Transcript Radiotherapie Glomus Tumoren

Radiotherapie Glomus Tumoren
 Historie
 Dosis
 Techniek
 Bijwerkingen
 Xerostomie
 Secundaire Tumoren
Dus Radiochirurgie?
Historie
 Wang et al.
Chemodectoma of the temporal bone: A comparison of surgical and
radiotherapeutic results.
Int J Radiat Oncol Biol Phys (1988) 643-648
 Springate et al.
Radiation or surgery for chemodectoma of the temporal bone: A review
of local control and complications
Head & Neck (1990) 303-307
Historie - Wang et al.
Groep I
Groep II-III
Chirurgie
5/8
1/5
Radiotherapie
2/2
8/8
Chir. Totaal
8/8
3/5
Dosis 29-67.5 Gy
Recurrent
46%
2/5
84%
85%
Historie - Wang & Springate
Jaar
Dosis
LC
FU
Grubb, U Michigan
1965
20-51
11
/
11
1m-10
Fuller, Mayo Clinic
1967
30-36
33
/
34
5-10
Hudgins, Baylor
1972
40-50
9
/
9
1-7
Silverstone, Mount Sinai
1973
40-50
5
/
5
20m-8
Arthur, Queen Elizabeth
1977
30-50
19
/
20
3m-15
Gibbins, U H Wales
1978
42.5-55
12
/
14
8.7
Kim, U Virginia
1980
13-62
15
/
17
1-30
Cole, Geisinger
1977
20.9-57
18
/
20
3m-16
Cummings, PMH
1984
35
34
/
36
3-23
Dickens, U Florida
1982
37.5-56.4
6
/
6
3-12
Hatfield, MGH
1972
15-45
4
/
4
9.7
Thomson, Arhus
1975
50-60
8
/
10
0-11
Reddy, U Kansas
1983
22-56
9
/
9
2-22
Tidwell, MDA
1975
45-50
16
/
17
na
Van Miert, Royal Vict Inf
1964
50-55
11
/
13
na
Simko, U Washington
1978
28-65
10
/
13
na
Lybeert, RRTI
1984
40-60
19
/
19
na
Maruyama, U Minnesota
1972
30-60
13
/
14
na
252
/
271
93,0
Dosis
 Cummings et al.
The Treatment of Glomus Tumors in the Temporal Bone by
Megavoltage Radiation.
Cancer (1984) 2635-2640
Dosis – Cummings et al.
 45 Patiënten (1958-1978)
 Biopsie 24 patiënten
 V : M = 31 : 14
 Leeftijd 17-81 jaar
 41 patiënten: 35 Gy / 3 weken Co-60
 Maximum 38.5 Gy
 FU 3-23 jaar
 LC 42/45
 2 randrecidieven
 4 chronische otitis externa, 1 stenose meatus acusticus externus
Dosis – Cummings et al.
Dosis
 Cummings et al.
15 x 2.35 Gy
 RRTI
20 x 2 Gy
 Voorstel
 25 x 1.8 Gy @ 100%
 12 x 2.8 Gy @ 80%
Techniek
 Vroeger wigvelden
 Nu “conventionele” EBRT of SRT of SRS
Techniek
 Krych et al.
Long-term results of irradiation for paraganglioma.
Int J Radiat Oncol Biol Phys (2006) 1063-1066
 1967-1994 33 patienten
 9 Co-60
 16 MV
 8 SRS
25 x 1.8 Gy
1 x 15 Gy
Krych et al.
 10 jaar act. LC 93%
 Late Effecten
 Smaakstn (5), xerostomie (7), gehoor (2)
 Sec Tumoren: in literatuur 3 gemeld
Secundaire Tumoren
 Hoge dosis gebied, rand (penumbra)
Sarcomen
 Lage dosis gebied
Maligniteiten in sneldelend weefsel
 Hall et al.
Radiation induced second cancers: The impact of 3D-CRT and IMRT
Int J Radiat Oncol Biol Phys (2003) 83-88
 Toename van 1% naar 1.75%
 Steves RA and Bataini J.
Neoplasms induced by megavoltage radiation in the head and neck
region.
Cancer 47(1981)1770
4 out of 1000
Conclusie
 Vroeger vooral de grotere tumoren met botdestructie en
hersenzenuwuitval
 Relatief lage dosis is voldoende voor een LC van > 90%
 Weinig bijwerkingen
 SRT/SRS