Outcome of Cervix Cancer Patients Treated with High Dose Rate Brachytherapy at King Abdul

Saudi Jornal of Obstertic and Gynecolgy Vol. 5, No - 2005 The Role of Computer Tomography and Lymphangiogram in the Planning of Radical Radiotherapy for Carcinoma of the Uterine Cervix

The Medical Jurnal of Cairo University Tumor Volume Measurement Using CT in Nasopharyngeal Carcinoma: Is it a Prognostic Factor for Response to Radiation Therapy

International J. of Scientific Rsearch. Vol 2005 Optimization of Radiotherapy for Breast Cancer during Pregnancy

Ann Saudi Med. 2001 Jan-Mar;21(1-2):65-7

Rectal cancer associated with schistosomiasis: report of two cases and review of the literature.

Al-Mashat F, Sibiany A, Radwi A, Bahadur Y, Al-Radi A, Meir H, Ahmed GE.

PMID: 17264594 [PubMed

Cancer. 1997 Jan 1;79(1):81-9 Evaluation of radiation effect, tumor differentiation, and prostate specific antigen staining in sequential prostate biopsies after external beam radiotherapy for patients with prostate carcinoma.

Crook JM, Bahadur YA, Robertson SJ, Perry GA, Esche BA.

Department of Radiation Oncology, Ottawa Regional Cancer Centre, Ontario, Canada.

BACKGROUND: Sequential systematic biopsies after radiotherapy (RT) for prostate carcinoma were evaluated with respect to radiation effect, tumor differentiation, and prostate specific antigen (PSA) staining, and these histopathologic parameters were correlated with local outcome. METHODS: Since 1990, transrectal ultrasound-guided biopsies have been used to follow patients with localized prostate carcinoma after radical external RT at the General Hospital division of the Ottawa Regional Cancer Centre. Eighty-nine patients with residual tumor in 1 or more biopsies at 10-78 months of follow-up were selected for review. All patients had undergone biopsy on more than one occasion. The 198 biopsies were stained for PSA, high molecular weight keratin, and proliferative cell nuclear antigen (PCNA). Therapy effect was graded by nuclear and cytoplasmic changes. RESULTS: Of these 89 selected patients, 25 progressed to local failure (LF), 38 had delayed tumor clearance, and 26 remained biopsy positive without local or biochemical progression. In the 24- and 36-month biopsies, RT effect correlated with mean nadir serum PSA (Grade 4-6 RT effect: 0.7 ng/mL; Grade 0-3 RT effect: 1.3 ng/mL [P = 0.01]) and with local outcome (Grade 0-2 RT effect: 55% LF; Grade 3-4 RT effect: 30% LF; and Grade 5-6 RT effect: 0% LF [P = 0.003]). Of tumors with minimal RT effect, 61% were PCNA positive, compared with 34% for moderate and 17% for marked RT effect (P < 0.001). Adjacent areas within biopsies showed varied RT effect in 27 patients, of whom 41% had local failure, compared with 18% of patients with uniform RT effect (P = 0.03). Gleason score was assigned only if RT effect was minimal (36 patients/59 biopsies); 74% had the same Gleason score (+/-1) as the original, whereas 23% were 2 points lower. Only 1 biopsy lost PSA staining completely and 10% stained faintly, whereas 34% stained moderately and 55% strongly. CONCLUSIONS: PSA staining is apparently retained in residual tumor after RT, despite obvious RT effect. RT effect correlates with serum PSA nadir, PCNA staining, and local outcome. Varied RT effect is commonly observed in biopsies, and correlates with local failure. There is no convincing evidence for tumor dedifferentiation after RT.

PMID: 8988730 [PubMed - indexed for MEDLINE] Cancer. 1997 Jan 15;79(2):328-36

Radiotherapy for localized prostate carcinoma. The correlation of pretreatment prostate specific antigen and nadir prostate specific antigen with outcome as assessed by systematic biopsy and serum prostate specific antigen.

