Background: Patient based quality assurance (QA) procedures for IMRT patients is a daily routine now to be sure about the agreement of treatment planning system (TPS) calculated dose and the dose delivered by the lineer accelerator.

In this presentation, the short-term results and total 207 applications are given of the 89 gynecologic cancer patients who treated in our clinic between June 2008 and December 2011. Three-dimensional conformal brachytherapy technique is used with iridium-192 source (Varisource) after external radiotherapy. In cervix cancer dose is defined to CTV, and in corpus uteri cancer to surface or 5 nun beyond the vagina. CTV definition, critical organ doses and treatment protocols are defined according to the literature.

PURPOSE:The aim of the study is to assess the predictive power of DCE-MRI semi-quantitative parameters during treatment of breast cancer, for disease-free (DFS) and overall survival (OS). MATERIALS AND METHODS:Forty-nine women (age range, 28-84 years; mean, 50.6 years) with breast cancer underwent dynamic contrast enhancement MRI at 1.0T imaging, using 2D FLASH sequences. Time intensity curves (TICs) were obtained from the regions showing maximal enhancement in subtraction images. Semi-quantitative parameters (TICs; maximal relative enhancement within the first minute, E (max/1); maximal relative enhancement of the entire study, E(max); steepest slope of the contrast enhancement curve; and time to peak enhancement) derived from the DCE-MRI data. These parameters were then compared with presence of recurrence or metastasis, DFS and OS by using Cox regression (proportional hazards model) analysis, linear discriminant analysis. RESULTS:The results from of the 49 patients enrolled into the survival analysis demonstrated that traditional prognostic parameters (tumor size and nodal metastasis) and semi-quantitative parameters (E(max/1), and steepest slope) demonstrated significant differences in survival intervals (p<0.05). Further Cox regression (proportional hazards model) survival analysis revealed that semi-quantitative parameters contributed the greatest prediction of both DFS, OS in the resulting models (for E(max/1): p=0.013, hazard ratio 1.022; for stepest slope: p=0.004, hazard ratio 1.584). CONCLUSION:This study shows that DCE-MRI has utility predicting survival analysis with breast cancer patients.

Aim: To determine 2 diff erent prognostic indexes (PI) for the diff erentiation of subgroups of nonmetastatic breast cancer patients with the Cox regression analysis and survival tree (ST) methods and the additional usage of the KaplanMeier estimates to investigate the predictive power of these methods. Materials and methods: Prognostic factors data were collected for 410 patients. Th e Cox regression analysis examines the relationship of the survival distribution and covariates. Th e ST method is a tree-structured survival analysis based on a recursive partitioning algorithm. In this study, Harrell’s concordance indexes of models for training and test sets were computed. Furthermore, survival curves were estimated by the Kaplan-Meier method. Disease-free survival (DFS) was calculated from the time of initial diagnosis (initiation of the fi rst treatment) to the fi rst recurrence of disease. Results: Aft er a median follow-up of 48 months, 100 (24.4%) patients have had at least 1 of the DFS events. In Cox regression analysis, we proposed the simple PI, which is a sum of axillary nodal and HER2/neu status. In the ST method, we identifi ed 3 variables: HER2/neu, axillary nodal, and estrogen receptor status. Th e axillary nodal status was the most important determining factor for recurrence. Conclusion: We found that the PI of the ST and Cox regression methods had similar performance levels in predicting DFS, and the error rates of the models were close to each other in the training and test sets. Furthermore, we determined that the axillary nodal status and HER2/neu were the most important determining factors for prediction of DFS in breast cancer patients.

BACKGROUND:We aimed to evaluate retrospectively the correlation of loco-regional relapse (LRR) rate, distant metastasis (DM) rate, disease free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients who are at intermediate risk for LRR (T1-2 tumor and 1-3 positive axillary nodes) treated with or without postmastectomy radiotherapy (PMRT) following modified radical mastectomy (MRM).METHODS:Ninety patients, with T1-T2 tumor, and 1-3 positive nodes who had undergone MRM received adjuvant systemic therapy with (n = 66) or without (n = 24) PMRT. Patient-related characteristics (age, menopausal status, pathological stage/tumor size, tumor location, histology, estrogen/progesterone receptor status, histological grade, nuclear grade, extracapsular extension, lymphatic, vascular and perineural invasion and ratio of involved nodes/dissected nodes) and treatment-related factors (PMRT, chemotherapy and hormonal therapy) were evaluated in terms of LRR and DM rate. The 5-year Kaplan-Meier DFS and OS rates were analysed.RESULTS:Differences between RT and no-RT groups were statistically significant for all comparisons in favor of RT group except OS: LRR rate (3% vs 17%, p = 0.038), DM rate (12% vs 42%, p = 0.004), 5 year DFS (82.4% vs 52.4%, p = 0.034), 5 year OS (90.2% vs 61.9%, p = 0.087). In multivariate analysis DM and lymphatic invasion were independent poor prognostic factors for OS.CONCLUSION:PMRT for T1-2, N1-3 positive BC patients has to be reconsidered according to the prognostic factors and the decision has to be made individually with the consideration of long-term morbidity and with the patient approval.

