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306

STRUCTURAL AND FUNCTIONAL CHANGES AFTER CONSERVATION THERAPY

I.Kunkler. W.Jack, C.Tyler, U.Chetty,J.Dixon, G. Kerr, A.Rodger, L Matheson, Dept of Clinical Oncology and Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU,Scotland.

~ . ] ~ l i d . Due to the difficulty of assessing morbidity, cosmesis and ftmcdonal changes in a busy breast clinic, a specific clinic attended by research clinician and physiotherapist was established. Methods.Of 289 patients with stage 1 and 11 breast cancer treated by conservation therapy (1982-7), 159 relapse free survivors were invited to attend a clinic to assets cosmesis and late radiarion morbidity. 119 attended (median follow up:120 mths). Following whole breast irradiation (45Gy) 66 were boosted by Ir-192 implant (20 or 30 Gy) and 52 by 8-~.0 Mev electrons. Loco-regional symptomatology, scar lengr~h, volume of tissue excised, type of axillary surgery, turnout bed boost, telangiectasia and fibrosis were assessed by one observer (WJ). Cosmetic outcome, independently rated by 3 observers bJ~ded to the identity of the patient on a single PA photograph of both/preasts was measured using agreed criteria. A physiotherapist measured ~trrn swelling, power and range of shoulder movement. Morbidity to the lungs, ribs and shoulder girdle was scored using EORTC grading. ~dlJ.~.Cosmesis was excellent in8 (7%), good in 39 (33.9%), fair in 46 (40%l and poor in 22 (19.1%). Significant assocl#tions with cosmesis were found with excised volume (p-0.0157), visible tissue loss (p-0.0001), telangiectasia (p=0.0328),"fibrosis" (p~.O.001), higher boost dose (30Gy vs 20 Gy,X2=l.063,p-0.0181 and severity of breast pain. Grade 0-3 lung morbidity occurred in 62 (56.9%),45 (41.3%), 2 (1.8%) and 0 respectively.Com'!usl,on: a specific clinic for the documentation of structural and functional changes by clinician and physiotherapist following conservation therapy has proved practical and acceptable to patients.

308

RETROSPECTIVE ANALYSIS OF PEDIATRIC OLIGODENDROGLIOMA : ST. JUDE EXPERIENCE

\ I I I ~ I~N ' , [ l , .h [ l lh t t l t ' , ( t*,~. t ,Jt[llt*,,

D F - S A I , G . , H A R ~ W . ~ ~ U A T N A G A J ~ & KUNJ...E.~ RADIATION ONCOLOGY, ST.JUDI~ CI~m,~I,R~'S [U~F..ARCH HOSPITAL. MEMPEU[S, TN USA.

BACKGROUND: The tgeatment of pediatric oligodendroglioma is undergoing temporal evolution. Based on pathology, extent of resection, imaging characteristics, subsets of patients are being u-eared by surgery alone:. Further refining of this criteria is needed. PURPOSE: To identify .sgbsets of patients who could be treated by resection alone and who need radiation. MATERIALS AND METHODS : A review of 31 patients treated at the St.Jude Children R e . a r c h Hospital treated between Nov 1982 and April 1996 is undertaken with a mean follow-up of 41 months ( max. 138 rain. of 2.5 months). Age range is 2 months to 18 years(median 9). Pure Ollgo comprised of 20 cases, Oligoastro 5 and anaplastic 6. Anatomical sites were Temporal 18, Occipital 3 parietal 2, frontal 6 and Midbrain ,thalamus and posterior fossa leach. Surgery was gross total r~section in 16. subtotal resection in 12 and biopsy alone in 3 patients. Radiotherapy was administered in 12 cases and 19 were observed. Chemotherapy was given in 5 cases. RESULTS: 24 were alive at the time of analysis and 7 had died( 50% with anaplastic histology compared to 15% of pure ollgos). 19 were alive with NED status, 3 with stable disease, I recurrent disease. No distant metast~is were observed. Detailed Statistical analysis will be presented. CONCLUSION: Review of pediatric oligos treated indicates a subset of patients who could be treated with resection alone. These tend to be pure ollgo histoloD/who are completely resected. Presence of astocytic component or anaplastic histology portends poor outcome. These findings need to be cenfirmed in larger patient studies.

307

R~SK FACTORS IN PEDIATRIC CNS TUMOURS

Maria Anna Skowro6ska-Gardas Center of Oncolo~y, Warsaw, Poland

From 1980 t i l l 1990 in the F i rs t RadlotheraDy Department in the Center of Oncology in Warsaw 29: chi ldren, age 1-16 years, with C~IS tumours were treated. The statistical analysis of risk factors was carried out, with the intention of definin~ patients 8POUDS with increased risk of treatment failure. Probability of total and disease free survival was calculated by KaPplan-geler method survival curves, and difference were assessed with lob-rank test. Multlvariante statistical analvsis of risk factors were performed usin~ the accelerated time to failure model. 9urvical more than 5 years was achieved in 1966 (~7~) children, and event free survival in Id5 (50%). In the group of youn~ children ( < ~ years) results were similiar as in older ~roup. Multivarlante statystical analysis of risk factors allowed to separate patients with Door prognosis. There are children with short time of symptoms, with hiRh grade astrocytoma, who were not sur~icallv treated, were in poor clinical state before radiotherapy and who progressed durin~ irradiation.

309

RETINOBLASTOMA: SURVIVAL AND PROGNOSTIC FACTORS. A. Herv~s, F. Valc&cel, A. De la Torte, M.I. Gonzalez, E. Polo, M.C. Ispizua, G. Aragrn. Hospital Puerta de Hierro. Madrid. Spain.

At the present, with the treaUnent available in the management of the refinoblastoma the survival of this patients reach the 90% at 5 years at specialized centers. Mather ia l and Methods: Between 1964 and 1991 we have analized 54 patients with 97 eyes affected with retinoblastoma. Tumor was bilatexal in 43 patients and unilateral in I I. The mean age of the aerie was 13 months. The localization was the right eye in 50 cases and the left eye in 47 cases. The classification according to R-E was: group 1:5, gr . l l :14, gr . l l l :9 , gr.IV:3, gr.V:58. The treatment was the enucleatiou in 46 cases and the external beam radiation in 60 cases (47 as exclusive tretment and 13 postoperative). The mean dose tumor was 39 Gy (30-47 Gy). In 4 patients we used Stallard plaques with a dose of 40 Gy to the maxim depth tumoral. Twenty three patients received systemic ~reatment with chemotherapy. In the statistical analysis we have used the Kaplan-Meier method, Mantel-Cox test and Cox models for the multivariate analysis. Resu l t s :The overall survival rates for the 54 patients was 92% and 85% at 5 and 10 years. In the univariate analysis the factors associated with a lower probability of survival were: age > = 12 months (p=0.03), group V of the R-E classification (p=0.03), nerve optic infiltration (p=0.0007) and unilateral disease (p= 0.0008). In the multivariate analysis the factors associated with a less probability of survival were: optic nerve infiltration (RR:22) and age > = 12 months (RR: 18).