Crook JM, Bahadur YA, Bociek RG, Perry GA, Robertson SJ, Esche BA.

Department of Radiation Oncology, Ottawa Regional Cancer Centre, Canada.

BACKGROUND: The objective of this study was to correlate the failure pattern of localized prostate carcinoma after radiotherapy (RT) with pretreatment (preTx) PSA and post-RT nadir PSA, using systematic biopsies and serum PSA in the assessment of outcome. METHODS: From January 1990 to February 1994, 207 patients treated with external beam RT were followed prospectively with systematic transrectal ultrasound-guided biopsies and measurements of serum PSA levels. Three hundred forty-three biopsies were performed, with 4-7 samples taken per session. The distribution of T classification was as follows: 19 patients had T1b, 15 had T1c, 34 had T2a, 79 had T2b/c, 53 had T3, and 7 had T4. Median follow-up was 36 months (range, 12-70 months). Failures were categorized as biochemical (chemF) (PSA > 2.0 ng/mL and > 1 ng/ mL over nadir), local (LF) (positive biopsy and PSA > 2), and distant (DF). The Cox proportional hazards model was used for multivariate analysis (MVA). RESULTS: Overall, failures were seen in 68 of 207 patients: 20 LF, 24 DF, 7 LF + DF, and 17 chemF. In univariate analysis, failures correlated significantly with preTx PSA, post-RT nadir PSA, T classification, and Gleason's score (GS). The total failure rate was 12% for T1b, T1c, and T2a; 39% for T2b and T2c; and 60% for T3 and T4 (P < 0.0001). By evaluation with preTx PSA, at 36 months the total failure rate was 3% for preTx PSA < or = 5 ng/mL 16% for 5.1-10 ng/mL, 32% for 10.1-15 ng/mL, 42% for 15.1- 20 ng/mL, 63% for 20.1-50 ng/mL, and 88% for > 50 ng/mL (P < 0.0001). By evaluation with post-RT nadir PSA, at 36 months the total failure rate was 4% for nadir PSA < or = 0.5 ng/ mL, 26% for 0.6-1 ng/mL, 33% for 1.1-2 ng/mL, and 92% for > 2 ng/mL (P < 0.0001). In MVA, nadir PSA (P < 0.0001) and T classification (P < 0.0005) were independent predictors for any failure. LF occurred in 13% of patients (27 of 207). For these 27 patients, the categorization of T classification was: T1b/T1c/T2a, 7%; T2b/T2c, 16%; and T3/T4, 15% (P = not significant). In MVA, only nadir PSA (P = 0.0004) predicted for LF. DF occurred in 15% of patients (31 of 207). In MVA, nadir PSA (P < 0.0001) and T classification (P < 0.0001) predicted for DF, with pretreatment PSA of borderline significance (P < 0.05). To assess preTx predictors of outcome, post-RT nadir PSA was removed from the model. PreTx PSA then became the dominant variable to predict any failure (P < 0.0001), LF (P = 0.05), chemF (P = 0.0001), and DF (P < 0.003), while T classification also predicted for any failure (P = 0.03), chemF (P = 0.05), and DF (P < 0.0001). CONCLUSIONS: Systematic prostate biopsies, performed as part of the rigorous followup of prostate carcinoma after RT, define the patterns of failure and confirm the prognostic value of preTx PSA, post-RT nadir PSA, and T classification. Prior to treatment, preTx PSA is the overwhelming independent predictor of failure, but it is surpassed by post-RT nadir PSA when this is added to the model.

