Purpose: Patients with early stage breast cancer (ESBC) are conventionally treated with breast-conserving surgery (BCS) followed by whole-breast external beam radiation therapy (EBRT). The emergence of targeted intraoperative radiation therapy (TARGIT) with Intrabeam has been used as a therapeutic alternative for patients with risk-adapted ESBC. Here we present our radiation therapy toxicities (RTT), postoperative complications (PC), and short-term outcomes of the prospective phase II trial at the McGill UniversityMethods and Materials: Patients aged =50 years with biopsy-proven hormone receptor-positive, grade 1 or 2, invasive ductal carcinoma of the breast, cT1N0, were eligible for the study. Enrolled patients underwent BCS followed by immediate TARGIT of 20 Gy in 1 fraction. Upon final pathology, patients with low-risk breast cancer (LRBC) received no further EBRT, and those with high-risk breast cancer (HRBC) received further 15 to 16 fractions of whole breast EBRT. HRBC criteria included pathologic tumor size >2 cm, grade 3, positive lympho-vascular invasion, multifocal disease, close margins (<2 mm), or positive nodal disease.Results: A total of 61 patients with ESBC were enrolled in the study; upon final pathology, 40 (65.6%) had LRBC, and 21 (34.4%) had HRBC. The median follow-up was 3.9 years. The most common HRBC criteria were close margins in 66.6% (n = 14) and lymphovascular invasion in 28.6% (n = 6). No grade 4 RTT were observed in either group. The most common PC were seroma and cellulitis for both groups. The rate of locoregional recurrence was 0% in both groups. The overall survival in LRBC was 97.5% and in HRBC 95.2% with no significant differences. Deaths were nonbreast cancer related.Conclusions: In patients with ESBC undergoing BCS, the use of TARGIT shows low rates of RTT and PC complications. Moreover, our short-term outcomes show no significant difference at 3.9 years median follow-up for locoregional recurrence or overall survival

Background and purpose: Breast cancer locoregional (LR) radiation in the elderly requires careful consideration between the benefits of aggressive treatment and its potential toll on these patients. Extreme weekly LR hypofractionated radiation (HFRT), delivering >5 Gy per fraction, may be better suited in such a population. It represents a good compromise between RT omission and exhaustive daily radiation. This study aims to report the local and LR control rate as well as the acute and long-term side effects of the elderly patients treated with HFRT in our institution, and to compare these results to those from the literature. Materials and methods: We conducted a retrospective study by reviewing medical records of elderly patients with breast cancer treated with adjuvant once-weekly LR HFRT between 2011 and 2020. Fifty patients presenting with primary non-metastatic node-positive breast tumors were included. Treatment outcomes including local/LR control and overall survival were reported. Early and late toxicity profiles were also assessed. Results: After a median follow-up of 4.8 years, only one local recurrence in the chest wall occurred and there was no regional recurrence. The distant metastatic rate was 6%. The long-term recurrence-free survival rate was 80% at 5 years. The cause specific survival rate was 90% at 5 years. The overall survival rate was 69.4% and 55.5% at 3 and 5 years, respectively. There were 44 (88%) patients with Grade 1 or 2 early toxicity. There was no Grade 3 or higher acute toxicity registered. Late toxicity was mainly Grade 1 or 2 subcutaneous fibrosis, lymphoedema, and neuropathy except for one patient with Grade 3 fibrosis. Conclusion: Extreme LR HFRT is well tolerated with good outcomes and is a good alternative for elderly and frail patients. Our results confirm the efficacy and safety of such a regimen. Further randomized trials assessing both oncologic outcome and toxicity profile are justified. (c) 2021 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 162 (2021)156-161