Vulva, as a primary site of malignant lymphoma in women, is extremely rare. We report herein an 83-year-old patient with a primary, stage IIE vulvar, follicular center cell, B-cell lineage non-Hodgkin's lymphoma (NHL), with an excellent response to radiation therapy and event-free survival of 18 months. Early-stage primary vulvar NHL can be successfully treated only by limited field irradiation.

The objective of this study was to compare the performances of Cox regression analysis (CRA) and random survival forests (RSF) methods with simulation and a real data set related to breast cancer. In the simulations, we compared across the methods under varying sample sizes by using Monte Carlo simulation method. The results showed that the performance of the CRA was a slightly better for analysis based on Harrell's concordance index than RSF approaches based on log-rank, conservation of events, log-rank score and approximate log-rank splitting rules. In the real data application, a retrospective analysis was performed in 279 breast cancer patients diagnosed. According to Harrell's concordance index, RSF based on approximate log-rank splitting rule to determined major risk factors for disease-free survival (DFS) showed a slightly better performance than other approaches. In general, performances of all the methods were almost similar. The predictive capability of CRA can be used for different sample sizes and potential future suitable survival data problems, whereas RSF provide interpretive results.

The purpose of this study is to determine new prognostic indexes for the differentiation of subgroups of breast cancer patients with the techniques of decision tree algorithms (C&RT, CHAID, QUEST, ID3, C4.5 and C5.0) and Cox regression analysis for disease-free survival (DFS) in breast cancer patients. A retrospective analysis was performed in 381 breast cancer patients diagnosed. Age, menopausal status, age of menarche, family history of cancer, histologic tumor type, quadrant of tumor, tumor size, estrogen and progesterone receptor status, histologic and nuclear grading, axillary nodal status, pericapsular involvement of lymph nodes, lymphovascular and perineural invasion, adjuvant radiotherapy, chemotherapy and hormonal therapy were assessed. Based on these prognostic factors, new prognostic indexes for C&RT, CHAID, QUEST, ID3, C4.5 and C5.0 and Cox regression were obtained. Prognostic indexes showed a good degree of classification, which demonstrates that an improvement seems possible using standard risk factors. We obtained that C4.5 has a better performance than C&RT, CHAID, QUEST, ID3, C5.0 and Cox regression to determine risk groups using Random Survival Forests (RSF).

Cytotoxic agents can increase the efficacy of radiation. Radiosensitizing effects (interaction within the radiation field) can be additive or supra-additive. Multiple mechanisms underlie radiosensitizing properties of cytotoxic agents and include increased radiation damage, inhibition of DNA repair, cell-cycle synchronization, increased cytotoxicity against hypoxic cells, inhibition of prosurvival pathways, and abrogation of rapid tumor cell repopulation. The agents, which have the most radiosensitizing effects, are cisplatin and paclitaxel. In addition to the classic cytotoxic agents with radiosensitizing properties several novel agents show promising interactions with radiation (e.g. EGFR inhibitors, antiangiogenic agents). Today, a sequential treatment is the standard treatment in the early stage breast cancer patients. However, concomitant chemotherapy and radiotherapy (RT) could be more appropriate to patients with high risk of recurrence, for example, in those with axillary lymph node metastases, close or positive surgical margins, large tumor size, young age and presence of lymphovascular invasion. Phase III trials are needed to define the benefits and the late effects of concomitant modern RT techniques (with 3 dimensional conformal, intensity modulated or image guided RT) with taxanes, capecitabine and targeted biologic agents in the adjuvant settings.

