128 Abstracts / Brachytherapy 7 (2008) 91e194

is brachytherapy. From regard on location of the change on some of thepatients brachytherapy is a treatment from choice. Brachytherapy in singlecases is performed as radical treatment, in most of cases due to advancedclinical stage has an palliative aim. Because of lack of clear consensusregarding value of doses used in brachytherapy there are different fractiondoses used in clinical treatment. The work is about result of treatment oflung cancer with HDR-BT using different treatment schemas.Methods and Materials: 1036 patients with lung cancer were treated usingHDR-BT since May 1999 to December 2005 in Greatpoland Cancer Center.The age of the patients ranged from 27 to 88 years, average 62.6 years.Dyspnoea was most frequent indication for brachytherapy. Patients weretreated: Sole radical HDR-BT (15 patients), radical brachytherapycombined with external beam radiation therapy (EBRT) (70 patients),sole palliative treatment (460 patients), palliative HDR-BT combinedwith EBRT (199 patients), combined with chemotherapy (146 patients),combined with EBRT and chemotherapy (66 patients). They haveundertaken clinical and endobronchial observation with rating of localremission and retiring difficulties with breathing, cough and hemoptysisin thirst, third, sixth and twelve month of observation.Results: Sole radical HDR-BT: complete remission (CR) assessed in 4weeks from the end of the treatment was observed in 100% of patients,average local control (LC) e 19.7 months, overall survival (OS) e 21.2months. Radical HDR-BT combined with external beam radiation therapy(EBRT): CR e 48.5 %, partial remission (PR) e 32.1 %, no data (ND) -19.4 %; LC e average 8.4 months, OS - average 10 months. Solepalliative HDR-BT: CR e 13.4 %, PR e 65.6 %, no remission (NR) e17.7 %, progression - 3.4 %, LC e 5.7 months, OS e 8.1 months.Conclusions: 1. HDR-BT in advanced lung cancer was an efficient methodthat caused in many patients retiring of the symptoms and improvementof life quality. 2. HDR-BT in chosen cases can be applied as a radicaltreatment e after careful qualification. 3. HDR-BT can be combined withanother treatment methods what increase palliative or radical effect.

PD29 Presentation Time: 7:30 AM

HDR brachytherapy for skin cancers

Fabrizio Piro Radiation Oncology Center, Mariano Santo, Cosenza, Italy.

Purpose: To evaluate outcome and toxicity in patients (pts.) treated withhigh dose rate brachytherapy, and with minimum followup of 60 months.Methods and Materials: From August 1999 to September 2007, 98consecutive pts. with skin cancer (20% squamous cell) (5% cancer O4cm) were enrolled in this perspective study: HDR treatment consisting oftwice-daily fractionation of 350 cGy each, 6 hour apart final dosedelivered 49 Gy as exclusive modality or postoperative treatment forpositive margins; as postoperative treatment for squamous cell with clearmargins the final dose delivered was 42 Gy. To provide the maximumcoverage of the tumor the implants were performed with afterloadingcatheters embedded in personalized surface molds or interstitial implantplanned with a semi-3-D technique aided by simulator. Radiopaquemarkers for target definition were obligatory. The followup consisted inclinical examination. We studied the pts. with a minimum followup of 5years. For failure cases a review of dosimetry was performed.Results: The eligible pts. were 73, the median followup 64 months (range60e76). The cosmetics results were poor in 6% of cases; the onlyimportant toxicity was a telangiectasia of the skin. The local relapse were10% (7 cases) especially for bulky cases (3), for 3 of these cases a full-dose reirradiation was performed without severe toxicity. The cases ofmissing target 4% (3).Conclusions: This treatment schedule is effective and can be used in skincancers with a good compliance of the treated pts. HDR is a techniquewith a good learning curve. This schedule is the standard for skin cancerin our Center.

PD30 Presentation Time: 7:30 AM

GliaSite brachytherapy for recurrent malignant gliomas

Samuel L. Cooper, B.S.1 John A. Fortney, M.D.1 Sunil J. Patel, M.D.2

Joseph M. Jenrette, M.D.1 1Radiation Oncology, Medical University of

South Carolina, Charleston, SC; 2Neurosurgery, Medical University of

South Carolina, Charleston, SC.