PMID: 9010106 [PubMed - indexed for MEDLINE]

The Journal of King Abdulaziz University - Medical Sciences, Vol 13, No 1 (2006)

Glioblastoma Multiform: Analysis of Patients Treated with Radiotherapy at King Abdulaziz University Hospital Yasir A. Bahadur

Treatment of Glioblastoma Multiform typically involves maximal surgical resection, followed by adjuvant radiation therapy. In this study, all patients with GBM treated with radiation therapy after initial surgical intervention at King Abdulaziz University Hospital were reviewed. From April 2000 to December 2002, 13 patients were treated, 9 (69%) males and 4 (31%) females. Two (15%) patients had near complete resection, one (8%) had biopsy only and 10 (77%) had partial resection. Radiation therapy was given on palliative intent in 10 (77%) patients with dose of 24-30 Gy, and 3 (23%) cases treated radically with dose of 54-60 Gy. Radiological follow-up after 6-8 weeks from completion of radiation therapy showed complete response in 8%, partial response in 38%, stable disease in 8%, disease progression in 38% and 8% did not have their radiologic evaluation. Evaluation after one year showed overall survival rate was 36%, the median survival time was 9.5 months; the median time to disease progression was 6 months. Radiation therapy provided good palliation for these patients The Journal of King Abdulaziz University - Medical Sciences, Vol 13, No 2 (2006)

Correlation between Irradiated Small Bowel Volume and Toxicity in Rectal Cancer Patients Receiving Concomitant Pelvic Irradiation and 5-Fluorouracil Chemotherapy Yasir A. Bahadur

Abstract

The aim is to study the relationship between radiation induced small bowel toxicity and radiation dose received by the small bowel during pelvic irradiation for patients with rectal cancer treated with pelvic radiotherapy and concomitant 5-Fluorouracil. Thirty-two patients with rectal cancer were referred for either a postoperative or preoperative pelvic irradiation concomitant with 5-Fluorouracil chemotherapy at the Radiotherapy Unit of King Abdulaziz University Hospital. All patients had computerized 3D treatment planning. Radiation therapy was given in two phases, to a total dose of 5040 cGy / 28 fractions / 5.5 weeks. Small bowel loops were contoured on CT cuts and a dose volume histogram was constructed and the mean radiation dose received by the small bowel, the volume of the small bowel irradiated and the mean radiation dose / volume of small bowel involved ratio. Univariate analysis showed a significant association between small bowel toxicity and mean radiation therapy dose received by small bowel (p = 0.001), the volume of small bowel involved (P = 0.043) and the type of surgical intervention with higher incidence for those patients who had abdominoperineal resection (P = 0.003). In conclusion, this study confirms the relation between small bowel toxicity and the volume of small bowel receiving radiotherapy.

Full Text: PDF http://journals.sfu.ca/kaumedscj/index.php/kaumedscj/article/view/166 Int J Radiat Oncol Biol Phys. 2000 Sep 1;48(2):355-67

Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients.

Crook J, Malone S, Perry G, Bahadur Y, Robertson S, Abdolell M.

Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. [email protected]