To identify the outcomes of prognostic factors of solitary plasmacytoma mainly treated with local radiotherapy (RT). The data were collected from 80 patients with solitary plasmacytoma (SP). Forty patients (50.0%) received radiotherapy (RT) alone while 38 of them (47.5%) were treated with surgery (S) and RT. The median radiation dose was 46 Gy (range 30–64). The median follow up was 2.41 years (range 0.33–12.33). Ten‐year overall survival (OS) and local relapse‐free survival (LRFS) were 73% and 94%, respectively. The median progression‐free survival (PFS) and multiple myeloma‐free survival (MMFS) were 3.5 years and 4.8 years, respectively. On multivariate analyses, the favorable factors were radiotherapy dose of ≥50 Gy and RT + S for PFS and younger age for MMFS. For the patients with medullary plasmacytoma, the favorable factor was younger age for MMFS. RT at ≥50 Gy and RT + S may be favorable prognostic factors on PFS. Younger patients, especially with head‐neck lesion and without pre‐RT macroscopic tumor, seem to have the best outcome when treated with RT ± S. Progression to MM remains as the main problem especially for older patients. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.

To assess the degree of protective effects of amifostine on kidney functions via semiquantitative static renal scintigraphy and histopathologic analysis.

Although lymph node involvement is common in ovarian cancer, axillary and supraclavicular lymph node involvement is quite rare. In the 55-year-old patient without any lesions that are scannable via conventional methods, in which increase of CA-125 level was detected during follow-up, recurrence was detected via combined positron emission tomography and computed tomography investigation. This case recurring with intraabdominal and supraclavicular and axillary lymph node (which are rare regions of involvement) metastasis has been discussed with literature information. In this article, the importance of combined positron emission tomography and computed tomography investigation in patients with suspected recurrence in whom no tumor detectable via conventional methods has been identified was highlighted.

The total micronucleus (MN) assay has been used for purposes of biological dosimetry for many years. The variable spontaneous incidence of micronuclei in peripheral blood lymphocytes affects the sensitivity of biological dose estimations at low doses. It has been suggested that this problem could be solved by using the micronuclei-centromere assay.In this study. Co-60 gamma ray dose response curves for micronuclei (MN) and micronuclei without centromeres (MNC-) in the range of 0-5.0 Gy were established using a pancentromeric FISH probe on cultured binucleate lymphocytes from 2 donors. There were no significant inter-donor differences in the dose responses for either MN or MNC-. The relative proportions of MN that contained centromeres (MNC+) decreased with radiation dose, which is in line with the proposition that radiation predominately causes chromosomal breakage rather than whole chromosome loss. The a coefficients of MNC- curves decreased to 62% of the values for total MN whilst the beta coefficients were unchanged.MN and MNC+ frequencies of 60 control smoker and 40 non-smoker donors were also compared. No effect of smoking was observed. However the MNC+ spontaneous frequencies showed an age and gender effect with the highest frequencies in older women.

Malignant lymphoma as a solitary chest wall mass is rare. Although surgical resection is the main treatment modality for malignant chest wall tumors, the treatment of primary chest wall lymphomas is controversial. A 65-year-old male patient with an enlarging mass on the left side of his chest wall, which had first appeared four months before, applied to our hospital. The patient was directed to our polyclinic with a diagnosis of large B-cell lymphoma after the biopsy. Following the clinical investigation, stage IIEB extranodal am-Hodgkin's lymphoma was determined, and after a palliative radiotherapy, eight cycles of chemotherapy were planned. However, shortly after the completion of the sixth cycle of chemotherapy, poor performance status developed secondary to chemotherapy and the patient was diagnosed with pulmonary embolus. Following the stop of chemotherapy after six cycles, a complete clinical remission and a nearly complete radiologic remission were achieved. The patient is still under follow-up and was free of disease at four months.

Hematol Oncol Stem Cell Ther 1(4) October 2008 hemoncstem.edmgr.com 241 Monoclonal extramedullary plasmacytoma (EMP) is a rare plasma cell tumor. The dil agnosis is based on a mass of clonal plasma cells separate from bone or bone marrow without evil dence of occult disease elsewhere. It occurs in the upper aerodigestive tract in more than 80% of patients, most often in the nasal cavity, paranasal sinuses, nasopharynx, oropharynx and larynx.1,2 Regional nodes are invaded in less than 10% of patients.1 The disease is more coml mon in males with a peak incidence in the sixth decade. Primary EMP often presents with a mass and produces local compressive symptoms. The differential diagnosis includes benign reactive processes, carcinoma and lyml phoma. Radiotherapy (RT) is an effective modality of treatment for EMP with high local control rates (85% to 100%).1,3l6 Currently moderate dose RT (40l50 Gy) using involved fields is recommended.