Purpose: To report on a retrospective analysis of a single institution’sexperience using the GliaSite Radiotherapy system in the treatment ofpatients with recurrent malignant gliomas.Methods and Materials: Between 2001 and 2006, thirty patients withrecurrent malignant gliomas were treated with the GliaSite RadiotherapySystem. The patients had previously been treated with surgery and externalbeam irradiation. Twenty-four of the treated patients had recurrentglioblastoma multiforme and six patients had recurrent malignant glioma.Twelve patients were female and eighteen patients were male. The meanage was 53.4 years. The median Karnofsky performance status (KPS) was80. Sixteen patients received Gliadel wafers at the time of surgery and 26patients were treated with temazolamide. All underwent surgery for re-resection with placement of the Gliasite Radiotherapy system. After therecurrence was pathologically confirmed, the patient was treated withaqueous 125I solution (Iotrex) to a mean dose of 59.83 Gy (range 55 e61.3 Gy), a mean depth of 0.8 cm (either 0.5 cm or 1.0 cm), and a meandose rate of 53.63 Gy/hr.Results: At the time of analysis 27 patients (90%) had died, one patient wasstill alive (3%), and two patients (7%) had been lost to followup. Overallsurvival for patients with glioblastoma multiforme was 19.1 months (range8e39.6 months), and overall survival for patients who initially had WHOgrade III glioma was 29.7 months (12.9e49.3 months). The mean survivalfollowing Gliasite was 10.6 months (46 weeks) for patients with recurrentglioblastoma multiforme and 5.7 months for patients with non-glioblastomarecurrent malignant glioma. The estimated 1 year survival was 23.3%. Oneepisode of wound infection occurred requiring removal of the GliasiteRadiotherapy system until the infection was treated. There was also oneepisode of a catheter associated CSF leak that was with surgically closed.Conclusions: The use of the Gliasite Radiotherapy system after reresectionfor recurrent malignant glioma seems to lead to a survival benefit. Theresults of this analysis are similar to those that are previously published.Further analysis in the form of a randomized trial is necessary todetermine the overall benefit yielded by this treatment technique.

PD31 Presentation Time: 7:30 AM

Brachytherapy for T1-T2 tonsillar carcinoma: Long-term results

on 38 patients

Julie Harvey, M.D.1 Laval Grimard, M.D.1 Bernd Esche, M.D.1 Andre

Lamothe, M.D.2 Johanna Spaans, M.Sc.3 1Radiation Oncology, Ottawa

Hospital Regional Cancer Center, Ottawa, ON, Canada; 2Otolaryngology,

University of Ottawa, Ottawa, ON, Canada; 3Ottawa Hospital Research

Institute, Ottawa Regional Cancer Center, Ottawa, ON, Canada.

Purpose: To review the Ottawa Hospital Regional Cancer Centre (OHRCC)clinical experience with T1 and T2 tonsillar carcinoma treated with externalbeam radiation, brachytherapy, and surgery.Methods and Materials: Patients receiving brachytherapy during1989e2005 as part of their treatment for T1-T2 squamous cell carcinomaof the tonsil were identified. Tumor and treatment characteristics andtoxicities were recorded. Local control, locoregional control, diseasespecific survival and overall survival estimates were generated.Results: Thirty-eight patients were identified. They were treated accordingto the following protocol: External beam radiation therapy to the primarysite and neck nodes up to 45e50 Gy followed by an interstitialbrachytherapy boost to the primary site for 25e30 Gy using Iridium-192.The Pernot (n 5 32) or Baillet (n 5 6) techniques were used and the dosewas prescribed according to the Paris System. Positive nodes received anadditional boost with electrons or were treated surgically with neckdissection. There were 31 males (8 T1, 23 T2) and 7 females (7 T2).Mean age was 60 and mean followup period was 50 months. The earlystage group included two T1N0 patients and 16 T2N0 patients. The latestage group included two Stage III patients and 18 Stage IV patients. At 5years, the local control was 87.5% (7/8) for T1 and 93.3% (28/30) for T2patients, and locoregional control was 87.5% and 83.3%, respectively.The 5-year overall survival was 62% for T1 and 66.7% for T2, anddisease specific survival 87.5% and 86.6%, respectively. Furthermore,

