673 poster HDR BRACHYTHERAPY AS CONSERVATIVE TREATMENT FOR EARLY LOWER RECTUM ADENOCARCINOMA

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B RACHYTHERAPY: M ISCELLANEOUS

Results: A total dose of 50 Gy with PDR at a rate dose of 0.7 Gy/h was administered to the surgical bed. There was no important acute toxicity. The catheters were removed without problems and for the moment, the patient is alive and free of disease. The patient will need to be monitored for possible late toxicity. Conclusions: Conservative treatment of orbital tumors with surgery and intraoperative brachytherapy can be performed in certain circumstances if tumor removal is feasible. Col.laboration with surgeons is mandatory. 671 poster SALVAGE HIGH-DOSE-RATE INTERSTITIAL BRACHYTHERAPY IN RECURRRENT AND PREVIOUSLY IRRADIATED HEAD AND NECK CANCER. L. Gutierrez Bayard1 , M. C. SALAS BUZON1 , M. E. Angulo Pain2 , E. Munive Alvarez1 , E. Gonzalez Calvo1 1 H OSPITAL U NIVERSITARIO P UERTA DEL M AR, Oncology radiation departament, Cadiz, Spain 2 H OSPITAL U NIVERSITARIO P UERTA DEL M AR, Department of Radiophysics, Cadiz, Spain Purpose: Despite advances in the treatment of head and neck cancer (HNC), 15%-50% of patients will have their disease recur. For patients who present with locally recurrent disease or a second primary tumor in a previously irradiated field, therapeutic options are limited. Surgical salvage as curative intent resection is the preferred option for those with limited-volume disease. Reirradiation with or without the addition of chemotherapy may hold promise for long-term survival for selected patients. Materials: High- dose- rate (HDR) brachytherapy can play an important role in the salvage treatment of previously irradiated recurrent head and neck cancer. We report a 56-year old man diagnosed of tongue cancer, with recurrent metastatic contralateral cervical node 1.5 years after radical treatment with surgery and adjuvant external radiotherapy. He received multidisciplinary treatment with chemotherapy, surgery and HDR interstitial brachytherapy. Results: After 2.5 year of follow up, the patient is free of recurrence, his performance status is zero, without pain, and toxicity according to the Radiation Therapy Oncology Group (RTOG) grading system and National Cancer Institute common toxicity criteria (version 3.0) was grade I late soft tissues fibrosis. Conclusions: Re-irradiation with HDR brachytherapy is feasible in recurrent HNC. The delayed toxicities seem to be decreased compared to conventional external beam therapy. This technique offers dosimetric advantage, radiation safety and patient comfort, with a good local control and acceptable morbidity. Multidisciplinary planned surgical resection followed by HDRBT, have obtained a good response in this high-risk patients. Treatment in recurrent head and neck cancer is a therapeutic challenge, but we think the multidisciplinary cancer team has been very important in patient outcomes.

Brachytherapy: Miscellaneous 672 poster ENDOBRONCHIAL BRACHYTHERAPY : A TREATMENT OPTION WITH MINIMAL SIDE EFFECTS S. Shadchehr1 , J. Pantano1 , T. Lo2 , C. Lamb1 1 L AHEY C LINIC, Pulmonary Medicine, Burlington, USA 2 L AHEY C LINIC, Radiation Oncology, Burlington, USA Purpose: Limited treatment options exist for patients with locally recurrent lung cancer and metastatic endobronchial tumors. Endobronchial brachytherapy (EBBT) remains a viable option to provide localized radiation to palliate symptoms and reestablish airway patency with minimal side effects. Materials: The radiation oncology database of patients treated with EBBT in our institution from February 1996 to April 2009 was used for this study with IRB approval. It was a retrospective chart review of 88 patients. Each patient record was analysed for presenting symptoms including cough, dyspnea, chest pain, hemoptysis, pneumothorax, and respiratory failure necessitating hospital admission before and after EBBT. Endobronchial brachytherapy was typically delivered in 3 sessions of 6 to 7 Gy each, in weekly intervals. Results: The incidence of catheter malposition was 25% in the right upper lobe (RUL).A small percentage of procedure related side effects were noted in our cohort: 4.5%. One patient (2.5%) developed cough immediately after the procedure. Three patients (3.8%) developed respiratory failure after the procedure, necessitating transfer to a higher level of care for either increased oxygen therapy or closer monitoring without endotracheal intubation. There were no deaths as a result of treatment. There were no documented symptoms of shortness of breath, chest pain, hemoptysis, or pneumothorax documented related to EBBT.EBBT improved the following symptoms: hemoptysis (90.9%), respiratory failure (85.7%), cough (79.5%), chest pain (76.9%), and shortness of breath (73.2%).Survival was defined as days alive after EBBT.

