1 / 36

Radiotherapy in the Management of Superior Sulcus Tumors

Radiotherapy in the Management of Superior Sulcus Tumors. Enis Özyar MD, Professor of Radiation Oncology Acıbadem University. Application of Radiotherapy. Definitive Preoperative Postoperative Pre and postoperative. Radiotherapy Technique. External Intraoperative external

maxima
Download Presentation

Radiotherapy in the Management of Superior Sulcus Tumors

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Radiotherapy in the Management of Superior Sulcus Tumors Enis Özyar MD, Professor of Radiation Oncology Acıbadem University

  2. Application of Radiotherapy • Definitive • Preoperative • Postoperative • Pre and postoperative

  3. Radiotherapy Technique • External • Intraoperative external • Brachytherapy

  4. Rationale of Preoperative Radiotherapy ? • Improves resectability • Decrasing tumor seeding • Blocking lymphatic channels • Maximizing local control

  5. Radiotherapy Doses

  6. RT RT Surgery Chemo CRT

  7. Classical Outcomes • Disease free survival • Progression free survival • Overall survival • Early toxicity • Late toxicity

  8. New Outcomes • Resectability rate • Complete resection rate • Pathological comlplete response rate (pCR) • Surgical morbidity and mortality

  9. Preoperative Radiotherapy Retrospective Studies

  10. Preop. Chemoradiotherapy Retrospective Studies

  11. Preop CRT > Preop RT

  12. Preop. Chemoradiotherapy Phase II Prospective Studies • SWOG 94-16 / INT 0160 • Japanase CO6 9806

  13. SWOG 94-16 / INT 0160 Cisplatin Etoposide + RT 45 Gy 110 Mediast. (-) patients Progressive disease Re evaluation 2-4 weeks Stable or response (+) Rusch VW et al., JCO 2007

  14. SWOG 94-16 / INT 0160 Stable or Response (+) Surgery 2 cycles chemotherapy

  15. Results

  16. Results

  17. Potential Prognostic Factors

  18. Post induction Radiological/Pathological Discordance 26 (% 65) 33 (% 72) 14 13

  19. Japanase CO6 9806Study Cisplatin Mito, Etoposide + RT 45 Gy 1 w split 76 pts Progressive disease Re evaluation 2-4 week Stable or Response (+) Kunitoh H. et al., JCO 2008

  20. Japanase CO6 9806Study Stable or response Surgery No Response Radiotherapy Boost Kunitoh H. et al., JCO 2008

  21. Results

  22. Results

  23. Are there a role for cranial prophylaxis ? • Retrospective analysis, • SWOG 9416 protocol and similar patients • CNS metastasis in 10 out of 33 (% 30) patient • Role of prophylaxis should be investigated Sun et al., Lung Cancer Proce. 2005

  24. What to do in daily practice ? Mediast. Evaluat. Surgery PET N0, N1 N2 and >

  25. What to do in daily practice ? N0, N1 Preop. CRT Doublet + 45 Gy Surgery N2 and > Surgical inop. CRT Doublet + >60 Gy

  26. SWOG 0220 Study

  27. Conclusions • Mediastinal staging is important • Single modality results are inadequate (KT, RT • ve surgery) • SWOG preop CRT and surgery results better outcome • Multidisciplinary approach

  28. Technical Aspects of Radiotherapy • 2 Dimensional • 3 Dimensional Conformal • IMRT • IGRT • Gated Radiotherapy • Stereotaktic Radiotherapy

  29. 2 Dimensional Radiotherapy

  30. 3 Dimensional Radiotherapy

  31. 3 Dimensional RT IMRT

  32. 3 Dimensional RT IMRT Dose distribution

  33. IGRT

  34. Gated Radiotherapy

  35. Stereotaktic Radiotherapy

  36. What is the Impact of Advanced Radiotherapy Technology ? • More respect to normal tissues • Irradiation of tumor with better coverage and dose escelation • Increase in local control • Decrease in toxicity

More Related