BRAIN METASTASIS OF BREAST CANCER TREATED WITH ...

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82

XXI Congresso da Sociedade Brasileira de Radioterapia (SBRT)

1

TEMÁRIO: RESIDENTES (SUBMISSÃO PARA O X ENCONTRO DE RESIDENTES EM RADIOTERAPIA) CÓDIGO: 88346

BRAIN METASTASIS OF BREAST CANCER TREATED WITH RADIOSURGERY: SURVIVAL ANALYSIS FROM 2007 TO 2018Autores: Nathalya Ala Yagi / Yagi, N. A. / Hospital Araújo Jorge; Nilcena Maya Aires Freitas / Freitas, N. M. A. / ; Mattheus Humberto do Vale / Vale, M. H. / ; Thais Renovato Gontijo / Gontijo, T. R. / ; Sylvia Sousa Pires / Pires, S. S. / ; Thais Franco Simionatto / Simionatto, T. F. / ; Ana Flávia de Paula Campedelli / Campedelli, A. F. P. / ; Jean Teixeira Paiva / Paiva, J. T. / ; Vladimir Arruda Zaccariotti / Zaccariotti, V. A. / ; João Batista Arruda / Arruda, J. B. / ; Edésio Martins / Martins, E. / ; Ruffo Freitas-Jr / Freitas-Jr, R. / ; Sebastião Peleja / Peleja, S. / ;

Introduction: Metastatic brain tumors outnumber the primary tumors by 10: 1. The best survival rate of brain metastases is represented by female gender, good performance status (PS), primary breast cancer, time between diagnosis of primary tumor and development of brain metastases greater than six months and single lesion. Objectives: To evaluate the epidemiological profile of patients diagnosed with metastatic breast cancer for central nervous system (CNS) undergoing radiosurgery (SRS) and to determine: 1) Overall survival (OS); 2) Brain disease free survival (DFS) after breast cancer diagnosis; 3) Survival after the first SRS and compare them with immunohistochemical data. Methods: Retrospective cohort study of patients diagnosed with brain metastasis of breast cancer treated with SRS in a single institution from 2007 to 2018. Statistical analysis was performed by Fisher‘s test and Kaplan-Meier curve. Results: In a total of 146 patients with CNS metastasis of breast cancer treated with SRS, only 45 patients (30%) received whole brain radiotherapy (WBRT), of which 25 patients were post-radiosurgery. The survivals analyzed were: 1) OS, median 46 months (95% CI 38.23-55.36; SD ± 4.37) and mean 44 months (95% CI 41.35-47.21; SD ± 1.49). No difference was found between immunohistochemical subtypes (p = 0.07), being the average for luminal patients was 49 months (95% CI 44.92-5.33; SD ± 2.14), the median for the triple negative was 40 months (95% CI 31.39-50.13; SD ± 4.78) and HER2 was 46 months (95% CI 39.99-5.60; SD ± 3.47). 2) DFS after breast cancer diagnosis, median 23 months 3) Survival after first SRS, median 9 months (95% CI 7.01-10.98; SD ± 1.01) and mean 15 months (95% CI 11.67-19.99; SD ± 2.12). There was no statistical difference between different immunohistochemicals (p = 0.57), being median found for luminal patients was 8 months (95% CI 4.97-11.02; SD ± 1.54), triple negative was 6 months ( 95% CI 3.28-8.71; SD ± 1.38) and HER2 was 10 months (95% CI 7.33-12.66; SD ± 1.36). 4) DFS after radiosurgery, median 6 months (95% CI 4.9-7.03; SD ± 0.52) Conclusion: Radiosurgery is an important therapeutic modality for the treatment of brain metastases in breast cancer, regardless of the immunohistochemical subtype. WBRT can be avoided in 70% of patients, maintaining comparable survival and preventing impairment of neurocognitive function.

Contato: Nathalya Ala YagiE-mail: [email protected]


CHALLENGES IN THE ESOPHAGEAL CANCER STAGING IN BRAZILAutores: Gerson Hiroshi Yoshinari Júnior / Yoshinari Jr., G. H. / Hospital Márcio Cunha - FSFX; Ary Fraga Dercy / Dercy, A. F. / Hospital Márcio Cunha - FSFX; Henrique Hott Fernandes / Fernandes, H. H. / Hospital Márcio Cunha - FSFX; Cesar Caldas Teixeira / Teixeira, C. C. / Hospital Márcio Cunha - FSFX; Harley Francisco de Oliveria / Oliveira, H. F. / Faculdade de Medicina de Ribeirão Preto - USP; Gislene Amarães Gomes / Gomes, G. A. / Hospital Márcio Cunha - FSFX; Luciano Souza Viana / Viana, L. S. / Hospital Márcio Cunha - FSFX; Mariana Paranhos Alvarenga / Alvarenga, M. P. / Hospital Márcio Cunha - FSFX;

