Evaluation of 3D-CRT and VMAT Radiotherapy Plans for Left Breast Cancer with Regional Lymph Nodes Irradiation

Introduction: Radiation therapy after breast surgery is an integral part of the treatment of early breast cancer. The goal of radiation therapy is to achieve the best possible coverage of the planning target volume (PTV), while reducing the dose to organs at risk (OARs) which are normal tissues whose sensitivity to irradiation could cause damage that can lead to modification of the treatment plan. In the last decade, radiation oncologist started to use the Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast, in order to achieve better dose distribution and target dose to the PTV and OAR. The aim of this study is to compare 2 external radiotherapy techniques (VMAT vs 3D) for patients with node-positive left breast cancer. Patients and Methods: We randomly selected 10 cases of postoperative radiotherapy for breast cancer in our hospital. The patients are all female, the average age was 45.4 years old, and the primary lesions are left breast. The ANOVA test was used to compare the mean difference between subgroups, and the p value Results: Dose volume histogram (DVH) was used to analyze each evaluation dose of clinical target volume (CTV) and organs at risk (OARs). Compared to 3DCRT plans, VMAT provided more uniform coverage to the breast and regional lymph nodes. The max point dose for tVMAT was lower on average (106.4% for VMAT versus 109% for 3DCRT). OAR sparing was improved with tVMAT, with a lower average V17Gy for the left lung (27.91% for VMAT versus 30.04% for 3DCRT, p and lower for V28Gy (13.75% for VMAT versus 22.34% for 3DCRT, p = 0.01). We also found a lower V35Gy for the heart on VMAT plan (p = 0.02). On the contrary, dose of contralateral breast was lower in 3DCRT than VMAT (0.59 Gy vs 3.65 Gy, p = 0.00). Conclusion: The both types of plans can meet the clinical dosimetry demands of postoperative radiotherapy for left breast cancer. The VMAT plan has a better conformity, but 3CDRT can provide a lower dose to the contralateral organs (breast and lung) to avoid the risk of secondary cancers.

Radiation Therapy of Head and Neck Paragangliomas: Experience from Radiotherapy Department at the National Institute of Oncology in Rabat (Morocco)

Background and Purpose: Paragangliomas are rare tumors of the head and neck. Their management remains problematic and varies considerably depending on the center. This study reported 14 years of experience in the management of head and neck paraganglioma (HNPGls). We aimed to assess the therapeutic results of these tumors in terms of local control and overall survival. Materials and Methods: We included 16 patients followed for HNPGls and treated by radiotherapy from January 2006 to June 2018 in the National Institute of Oncology in Rabat. Results: The median age was 44.5 years (15 - 67). 13 patients were female and three male with a sex ratio of 4.3. Cervical mass was the common sign (56.3%). All patients received radiation therapy. This radiation was exclusive in 43.7% of cases or adjuvant to partial surgical resection in 56.3%. The median dose of radiotherapy was 54 Gy (46 - 60) and it was delivered by a three-dimensional conformal radiotherapy technique in 15 patients and volumetric modulated arc therapy in one. There were few acute complications such as grade I and II mucositis and dermatitis. After a median follow-up of 5.6 years (2 - 13.4), local control, defined by radiological stability or regression, was obtained in 14 patients, two patients progressed and one died. Progression-free survival rates at 5 and 7 years were 93.8% and 78.1% respectively, and overall survival at 5 and 7 years was 92.3%. Conclusions: Surgery is the first-line treatment for HNPGls. When surgery is not possible or incomplete, radiotherapy has its place in the therapeutic strategy of this rare disease for long-term local control.

Primary breast leiomyosarcoma: case report and literature review

PURPOSE: Leiomyosarcoma of the breast is extremely rare. To date, the factors that are predictive of patient prognosis have not been identified. To clarify the nature of leiomyosarcoma of the breast, and also to establish the proper treatment strategy, we report this case We report this case while discussing The Clinical presentation, diagnosis, therapy and pathologic feature. INTRODUCION: Sarcomas comprise less than 1% of all primary breast neoplasms and only a minority of these are leiomyosarcomas. There were only 35 cases being reported in English literature. The mainstay of treatment is surgical excision with clear margins and longterm followup is essential. Its prognosis is better compared to other breast sarcoma. CASE PRESENTATION: We report a case of primary leiomyosarcoma of the breast occurring in young female patient which was successfully treated by surgery and radiotherapy. CONCLUSION: According to literature data, primary leiomyosarcoma is characterized by a better prognosis compared with other breast sarcomas, To date, the factors that are predictive of patient prognosis have not been identified. .The rarity and diagnostic difficulty imposed a multidisciplinary approach.

Survey of current practices in the management of cervical cancer by Moroccan radiotherapists

Objective:To assess the applicability degree of the international guidelines by Moroccan radiotherapists,in order to improve the management of cervical cancer(CC),since CC is the second most common cancer for women in Morocco.Methods:This cross-sectional study was carried out using a questionnaire sent online to Moroccan radiotherapists.The questionnaire covered participants'characteristics,initial assessment and treatment preparation,techniques and indications for radiotherapy and brachytherapy,dose and indications,as well as on the protocol adopted in the intermediate stages and the location of adjuvant treatments and assessments'follow-up.Results:74 radiotherapists out of 300 have responded to the survey.Only 27.0%of practitioners reported discussing patient records systematically in a multidisciplinary consultation meeting(MCM).For the initial assessment,77.0%requested pelvic magnetic resonance imaging(MRI).It is significantly less requested in regional oncology centers(ROCs)than in university hospital centers(UHCs)or the private sector(P<0.001).Furthermore,Clinicians in ROCs do not have access to new techniques of radiotherapy.In 83.8%of cases,the most prescribed radiotherapy protocols were 45–46 Gy in 1.8–2 Gy per fraction.Three-dimensional gynaecological brachytherapy high-throughput dose guided by dosimetric scanner was available in 75.5%of structures while interstitial gynaecological brachytherapy was only available in 23%of centers.The two most prescribed dose protocols were 47 Gy and 37 Gy in 74.4%and 21.6%of cases,respectively.Finally,monitoring during the first two years was based mainly on pelvic MRI(82.2%)while PET/CT was recommended by only less than 10%.Conclusions:The findings obtained show that our radiotherapists generally comply with international guidelines for the cervical cancer management.However,they should still enhance their practices for the first staging evaluation,the use of systematic MCMs,the doses and treatment techniques used,and the follow-up evaluation.