Poster highlights Poster highlights (clinical) (clinical) ICARO 2009 ICARO 2009 April 29th April 29th
Internal audit is part of your QA Internal audit is part of your QA system system � A key element of internal A key element of internal � audit is internal review of audit is internal review of clinical results (outcome clinical results (outcome studies). studies). � This allows to benchmark This allows to benchmark � with other centres. with other centres. � Differences can be Differences can be � investigated. investigated. � Good practice is confirmed Good practice is confirmed � � Research encourages Research encourages � good practice good practice
Clinical data Clinical data � HIV patients (posters 101, 107) HIV patients (posters 101, 107) � � Brachytherapy Brachytherapy (103, 104) (103, 104) � � Uncommon cancers (83, 130) Uncommon cancers (83, 130) � � Clinical trials and series (98, 102,106, 108, 128) Clinical trials and series (98, 102,106, 108, 128) � � Biology & radiobiology (135, 138) Biology & radiobiology (135, 138) � � Radiotherapy technique (84, 86, 92, 126) Radiotherapy technique (84, 86, 92, 126) � � Paediatrics (82, 86) Paediatrics (82, 86) � � General (100, 120) General (100, 120) �
HIV HIV E Oyekunle (Nigeria) P Siraprapasiri (Thailand) � 43 HIV positive 43 HIV positive � 23 pts 23 pts � � patients with cancer patients with cancer � CD4 count indeed CD4 count indeed � � Rate of recurrence and Rate of recurrence and drops during RT. drops during RT. � met’ ’s s increased increased met � Dose Dose- -dependant. dependant. � � Further Further � � Worse in aging pts and Worse in aging pts and � immunosuppression in in immunosuppression those without ART. those without ART. 40 % 40 % � Perhaps ART should Perhaps ART should � � CD4 count should be CD4 count should be � be part of RT. be part of RT. monitored monitored
Brachytherapy Brachytherapy � Comparing Fletcher and ring applicator in Comparing Fletcher and ring applicator in � cervix cancer. cervix cancer. � Too much variability in dose distribution Too much variability in dose distribution � between consecutive fractions with Fletcher- - between consecutive fractions with Fletcher type applicator type applicator � Not seen with ring applicator, more Not seen with ring applicator, more � reproducible. reproducible. NA Laghari (Pakistan)
Brachytherapy Brachytherapy � Cervix cancer 2nd cause of death. Cervix cancer 2nd cause of death. � � 70% inoperable (even less operated). 70% inoperable (even less operated). � � RT + HDR RT + HDR brachy brachy is used. is used. � � Cost of 1 HDR Ir192 source US$7.000 Cost of 1 HDR Ir192 source US$7.000 � � For an average of 29.5 insertions. For an average of 29.5 insertions. � � HDR unit use should be optimised (referral, HDR unit use should be optimised (referral, � other cancer) and X- -ray verification unit is ray verification unit is other cancer) and X needed. needed. H Mahmood (Pakistan)
Uncommon cancer Uncommon cancer M De Melo (Brazil) DA Dawotola (Nigeria) � Cervix cancer <25y Cervix cancer <25y � Large breast cancer (> Large breast cancer (> � � 25 cm). 25 cm). � Series of 40 pts Series of 40 pts � � Mean age 34.5 y. Mean age 34.5 y. � � 14 in situ (do well) 14 in situ (do well) � � Radical surgery + CT Radical surgery + CT � � 26 invasive, 20 treated 26 invasive, 20 treated � + RT. + RT. with ERT+BT. with ERT+BT. � Separation > 22 cm. Separation > 22 cm. � � More than half had More than half had � disease progression � C0 60 treatment. C0 60 treatment. disease progression � during the treatment! during the treatment! � Skin tolerance detailed Skin tolerance detailed � � Only 60% 5yOS for Only 60% 5yOS for (36 % grade 3 & 4). (36 % grade 3 & 4). � stage I. stage I.
