Poster highlights Poster highlights (clinical) (clinical) ICARO - - PowerPoint PPT Presentation

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

• 43 HIV positive

43 HIV positive patients with cancer patients with cancer

• Rate of recurrence and

Rate of recurrence and met met’ ’s s increased increased

• Further

Further immunosuppression immunosuppression in in 40 % 40 %

• CD4 count should be

CD4 count should be monitored monitored

• 23 pts

23 pts

• CD4 count indeed

CD4 count indeed drops during RT. drops during RT.

• Dose

Dose-

• dependant.

dependant.

• Worse in aging pts and

Worse in aging pts and those without ART. those without ART.

• Perhaps ART should

Perhaps ART should be part of RT. be part of RT.

E Oyekunle (Nigeria) P Siraprapasiri (Thailand)

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,

• ther cancer) and X
• ther cancer) and X-
• ray verification unit is

ray verification unit is needed. needed.

H Mahmood (Pakistan)

Uncommon cancer Uncommon cancer

• Cervix cancer <25y

Cervix cancer <25y

• Series of 40 pts

Series of 40 pts

• 14 in situ (do well)

14 in situ (do well)

• 26 invasive, 20 treated

26 invasive, 20 treated with ERT+BT. with ERT+BT.

• More than half had

More than half had disease progression disease progression during the treatment! during the treatment!

• Only 60% 5yOS for

Only 60% 5yOS for stage I. stage I.

• Large breast cancer (>

Large breast cancer (> 25 cm). 25 cm).

• Mean age 34.5 y.

Mean age 34.5 y.

• Radical surgery + CT

Radical surgery + CT + RT. + RT.

• Separation > 22 cm.

Separation > 22 cm.

• C0 60 treatment.

C0 60 treatment.

• Skin tolerance detailed

Skin tolerance detailed (36 % grade 3 & 4). (36 % grade 3 & 4).

M De Melo (Brazil) DA Dawotola (Nigeria)

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 Mahantshetty, India). , India).

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 Concurent chemoradiotherapy chemoradiotherapy vs. radiotherapy in

• vs. radiotherapy in

advanced advanced unresectable unresectable rectum cancer rectum cancer R Engineer (India) R Engineer (India)

• 90 inoperable patients

90 inoperable patients randomised between randomised between

• RT

RT-

• CT (45

CT (45 Gy Gy + + Capecitabine Capecitabine) )

• RT (45 + 20

RT (45 + 20 gy gy) )

• Normal side

Normal side-

• effects

effects (nothing unusual) (nothing unusual)

• Statistical power?

Statistical power?

55 39,1 6,5 33 29,5 9 10 20 30 40 50 60 RT-CT RT

• perated

R0 CR

(%)

• 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 strengthen the strengthen the α α and and β β values (increase pt values (increase pt 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 NPC treated with BID EBRT (S Soetopo Soetopo, , 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 to nl tissues (KW Boccaletti Boccaletti, Brazil) , Brazil)

• IMRT in

IMRT in peadiatric peadiatric patients, only CNS. Concerns patients, only CNS. Concerns regarding 2nd cancer (RC regarding 2nd cancer (RC Villar Villar, Brazil). , Brazil).

• IMRT for functional lung avoidance, using

IMRT for functional lung avoidance, using perfusion SPECT (K perfusion SPECT (K Lavrenkov Lavrenkov, Israel, India, UK). , Israel, India, UK).

• IMRT + IGRT (

IMRT + IGRT (tomo tomo) in pancreas and bile duct ) in pancreas and bile duct cancer (R cancer (R Enegineer Enegineer, India). , India).

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, (III, IVa IVa, , IVb IVb). RT ). RT-

• CT

CT (V (V Sukhtomia Sukhtomia, Thailand) , Thailand)

Paediatric series Paediatric series childen childen can be cured! can be cured!

• 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

• f children important. Mean estimated
• f children important. Mean estimated

cost/patient 9.772 US$ (AFY cost/patient 9.772 US$ (AFY Centrone Centrone, , 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