Background This study aimed to explore whether statins reduce radiation‐induced vascular complications in cancer patients postradiotherapy to the thorax, head, and neck. Methods and Results We conducted a retrospective cohort study within a provincial linked database of 5718 cardiac patients with thorax and head or neck cancer having undergone radiotherapy between 2000 and 2011. One thousand five hundred fifty‐two patients were identified as nonstatin users and 4166 as statin users. The primary outcome of interest was the composite of cerebrovascular (transient ischemic attack, and fatal or nonfatal stroke) or cardiovascular events (fatal or nonfatal myocardial infarction). Time‐dependent Cox proportional hazard analyses were performed. The crude event rate was 10.31% for nonusers and 9.03% for statin users (hazard ratio of 0.92 [95% CI 0.76–1.10, P =0.3451]), over a mean time to event/censoring of 534±687 days for nonusers and 594±706 days for the statin users. After adjusting for age, sex, prior history of stroke/transient ischemic attack or myocardial infarction, diabetes mellitus, dyslipidemia, atrial fibrillation, chronic kidney disease, heart failure, and hypertension, statin use postradiotherapy was associated with a nonsignificant 15% relative risk reduction, but a strong trend toward reducing the primary outcome (hazard ratio=0.85 95% CI 0.69–1.04, P =0.0811). The use of statins was associated with a significant reduction of 32% for the outcome of stroke alone (hazard ratio=0.68, 95% CI 0.48–0.98, P =0.0368). Conclusions Statin use post radiation therapy was associated with a significant reduction in stroke, with a trend toward significantly reducing cardiovascular and cerebrovascular events.

Introduction: Radiation-induced atherosclerosis increases the incidence of cardiovascular and cerebrovascular events, independent of traditional vascular risk factors. Moreover patients with a canc...

The role of stereotactic single fraction radiosurgery for 1–3 brain metastases has been previously defined by the RTOG 9508 randomized trial. Our research group has published preclinical and phase 1 clinical trial data suggesting that fractionated lesional radiation therapy to 60 Gy in 10 fractions can serve as an alternative approach to radiosurgical boost. This multi-institutional phase 2 clinical trial reports on three important clinical endpoints of this fractionated approach within the historical control context of RTOG 9508. A phase 2 clinical trial (NCT01542542) of 60 Gy in 10 fractions of lesional (1–3) radiation therapy (given simultaneously with 30 Gy in 10 fractions whole-brain helical tomotherapy) was conducted at five institutions. The co-primary endpoints for this study were overall survival (OS), intracranial control (ICC) and intralesional control (ILC). A sample size of 87 patients was calculated based on statistical assumptions of alpha = 0.025 and beta = 0.1 and study accrual time of 4.5 years. We hypothesized that fractionated radiation therapy would be considered unsuitable if the median OS was degraded by 2 months, or if 6-month ICC/ILC are inferior by 10% compared to published RTOG 9508 results (median OS 6.5 months, 6 month ICC 85% and 6 month ILC 90%). A total of 87 patients were enrolled on the clinical trial over a 4.5 year accrual period. The mean age of participants was 61 years (range, 23–84 years) with 54/87 (62%) female patients, 54/87 (62%) lung cancer patients, and 41/87 (47%) had solitary brain metastases. Primary disease was treated and controlled in 57/87 (65%) with 60/87 (69%) with known extracranial disease. Median KPS and MMSE was 80/100 and 29/30, respectively. Lesion size ranged from 2.0 to 30.0 mm. Radiological lesion and extra-lesional CNS progression was documented in 15/87 (17%) and 11/87 (13%) patients, respectively. Median overall survival for all patients was 5.4 months. Median time to lesional progression and intracranial progression was 5.0 and 4.9 months, respectively. Six month actuarial estimates of ICC and ILC were 78% and 89%, respectively. Observed acute toxicities included one episode of grade 3 tumor flare and one episode of grade 4 seizures. Two (2%) patients developed suspected asymptomatic radionecrosis of their index lesions on MRI follow-up. Phase 2 estimates of all three clinical endpoints studied in this clinical trial compare favorably to the actuarial estimates of these endpoints observed in RTOG 9508. Fractionated radiation therapy to 60 Gy in 10 fractions can be considered as an alternative to single fraction radiosurgery for the treatment of oligometastatic brain lesions. This treatment option is particularly relevant in practice locations without stereotactic radiation therapy apparatus.

