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Patient and Tumour Characteristics

Patient and Tumour Characteristics. Median age 60 years (26-92) Karnofsky Status: median 90 (50-100) Histology: SCC : n=120 (83%) Tumor size: ≥ 5 cm: n=78 (52%) ≤Ib1,IIA=18(12%) Lymph node involvement: n=57 (39%). Treatment schedule (Overall treatment time 6-7 weeks).

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Patient and Tumour Characteristics

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  1. Patient and Tumour Characteristics • Median age 60 years (26-92) • Karnofsky Status: median 90 (50-100) • Histology: SCC: n=120 (83%) • Tumor size: ≥ 5 cm: n=78 (52%) ≤Ib1,IIA=18(12%) • Lymph node involvement: n=57 (39%) Treatment schedule (Overall treatment time 6-7 weeks) - EBT: 45 Gy/1,8 Gy per fraction- HDR–BT: 4 x 7 Gy (40 Gy (EQD2)) pt A/HR CTV- Since 2001 (D90): total dose 85+ Gy (EQD2)- Intracavitary + interstitial, if insufficient response- Cis-Platinum 5x40mg/m2 (57%), since 4/99

  2. MRI based Treatment Planning Major Learning Period: 98-2000 (n=73) • no systematic prospective protocol (point A/OAR) Systematic prospective protocol since 2001 (n=72) • HR CTV concept • GTV, HR CTV+OAR contouring • Biological modelling (linear-quadratic) • Dose Volume constraints: OAR (2 cm3): 75/90 Gy (EQD2, α/β3) • Prescription: HR CTV - (D90): 80-85+ Gy(EQD2, α/β10) • Prospective 3D image based optimisation

  3. Outcome after complete remission non central true pelvic and distant recurrence non central true pelvic central true pelvic recurrence pelvic lymph node and distant • n=138 • Treatment time: 98-2003 • Median follow up: 39 months pelvic lymph node distant recurrence disease free (64%)

  4. Initial tumor extension good remission, sufficient for intracavitary BT Continuous Complete Remission Stage IIB, Large Tumour, ≥ 5 cm (treated 12/2002) Before EBRT: 5 cm wide, 5 cm thick, 7 cm high: 85 cm3 At 1. Brachytherapy after EBRT:2 cm x 3 cm x 3 cm, 9 cm3, 6 months after treatment: Radioth&Oncol 2005

  5. Stage IIIB- (treated 11/1998) Insufficient response-no adaptation of application technique At time of diagnosis Initial tumor extension At Brachytherapy after EBRT Dose distribution at brachytherapy 9 months after treatment Residual tumor Insufficient adaptation Recurrence

  6. CCR true pelvis (98-00) CCR true pelvis (01-03) 100% 96% 91% 72% Total:Events: < 5cm n=33 n=1 (at 36m) ≥5 cm n=40 n=10 Total:Events: < 5cm n=34 n=0 ≥5 cm n=38 n=4 (30) (26) (22) (23) (15) (10) (28) (12) (4) (30) (17) (9) Tumor size ------- < 5cm ------- ≥5cm CCR at 3 years: Vienna 93-2003 (335 patients)

  7. Late side effects at 3 years LENT/SOMA: absolute numbers

  8. Conclusion MRIassisted treatment planning in intracavitary cervical cancer brachytherapy plus risk adapted interstitial brachytherapy + cis-Platinum (145 consecutive patients) • High local control tumors < 5 cm:up to100% tumors ≥ 5 cm:~ 90% • Low rate of side effectsG3/4: < 5% (crude)

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