PURPOSE: Postradiotherapy (RT) prostate biopsies are prone to problems in interpretation. False negatives due to sampling error, false positives due to delayed tumor regression, and indeterminate biopsies showing radiation effect in residual tumor of uncertain viability are common occurrences. METHODS AND MATERIALS: A cohort of 498 men treated with conventional RT from 06/87-10/96 were followed prospectively with systematic transrectal ultrasound (TRUS)-guided post-RT prostate biopsies, starting 12-18 months after RT. If there was residual tumor but further decline in serum prostate-specific antigen (PSA), biopsies were repeated every 6-12 months. Patients with negative biopsies were rebiopsied at 36 months. Residual tumor was evaluated for RT effect and proliferation markers. The 498 men had 978 biopsies. Median time of the first biopsy (n = 498) was 13 months, biopsy #2 (n = 342) 28 months, biopsy #3 (n = 110) 36 months, biopsy #4 (n = 28) 44 months, and biopsy #5 (n = 4) 55 months. Median follow-up is 54 months (range 13-131). One hundred seventy-five patients (34%) had prior hormonal therapy for a median of 5 months (range 1-60). RESULTS: Clinical stage distribution was T1b: 46; T1c: 50; T2a: 115; T2b/c: 170; T3: 108; T4: 11; Tx: 1. Distribution by Gleason score was: 28% Gleason score 2-4; 42%: 5-6; 18%: 7; and 12%: 8-10. Seventy-one men have died, 26 of prostate cancer and 45 of other causes. Actuarial failure-free survival by T stage at 5 years is T1b: 78%; T1c: 76%; T2a: 60%; T2b/c: 55%; T3: 30%; and T4: 0%. Actuarial freedom from local failure at 5 years is T1b: 83%; T1c: 88%; T2a: 72%; T2b/c: 66%; T3: 58%; and T4: 0%. The proportion of indeterminate biopsies decreases with time, being 33% for biopsy 1, 24% for biopsy 2, 18% for biopsy 3, and 7% for biopsy 4. Thirty percent of indeterminate biopsies resolved to NED status, regardless of the degree of RT effect, 18% progressed to local failure, and 34% remained as biopsy failures with indeterminate status within the time frame of this report. Positive staining for proliferation markers was associated with both subsequent local failure and also any type of failure. In multivariate analysis, only PSA nadir (p = 0.0002) and biopsy status at 24-36 months (p = 0. 0005) were independent predictors of outcome. CONCLUSIONS: Post-RT prostate biopsies are not a gold standard of treatment efficacy, but are an independent predictor of outcome. Positive immunohistochemical staining for markers of cellular proliferation is associated with subsequent local failure. Indeterminate biopsies, even when showing marked RT effect, cannot be considered negative.

PMID: 10974448 [PubMed - indexed for MEDLINE] Indian J Cancer. 2007 Apr-Jun;44(2):56-61.

Safety and efficacy of cetuximab-chemotherapy combination in Saudi patients with metastatic colorectal cancer.

Ibrahim EM, Zeeneldin AA, Al-Gahmi AM, Sallam YA, Fawzi EE, Bahadur YA.

Department of Oncology and Hematology, Sections of Medical Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. [email protected]

BACKGROUND: Cetuximab-based combination chemotherapy (CBCC) proved safe and effective as second-line strategy for metastatic colorectal cancer (mCRC). This prospective phase-II study was designed to assess the efficacy and safety of CBCC as first-, second- or third-line among Saudi patients with mCRC. MATERIALS AND METHODS: Patients with mCRC were offered CBCC to assess time-to-disease progression (TTP), response rate and duration, overall survival (OS) and safety. RESULTS: Nineteen patients were eligible and their median age was 51 years. Seven patients received CBCC as first-line and 12 as second- or third-line. Responses: 11 (58%) partial responses, 5 (26%) stable disease and 3 (16%) disease progressions. The median response duration was 4.3 months [95% confidence interval (CI): 3.4-5.2 months]. The median TTP was 6.8 months (95% CI: 2-13.9 months) for all 19 patients compared to 9.3 months (95% CI: 3.9-14.6 months) for the seven patients who received CBCC as first-line. The median OS for the entire population was 12.3 months (95% CI could not be determined). On the other hand, while the median OS for those who received CBCC as first-line have not been reached, the median OS for those who received CBCC after failure of other salvage therapies was 12.3 months (95% CI: 3.2-21.4 months). CBCC was generally tolerable. One patient had a severe hypersensitivity reaction and another fatal cardiac arrest. CONCLUSION: CBCC is active with an acceptable safety profile. Until results from phase- III clinical trials are available, using CBCC as first-line is probably justified. Outcome of Cervix Cancer Patients Treated with High Dose Rate Brachytherapy at King Abdul Aziz University Hospital Yasir Bahadur MBBS, FRCPC

Purpose: To review the treatment results of cervix cancer patients treated with high .dose rate brachytherapy at King Abdul Aziz University Hospital

Methods: All cervix cancer patients treated with high dose rate brachytherapy at King Abdul Aziz university hospital between January 2004 and December 2006 have been reviewed. The patient's demographic data, treatment parameters and follow up have been reported and histopathological grade and stage has been correlated with .initial response to treatment and disease Free survival has been calculated