129Abstracts / Brachytherapy 7 (2008) 91e194

local control was 88.9% and 95.0%, locoregional control was 88.9% and80%, and overall survival was 61.0% and 70.0% for early (n 5 18) andlate stages (n 5 20), respectively. Complications were limited to one caseof moderate xerostomia, one case of grade 3 soft tissue necrosis and 2cases of Grade II dysphagia. Two patients had unsuccessful salvagesurgeries. Six patients developed second malignancies.Conclusions: These results are in line with the published literature for theuse of brachytherapy as a boost technique for tumors of the tonsil witha high local control rate and little morbidity.

PD32 Presentation Time: 7:30 AM

Brachytherapy with permanent gold grain seeds for squamous cell

carcinoma of the lip

Jeffrey Q. Cao, M.D.1 David P. D’Souza, M.D.1 James A. Gilchrist, MB,

FRCPC1 J.A. Hammond, MBBCh1 Craig Lewis, M.Sc.2 Michael Lock,

M.D.1 George B. Rodrigues, M.D.1 1Radiation Oncology, London

Regional Cancer Program, London Health Sciences Centre, London, ON,

Canada; 2Physics, London Regional Cancer Program, London Health

Sciences Centre, London, ON, Canada.

Purpose: To describe patient, tumor, and treatment characteristics as well astreatment outcomes of a single institutional series of patients treated withradioactive gold grain implantation of squamous cell carcinoma of the lip.Methods and Materials: We performed a retrospective analysis of patientsdiagnosed with squamous cell carcinoma of the lip treated at our institutionbetween January 1996 and December 2006. We identified 51 patients (41male and 10 female) treated with permanent gold (198Au) grain seedimplant brachytherapy. The seed arrangements (single plane using halfcircle geometry) were designed to produce a total dose of 5500 cGy at0.5 cm from the plane of the implant using a constant activity of 3mCi perseed. The most common number of seeds implanted was 8 (range 10e20).The primary endpoints were local recurrence and cosmetic outcome.Results: Median followup was 27 months (range 0.7e115). The mediancohort age was 69 years (range 20e96). Of these, 42 patients presentedwith lower lip lesions and 9 presented with upper lip lesions. The majoritywere T1 lesions (90%) but 5 patients had T2 disease (largest 3.5cm.) Nopatients had evidence of regional lymph node or distant metastasis. Tumorgrade was recorded in 38 of the cases and 97% were moderately to well-differentiated. Twelve patients had recurrent disease with prior surgery and5 patients had previous radiation to the head and neck. Complete responsewas achieved in 49 patients, of which 46 patients did not experience anyrecurrence at time of analysis. Three patients recurred with a mediandisease-free survival of 24 months (range 4.5e104). Forty-eight patientsachieved a good cosmetic result as assessed by either the physician or patient.Conclusions: Permanent gold grain seed implant brachytherapy providesexcellent local control and good cosmesis in patients with squamous cellcarcinoma of the lip.

PD33 Presentation Time: 7:30 AM

Perioperative brachytherapy ± intensity modulated radiotherapy

with or without chemotherapy for carcinoma of the oral tongue

Boris Bahoric, M.D.1 Martin Black, M.D.2 Michael Hier, M.D.2 Richard

Payne, M.D.2 Khalil Sultanem, M.D.1 1Radiation Oncology, SMBD Jewish

General Hospital, Montreal, QC, Canada; 2ORL, SMBD Jewish General

Hospital, Montreal, QC, Canada.

