively. Local control, relapse-free survival, cancer-specific survival, late side effects, and cosmetic results were assessed. RESULTS: The crude rate of total ipsilateral breast failure was 6.7% (3 of 45), 11.4% (5 of 44), and 8.3% (3 of 36) for patients treated with APBI, WBRT, and WBRT + TBB, respectively. The differences in the 5- and 7-year actuarial rates of ipsilateral breast recurrence were not statistically significant among patients treated with APBI (4.4% and 9.0%), WBRT (4.7% and 14.8%), and WBRT + TBB (5.7% and 9.5%). No statistically significant difference in either the 7-year probability of relapse-free survival (79.8%, 73.5%, and 77.7% for APBI, WBRT, and WBRT + TBB, respectively) or cancer-specific survival (93.3%, 92.9%, and 93.9% for APBI, WBRT, and WBRT + TBB, respectively) was found. The 7-year actuarial elsewhere breast failure rate was 9.0% in the APBI group and 8.3% in the control group (p = 0.80). The rate of excellent/good cosmetic results was 84.4% in the APBI group and 68.3% in the control group (p = 0.04). The corresponding rates of asymptomatic fat necrosis were 20.0% and 20.6%. Symptomatic fat necrosis occurred in 1 patient (2.2%) treated with APBI. The incidence of Grade 2 or worse late radiation side effects was similar for both groups (26.7% vs. 28.6%). CONCLUSION: Accelerated partial breast irradiation using interstitial high-dose-rate implants, with proper patient selection and quality assurance, yields similar 7-year results to those achieved with standard breast-conserving therapy. APBI does not increase the risk of elsewhere breast failures.

Adult↗
PubMed2004

[Brachytherapy boost irradiation in the treatment of high risk, localised prostate cancer. Initial national experience in Hungary].

PURPOSE: To describe the technique and early results of ultrasound (US)-guided interstitial prostate brachytherapy (BT) introduced at our institute. MATERIALS AND METHODS: Between December 2001 and July 2002, ten patients with clinically localised, high risk prostate cancer were treated with external beam irradiation and high dose rate (HDR) BT boost at the Radiotherapy Department of National Institute of Oncology, Budapest. Using CT based treatment planning, 46 Gy was delivered to the whole pelvis and then the prostate and vesicles were treated up to a total dose of 60 Gy by conformal external beams. BT boost was given in the first four weeks of external irradiation. Nine patients were under total androgen blockade. The interstitial BT was performed in spinal anaesthesia. Steel needles were implanted into the prostate using transrectal US guidance. The Ir-192 HDR isotope was loaded into the needles by remote control after-loading equipment. Treatment planning was based on transversal ultrasound images. The target volume was the whole prostate. The median number of inserted needles was 9 (range: 5-13). The prescribed dose to the surface of the prostate was 8 or 10 Gy, and the maximum reference dose of the urethra or rectum was less than 125% and 80% of the prescribed dose, respectively. PSA (prostate specific antigen) levels and acute side effects were monitored and documented regularly. RESULTS: The prescribed treatment was completed on all patients. The median follow-up time from the completion of the radiotherapy was 6 months (range: 2-11 months). Perioperative side effects (haematuria caused by puncture of the bladder) occurred in two cases. Acute grade 2 toxicity was observed in four patients: genitourinal inflammation in 4, and proctitis in 2 cases. No PSA relapse occurred so far. CONCLUSION: In our study we described our technique of interstitial BT boost as a part of prostate radiotherapy used for the first time in Hungary. The US based treatment planning resulted in adequate dose distribution in all cases. Incidence of perioperative and acute side effects were comparable to data known from the literature. Appropriate technical background and well organised team work are needed to ensure the good quality of the treatment.

Aged↗
PubMed2004

Interstitial high-dose-rate brachytherapy in the treatment of base of tongue carcinoma.

