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Medical Dosimetn. Vol. 20. No. 2. LID. 143-145, 1995 Copyright 0 1995 America ‘Association of Mkhical Dosimetrists

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@ S~~~ct~d ~bst~~ct~ From the journal Ra~~o~hera~y and Oncology

PATIENT PREFERENCE FOR HIGH OR LOW DOSE RATE BRACHYTHERAPY IN CARCINOMA OF THE CERVIX

Jim Wright,” Glenn Jones,“.b Tim Whelan,“.b Himu Lukka”b

aDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada; bDivision of Radiation Oncology, Ontario Cancer Foundation, 699 Concession Street, Hamilton, Ontario, L8V 5C2, Canada

Vol. 33, 1994, pp. 187-194

Key words: Cervix cancer; Radio~empy; Brachy~erapy; Dose rate; Patient preference

High and low dose rate are two competing methods of brachytherapy. Existing data do not support choosing one method over the other for treating carcinoma of the uterine cervix. Arguments include clinical efficacy, monetary cost, radiation safety, and patient preference. There are no pub- lished data on patient preference. We developed a question- naire to elicit patient preference and to measure its strength. Subjects received descriptions of both treatment options and their probable outcomes. We elicited preference for one low or three high dose rate fractions, and for two low or five high dose rate fractions, assuming both methods to be isoef- fective. Strength of initial preference was measured by ask- ing subjects how much of a change, in either the chances for cure or the chances for toxicity, would make them change preference. The questionnaire was completed by female staff at our centre (n = 90), by a group of previously treated patients (H = 18), and by a group of newly diagnosed pa- tients (n = 20). When both methods were assumed to be isoeffective, only 34% of the 38 patients preferred three fractions of high dose rate to one fraction of low dose rate. However, when high dose rate was assumed to be 2% more curative, or 6% less toxic, a simple majority of 50% then said they would prefer high dose rate. Both preference and strength of preference for low dose rate were significantly associated with a greater travelling distance for advents. Age, marital status, family structure, education, employment, and family income were not associated. In summary, a ma- jority of our patients preferred low dose rate brachytherapy. Preference changed predictably with differences in fraction numbers, efficacy, toxicity, and travelling distance. SSDI 0167-8140(94)01485-L

BRAC~THERAPY FOR LOWER LIP ~~E~O~ CANCER: TUMORAL AND TREATMENT FACTORS INFLUENCING RECURRENCES AND COMPLICATIONS

S. Beauvois,a S. Hoffstetter,b D. Peiffert,b E. Luporsi,” J. M. Car~lus,~ D. Dartois,’ M. Pernotb

“Radiotherapy Department, Institut Jules Bordet, 1000 Brussels, Belgium; ‘Brachythempy Dep~ent, Centre

Alexis Vautrin, 545 11 Vandoeuvre les Nancy, France; “Statistical Analysis Department, Centre Alexis Vautrin, 545 11 Vandoeuvre les Nancy, France; dSurgery Department, Centre Alexis Vautrin, 545 11 Vandoeuvre les Nancy, France; “Archives Department, Centre Alexis Vautrin, 54511 Vandoeuvre les Nancy, France

Vol. 33, 1994, pp. 195-203

Key words: Lip cancer; Brachytherapy; Iridium-192

From 1972 to 1991, 237 patients with squamous cell carci- noma of the lower lip were treated by exclusive LDR brachy- therapy (‘g21r). There were 158 Tl, 61 T2, 17 T3 and 1 T4 with 231 NO, 3 Nl and 3 N2 patients. The actuarial values at 5 years for local and regional controls, overall and specific survivals were 95%, 91%, 74% and 91%. Salvage treatment increased local control up to 99% and regional control to 94%. No heterolabial recurrence has been observed since the entire lip is treated, even for small tumors. The regional control depends closely on the thickness of the labial tumor ( 21 1 cm, p < 0.0001). The healing of ~eatment-induced mucositis is sometimes delayed for thick tumors (s 1 cm, p = 0.015). Late complications are not related to tumoral thickness but to the treated thickness ( > 1.4 cm, p = 0.018) and particularly to the thickness of normal tissue included in the 85% isodose (treated thickness-tumoral thickness > 0.4 cm, p = 0.025). The use of a leaded protection and low linear radioactivity wires (< 2 mCi/cm, ~8.6 @Gy/ hem’/cm) especially for large target volumes is required to lessen late complications. Based on this review, we advocate exclusive bmchy~erapy for small and inte~ediate tumors, with elective bilateral submaxillary and submental dissection for thick, high grade or cotmnissure tumors. Simple recom- mendations are made to assure quality of the brachytherapy treatment. SSDI 0167-8140(94)01480-Q

THE ~LA~ONSHIP BETWEEN CELLULAR RADIATION SENSITIVITY AND TISSUE RESPONSE MAY PROVIDE THE BASIS FOR INDIVIDUALISING RADIOTHERAPY SCHEDULES

N. G. Bumet,” J. Nyman, b I. Turesson,b R. Wurm,” J. R. Yamold,’ J. H. Peacocka

“Radiotherapy Research Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK;; ‘Dep~ent of Oncology, Sahlgren’s Hospital, S-413 45 Gothenburg, Sweden; “Academic Dep~ment of Radiotherapy and Oncology, Royal Marsden Hospital, Downs Road, Sutton, Surrey, UK

vol. 33, 1994, pp. 228-238

Kcv words: Fibroblast radiosensitivity; Normal tissue response; Radiotherapy

There is a wide variation in normal tissue reactions to radio- therapy and in many situations the severity of these reactions

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