Purpose: Conventional radiation therapy (RT) administered in 25 fractions after breast-conserving surgery (BCS) is the standard treatment for ductal carcinoma in situ (DCIS) of the breast. Although accelerated hypofractionated regimens in 16 fractions have been shown to be equivalent to conventional RT for invasive breast cancer, few studies have reported results of using hypofractionated RT in DCIS.Methods and Materials: In this multicenter collaborative effort, we retrospectively reviewed the records of all women with DCIS at 3 institutions treated with BCS followed by hypofractionated whole-breast RT (WBRT) delivered in 16 fractions.Results: Between 2003 and 2010, 440 patients with DCIS underwent BCS followed by hypofractionated WBRT in 16 fractions for a total dose of 42.5 Gy (2.66 Gy per fraction). Boost RT to the surgical bed was given to 125 patients (28%) at a median dose of 10 Gy in 4 fractions (2.5 Gy per fraction). After a median follow-up time of 4.4 years, 14 patients had an ipsilateral local relapse, resulting in a local recurrence-free survival of 97% at 5 years. Positive surgical margins, high nuclear grade, age less than 50 years, and a premenopausal status were all statistically associated with an increased occurrence of local recurrence. Tumor hormone receptor status, use of adjuvant hormonal therapy, and administration of additional boost RT did not have an impact on local control in our cohort. On multivariate analysis, positive margins, premenopausal status, and nuclear grade 3 tumors had a statistically significant worse local control rate.Conclusions: Hypofractionated RT using 42.5 Gy in 16 fractions provides excellent local control for patients with DCIS undergoing BCS. (C) 2013 Elsevier Inc.

Purpose: For patients with anal canal and advanced rectal cancer, chemoradiation therapy is a curative modality or an important adjunct to surgery. Nearly all patients treated with chemoradiation experience some degree of radiation-induced dermatitis (RID). Prevention and effective treatment of RID, therefore, is of considerable clinical relevance. The present phase III randomized trial compared the efficacy of silver clear nylon dressing (SCND) with that of standard skin care for these patients.Methods and Materials: A total of 42 rectal or anal canal cancer patients were randomized to either a SCND or standard skin care group. SCND was applied from Day 1 of radiation therapy (RT) until 2 weeks after treatment completion. In the control arm, sulfadiazine cream was applied at the time of skin dermatitis. Printed digital photographs taken 2 weeks prior to, on the last day, and two weeks after the treatment completion were scored by 10 blinded readers, who used the common toxicity scoring system for skin dermatitis.Results: The radiation dose ranged from 50.4 to 59.4 Gy, and there were no differences between the 2 groups. On the last day of RT, when the most severe RID occurs, the mean dermatitis score was 2.53 (standard deviation [SD], 1.17) for the standard and 1.67 (SD, 1.2; P = .01) for the SCND arm. At 2 weeks after RT, the difference was 0.39 points in favor of SCND (P = .39). There was considerable intraclass correlation among the 10 observers.Conclusions: Silver clear nylon dressing is effective in reducing RID in patients with lower gastrointestinal cancer treated with combined chemotherapy and radiation treatment. (C) 2012 Elsevier Inc.

613 Background: Local recurrence (LR) of ductal carcinoma in situ (DCIS) is reduced by whole breast irradiation following breast conservative surgery (BCS). The benefit and indication for adding a radiotherapy boost to the surgical cavity for DCIS is unclear. Methods: 220 consecutive cases of DCIS treated at the McGill University Health Centre (MUHC) with BCS and radiotherapy between January 2000 and December 2006 were reviewed to assess the impact of the radiotherapy boost on local control. All patients were CT-simulated and received whole breast irradiation ranging from 42.4-50.4 Gy in 16-28 fractions. 36% of the patients received a radiotherapy boost of a median dose of 10 Gy (range: 9-16 Gy) to the surgical cavity. Median follow-up was same for Boost and No-Boost groups (46 months). Descriptive statistics and time to event analyses was carried out using Kaplan-Meir survival analyses. Results: Compared with the No-Boost group, patients who received the boost had more positive (6% vs. 1%) and < 0.1 cm margins (51% vs. 8%) (p < 0.0001), and were in higher risk categories as defined by the Van Nuys Prognostic (VNP) index (p = 0.015). Despite being in higher risk for LR, none (0/79) of the patients who received a boost recurred locally while 8/141 patients who did not receive a boost suffered an in-breast LR (Log-rank p = 0.03). Univariate analysis of prognostic factors (age, tumor size, margin status, histological grade, necrosis, and VNP risk category) revealed only the presence of necrosis to significantly correlate with LR (Log-rank p = 0.003). All 8 LR occurred in DCIS with necrosis. No significant difference in LR rate was observed between whole breast irradiation dose and fractionation schedule. Conclusions: Our results suggest that use of a radiotherapy boost significantly impacts local control in DCIS. The use of a boost may outweigh the poor prognostic effect of necrosis. No significant financial relationships to disclose.