Purpose: To evaluate the feasibility and efficacy of combined approach ofutilizing surgery to the primary site and neck lymph nodes, followed bybrachytherapy to the tongue, and external beam radiotherapy (XRT) tothe neck in case of positive neck pathology. If criteria set by Bernier et al.(two or more lymph nodes positive or there is extracapsular extension)were met, XRT was combined with chemotherapy.Methods and Materials: From January 2001 to September 2006, 16patients of median age of 64 years (34e92) with stages I (3 patients), II(2 patients), III (4 patients), IVA (7 patients) had surgical resection ofthe primary and unilateral or bilateral lymph node dissection.Intraoperatively, various number of catheters were placed equidistantly atthe resection margin. The surgical defect was covered with either free flap

or left to granulate. 4e5 days following surgery patients received 30 Gyin 10 fractions at 5 mm from the catheters if the surgical margins wereclear (9 patients) or 36 Gy in 12 fraction in case of positive margins (5patients). Four weeks after surgery patients would receive external beamradiotherapy to the neck if positive nodes were found on dissection. 55Gy in 25 fractions was delivered to the involved neck and 50 Gy in 25fractions to the contralateral neck. Treatment was delivered via IMRT,with sparing of the oral cavity, parotid glands, and previously treated areaby brachytherapy. Chemotherapy was used in conjunction with IMRT ifcriteria set by Bernier et al. were met (4 patients).Results: With a median followup of 23.6 months (13e46 months) 4/16patients had local recurrence. 2 of them were salvaged by further surgeryand radiotherapy. To date four patient had died: 3 died of second primaries,and one of uncontrolled neck disease (recurred shortly after surgery andbrachytherapy). 3/4 of patients who died had the tongue primary controlledat the time of death. 2 more patients developed new lung primaries 1 and 2years after the treatment. In both patients the primary site is controlled. Sixpatients are alive and well with no evidence of disease, median followupof 23.5 months (16e46 months). There was no RTOG Grade 3 or 4 latetoxicities of mucosa, salivary glands or skin observed.Conclusions: Perioperative brachytherapy is feasible with good localcontrol (75%), and excellent late toxicity profile. It may allow for lessradical surgical resection, and better functional result. When neck needsto be irradiated, oral cavity may be spared. Distant relapse remains a bigproblem in this patient population. Phase II trial with escalated dose ofbrachytherapy is on the way.

BREAST POSTER DISCUSSION SESSION (DOSIMETRY)

Tuesday May 6, 2008

9:50 AMe10:50 AM

PD34 Presentation Time: 9:50 AM

Comparison between graphical optimization and geometrical

optimization in HDR interstitial breast implants

Subrata Saha, M.D., Aparna Gangopadhyay, M.D., Kousik Ghosh, M.Sc.,

Avijit Basu, M.D., Aloke Ghosh Dastidar, M.D. Radiotherapy, Medical

College Hospital, Calcutta, India.

Purpose: Brachytherapy, either as boost or as a sole post lumpectomyradiation therapy modality plays a significant role in breast cancertreatment. The goal of HDR breast implant (unlike other cancers) is toattain good cosmesis, in addition to local control. Prudent optimization ina comprehensive plan is the corner stone of a good implant. When PTVdefinition and delineation are possible e as with CT based planning,graphical optimization is considered much better than geometricaloptimization (GO), as far as coverage and dose homogeneity is concerned.In spite of this, most centres apply GO for individualized image basedplanning of breast implants, possibly due to time constraints. This workaims to compare GO with graphical optimization for HDR breast implantsin terms of conformity and dose homogeneity parameters (as per ICRU 58).Methods and Materials: 48 HDR interstitial breast implants (Boost 5 37,PBI 5 11) were enrolled in this study between November 2006 andSeptember 2007: 37 had 2-plane and 11 had 3-plane insertions. Targetvolume, implant planes necessary and orientation of needle entry and exitpoints were conceived from pre-implant CT. Individual post insertionCT ebased planning was done. Following applicator contouring, markingof active lengths and contouring of CTV using Varian Brachyvisionsoftware, two computer planning options- GO and graphical optimizationwere compared for each treatment. V100, D90, V150, V200, DHI, DNR,Coverage index, Dskin and Dchest wall were recorded for comparison, alongwith conformity parameters viz. COIN.Results: Both optimization options achieved almost similar V100 of median93% (88 e 97). D90 for graphical optimization plans was slightly higher(median 98%) against median 94% for GO plans. With graphicaloptimization, high dose volumes were markedly lower as evidenced byV150 (24% with graphical optimization vs. 46% with GO) and V200(7% with graphical optimization vs. 12% with GO). Dose homogeneitywas improved with graphical optimization (DHI 0.73 against 0.53 withGO). Graphical optimization also offered better conformity (median