Volumetric modulated arc therapy (VMAT) – one of the most advanced radiation therapy techniques – is being used since March 2011 at the Radiation Oncology Division of the Institute of Oncology Ljubljana. A fundamental distinction of VMAT with respect to other radiation therapy techniques is that the patient is irradiated with a photon beam continuously while the gantry is rotating around patient's body. During the treatment, three parameters are modulated simultaneously: the shape of the treatment field, rotation speed of the gantry, and the delivery dose rate. Intensity modulated radiation therapy (IMRT), in contrast, uses fixed treatment fields and a constant dose rate. Two most important advantages of VMAT over IMRT are a shorter treatment time – and consequently a smaller possibility for an unwanted change of patient position (or the position of the treatment target – tumor – inside the patient's body) on the treatment table during irradiation – and a lower dose load to the tissue around the target. At the same time, conformity of dose distribution in target area and spearing of healthy organs and tissues in its surroundings are at least as good as the one achieved by IMRT and in some cases (e.g. irradiation of the pelvis), however, they are even better. The present contribution presents VMAT, its characteristics, procedure, indications for its use, as well as the dangers associated with such precise irradiation treatment.
F.22 Improvement to existing health/diagnostic methods/procedures
COBISS.SI-ID: 1317755Aim: To review the treatment results and identify prognostic factors for disease control and survival in a cohort of nasopharyngeal carcinoma (NPC) patients from a non-endemic population in Slovenia, diagnosed between 1990 and 2003. Background: In Caucasians, nasopharyngeal carcinoma is a rare malignant tumor. Its diagnosis and treatment are complex and have been dramatically impacted by recent technological advances. Materials and methods: In the Cancer Registry of Slovenia database, a total of 126 patients with NPC were identified, 93 of whom were available for analysis. All patients were treated with conventional two-dimensional radiotherapy (RT) and 29.3% underwent chemotherapy (ChT). Results: The median follow-up time for those alive at the last follow-up examination was 74.5 months. Disease recurred locally in 17 patients, regionally in 4 patients and at distant sites in 18 patients, resulting in 5-year locoregional control (LRC), distant failure-free survival (DFFS) and disease-free survival (DFS) of 73.7%, 78.6% and 59.3%, respectively. Disease-specific survival at 5 years was 59% and overall survival (OS) was 49.7%. In a multivariate analysis, LRC was favorably affected (P ( 0.05) by an undifferentiated histology (hazard ratio [HR] = 2.86), DFFS through the absence of neck metastases (HR = 0.28), DFS by younger age (HR = 0.46), and more intensive RT (expressed as the isoeffective dose, EQD2,T; HR = 2.08). The independent prognosticator for OS was age ((55 years vs. )55 years, HR = 0.39); in the (55 years subgroup, an improved OS was connected to a more intensive RT regimen of EQD2,T Ž 66 Gy (HR = 4.17). Conclusions: Our results confirm an independent and favorable effect from an undifferentiated histology, the absence of neck metastases, a younger patient age at diagnosis, and more intensive RT regimens for disease control and survival.
F.30 Professional assessment of the situation
COBISS.SI-ID: 1268859Background: The purpose of this article is to describe the role of functional radiological imaging modality–CT perfusion in the evaluation of head and neck tumors. Methods: Perfusion CT imaging provides a rapid evaluation of tissue perfusion and can be easily implemented in every head and neck CT protocol. The determination of tissue perfusion using CT is based on examining the relationships between the arterial, tissue and potentially the venous enhancement after the introduction of a bolus of contrast material. The quantification of the perfusion values allows us to determinate the processes of neovascularization, also known as angiogenesis, essential for the growth of head and neck tumors. Conclusions: Perfusion CT is a robust, accessible and promising method for the assessment of functional parameters on the tissue level. It helps outlining the malignant tissue as well as differentiating recurrent disease from nonspecific post-therapeutic changes and can be used as a therapeutic monitoring tool during and after tumor therapy.
F.12 Improvements to an existing service
COBISS.SI-ID: 1308539Traditionally, Chair of Otorhinolaryngology at the Medical Faculty (University of Ljubljana), ENT Clinic (UKC Ljubljana) and Association of Otorhinolaryngologists (at the SZD) organize on annual basis a professional meeting, Otolaryngology Day, on topics suggested by participants of the previous meeting. In 2012, the meeting was dedicated to ear problems, problems of acute laryngitis in children, nose trauma, and neck lymphadenopathy. Special attention was intended for urgency in ENT region, including also respiratory distress due to malignancies of the head and neck. To this section also belongs the lecture on endoscopic surgery of the larynx, where the options of endoscopic treatment of patients with early stage vocal cords cancer and small recurrences after irradiation were presented. Section was concluded with workshop on patients with tracheostomy. There were 130 family doctors, pediatricians and otorhinolaryngologists who attended the meeting. A book of lectures was also published.
F.18 Transfer of new know-how to direct users (seminars, fora, conferences)
COBISS.SI-ID: 260488448Although head and neck cancer is one of the most frequent cancers in the world, the knowledge about its etiology, symptoms, disease course, treatment and consequences of its treatment is scarce. On the basis of the study on the knowledge about head and neck cancer “About Face” a similar survey was performed among inhabitants of some Slovenian towns and among the patients treated for head and neck cancer at University Department of Otorhinolaryngology and Head & Neck Surgery in Ljubljana. According to the results of the survey, the inhabitants of Slovenia have more knowledge about head and neck cancer than the inhabitants of seven European countries. The patients with head and neck cancer and their relatives have even more information about some data – probably as a result of their own experience.
F.30 Professional assessment of the situation
COBISS.SI-ID: 470956