BACKGROUND AND PURPOSE: . To date none of the studies examined the feasibility and efficacy of interstitial high-dose-rate (HDR) brachytherapy in the treatment of carcinoma of the tongue base. Therefore the aim of this study was to contribute to this issue. PATIENTS AND METHODS: . Between 1992 and 2000 37 patients (mean age 55 years) with T1-4 and N0-3 carcinoma of the base of tongue were presented. Neck dissection was carried out in twelve cases (32%). 30 patients with advanced stage received brachytherapy boost after 50-66.5 Gy (mean, 60 Gy) locoregional external beam irradiation (EBI) and 7 patients with early stage (T1-2, N0) were managed locally with wide tumor excision and sole brachytherapy. 4 of them underwent neck dissection and the others were subjected to 50 Gy regional EBI. The mean dose of boost and sole brachytherapy was 18 Gy and 28 Gy, respectively. RESULTS: . The median follow-up time for surviving patients was 51 months. The 7 sole brachytherapy patients are living with no evidence of disease. For patients treated with EBI and brachytherapy boost, the 5-year actuarial rate of local, locoregional recurrence-free and overall survival was 60%, 52% and 46%, respectively. For all patients in univariate analysis larger tumor size (T4 vs. T1-3) was significant negative predictor of local (RR: 7.23) and locoregional control (RR: 3.87), but nodal involvement was not. Delayed soft tissue ulceration and osteoradionecrosis occurred in 4 (13%) EBI and brachytherapy treated patients. None of the sole brachytherapy patients experienced severe late radiation toxicity. CONCLUSION: . EBI combined with interstitial HDR brachytherapy boost result in acceptable local tumor control with low incidence of late side effects in patients with advanced disease. Fractionated sole HDR brachytherapy following tumor excision is a feasible treatment option for patients with early stage cancer and gives excellent local results.

Adult↗
PubMed2003

[Successful treatment of a localised pancreatic cancer with radiotherapy alone: a case report].

AIM: To present a unique case of an early (T1N0M0) adenocarcinoma of the head of the pancreas, which was successfully treated with radiotherapy alone. MATERIAL AND METHOD: After the computer tomography operated histological verification the combination of interstitial high dose rate after-loading brachytherapy (18 Gy, 6 Gy/die) and percutan irradiation (46 Gy) was applied. RESULT: Fifty-two months after completion of the treatment the patient is alive with no evidence of disease. CONCLUSION: The combination of these therapeutic modalities may be an effective tool to deliver curative dose without any significant sequelae in the treatment of operable pancreatic carcinoma, when the patient's condition contraindicates surgery.

Adenocarcinoma↗
PubMed2003

[Radiotherapy and breast reconstruction: the issue of compatibility].

BACKGROUND: Breast reconstruction after mastectomy represents an improvement in the quality of life of breast cancer patients. Radiotherapy is also suggested for many of them to prevent local relapse. However, irradiation increases the risk of complications require surgical procedures. PURPOSE: This study was undertaken to analyse the compatibility of breast reconstruction and irradiation in the treatment of breast cancer. METHODS: Computerised searches for publications debating this issue were done of MEDLINE data. Studies were grouped according to the techniques and types of reconstruction: reconstruction with silicone implant or autogenous skin-muscle flap, timing of reconstruction (immediate or delayed), and sequencing of treatments (pre- or post-reconstruction irradiation). The results of studies were assessed and compared in respect to reconstruction related chronic complications. RESULTS: The incidence of complications was significant even in the absence of irradiation, but radiotherapy increased the risk of complications to less or more extent. When reconstruction was done with implant, the most common type of complication was Grade III-IV capsular contracture. In patients subjected to immediate reconstruction, the complication rates with or without radiotherapy were from 0% to 64% and from 0% to 12%, respectively. In women who underwent delayed reconstruction, the incidence of complications with or without irradiation was from 22% to 55%, and from 17% to 34%, respectively. The negative effect of radiotherapy was more significant with immediate than with delayed reconstruction. In patients who underwent reconstruction with skin-muscle flaps, the most common type of complication was skin necrosis. The incidence of complications with or without radiotherapy was from 12% to 39% and from 5% to 25%, respectively. Cancer, developing after cosmetic augmentation mammaplasty in the breast, can be treated with lumpectomy and radiotherapy without removal of the implant. In series with this method of treatment the incidence of complications (mainly capsular contracture) was from 0% to 65%. The use of moderate dose (45-50 Gy), wedge filters, and no use of bolus application decreased the risk of complications. CONCLUSIONS: Radiotherapy and breast reconstruction are not incompatible, but careful consideration of their relative timing and technique is important. Plastic surgeons should counsel patients before starting their cancer disease treatment, and those who choose to have reconstruction need to be informed about risks for specific complications associated with the procedure. Results of the studies debating this issue are controversial. Longer follow-up time, larger patient material and better specified parameters are needed to validate results.

