RESUMEN
BACKGROUND AND PURPOSE: Dose escalation improves local control in prostate cancer. In this study we assess the feasibility of dose escalation to prostate and / or seminal vesicles to 76 Gy with intensity-modulated radiotherapy (IMRT); report data on dosimetry and acute toxicity in 40 patients at P. D. Hinduja National Hospital and Medical Research Center, Mumbai. MATERIALS AND METHODS: In the period from May 2006 to September 2008, 40 consecutive patients with localized prostate adenocarcinoma (T1- 3 N0) were definitively treated with IMRT to a dose of 76 Gy / 38 fractions. Patients were seen on a weekly basis during treatment, and one month (M1) and three months (M3) thereafter. The radiation therapy oncology group (RTOG) toxicity scale was used to evaluate acute gastrointestinal (GI) and genitourinary (GU) toxicities. Additional symptoms such as rectal blood loss, urgency, dysuria, urinary frequency, nocturia, incontinence were scored as well. RESULTS: All 40 patients completed treatment successfully. Acute RTOG Grade 1 and Grade 2 GI toxicities were noted in 47.5% (19 patients) and 12.5% (five patients) respectively, leaving 40% (16 patients) free of any acute toxicity. Thirty-six (90%) and four patients (10%) had Grade 0-1 and Grade 2 acute RTOG-scaled GU toxicity respectively. There was no Grade 3 or higher GI / GU toxicity. CONCLUSIONS: The escalated dose of 76 Gy to the prostate with IMRT was very well tolerated by all our patients with acceptable acute GU and GI toxicity, thereby, establishing the feasibility of dose escalation in the Indian scenario.
Asunto(s)
Adenocarcinoma/radioterapia , Neoplasias de la Próstata/radioterapia , Radioterapia de Intensidad Modulada , Anciano , Anciano de 80 o más Años , Humanos , India , Masculino , Persona de Mediana Edad , Radiometría , Radioterapia/efectos adversos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Radioterapia de Intensidad Modulada/efectos adversosRESUMEN
Intraocular malignant lesions are frequently encountered in clinical practice. Plaque brachytherapy represents an effective means of treatment for intraocular lesions. Recently Radiopharmaceutical Division, BARC, Mumbai, has indigenously fabricated reasonable-cost I-125 sources. Here we are presenting the preliminary experience of dosimetry of sources, configuration of treatment planning system (TPS) and quality assurance (QA) for eye plaque therapy with Occu-Prosta I-125 seeds, treated in our hospital, for a patient with ocular lesions. I-125 seeds were calibrated using well-type chamber. BrachyVision TPS was configured with Monte Carlo computed radial dose functions and anisotropy functions for I-125 sources. Dose calculated by TPS at different points in central axis and off axis was compared with manually calculated dose. Eye plaque was fabricated of 17 karat pure gold, locally. The seeds were arranged in an outer ring near the edge of the plaque and in concentric rings throughout the plaque. The sources were manually digitized on the TPS, and dose distribution was calculated in three dimensions. Measured activity using cross-calibrated well-type chamber was within +/-10% of the activity specified by the supplier. Difference in TPS-calculated dose and manually calculated dose was within 5%. Treatment time calculated by TPS was in concordance with published data for similar plaque arrangement.
RESUMEN
This single institutional study evaluated the prognostic factors and treatment outcome of 113 Indian patients with primary nasopharyngeal non-Hodgkin's lymphoma. At presentation, 28% had stage I and 62% had stage II disease. Treatment comprised of a combination of chemotherapy (CTh) and radiotherapy (RT) in the majority of the patients (76%). After a median follow-up of 56 months, the 5-year disease-free survival (DFS) and overall survival (OS) for the whole group were 55.8% and 57.9%, respectively. Multivariate analysis showed that; age > 30 years [hazard ratio (HR) = 6.59, 95% confidence interval (CI) = 2.59 - 16.7, P < 0.0001], WHO performance score > or = 2 (HR = 2.34, 95% CI = 1.01 - 5.46, P = 0.050), T-cell lymphomas (HR = 2.81, 95% CI = 1.14 - 6.96, P < 0.001) and the presence of B symptoms (HR = 3.65, 95% CI = 1.77 - 7.53, P = 0.025), had a negative influence on survival. Patients treated with a combination of CTh and RT had a significantly better outcome than those treated with CTh alone (OS: 69%vs. 31%, P < 0.00001). HR for death in the CTh alone group was 3.73 (95% CI = 1.95 - 7.13). The CR (P = 0.01), DFS (P = 0.01) and OS (P = 0.03) rates were significantly better for patients receiving a RT dose of > or =4500 cGy. HR in the subgroup that received a RT dose of <4500 cGy was 2.51 (95% CI = 1.04 - 6.06). These results suggest that combined modality treatment, comprising of CTh and RT (with an RT dose of > or =4500 cGy), results in satisfactory outcome in patients with this rare neoplasm.