PURPOSE:Local recurrence (LR) of ductal carcinoma in situ (DCIS) is reduced by whole-breast irradiation after breast-conserving surgery (BCS). However, the benefit of adding a radiotherapy boost to the surgical cavity for DCIS is unclear. We sought to determine the impact of the boost on LR in patients with DCIS treated at the McGill University Health Centre.METHODS AND MATERIALS:A total of 220 consecutive cases of DCIS treated with BCS and radiotherapy between January 2000 and December 2006 were reviewed. Of the patients, 36% received a radiotherapy boost to the surgical cavity. Median follow-up was 46 months for the boost and no-boost groups. Kaplan-Meier survival analyses and Cox regression analyses were performed.RESULTS:Compared with the no-boost group, patients in the boost group more frequently had positive and <0.1-cm margins (48% vs. 8%) (p < 0.0001) and more frequently were in higher-risk categories as defined by the Van Nuys Prognostic (VNP) index (p = 0.006). Despite being at higher risk for LR, none (0/79) of the patients who received a boost experienced LR, whereas 8 of 141 patients who did not receive a boost experienced an in-breast LR (log-rank p = 0.03). Univariate analysis of prognostic factors (age, tumor size, margin status, histological grade, necrosis, and VNP risk category) revealed only the presence of necrosis to significantly correlate with LR (log-rank p = 0.003). The whole-breast irradiation dose and fractionation schedule did not affect LR rate.CONCLUSIONS:Our results suggest that the use of a radiotherapy boost improves local control in DCIS and may outweigh the poor prognostic effect of necrosis.

PURPOSE:Despite multimodality treatments, the outcome of patients with glioblastoma multiforme remains poor. In an attempt to improve results, we have begun a program of accelerated hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with concomitant and adjuvant temozolomide (TMZ). METHODS AND MATERIALS:Between March 2004 and June 2006, 35 unselected patients with glioblastoma multiforme were treated with hypo-IMRT. During a 4-week period, using a concomitant boost technique, a dose of 60 Gy and 40 Gy were delivered in 20 fractions prescribed to the periphery of the gross tumor volume and planning target volume, respectively. TMZ was administered according to the regimen of Stupp et al. RESULTS:The median follow-up was 12.6 months. Of the 35 patients, 29 (82.8%) completed the combined modality treatment, and 25 (71.4%) received a median of four cycles of adjuvant TMZ. The median overall survival was 14.4 months, and the median disease-free survival was 7.7 months. The median survival time differed significantly between patients who underwent biopsy and those who underwent partial or total resection (7.1 vs. 16.1 months, p = 0.035). The median survival was also significantly different between patients with methylated vs. unmethylated 0-6-methylguanine-DNA methyltransferase promoters (14.4 vs. 8.7 months, p = 0.049). The pattern of failure was predominantly central, within 2 cm of the initial gross tumor volume. Grade 3-4 toxicity was limited to 1 patient with nausea and emesis during adjuvant TMZ administration. CONCLUSION:The results of our study have shown that hypo-IMRT with concomitant and adjuvant TMZ is well tolerated with a useful 2-week shortening of radiotherapy. Despite a high number of patients with poor prognostic features (74.3% recursive partitioning analysis class V or VI), the median survival was comparable to that after standard radiotherapy fractionation schedules plus TMZ.