Results: Twenty four patients with mean age of 51.6 years. All patients had squamous cell carcinoma; 12.5% G1, 54.2% G II and 33.3% G III. Stage IA 12.5%, IB 4.2%, IIA 16.7%, IIB 25%, IIIA 8.3%, IIIB 20.8% and IVA 12.5%, treatment .toxicity was diarrhea GII in 12.5% and G II cystitis in 21% .Initial treatment response was 50% CR, 25% PR, 8.3% SD, and 16.7% DP After a mean follow up period of 39 months, the mean DFS was 27.3 months 95% confidence interval (CI) 23.52 – 31.07. The median DFS was 29 months (95% CI , 23 .– 35 months). Two year DFS was 60% and the 3 year DFS was 27% There was no correlation between DFS and histopathological grade (p = 0.53) or FIGO stage (p = 0.66), and no correlation was found between DFS and response to treatment (p = 0.88). On multivariate analysis, histopathological grade, FIGO stage, .initial response all had no influence on DFS

Conclusion: The use of external beam radiation therapy concomitant with weekly cisplatin followed by high dose rate brachytherapy is an acceptable treatment .modality for carcinoma of the cervix with mild treatment related toxicity

. Keywords: Cervix cancer, HDR brachytherapy 3D Conformal Radiotherapy Techniques for Simultaneously Integrated Boost in Breast Conserving Radiation Therapy Dr Yasir Bahadura Dr Camelia Constantinescub Dr Ehab Fawzytb Ms Noor Ghasalb aDepartment of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia bDepartment of Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia

:Abstract

Aim: To evaluate the dosimetric outcomes of two different three dimensional conformal .radiation therapy (3D-CRT) of concomitant boost delivery to the intact breast

Methods: Ten patients where evaluated using two standard opposed tangents conformal to the whole breast PTV, plus a pair of wedged fields conformal to the boost PTV; all fields have the same isocenter, placed in the whole breast PTV (WBI) or located in the boost (BI) PTV for the difference in maximum and minimum doses, also mean doses and volumes receiving 90% and 107% of .the prescribed dose. Lung irradiation was analysed in terms of maximum and mean doses

Results: For breast PTV coverage and conformity a significant differences were observed only in the maximum doses (62.3 Gy vs. 61 Gy, p = 0.003) and higher dose homogeneity index (DHI) (0.66 versus 0.64 p = 0.003) in favour WBI. For boost PTV coverage and conformity a significant difference between the two groups with maximum dose (62.6 versus 60.87 p= 0.003) as well the DHI (0.97 versus 0.94 p= 0.002) in favour of WBI and the CI was significantly better in WBI (0.87 versus 0.64 p= 0.001). Dose to lung or healthy tissue was not statistically significant difference between the .two methods

Conclusion: This study shows a superiority of using the whole breast isocenter technique over boost isocenter technique in whole breast PTV coverage, dose homogeneity index and boost PTV .coverage. The clinical significance of this difference needs further clinical studies

Keywords: Breast Cancer, Breast Boost, Planning, Breast Isocenter

A comparison study on different treatment planning techniques for whole breast radiation therapy

Dr Yasir Bahadura Dr Camelia Constantinescub Dr Mohamad Ezzatb Ms Noor Ghasal aDepartment of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia bDepartment of Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia

:Abstract

Aim: To investigate two new conformal techniques to reduce the dose to healthy tissue while .enhancing or preserving homogeneity in the Planning Target Volume during whole breast radiotherapy Material and methods: Ten patients have been evaluated using CT dataset. The conventional two- field tangential (2T) photon treatment was used to define a baseline of reference and compared with three coplanar fields’ (3F) technique and with one static field and one dynamic short arc (1F-1A) technique. We compared Dmax, Dmean, DHI, CI, V90%, V95%, and V107% in the PTV, Dmax, Dmean V5Gy, V20Gy of .lung and Dmax, Dmean, V5Gy of healthy tissue Results: Both new conformal techniques are significantly superior to the conventional 2T technique with respect to the volume fraction covered by V90%, V95% and V107% dose levels, significant differences are observed only in the maximum doses. The target coverage, measured by the Conformity Index shows equivalence between 3F and 1F-1A which are both significantly superior to the reference approach. For lung toxicity, the reduction obtained with both new techniques is better compared to 2T, V20Gy (p < 0.003). High dose levels delivered to lung are significantly low for both new techniques vs. 2T conventional technique and comparable between the new techniques. The lung volume (V5Gy) presents significant better results for the two new techniques (p < 0.001) for 3F and (p < 0.001) for 1F-

1A vs. 2T technique. The dose bath in healthy tissue V5Gy shows significantly better values for both .new techniques (p < 0.001) for 3F and (p < 0.002) for 1F-1A,compared to 2T technique Conclusion: The use of the 3F or 1F-1A techniques for whole breast radiotherapy gives less lung and healthy tissue irradiation as compared with 2T conventional techniques. additional attention .must be paid to daily verification of treatment set-up

Keywords: Breast radiotherapy, Conformal, Arc, Lung toxicity

The role of Computed Tomography Based Treatment Planning in High Dose Rate (HDR) Brachytherapy in Carcinoma of The Cervix

Yasir Bahadur MBBS, FRCPC Department of Radiology King Abdu-lAziz University Hospital, Kingdom of Saudi Arabia Abstract Aim: To compare the high dose rate (HDR) brachytherapy treatment planning using standard orthogonal radiography and computerized tomography (CT) for carcinoma of .the cervix

Methods: Forty applications with orthogonal planning using the Brachy Vision treatment planning system version 7.3.10 were performed. Orthogonal and CT based planning in these applications were compared; the doses to point A, rectum and bladder were defined according to the American Brachytherapy Society (ABS) recommendation. Using CT planning, we calculated the dose volume histogram .(DVH) for the CTV, rectum and bladder

Results: Using orthogonal films to prescribe to point A, only 63.5% of CTV received the prescribed dose. The mean dose to the bladder point is 2.9 Gy and 17% of the bladder volume was encompassed by 2.9 Gy isodose line. The mean dose at the rectum point is 3.4 Gy and 21% of the rectum volume was encompassed by 3.4 Gy isodose line. The maximum dose to the rectum and the bladder derived from the CT is .1.7 and 2.6 times higher than the orthogonal reference points

Conclusions: CT based treatment planning for HDR brachytherapy of cancer cervix is reliable and more accurate in definition and calculation of the dose to the target as well as the critical organs. It allows dose calculation based on the actual volume .rather than points or bony landmarks

.Keywords: Cancer cervix, Brachytherapy, CT based planning HDR, 3-D treatment planning

3D anatomy-based planning optimization for HDR brachytherapy of cervix cancer

Dr Yasir Bahadura Dr Camelia Constantinescub Dr Mohamad Ezzatb Ms Noor Ghasalb aDepartment of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia bDepartment of Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia Aim: To evaluate the dosimetric superiority of inverse planning optimization and isodose line manually optimization (both 3D planning methods) versus conventional treatment plan (point A planning method), using various dosimetric indices in HDR brachytherapy planning for cervical .carcinoma

Methods and materials: The data from 10 patients treated with HDR brachytherapy for cervical cancer using tandem and ovoids has been analyzed. Target and organ at risk volumes were defined using systematic guidelines. Dose distributions were created according to three different dose calculation protocols: point A, isodose line manually optimization, and inverse planning and dose– volume histograms from these plans were analyzed, and all plans were evaluated for V100%, V95%, the conformity index CI = V100%/VCTV, and the dose homogeneity index DHI = (V100% - V150%)/ V100% for target. For rectum D5cc, V50%, V70% and V100% of prescription dose were evaluated. For bladder D5cc, V50%, .V80% and V100% of prescription dose were evaluated

