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Background: We used 3-deoxy-3-
18
F-fluorothymidine (FLT) PET-
CT to delineate biological tumour volume in thoracic oesophageal
carcinoma, for a treatment planning simulation. We compared
results with that of
18
F-fluorodeoxyglucose (FDG) PET-CT, on the
basis of dosimetric analysis.
Methods: 22 patients with oesophageal squamous-cell carci-
noma detected by FLT and FDG PET-CT were enrolled. We used
the treatment planning system to compare hypothetical treat-
ment plans based on the optimal threshold for standard uptake
value of FLT and FDG PET-CT. We compared parameters in dose–
volume histograms of the two groups, planning fields in similar
directions and ensuring the prescribed dose line surrounded
95% of the target volume.
Findings: Gross tumour volume, clinical target volume, and
planning target volume were less with FLT than with FDG PET-
CT imaging. The conformity index and homogeneity index did
not differ significantly between FLT and FDG PET-CT treatment
planning. The difference in V
20
of bilateral lung, V
40
of heart,
and maximum dose received by the spinal cord did not differ sig-
nificantly between FLT and FDG. Values for mean lung dose, V
5
,
V
10
,V
30
,V
40
, and V
50
of bilateral lung, and mean heart dose and
V
30
of heart were significantly lower with FLT PET-CT based plan-
ning than with FDG PET-CT (t= -5.442 to 2.637, p< 0.05).
Interpretation: Treatment planning based on FLT PET-CT had
potential benefits for some organs at risk, such as lungs and
heart.
Funding: Research Fund of Shandong Provincial Health Bureau
of China.
The authors declared no conflicts of interest.
doi:10.1016/j.ejcsup.2011.02.055
P55 THORACO-ABDOMINAL FLAP COVER FOR LARGE POST-
MASTECTOMY DEFECTS – EXPERIENCE FROM A REGIONAL
CANCER CENTRE IN NORTHEAST INDIA
J. Purkayastha *, B.K. Das, B.B. Borthakur, A. Talukdar,
M. Ahmed. Department of Surgical Oncology, Dr. B Borooah Cancer
Institute, Guwahati, Assam, India
Background: Tumours of the breast have become one of the
most common malignancies in India in recent years, and seem
to be increasing. Common malignancies affecting the breast are
carcinoma and sarcoma, including phyllodes tumour. Because
of a lack of awareness in the general population, patients present
late and with large advanced tumours. Surgery for large tumours
leads to extensive defects that may not be suitable for primary
closure. Extensive, complex surgical procedures are not suitable
for our centre because of a lack of resources and time constraints.
We share our experience of closure of such defects using a simple
procedure, the thoraco-abdominal (TA) flap.
Methods: Between January, 2003, and December, 2010, a total of
1232 patients had surgery for breast tumours at our centre. Of
these, 912 (74%) of patients had a mastectomy. 78 (8.5%) of patients
had a large post-mastectomy defect that could not be closed pri-
marily. Soft-tissue cover using the TA flap was done for all of these
patients. The TA flap is a rotation-advancement variant of the fas-
cio-cutaneous flap, with random pattern blood supply.
Findings: Primary healing could be achieved in 73 (94%) of
patients who had TA flap cover. Three patients had marginal
necrosis that responded to conservative treatment. Two patients
developed major necrosis with loss of TA flap and needed salvage
myocutaneous flap repair. All patients were able to receive the
planned adjuvant chemo and/or radiation therapy.
Interpretation: The aim of surgery in large advanced breast
tumours is adequate disease extirpation with early recovery, so
that adjuvant therapy can be done to improve survival. The TA
flap is a simple, safe, reliable, and effective technique with mini-
mum morbidity for coverage of large post-mastectomy defects,
and is particularly suited for surgeons and patients in our region.
Funding: None.
The authors declared no conflicts of interest.
doi:10.1016/j.ejcsup.2011.02.056
P56 EFFECTS OF HYPOXIA ON ANGIOGENESIS AND PROLIFERA-
TION – CORRELATION WITH TUMOUR RESPONSE IN PATIENTS
WITH CERVICAL CANCER TREATED WITH COMBINED RADIA-
TION AND CARBOGEN–NICOTINAMIDE
S. Mutya Sekarutami
a,
*, S. Gondhowiardjo
a
, F. Aziz
b
, N.C.
Sregar
c
, A. Harahap
c
.
a
Department of Radiotherapy, Cipto
Mangunkusumo General Hospital, Jakarta, Indonesia.
b
Department of
Obstetry and Gynecology, Cipto Mangunkusumo, Jakarta,
Indonesia.
c
Eijkman Institute, Jakarta, Indonesia
Background: Hypoxia has been shown to cause tumour resis-
tance to radiation and chemotherapy. Treatment failure in large
tumours of locally advanced cervical cancer is associated with
intratumoral hypoxic circumstances. We investigated the associ-
ation between hypoxia, angiogenesis, proliferation, and tumour
volume in patients with locally advanced cervical cancer, and
evaluated the effectiveness of carbogen-nicotinamide (CON) as
a hypoxia modifier to enhance cell oxygenation.
Methods: 89 patients with locally advanced cervical cancer
treated at the Department of Radiotherapy, Cipto Mangunkusumo
General Hospital, Jakarta, were included in this study. Patients
were divided into two groups. Group 1 consisted of 29 patients
who received radiotherapy combined with CON (RT + CON); group
2 had 60 patients who received chemo-radiotherapy (CRT) with
cis-platinum. Group 2 was randomly divided into two subgroups,
who received CRT plus CON or CRT alone. Biopsy specimens were
taken to identify CA9 as a hypoxia marker, vascular endothelial
growth factor (VEGF) as an angiogenesis marker, and S-phase
fraction (SPF) as a proliferation marker. Analysis was done to
evaluate the correlation between the three markers, between
the markers and tumour volume, and the benefit of introducing
CON.
Findings: A significant positive correlation was noted among
pre-irradiated tumour volume and two markers: CA9 (r= 0.514,
p= 0.007) and SPF (r= 0.422, p= 0.032), but there was a weak and
non-significant correlation between tumour volume and VEGF
(r= 0.422, p= 0.114). Significant correlations among the markers
were also found: CA9 with VEGF (r= 0.678, p= 0.000), VEGF with
SPF (r= 0.475, p= 0.005), and SPF with CA9 (r= 0.510, p= 0.002).
CON effectiveness was analysed by evaluating treatment
22 EJC SUPPLEMENTS 9 (2011) 1–23