Background The use of fractionated stereotactic radiotherapy (fsrt) has evolved with technical advances in noninvasive immobilization, radiation delivery, and image guidance. The application of fsrt to pituitary tumours is aimed at reducing toxicity through improved dose conformality and reduced treatment margins. The aim of the present paper is to report our own experience and to review the published data on fsrt for pituitary macroadenomas. Methods Between September 2000 and October 2005, 13 patients with pituitary macroadenoma underwent fsrt at our institution. In 12 patients, radiotherapy treatment followed surgical resection (transsphenoidal resection in 8, frontal craniotomy in 3, and multiple transsphenoidal resections followed by craniotomy in 1). In 4 patients, the tumours were functional (2 adrenocorticotropic hormone–secreting, 1 prolactinoma, and 1 growth hormone–secreting); the tumours in the remaining patients were clinically non-secretory. Before radiation, 3 patients had panhypopituitarism, and 6 patients had visual field defects. All patients were treated with fsrt using non-coplanar micro–multileaf collimation portals. A median dose of 50.4 Gy (range: 45–60 Gy) was prescribed to the 76.9%–95.2% isodose surface and delivered in 1.8-Gy fractions. The median planning target volume (gross tumour plus 3 mm) was 33.5 cm3 (range: 3.2–75 cm3). Results After a median follow-up of 24 months (range: 6–60 months), local control was 100%. One patient achieved clinical complete response. Treatment was well tolerated acutely for all patients. Neither radiation-induced optic neuropathy nor any radiation-related endocrine dysfunction was observed in our patients. Conclusions In accordance with published series, we found fsrt to be safe and effective in the management of large pituitary macroadenomas.