Results: Both 3D planning methods showed significant better target coverage compared with point A calculation: average 85.65% isodose manually shaping vs. 48.43% point A calculation (p < 0.003) and

90.33% inverse planning vs. 48.43% point A calculation (p < 0.001) for V7Gy. Dose homogeneity was better for both 3D planning protocols: average 0.33% isodose manually shaping vs. 0.39% point A .calculation (p < 0.008) and 0.31% inverse planning vs. 0.39% point A calculation (p < 0.031) for DHI For organs at risk, point A calculation average was 4.29 Gy vs. 4.99 Gy isodose manually shaping (p <

0.037) and 4.29 Gy point A calculation vs. 5.14 Gy inverse planning (p < 0.013) for D5cc of rectum; and average 4.88 Gy point A calculation vs. 6.32 Gy isodose manually shaping (p < 0.019) and 4.88 Gy

.point A calculation vs. 5.78 Gy inverse planning (p < 0.019) for D5cc of bladder

:Conclusion The 3D planning methods improve dose conformity and homogeneity of target coverage while minimizing dose to critical structures by chosen the appropriate priorities and allows for easy .comparison between patients

Keywords: Cancer cervix, inverse planning, Brachytherapy

A comparison Study of Radiotherapy Toxicity between Conventional and Hypofractionated whole breast radiotherapy Yasir Bahadur, FRCRC

:Purpose

The aim is to compare the acute skin toxicity between two different fractionation schedules of adjuvant whole breast radiotherapy, conventional fractionation radiotherapy (CFR) and .(hypofractionated radiotherapy (HFR

:Patients and methods

This is a prospective study of breast cancer patients referred for adjuvant radiation therapy (RT). RT was given either as CFR (5000 cGy/ 25 fractions / 5 weeks) or HFR (4005 cGy/15 fractions / 3 weeks) . Acute RT toxicity was evaluated using the Radiation Therapy Oncology Group toxicity

.(RTOG) grading System; the incidence of RT Toxicity was compared

:Results

Seventy eight patients were accrued in the study, 57.7% had breast conservative surgery (BCS) and

42.3% had modified radical mastectomy (MRM), 53.8% treated with HFR and 46.2% with CFR,

64.1% had grade 0 /II RT toxicity and 35.9% had grade III/IV toxicity. On univariate analysis, the incidence of RT toxicity was (52.8%) in CFR group as compared to 21.4% in HFR group (p= 0.004), other variables were not statistically significant. On multivariate analysis radiotherapy fractionation

.(was the only factor of statistical significance regarding the incidence of radiation reaction (p=0.03

ConclusionThis study showed less incidence of acute radiation reactions in hypofractionated arm as

.compared to conventional fractionated arm in the adjuvant whole breast radiotherapy

A comparison study of the dose recieved during cone beam computarized tomograpgy and portal imaging techniques

Dr Yasir Bahadura Dr Camelia Constantinescub Mr Hussein Naseem a Dr Ehab Fawzyb aDepartment of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia bDepartment of Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia

:Abstract

Aim: To quantify and compare the doses to the tumour and the surrounding critical organs resulting from the orthogonal pair portal and megavoltage cone beam computarized tomography (MV CBCT) .imaging techniques

Materials and Methods: The dose to the patient resulting from the orthogonal pair and the MV CBCT imaging techniques, has been calculated based on a 6 MV Oncor linear accelerator equipped with an amorphous silicon flat panel. All calculations were done on Eclipse 3D treatment planning system. 18 patients representing three different treatment sites (head and neck, thorax, and pelvis) were analysed. Data from 6 patients for each treatment site were used to calculate the mean doses. Calculations were done for: the integral dose, maximum dose to the patient, dose at the isocenter, and mean dose to the .tumour and each critical organ