Breast Implants↗
PubMed2003

[Radiotherapy and delayed breast reconstruction with implant: examination of compatibility].

PURPOSE: Delayed breast reconstruction with implant is frequently used after mastectomy. However, given that many breast cancer patients receive adjuvant radiotherapy, the adaptation of this method raises questions concerning possible cumulative complications. In the present study the compatibility of post-mastectomy radiotherapy and delayed breast reconstruction with implant was examined. PATIENTS AND METHODS: We evaluated a consecutive series of 66 invasive breast cancer patients who have received delayed breast reconstruction with implant after modified radical mastectomy between January 1997 and June 1999. The average time was 51 months from primary surgery to reconstruction. The median dose of loco-regional irradiation was 50 Gy. Grade III atrophic dermatitis was observed in none of the irradiated women. We identified two patient groups: 29 patients did not and 37 patients did receive post-mastectomy radiotherapy. The types and time of reconstruction related chronic complications (capsular contracture, defect of implant shell and skin necrosis) were recorded. Incidence of complications was estimated by the Kaplan-Meier method. Cancer related events were also studied. RESULTS: When expander was used, minor discomfort of the patients was common during the filling course. At four (11%) irradiated patients the expansion with expander was incomplete, due to severe pain. At a median follow up time of 53 months the incidence of capsular contracture was 24.1% without and 29.7% with radiotherapy (p=0.4121). The five-year estimated rate of late complications was 40% and 50%, respectively (relative risk: 1.29, 95% confidence interval: 0.58-2.89, p=0.5173). The position of implant had an impact on the incidence of capsular contracture: 46.2% with subcutaneous and 22.6% with submuscular position (p=0.0881). Four patients (6%) developed local relapse (three in the skin and one subcutaneous). All were treated with tumor excision without implant removal. CONCLUSION: Delayed breast reconstruction with implant after post-mastectomy radiotherapy can be offered to patients who are interested in breast reconstruction and had no severe late radiation skin toxicity. Post-mastectomy radiotherapy does not significantly increase the risk of complications. The use of skin expander is less tolerated by irradiated patients. Submuscular position of implants moderates the risk of capsular contracture.

Adult↗
PubMed2003

Locoregional failure 15 years after mastectomy in women with one to three positive axillary nodes with or without irradiation the significance of tumor size.

BACKGROUND: There is insufficient evidence to suggest the routine use of postmastectomy radiotherapy (PMRT) in patients with one to three positive axillary nodes and T1/2 tumors. We have assessed the risk of locoregional recurrence (LRR) with or without RT in this group of patients, and focused on the results in subgroups defined by tumor size. PATIENTS AND METHODS: 249 women with T1/2 tumors and one to three positive nodes underwent mastectomy and axillary dissection between 1983 and 1987. Locoregional RT of 50 Gy was given to 175 patients. Chemotherapy or hormonal therapy was administered to 41 and 71 women, respectively. The median follow-up time of survivors was 189 months (range, 167-227 months). RESULTS: The rates of isolated LRR without or with RT were 16% (12/74) and 8% (14/175), respectively (p = 0.05), and the total (with or without distant relapse) LRR rates 23% and 12%, respectively (p = 0.03). 15-year overall survival amounted to 41% without RT and to 52% with RT (p = 0.2). The rates of isolated LRR for patients treated with chemotherapy or hormonal therapy only were 25% and 12%, respectively. In the absence of RT, age (> 45 vs = 45 years; p = 0.06), tumor size (T1 vs T2; p = 0.07), and extranodal invasion (ENI; absent vs present; p = 0.09) were related to the risk of developing an isolated LRR. On multivariate analysis, only tumor size (relative risk [RR], 3.92; 95% confidence interval [CI], 1.11-15.14) and age (RR, 3.37; 95% CI, 1.03-11.09) emerged as independent significant predictors, whereas ENI (RR, 1.50; 95% CI, 0.81-2.77) did not. In the T1 subgroup, the estimated 15-year isolated LRR rate was 9% (3/36) without and 9% (8/99) with RT (p = 0.9775). 15-year disease-free survival amounted to 62% and 57%, respectively (p = 0.5153). For patients without RT, according to the age groups (= 45 vs > 45 years), the 15-year rates of isolated LRR were 9% and 9%, respectively (p = 0.9910). In the T2 subgroup, the estimated 15-year isolated LRR rate was 30% (9/38) without and 10% (6/76) with RT (RR, 0.33; 95% CI, 0.12-0.92; p = 0.0244). 15-year disease-free survival amounted to 32% and 50%, respectively (p = 0.1213). For patients without RT, according to the age groups (< or = 45 vs > 45 years), the 15-year rates of isolated LRR were 57% and 16%, respectively (p = 0.0049). CONCLUSION: Patients with T1 tumor and one to three positive nodes are at low risk of isolated LRR either with or without RT. Patients with T2 tumor and one to three positive nodes are at high risk of isolated LRR without RT. Our findings support the routine use of PMRT in patients with T2 tumor, especially those aged < or = 45 years.