Purpose/Objective(s)To assess the potential benefits and limitations of IMRT in the treatment of skull base meningioma.Materials/MethodsWe undertook a retrospective treatment planning study using the CT simulation data for 8 patients with meningiomas of the skull base originally treated with fractionated stereotactic radiotherapy. Target volumes and organs at risk were delineated with the help of co-registered MRI images. A 3 mm margin was added to the gross tumor volume to create the planning target volume (PTV). Treatment plans were generated for non-coplanar 3DCRT, coplanar fixed-field IMRT (7-9 fields) and Helical Tomotherapy (HT) to deliver a total dose of 52.2 Gy in 1.8 Gy fractions. The treatment goals were to cover ≥95% and 99% of the PTV with 100% and ≥95% of the prescribed dose , respectively, whilst keeping the maximum point dose to optic nerves, chiasm and brain stem ≤54 Gy. Based on review by experienced radiation oncologist, a clinically accepted plan from each modality was selected for comparison. The parameters used for comparison were the ability of each plan to achieve the predetermined treatment goals along with the conformity index (CI), homogeneity index (HI), and target coverage index (Cov. I). Direct comparison of the DVH data for the PTV coverage and OAR sparing was done along with the repeated measures ANOVA with Tukey's multiple comparison post hoc tests for CI, HI, and Cov. I comparison.ResultsThe eight meningiomas of the skull base (6 cavernous sinus, 1 suprasellar, and 1 olfactory groove tumors) had a median PTV of 20.3 cc (range, 7.4-50.7 cc). The PTV coverage goals has been achieved in all HT plans, compared to 7 and 6 plans for fixed-field IMRT and 3DCRT , respectively, with 1-1.5% of the PTV missing the goals by 1-3% of the prescribed dose. The PTV coverage index for HT plans was significantly higher compared to fixed-field IMRT (p = 0.004), with no significant difference between either HT and 3DCRT or fixed-field IMRT and 3DCRT. The HT plans achieved the highest HI followed by fixed-field IMRT then 3DCRT (p = 0.002). In contrast, 3DCRT plans had higher CI than both IMRT modalities (p < 0.001). The treatment goals for the optic chiasm and optic nerves were achieved in all IMRT plans while it has been violated in 5 3DCRT (by 0.8-1.2 Gy). The treatment goal for the brainstem was achieved in all plans with no significant differences.ConclusionsWhen treating base of skull meningiomas, HT resulted in the best target coverage and dose homogeneity. When compared to 3DCRT, sparing of organs at risk was improved with either HT or fixed-field IMRT at the expense of a lower CI. Purpose/Objective(s)To assess the potential benefits and limitations of IMRT in the treatment of skull base meningioma. To assess the potential benefits and limitations of IMRT in the treatment of skull base meningioma. Materials/MethodsWe undertook a retrospective treatment planning study using the CT simulation data for 8 patients with meningiomas of the skull base originally treated with fractionated stereotactic radiotherapy. Target volumes and organs at risk were delineated with the help of co-registered MRI images. A 3 mm margin was added to the gross tumor volume to create the planning target volume (PTV). Treatment plans were generated for non-coplanar 3DCRT, coplanar fixed-field IMRT (7-9 fields) and Helical Tomotherapy (HT) to deliver a total dose of 52.2 Gy in 1.8 Gy fractions. The treatment goals were to cover ≥95% and 99% of the PTV with 100% and ≥95% of the prescribed dose , respectively, whilst keeping the maximum point dose to optic nerves, chiasm and brain stem ≤54 Gy. Based on review by experienced radiation oncologist, a clinically accepted plan from each modality was selected for comparison. The parameters used for comparison were the ability of each plan to achieve the predetermined treatment goals along with the conformity index (CI), homogeneity index (HI), and target coverage index (Cov. I). Direct comparison of the DVH data for the PTV coverage and OAR sparing was done along with the repeated measures ANOVA with Tukey's multiple comparison post hoc tests for CI, HI, and Cov. I comparison. We undertook a retrospective treatment planning study using the CT simulation data for 8 patients with meningiomas of the skull base originally treated with fractionated stereotactic radiotherapy. Target volumes and organs at risk were delineated with the help of co-registered MRI images. A 3 mm margin was added to the gross tumor volume to create the planning target volume (PTV). Treatment plans were generated for non-coplanar 3DCRT, coplanar fixed-field IMRT (7-9 fields) and Helical Tomotherapy (HT) to deliver a total dose of 52.2 Gy in 1.8 Gy fractions. The treatment goals were to cover ≥95% and 99% of the PTV with 100% and ≥95% of the prescribed dose , respectively, whilst keeping the maximum point dose to optic nerves, chiasm and brain stem ≤54 Gy. Based on review by experienced radiation oncologist, a clinically accepted plan from each modality was selected for comparison. The parameters used for comparison were the ability of each plan to achieve the predetermined treatment goals along with the conformity index (CI), homogeneity index (HI), and target coverage index (Cov. I). Direct comparison of the DVH data for the PTV coverage and OAR sparing was done along with the repeated measures ANOVA with Tukey's multiple comparison post hoc tests for CI, HI, and Cov. I comparison. ResultsThe eight meningiomas of the skull base (6 cavernous sinus, 1 suprasellar, and 1 olfactory groove tumors) had a median PTV of 20.3 cc (range, 7.4-50.7 cc). The PTV coverage goals has been achieved in all HT plans, compared to 7 and 6 plans for fixed-field IMRT and 3DCRT , respectively, with 1-1.5% of the PTV missing the goals by 1-3% of the prescribed dose. The PTV coverage index for HT plans was significantly higher compared to fixed-field IMRT (p = 0.004), with no significant difference between either HT and 3DCRT or fixed-field IMRT and 3DCRT. The HT plans achieved the highest HI followed by fixed-field IMRT then 3DCRT (p = 0.002). In contrast, 3DCRT plans had higher CI than both IMRT modalities (p < 0.001). The treatment goals for the optic chiasm and optic nerves were achieved in all IMRT plans while it has been violated in 5 3DCRT (by 0.8-1.2 Gy). The treatment goal for the brainstem was achieved in all plans with no significant differences. The eight meningiomas of the skull base (6 cavernous sinus, 1 suprasellar, and 1 olfactory groove tumors) had a median PTV of 20.3 cc (range, 7.4-50.7 cc). The PTV coverage goals has been achieved in all HT plans, compared to 7 and 6 plans for fixed-field IMRT and 3DCRT , respectively, with 1-1.5% of the PTV missing the goals by 1-3% of the prescribed dose. The PTV coverage index for HT plans was significantly higher compared to fixed-field IMRT (p = 0.004), with no significant difference between either HT and 3DCRT or fixed-field IMRT and 3DCRT. The HT plans achieved the highest HI followed by fixed-field IMRT then 3DCRT (p = 0.002). In contrast, 3DCRT plans had higher CI than both IMRT modalities (p < 0.001). The treatment goals for the optic chiasm and optic nerves were achieved in all IMRT plans while it has been violated in 5 3DCRT (by 0.8-1.2 Gy). The treatment goal for the brainstem was achieved in all plans with no significant differences. ConclusionsWhen treating base of skull meningiomas, HT resulted in the best target coverage and dose homogeneity. When compared to 3DCRT, sparing of organs at risk was improved with either HT or fixed-field IMRT at the expense of a lower CI. When treating base of skull meningiomas, HT resulted in the best target coverage and dose homogeneity. When compared to 3DCRT, sparing of organs at risk was improved with either HT or fixed-field IMRT at the expense of a lower CI.