Survival was evaluated and divided by pathological category into small cell carcinoma, non-small cell carcinoma, and metastatic. Our data showed that the best survival was in the metastatic/other group (272 days), followed by non-small cell carcinoma (122 days), and small cell carcinoma (112 days). This result appears to parallel the nature history of the disease. Conclusions: EBBT is a safe procedure with a low complication rate. Careful patient selection and modification of intended treatment in cases where there is evidence of prior radiation-induced damage seem to have averted significant treatment complications.EBBT in conjunction with other invasive interventional procedures can be a good option for palliating symptoms from endobronchial malignancies causing hemoptysis, cough, and shortness of breath. 673 poster HDR BRACHYTHERAPY AS CONSERVATIVE TREATMENT FOR EARLY LOWER RECTUM ADENOCARCINOMA G. Kacso1 2 , S. A. Istrate3 , Z. Sparchez4 2 , A. Rancea5 2 , A. Irimie5 2 1 O NCOLOGY I NSTITUTE "P ROF.D R . I ON C HIRICUTA ", Brachytherapy Department, Cluj-Napoca, Romania 2 I ULIU H ATIEGANU M EDICAL U NIVERSITY, Cluj, Romania, Cluj, Romania 3 I NSTITUTE OF O NCOLOGY P ROF. D R . I. C HIRICUTA, Radiotherapy Department, Cluj Napoca, Romania 4 3 RD M EDICAL C LINIC, Gastroenterology, Cluj-Napoca, Romania 5 O NCOLOGY I NSTITUTE "P ROF.D R . I ON C HIRICUTA ", Surgery, Cluj-Napoca, Romania Purpose: Efficacy and toxicity analysis of high dose-rate brachytherapy (HDR-BT) adjuvant after endoanal excision for early stage lower rectum adenocarcinoma (ELRAK). Materials: In our institution, since 2005, all patients with T1NoMo ELRAK involving less than 50 % of the rectal circumference and who refused amputation of the rectum were offered adjuvant HDR-BT after endoanal full-thickness excision, provided it was pT1-2 with negative margins (Ro). From June 2005 to June 2010, only 10 patients were included in this prospective study. Ambulatory one weekly fraction Iridium 192 HDR-BT was delivered via endorectal applicator (for elderly pT1 patients with contraindications for general anesthesia) or stainless equidistant parallel needles placed in the rectal wall through the Papillon type perineal template for all others. The dose prescription points were 5 mm external to the cylinder surface or needles axis. The dose was 5 fr of 6.5 Gy/fr for pT1, 6 fr of 7 Gy/fr for minimal pT2 (focal invasion limited to the inner muscle layer of the rectal wall). For frankly pT2 (external muscle layer involvement), 3fr of 4Gy were added as a boost to 50Gy/25fr/ 5 wks external beam radiotherapy (EBRT). Local recurrence obviated salvage amputation. Toxicity was recorded on CTC 3.0 criteria. Results: Median age was 69 years [47- 85], 50 % being T1, 30 % minimal T2 and 20 % frankly T2. With a median follow-up of 28 months [6 to 65 months], the local control was 100 %, 66 % and 50% for pT1, minimal and frankly pT2, respectively. The sole recurrence for the minimal pT2R0 subgroup was related to a close resection margin (0.2 mm). The overall 3 year local control was 100% including the salvage surgery (2 patients). The maximum rectal acute toxicity was G2, transient and there were no G2 or higher late toxicities. Conclusions: Adjuvant HDR-BT after conservative full thickness endoanal excision might be a reasonable alternative to amputation for lower rectum pT1or minimal pT2 Ro cN0Mo adenocarcinoma. Patients having a deep muscle invasion or with resection margins less or equal to 0.2 mm need upfront radical surgery, as dose escalade by BT boost to the EBRT can not palliate a suboptimal conservative surgery. 674 poster INTERSTITIAL BRACHYTHERAPY FOR SOLITARY METASTATIC LESIONS OF LUNG AND LIVER D. N. Sharma1 , G. Rath1 , S. Thulkar2 , P. Julka1 , A. Gandhi1 1 A LL I NDIA I NSTITUTE OF M EDICAL S CIENCES, Radiation Oncology, NewDelhi, India 2 A LL I NDIA I NSTITUTE OF M EDICAL S CIENCES, Radiology, NewDelhi, India Purpose: To study the feasibility of interstitial brachytherapy (IBT) in patients with solitary metastatic lesions of lung and liver, not suitable for surgery. Materials: Twelve patients with solitary metastatic lesions in lung (9 patients) or liver (3 patients), were enrolled in this study. The procedure of IBT was carried out in CT scan room under local anesthesia. A single stainless steel blind end needle for lesions up to 4 cm and two needles for lesions up to 6 cm in diameter were used. The needle was inserted percutaneously through the intercostal space into the center of lesion under the CT guidance. A single dose of 20 Gy with high dose rate (HDR) brachytherapy was prescribed at the periphery of lesion. The treatment was delivered on remote afterloading HDR brachytherapy unit in adjacent room and the needle was removed immediately after treatment. Results: There were 8 males and 4 females with a median age of 52 years. The lesion size raged from 3.0-5.5 cm (median 4.0 cm). The average time taken in IBT procedure was 50 minutes. No patient had acute severe proce-