Adult↗
PubMed2003

Role of early radiotherapy in the treatment of supratentorial WHO Grade II astrocytomas: long-term results of 97 patients.

OBJECT: To determine principal prognostic factors and the effect of timing of radiotherapy (RT) on disease-specific survival (DSS) and progression-free survival (PFS) in WHO Grade II astrocytomas. METHODS: Histologic slides of 166 consecutive patients with the original tissue diagnosis of low-grade, non-pilocytic astrocytoma were reviewed. One-hundred and six were selected where two additional certified neuropathologist agreed on the grading of WHO Grade II astrocytoma. In 97 out of 106 cases follow-up informations were available. Early postoperative RT was given to 36 out of 97 patients (37%). The two groups of patients (early vs. delayed RT) were well balanced in respect to extent of surgery and other main clinical prognostic factors. Median follow-up of surviving patients was 79 months. The 5- and 10-year PFS was 52.2% and 30.7% with early RT and 39.5% and 12.4% with delayed RT (p = 0.0388). In respect to DSS, there was no significant difference in the 5- and 10-year actuarial survival rate according to the timing of RT (60.5% and 26.5% vs. 66.6% and 23.7%; p = 0.7545). Age (p = 0.0145) and extent of surgery (p = 0.0473) were significant prognostic variables in respect to DSS. Subdividing the irradiated group based on the extent of surgery, early RT in the subtotal group significantly improved 5-year PFS (60.0% vs. 12.4%; p = 0.0036) and DSS (66.7% vs. 49.8%; p = 0.0389). However, postoperative RT had no influence on PFS (p = 0.6812) and DSS (p = 0.3987) in the group with extensive resection. CONCLUSION: Early postoperative RT in subtotally resected, Grade II astrocytomas significantly improves both progression-free and disease-specific survival. Early RT does not benefit patients with extensive resection, RT should be withheld in these patients until progression.

Adolescent↗
PubMed2003

Evaluation of geometrically optimized single- and double-plane interstitial high dose rate implants with respect to conformality and homogeneity.

The use of a stepping source in high dose rate brachytherapy supported with dwell-time optimization makes it possible to deviate from the classical dosimetry systems. Dose distributions of single- and double-plane implants were analysed for conformality and homogeneity at idealized target volumes. The Paris system was used for catheter positioning and target volume determination. Geometric optimization and individual dose prescription were applied. Volumetric indices and dose parameters were calculated at optimal active length, which was found to be equal to target volume length. The mean conformality, homogeneity, external volume and overdose volume indices were 0.78, 0.67, 0.22 and 0.13, respectively. The average minimum target and reference doses were 69% and 86%, respectively. Comparisons between the volumetric indices of geometrical optimized and non-optimized implants were also performed, and a significant difference was found regarding any index. The geometrical optimization resulted in superior conformality and slightly inferior homogeneity. At geometrically optimized implants, the active length can be reduced compared to non-optimized implants. Volumetric parameters and dose-volume histogram-based individual dose prescription are recommended for quantitative assessment of interstitial implants.

Brachytherapy↗