ASTR Poster Abstracts 1827

vated through pathways in the treated areas. The most common sensation was of numbness and tingling in the ipsilateral arm when the chest was being treated. In each case, the applicator was at least three aperture widths from the axilla; the angle with the axilla was approximately 90'; and the applicator was angled from 90-180 degrees to the affected arm. In each case, the sensation was only appreciated when the microwave energy was present. There was no correlation of sensation with temperature in the treatment volume. There was little correlation of sensation with power application. The sensation would saturate at power densities far below those used to achieve therapeutic heating. One patient reported such a severe "burning" sensation in the arm at even the lowest measureable power that further treatment was discontinued. Only one patient had a demonstrable motor deficit. These reports were patient specific and repeated from treatment to treat- ment in at least two thirds of the treatment sessions. Sensitive patients were sporadically distributed throughout the rest of the patient population.

C6

PROSTATE CANCER: AN IMPLANT PROCEDURE

G. Ray Ridings, M.D., F,A.C.R.

Southeast Missouri Radiation Oncology Center

If the boost dose of irradiation given locally to the prostate is given with minimal attendant trauma, then, it can be expected that the overall treatment is better tolerated by the patient, This insertion technique emphasizes (a) almost atraumatic insertion with (b) control of seed distribution and of dose pattern, It is accomplished by transperineal implantation of gold or radon seeds, using a perineal template and fluoroscopic control.

This program has been in use since January 1, 1978. Brachytherapy has been remarkably free of compli- cations, Short-term clinical results have been encouraging.

c7

TREATMENT OF CARCINOMA OF CERVIX WITH 10 MeV X-RAY AND HIGH DOSE RATE INTRACAVITARY RADIATION: DOSIMETRIC ANALYSIS OF COMPLICATIONS

Fang-Jen Lin, M.D., Ph.D. & M.S. Chen, M.D.

Department of Radiation Oncology, Chang Gung Memorial Hospital, Taipei, Taiwan 105, R.O.C.

Approximately 150 patients with cervical cancer received radiation therapy in this Department each year. About Z/3 of them had primary curative radiation therapy, and l/3 included those who developed recurrent disease after initial treatment by radical hysterectomy, those who were scheduled for postoperative radiation due to tumor extension beyond surgical field or lymph node involvement, those who had incomplete or irregular radiation therapy at other hospitals.

After staging workups, the patients were treated externally with 10 MeV X-ray, encompassing all pelvic nodes and entire vagina, and delivering 4400 to 4800 rads/22-24/5 weeks. In 2-3 weeks the patients were examined under anesthesia to evaluate the effect of external radiation and status of residual tumor and the afterloading applicators were placed after proper dilatation of cervix for the 1st intracavitary application.

Thorough dosimetric planning for high dose rate intracavitary remote afterloading application with Co-60 sources was done for every single patient. Only one day of hospitalization was required in preparation for anesthesia and dilatation of cervix for first insertion of applicators. The subsequent applications were regularly performed on out patient basis. Analysis of 83 cases who were able to complete all planned treat- ment in the period of March 1980 to July 1981, 15 patients developed rectal bleeding and only three needed prolonged care and one required colostomy. Follow-up period was 12 - 30 months.

Patients with rectal dose below 500 rads per application did not develop rectal bleeding. The volume of rectum in the region higher than 500 rads per application with rectal bleeders was larger than that non- bleeders with statistical significance, The high dose rate intracavitary applications is recommended for, and only for, the institutions or radiation therapists experienced in low dose rate system with good dosimetry support. The main advantages are: good personnel protection, economic benefit of out patient care without anesthesia and the possibility of treating much more patients per working day in areas of high incidence of cervical cancers, as well as good control application.

and complication rates comparable to conventional low dose rate

CS

PSYCHOSOCtAL SKILL TRAINING FOR RADIATION THERAPY TECHNOLOGISTS.

Cynthia Lee, M.S.W., M.P.H., Joanna Beckley, M.S.W., Donald Tesh, M.D.

