4662 Background: Pulmonary metastases of renal cell carcinoma (RCC) are associated with poor prognosis especially when the disease is rapidly progressing. The lung is a common site for metastases and respiratory failure is a common cause of death in patients with RCC. Inhalation therapy with IL-2 is thus an appealing method for palliation. This multi-center study summarizes the national experience with IL-2 inhalation in patients with lung metastases of RCC. Methods: All the patients had to have radiologically documented lung metastases, had to be able to comply with inhalation technique, and were not candidates for other treatment options. Treatment included 3 daily inhalations of 18 MU IL-2 by using a Salvia Lifetec Jetair inhalator. Treatment had to be continued until progression or complete response or life threatening toxicity or patient's refusal. Response was evaluated according to RECIST. Results: Forty patients (median 66.5 years), with histological or cytological diagnosis of RCC were enrolled. Nephrectomy was performed in a total of 32 patients. Previous treatments for metastatic disease included various combinations of systemic chemo-immunotherapy in 12 patients. Twenty-eight patients were systemic-treatment-naïve.The observed true response rate was 2.5% and disease stabilization rate was 55%. The disease-control rate (partial response plus disease stabilization rate) reached 57.5%. Time to progression ranged from 0.3 (in case of rapidly progressing disease) to more than 43 months, with a median of 8.7 months. The side effects included cough in 8 patients, weakness in 9, dyspnea in 3, fever in 2, sleepiness in 1, asthenia in 1, decreased appetite in 1, and abdominal pain in 1. Conclusions: Inhalation of IL-2 for treating pulmonary metastases of RCC is feasible, tolerable, and efficacious in controlling a progressive disease for considerable periods of time. Definition of response of biological therapy by RECIST system should be re-assessed and modified: stable disease should be regarded as a favorable and an important response. No significant financial relationships to disclose.
Ionizing radiation plays an important role in the treatment of patients with malignancy for cure and palliation. In the last decade there have been significant technological advances in radiation equipment, imaging and software. Owing to these developments, modern radiation is being shaped according to the size and form of the target organ and is accurate in locating the target location and can even take into account respiratory motion. Thanks to these developments, radiobiological concepts in radiation therapy have been tested and applied. Radiation doses have been increased to 5-20Gy/fraction and the number of treatments has been reduced to an average of five. This type of treatment is called Stereotactic Body Radiation Therapy (SBRT). The application of this treatment to various tumors may improve the effectiveness of radiation therapy, increasing local tumor control and reducing side effects. Another benefit is cutting the overall treatment time. The present article presents a review of literature on stereotactic radiation in lung tumors, prostate cancer, primary liver tumors and in oligo-metastases.
SummaryPericardial effusion caused by malignant disease is an uncommon disorder. We present a patient with rectal cancer who developed malignant pericardial effusion as the main site of relapse 18 months following surgery. We discuss the incidence and the therapy of this condition.Key words: Pericardial effusionrectal cancer
Local recurrences after breast-conserving surgery occur mostly at the site of the primary carcinoma. The main objective of postoperative radiotherapy is sterilization of residual cancer cells. Whole-breast radiotherapy is the standard of care, but its utility has recently been challenged in favor of radiotherapy limited to the area at highest risk of recurrence. Intraoperative electron radiotherapy (IOeRT) is an innovative technique for accelerated partial breast irradiation (APBI) that is applied to selected patients affected by early breast cancer.To describe our experience with IOeRT at the Rambam Health Care Campus in Haifa since we began utilizing this modality in 2006.From April 2006 to September 2010, 31 patients affected by unifocal invasive duct breast carcinoma < or = 2 cm diameter received wide local resection followed by intraoperative radiotherapy with electrons. Patients were evaluated for early and late complications, and other events, 1 month after surgery and every 3 months thereafter for the duration of the first 2 years.After a mean follow-up of 36 months, seven patients developed mild breast fibrosis and three suffered from mild postoperative infection. Rib fractures were observed in four patients before routine lead shielding was initiated. Additional whole-breast irradiation was given to four patients. None of the patients developed local recurrences or other ipsilateral cancers. Similarly, no contralateral cancers or distant metastases were observed.Intraoperative electron radiotherapy may be an alternative to external beam radiation therapy in an appropriate selected group of early-stage breast cancer patients. However, long-term results of clinical trials are required to better evaluate the indications and utility of this technique in the management of breast cancer.
Little attention has been paid to the fact that intensity modulated radiation therapy (IMRT) techniques do not easily enable treatment with opposed beams. Three treatment plans (3 D conformal, IMRT, and combined (anterior-posterior-posterio-anterior (AP-PA) + IMRT) of 7 patients with centrally-located lung cancer were compared for exposure of lung, spinal cord and esophagus. Combined IMRT and AP-PA techniques offer better lung tissue sparing compared to plans predicated solely on IMRT for centrally-located lung tumors.
5014 Background: After EORTC trial 22863, 3 years of endocrine treatment has become standard adjuvant treatment to RT for locally advanced prostate cancer. EORTC 22961 tests if similar survival can be achieved in patients who underwent EBRT (to 70 Gy) and 6 months of combined ADT without further ADT (SADT arm) as in patients with 2.5 years of further treatment with luteinizing hormone-releasing hormone agonist monotherapy (LADT arm). Methods: Eligible patients had T1c-2b N1–2 or pN1–2, or T2c-4 N0–2 (UICC 1992) M0 prostate cancer with PSA <150ng/ml. Non-inferior survival was defined as a morality hazard ratio (HR) = 1.35 for SADT vs LADT. Non inferiority at 80% power and 1-sided a=0.05 required 275 deaths. A stopping boundary was applied at 1-sided a=0.018. Results: 970 patients were randomized (483 SADT and 487 LADT). At 5.2 years median follow-up, 173 patients had died (100 vs 73). An Independent Data Monitoring Committee recommended disclosure of results based on an interim analysis showing futility. Patient characteristics were well balanced: median age 69 years, WHO PS 0 in 83.4%, most patients had T2c-T3 N0 disease. Progression (mostly biochemical and/or bone progression) occurred in 220 cases (159 on SADT vs 61 on LADT) and was treated by secondary hormonal manipulation. The 5-year overall survival rate was 85.3% on LADT and 80.6% on SADT (HR=1.43, 96.4% CI: 1.04–1.98), and failed to prove non-inferiority. The 5-year clinical progression-free survival rate was 81.8% on LADT versus 68.9% on SADT arm and the 5-year biochemical progression-free survival rate was 78.3% on LADT versus 58.9% on SADT, indicating inferiority of SADT with HR=1.93 and HR=2.29, respectively. Conclusions: The study was designed to demonstrate non-inferior survival with 6 months ADT compared to 3 years adjuvant ADT after irradiation for patients with locally advanced prostate cancer, but observed survival data indicate that non-inferiority cannot be confirmed. Progression-free survival was also shorter on SADT. No significant financial relationships to disclose.
