Ilaria Furfaro

Organs at risk in the brain and their dose-constraints in adults and in children: A radiation oncologist’s guide for delineation in everyday practice

PURPOSE Accurate organs at risk definition is essential for radiation treatment of brain tumors. The aim of this study is to provide a stepwise and simplified contouring guide to delineate the OARs in the brain as it would be done in the everyday practice of planning radiotherapy for brain cancer treatment. METHODS Anatomical descriptions and neuroimaging atlases of the brain were studied. The dosimetric constraints used in literature were reviewed. RESULTS A Computed Tomography and Magnetic Resonance Imaging based detailed atlas was developed jointly by radiation oncologists, a neuroradiologist and a neurosurgeon. For each organ brief anatomical notion, main radiological reference points and useful considerations are provided. Recommended dose-constraints both for adult and pediatric patients were also provided. CONCLUSIONS This report provides guidelines for OARs delineation and their dose-constraints for the treatment planning of patients with brain tumors.

Radiotherapy timing in the treatment of limited-stage small cell lung cancer: the impact of thoracic and brain irradiation on survival

Aims and Background Small cell lung cancer is an aggressive histologic subtype of lung cancer in which the role of chemotherapy and radiotherapy has been well established in limited-stage disease. We retrospectively reviewed a series of limited-stage small cell lung cancers treated with chemotherapy and thoracic and brain radiotherapy. Methods and Study Design A total of 124 patients affected by limited-stage small cell lung cancer has been treated over 10 years in our Institute. Fifty-three patients (42.8%) had concomitant radio-chemotherapy treatment and 71 patients (57.2%) a sequential treatment. Eighty-eight patients (70.9%) underwent an association of a platinum-derived drug (cisplatinum or carboplatinum) and etoposide. Prophylactic cranial irradiation was planned in all patients with histologically proven complete response to primary radio-chemotherapy. Results With a mean follow-up of 2.2 years, complete response was obtained in 50.8% of cases. We found a significant difference between different radio-chemotherapy association approaches (P = 0.007): percentages of overall survival were respectively 10.0%, 12.9% and 5.6% in early, late concomitant and sequential radiochemotherapy timing. Cranial prophylaxis did not seem to influence overall survival (P = 0.21) or disease-free survival for local relapse (P = 0.34). Conclusions Concomitant radio-chemotherapy is the best approach according to our experience. Our results show a benefit of prophylactic cranial irradiation in distant metastasis-free survival.

PO-0695: Lobectomy vs Stereotactic Ablative Radiotherapy in NSCLC:a multicentric series in four centers

S325 ________________________________________________________________________________ Patients were treated consecutively in the University Hospitals of Leuven between 2005 and 2014 and their data were retrospectively retrieved. PORT MPM patients were treated with RT doses up to 64 Gy in 2-Gy fractions. PORT NSCLC were treated with RT doses up to 60 Gy in 2-Gy fractions. Non-surgical patients were treated with RT doses up to 66 Gy in 2.75 Gy sequentially with chemotherapy or up to 70 Gy in 2 Gy fractions concurrently with chemotherapy. Dyspnea scores (CTCAE 4.03) before and after RT were retrieved and delta dyspnea was calculated as the difference between the dyspnea after RT (worse at any time point) and before RT. For every patient, 2 CT scans were retrieved: 1) CT0: a free breathing planning CT scan; 2) CT3M: deep inspiration breath-hold diagnostic follow up CT scan 3-6 months after the end of RT. CT0 and CT3M were non-rigidly co-registered in MIM. Differences in Hounsfield Unit (delta HU=HU3M-HU0) were represented as the slope of the dosedependent delta HU between 0 and 20 Gy (expressed in delta HU/Gy). Primary endpoint was delta dyspnea >= 2. Univariate and multivariate logistic regression analysis were performed in order to identify significant predictors of delta dyspnea >= 2. A p-value of < 0.05 was considered statistically significant.

Docetaxel in castration-resistant prostate cancer: A single-centre experience (Cancer Investigation 32, 9:445-450 DOI: 10.3109/07357907.2014.958233)

We present a single-institution experience reporting the efficacy and safety of docetaxel, administered as first-line chemotherapy, in castration-resistant prostate cancer (CRPC), focusing on patients and treatment parameters. From November 2004 to January 2012, 51 patients received chemotherapy with docetaxel. With a mean follow-up time (from the beginning of CHT) of 1.6 years (range 0.1–5.1 years), 35 patients (68.6%) died for prostate cancer and 48 patients (94.1%) showed progression of the disease. Five factors influenced overall survival: nodal status at diagnosis, neoadjuvant hormonal therapy, number of cycles of docetaxel administered, schedule of docetaxel and ECOG performance status before starting chemotherapy.We present a single-institution experience reporting the efficacy and safety of docetaxel, administered as first-line chemotherapy, in castration-resistant prostate cancer (CRPC), focusing on patients and treatment parameters. From November 2004 to January 2012, 51 patients received chemotherapy with docetaxel. With a mean follow-up time (from the beginning of CHT) of 1.6 years (range 0.1-5.1 years), 35 patients (68.6%) died for prostate cancer and 48 patients (94.1%) showed progression of the disease. Five factors influenced overall survival: nodal status at diagnosis, neoadjuvant hormonal therapy, number of cycles of docetaxel administered, schedule of docetaxel and ECOG performance status before starting chemotherapy.

P13.21ORGANS AT RISK IN THE BRAIN AND THEIR DOSE-CONSTRAINTS IN THE ADULTS AND IN THE CHILDREN: A RADIATION ONCOLOGIST'S GUIDE FOR DELINEATION

The aim of this study is to provide a stepwise contouring guide to delineate the organs at risk in the brain as it would be done in the everyday practice of planning radiotherapy for brain cancer treatment. Acute and late toxicity with risk of visual and hearing deficits, hormonal impairment and neurocognitive alterations, is a critical point in radiation treatment of patients affected by brain tumors. Moreover, accurate delineation of organ at risks is essential for the inverse-planning process of intensity modulated radiation treatment (IMRT). However, anatomic cerebral normal structures are not always easily recognizable either on simulation CT scan and on coregistered MRI scan used for radiotherapy planning. We have developed a detailed anatomy atlas on Computed tomography (CT) imaging and magnetic resonance (MR) imaging of brain. The following regions of interest were defined: optic chiasm, cochlea, pituitary gland, temporal lobe and hippocampus. Some main notions of anatomy of the organs at risk are provided together with some landmarks easily to be found on the imaging scans. Detailed contouring recommendations are provided in order to significantly improve the contour accuracy and concordance. This report also provides for all the above-mentioned organs at risk a systematic review for the recommended dose constraints both for adult and pediatric patients. This guide is a useful tool for improving daily practice and decreasing the differences in organs at risk delineation between radiation oncologists.

Docetaxel in castration-resistant prostate cancer: a single-centre experience.

We present a single-institution experience reporting the efficacy and safety of docetaxel, administered as first-line chemotherapy, in castration-resistant prostate cancer (CRPC), focusing on patients and treatment parameters.From November 2004 to January 2012, 51 patients received chemotherapy with docetaxel. With a mean follow-up time (from the beginning of CHT) of 1.6 years (range 0.1–5.1 years), 35 patients (68.6%) died for prostate cancer and 48 patients (94.1%) showed progression of the disease.Five factors influenced overall survival: nodal status at diagnosis, neoadjuvant hormonal therapy, number of cycles of docetaxel administered, schedule of docetaxel and ECOG performance status before starting chemotherapy.