The Tumor Institute of The Swedish Hospital Medical Center, Seattle, Wasllington

An educational program addressing the psychosocial aspects of cancer was incorporated into the curriculum of the Swedish Hospital Tumor Institute Radiation Therapy Technology School. Patient surveys given at the

1828 ASTR Poster Abstracts

Institute have indicated that the radiation therapy technologist is viewed as being a significant member of the treatment team. As such, the quality of interaction between the patient and technologist has considerable impact on the patient's overall psychological functioning during the treatment process. The goals were to increase the sensitivity of 1) radiation therapy technology students to psychosocial issues of persons experiencing the crisis of cancer; 2) provide experiential skill training in working with this population; and 3) assist with the development of individual coping mechanisms in the prevention of worker "burn-out". Curricula consisted of didactic presentation, the use of role playing and modeling in communications skill training, demonstration of relaxation and stress management techniques, audiovisual programming, and invited guest lectures. Results of post-questionnaires indicated that the goals of the class were met. Reported to be of particular benefit was the utilization of communications skill training in working with "difficult" patients, e.g., dealing with hostility, anxiety, depression. Heightened concern around issues of burn-out have led to an on-going problem-solving support group which now meets on a weekly basis. Finally, it is felt that this educational model will ultimately minimize the stress assoc~iated with radiation.

c9

PHASE I, II CLINICAL TRIALS WITH CARCINOMA OF THE PANCREAS

Rafael Garces, M.D., Edward Scanlon, M.D., S. G. Prasad, Ph.D., Janardan D. Khandekar, M.D

At Evanston Hospital we have undertaken a Phase I, II study of hyperthermia since January 1981, induced by a 13.56 Mhz radio frequency Mggnetrode unit. To date we have treated 97 patients with advanced cancers including 14 patients with cancer of pancreas.

To assess the effectiveness of the treatment, base-line cat scans were obtained prior to initiation of treatment and were compared to post treatment scans. Response is defined as 50 percent reduction in the perpendicular diameters of the tumor.

12 patients, including three who are presently on treatment, are treated by radiation to 4000 rads of split course over two weeks, 500 - 1000 mgm of five fu for three days during the first week followed by 10 - 50 mgm of methyl CCNIJ for three days during the second week. In selected patients intraoperative catheters were implanted in the tumor bed. Twice during each cycle the tumor bed temperature was continuously monitored using a fluoroptic thermo- metry system interfaced to an in-house computer. We were able to induce an average of 43.9 o C for periods up to 30 minutes within the tumor.

Presently three patients are still on treatment. Out of nine evaluable patients five have partially responded, are symptom free and are able to carry on their normal activity One out of five died two months after treatment. The rest have been alive for three, four, six and seven months. Patients have tolerated the treatments very well. Treatment protocol +hormometry techniques and detailed results will be presented.

Cl0

DEVELOPMENT OF AN INTEGRATED PSYCOSOCIAL PROGRAM IN A COMMUNITY RADIOTHERAPY CENTER

John W. Travis, Joseph M. Hyland, Elizabeth Novotny, Henriette Pruyser, Lolafaye Coyne

St. Francis Capital Region Radiotherapy Center and the Menninger Foundation, Topeka, Kansas

This paper describes the development of a psychosocial program in a radiotherapy center of a Mid- western city in the United States. The contrast between the considerable amount of literature on the psychosocial dimension of Oncology and the lack of the practical application of this knowledge is drawn. Reasons for this are discussed. A review of the literature on the psychosocial dimension in radiation therapy is made. A description of psychosocial oncology program initiated at the request of the oncologists in the community is given. The radiotherapy center currently serves a population base of 400,000. It treats upwards of 700 new patients a year and has a catchment area with a radius of 150 miles. The challenges in developing a psychosocial program include: (a) identification of psychosocial needs of cancer patients and their families; (b) funding and acquisition of personnel; (c) evaluation of efficacy of programs; (d) integration of services into the overall treatment of the cancer patient. The way in which these challenges are addressed is described. The center now has a multi-disciplinary psychosocial team which assesses the needs of each patient and family and provides the requisite psychosocial counselor. The team works in close liaison with the medical and technical staff. The services provided include individual, marital and family, and pastoral counseling together with pharmacotherapy, hypnotherapy and participation in patients's pain management. The functions of each member are described. Studies and research projects which developed concurrently with the services are outlined. They include: (a) clas- sification of emotional adjustment difficulties in cancer patients; (b) clinical assessment of counseling interventions in patients with emotional adjustment difficulties; (c) pilot study of patients with early- stage breast cancer, assessing the psychological effects of cancer while receiving radiotherapy; (d) a project funded by the National Cancer Institute assessing the efficacy of different types of counseling in patients in need of psychosocial treatment are described. In summary, the program has been integrated into the overall treatment of the cancer patient and family and could be a model for psychosocial pro- grams in other communities.