Clinical trials & series Clinical trials & series � Tolerability of RT Tolerability of RT- -CT in cervix cancer (BCR CT in cervix cancer (BCR Devi Devi, , � Malaysia). Malaysia). � Managing a randomised trial (N Begum, Pakistan). Managing a randomised trial (N Begum, Pakistan). � � NPC in young patients (P NPC in young patients (P Kamnerdsupaphon Kamnerdsupaphon, , � Thailand). Thailand). � RCT in bone metastases (V RCT in bone metastases (V Sukthomia Sukthomia, Thailand). , Thailand). � � RT vs. RTCT in advanced rectum ca (R Engineer RT vs. RTCT in advanced rectum ca (R Engineer � India). India). � IMRT vs conventional RT in cervix ca (U IMRT vs conventional RT in cervix ca (U � Mahantshetty, India). , India). Mahantshetty
209 in 908 pts included in Peshawar Dr N Begum Problem: patients tend to leave before completion because of lack of education, poverty, homesickness, long treatment, side effects… Results: compliance 87.5% in 5#/w and 91.4% in 6#/w. 5y LC 41% vs. 28% 5y DSS 53% vs. 39% Cost-effective. Proactive measures to ensure compliance. Proactive measures to ensure follow-up
95 pts 124 sites 10x3 Gy (1) 2x8.5 Gy (2) Pain relief faster in arm 2
Concurent chemoradiotherapy chemoradiotherapy vs. radiotherapy in vs. radiotherapy in Concurent advanced unresectable unresectable rectum cancer rectum cancer advanced R Engineer (India) R Engineer (India) � 90 inoperable patients 90 inoperable patients � 60 randomised between randomised between 55 (%) 50 � RT � RT- -CT (45 CT (45 Gy Gy + + Capecitabine) ) Capecitabine 39,1 40 � RT (45 + 20 33 � RT (45 + 20 gy gy) ) operated 29,5 30 R0 � Normal side Normal side- -effects effects � CR 20 (nothing unusual) (nothing unusual) 10 9 � Statistical power? Statistical power? � 6,5 0 RT-CT RT
� Interim analysis (audit) of toxicity in a RCT. Interim analysis (audit) of toxicity in a RCT. � � Interim analysis is useful; is usually done by Interim analysis is useful; is usually done by � an independent review committee and an independent review committee and unpublished (unless problems). unpublished (unless problems). � Weakens the validity and requires to Weakens the validity and requires to � α and β values (increase pt strengthen the α and β values (increase pt strengthen the number or reduce power). number or reduce power).
� EBRT for NPC; BID vs. 1#/d in 66 pts. EBRT for NPC; BID vs. 1#/d in 66 pts. � � VEGF VEGF- -A and MVD staining. A and MVD staining. � � Intense staining correlates with better outcome in Intense staining correlates with better outcome in � NPC treated with BID EBRT (S Soetopo Soetopo, , NPC treated with BID EBRT (S Indonesia) Indonesia) 5120 pooled patients 38% conventional 62% hypofractionation α/β value uniform low: Argument for hypo#?
RT techniques RT techniques � PTV coverage for breast ca with 2D and 3D 79% PTV coverage for breast ca with 2D and 3D 79% � vs. 93% coverage of PTV at the cost of more dose vs. 93% coverage of PTV at the cost of more dose to nl tissues (KW Boccaletti Boccaletti, Brazil) , Brazil) to nl tissues (KW � IMRT in IMRT in peadiatric peadiatric patients, only CNS. Concerns patients, only CNS. Concerns � regarding 2nd cancer (RC Villar Villar, Brazil). , Brazil). regarding 2nd cancer (RC � IMRT for functional lung avoidance, using IMRT for functional lung avoidance, using � perfusion SPECT (K Lavrenkov Lavrenkov, Israel, India, UK). , Israel, India, UK). perfusion SPECT (K � IMRT + IGRT ( IMRT + IGRT (tomo tomo) in pancreas and bile duct ) in pancreas and bile duct � cancer (R Enegineer Enegineer, India). , India). cancer (R
Clinical series Clinical series � 204 cervix ca pts treated in Sarawak with RT 204 cervix ca pts treated in Sarawak with RT- -CT. CT. � Acute adverse effects usual (only grade 1 & 2 Acute adverse effects usual (only grade 1 & 2 RTOG) (BCR Devi, Malaysia). 71% early stage? RTOG) (BCR Devi, Malaysia). 71% early stage? � NPC in 16 pts (10 NPC in 16 pts (10- -18y), 11with locally advanced 18y), 11with locally advanced � (III, IVa IVa, , IVb IVb). RT ). RT- -CT CT (III, (V Sukhtomia Sukhtomia, Thailand) , Thailand) (V
Paediatric series Paediatric series childen can be cured! can be cured! childen � Example of PPP to solve Example of PPP to solve acess acess to RT to RT � cancer treatment in children. Centralisation cancer treatment in children. Centralisation of children important. Mean estimated of children important. Mean estimated cost/patient 9.772 US$ (AFY Centrone Centrone, , cost/patient 9.772 US$ (AFY Brazil) Brazil) � IMRT in children. IMRT in children. �
Use of RT in lung Use of RT in lung cancer cancer � Audit of 565 lung ca Audit of 565 lung ca � treatments. treatments. � Use of RT 43%. Use of RT 43%. � � Maori Maori’ ’s s under under � represented. represented. � High early mortality. High early mortality. � � High number declining High number declining � care. care. G Stevens, NZ
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