Purpose: Silver-leaf nylon dressing (SLND) has been shown to have effective antimicrobial activity and to enhance healing in burns and skin grafts. The purpose of this study was to evaluate the value of SLND in preventing radiation dermatitis in patients undergoing radiotherapy to target volumes that included the perineum and concurrent chemotherapy.Methods and Materials: Fifteen consecutive patients with either anal canal or gynecologic cancer were offered the SLND as a preventive intervention. The evaluation was based on standardized photographs taken at the end of treatment. A historical control group of 15 patients with the same neoplasms who received standard skin care was assessed in the same fashion. Ten observers unaware of the treatment intervention were enrolled in the evaluation of the skin changes. The Mann-Whitney U test was used to assess the statistical significance of the differences in the dermatitis scores between the two patient groups.Results: The mean dermatitis score for controls was 2.62 (standard deviation, 0.48). The mean score for the SLND group was significantly lower at 1.16 (standard deviation, 0.40; p <0.0001).Conclusion: The results of this study suggest that SLND is effective in reducing radiation dermatitis, apparently because of its antibacterial properties. (C) 2004 Elsevier Inc.

Purpose: Despite major advances in treatment modalities, the prognosis of patients with glioblastoma multiforme (GBM) remains poor. Exploring hypofractionated regimens to replace the standard 6-week radiotherapy schedule is an attractive strategy as an attempt to prevent accelerated tumor cell repopulation. There is equally interest in dose escalation to the gross tumor volume where the majority of failures occur. We report our preliminary results using hypofractionated intensity-modulated accelerated radiotherapy regimen in the treatment of patients with GBM.Methods and Materials: Between July 1998 and December 2001, 25 patients with histologically proven diagnosis of GBM, Karnofsky performance status greater than or equal to60, and a postoperative tumor volume less than or equal to110 cm(3) were treated with a hypofractionated accelerated course of radiotherapy. The gross tumor volume (GTV) was defined as the contrast-enhancing lesion on the postoperative MRI T1-weighted images with the latter fused with computed tomography images for treatment planning. The planning target volume was defined as GTV + 1.5-cm margin. Using forward-planning intensity modulation (step-and-shoot technique), 60 Gy in 20 daily fractions of 3 Gy each were given to the GTV, whereas the planning target volume received a minimum of 40 Gy in 20 fractions of 2 Gy each at its periphery. Treatments were delivered over a 4-week period using 5 daily fractions per week. Dose was prescribed at the isocenter (ICRU point). Three beam angles were used in all of the cases.Results: Treatments were well tolerated. Acute toxicity was limited to increased brain edema during radiotherapy in 2 patients who were on tapering doses of corticosteroids. This was corrected by increasing the steroid dose. At a median follow-up of 8.8 months, no late toxicity was observed. One patient experienced visual loss at 9 months after completion of treatment. MRI suggested nonspecific changes to the optic chiasm. On review of the treatment plan, the total dose to the optic chiasm was confirmed to be equal to or less than 40 Gy in 20 fractions. When Radiation Therapy Oncology Group recursive partitioning analysis was used, 10 patients were class III-IV, and 15 patients were class V-VI. To date, 21 patients have had clinical and/or radiologic evidence of disease progression, and 16 patients have died. The median survival was 9.5 months (range: 2.8-22.9 months), the 1-year survival rate was 40%, and the median progression-free survival was 5.2 months (range: 1.9-12.8 months).Conclusion: This hypofractionated accelerated irradiation schedule using forward planning (step-and-shoot) hypofractionated, intensity-modulated accelerated radiotherapy is feasible and seems to be a safe treatment for patients with GBM. A 2-week reduction in the treatment time may be of valuable benefit for this group of patients. However, despite this accelerated regimen, no survival advantage has been observed. (C) 2004 Elsevier Inc.