Results: The integral dose per MU and the dose to the isocenter per MU were higher for orthogonal pair technique than for MV CBCT, for all treatment sites. For both techniques, the dose to the isocenter per MU were higher for head and neck and for thorax than for pelvis. The difference of maximum dose to the patient showed greater variation for head and neck, but not for thorax and pelvis. The dose per MU to the tumour (GTV/CTV/PTV) or to the critical organs located closer and posterior to the tumour were very small for both techniques. The area covered by the 5 cGy isodose line of the MV CBCT .technique is larger, including more volume of critical organs

Conclusion: The relatively high dose regions generated by MV CBCT occur inside critical organs and .tend to be larger than those generated by the orthogonal pair technique

Keywords: CBCT, Integral dose, IGRT

Outcome of localized Prostate Cancer Treated with A short Course of Neoadjuvant Hormonal Therapy and Radica Radiation Therapy

Yasir Bahadur MBBS, FRCPC

Abstract

Aim: To review the outcome of patients with localized prostate cancer treated at King Abdul-Aziz University Hospital with short course of neoadjuvant hormone .therapy followed by radical radiation therapy

Methods: Thirty five patients with intermediate and high risk localized prostate cancer were treated between February 2003 and June 2008, mean age was 65 years and high risk category were 22(63%) patients, intermediate risk were 13 (37%) patients. The treatment given was 3 month of neoadjuvant hormonal therapy (NHT) .(followed by 3 dimensional conformal radiation therapy (3DCRT

Results: After a median follow up duration of 29 months (range 6 -59 months), the mean biochemical disease free survival (BDFS) for all patients was 34.4 months. For intermediate and high risk groups were 34 months and 34.1 months respectively (p=0.81) and the overall mean survival for the whole group of patients was 42.3 months, for intermediate and high risk groups were 39.95 months and 41.76 months .(respectively (p= 0.42

Conclusion: Short course of NHT followed 3DCRT showed encouraging results for .localized prostate cancer patients Key words: prostate cancer, hormonal therapy, prostate radiotherapy

Brachytherapy Boost in the Neoadjuvant Radiation Therapy for Locally Advanced Rectal Cancer, King Abdul Aziz University Hospital Experience

Yasir Abdul-Aziz Bahadur MBBS, FRCRC

Purpose: The aim of this study is to evaluate the toxicity and tumor response when using brachytherapy boost as part of the neoadjuvant chemo-radiation therapy in .patients with rectal cancer

Patients and methods: A retrospective review of all patients with rectal cancer treated at the radiotherapy unit of King Abdul-Aziz University Hospital. Fifty five patients had neoadjuvat radiotherapy 45 Gy /25 fractions /5 weeks of external beam radiation as phase I followed by external beam boost: 540cGy/3 fractions / 3 days in 31 patients or HDR brachytherapy boost in 17 patients.6 patients had no boost or only one patient had brachytherapy alone. All patients received the same concomitant chemotherapy 5 FU (5 Fluorouracil, Leucovorin). The pathological response rate, toxicity profile, overall survival and disease free survival was compared between .different radiation therapies modalities

Results: Fifty five patients were 36 (65.5%) males and 19 (34.5%) females, mean age was 53.4 years. Nine patients (16.5%) had abdominoperineal resection (APR) 9 (16.5%) refused surgery and 37 patients (67%) had low anterior resection (LAR). The pathological response rate was complete response (CR) in 14 patients (25.5%), partial response (PR) in 29 patients (52.7%), unknown (did not do surgery) in 9 patients (16.5%) and stable disease in 3 patients (5.4%). In brachytherapy boost CR was 47% vs. 18% external beam boost (p=0.004). Toxicity profile was better in the brachytherapy group. After a mean follow up of 22 months, the overall survival was 93%, and the disease free survival was 60% and the overall survival and disease free . survival were not influenced by the modality of radiation therapy used Conclusion: the use of HDR brachytherapy boost result in a higher pathological response rate and relatively better toxicity profile as compared to the external beam radiation boost in the neoadjuvant radiation therapy for locally advanced rectal .cancer

Keywords: HDR brachytherapy, rectal cancer