Esophageal cancer has a high incidence in several regions of the country. Nevertheless, we observe the difficulty in performing the necessary staging exams and the lack of clinical data, particularly in services from the Public Health System. This study aims to evaluate the absence of clinical information and staging exams in esophageal cancer. We conducted an observational, retrospective, and cross-sectional, single-institute study. One hundred seventy-nine consecutive patients diagnosed with esophageal cancer, from 2015 to 2017, from Public Health System were analyzed. Information on demographics, clinical data, predictive, and prognostic risk factors was retrieved. The classic risk factors, smoking and alcoholism, were not described in 22% and 23% of the patients, respectively. The nutritional status was not reported in almost 17% of the patients. The need for alternative feeding method was not described in 83 patients. Squamous cell carcinoma (SCC) was present in 126 patients (81%) and adenocarcinoma in 15 patients (8%). The histologic classification was not reported in 13.4% of patients. One hundred eighteen patients (66%) presented no information on the tumor size. Tumor location was described in all patients. There were 132 patients (73%) without T staging, 102 (57%) without evaluation of lymph node involvement, and 106 (59%) without evaluation of distant metastases. In conclusion, we observe a significant lack of information for patients with esophageal cancer treated by the Public Health System. This lack may impact negatively in the correct evaluation and treatment of these patients, as in their prognostic.

Contato: Henrique Hott FernandesE-mail: [email protected]


FRACTIONATED STEREOTATIC RADIOSUR-GERY IN THE EXTRACONAL METASTASIS OF NEUROENDOCRINE TUMOR - CASE REPORT AND REVIEW OF LITERATUREAutores: Gerson Hiroshi Yoshinari Júnior / Yoshinari Jr., G. H. / Hospital Márcio Cunha - FSFX; Henrique Hott Fernandes / Fernandes, H. H. / Hospital Márcio Cunha - FSFX; César Caldas Teixeira / Teixeira, C. C. / Hospital Márcio Cunha - FSFX; Harley Francisco de Oliveira / Oliveira,

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 2

H. F. / Faculdade de Medicina de Ribeirão Preto - USP; Mariana Paranhos Alvarenga / Alvarenga, M. P. / Hospital Márcio Cunha - FSFX; Luciano de Souza Viana / Viana, L. S. / Hospital Márcio Cunha - FSFX; Braulon Rodrigo Viana / Viana, B. R. / Hospital Márcio Cunha - FSFX;

Case report: A 28-year-old male patient presented persistent diarrhea. Clinical investigation revealed tumoral images in the liver, pancreas, bones, and retroperitoneum, suggesting neoplastic involvement. Biopsy of the liver was performed, showing a high-grade neuroendocrine tumor (NET). During the systemic treatment based on chemotherapy, the patient developed severe ocular pain, refractory to analgesics, and bilateral eye mobility restriction. Magnetic resonance imaging (MRI) of the orbits showed bilateral extraconal expansive lesions in the right medial rectus and left lateral rectus muscles, measuring 10x11x11mm and 9x9x12 mm, respectively. We proposed a fractionated stereotactic radiosurgery (SRS) treatment with 25 Gy in five fractions. Intensity-modulated radiotherapy was employed. The patient evolved with an improvement of symptoms and preserved visual acuity confirmed by eye campimetry. An MRI performed five months after treatment showed a complete response of the lesions and discrete thickness of the right medial rectus muscle. Discussion: The actual epidemiology of NET metastases is unknown. A retrospective analysis showed that the most commonly affected site is the liver. The primary site that more often evolves to metastatic disease is the small intestine, followed by the pancreaticobiliary system. We reviewed the literature, retrieving eight articles containing case reports or series of cases of orbital involvement for metastatic TNE. Only one publication containing a sequence of cases presented SRS as a therapeutic approach, but only for unilateral involvement. The patient received treatment in five fractions, without information on the dose, progressing with the improvement of diplopia and proptosis. Follow-up revealed a stable disease. Partial resection followed by radiotherapy, use of image-guided radiotherapy (IGRT), and systemic therapy was also described therapeutic possibilities. Final Comments: Extraconal NET metastases are rare and therefore challenging in its management. The morbidity of the disease and treatment should be considered, limiting in the vast majority of cases the possibility of extensive resections. In this scenario, local therapies such as SRS and systemic therapies constitute valid therapeutic possibilities, reinforcing the importance of a multidisciplinary approach.

Contato: Henrique Hott FernandesE-mail: [email protected]


INSTITUTIONAL EXPERIENCE OF ORGAN PRESERVATION IN LOCOREGIONALLY ADVANCED SQUAMOUS CARCINOMA OF THE LARYNX AND HYPOPHARYNXAutores: Daniel Fleipe Souza Fantini / Fantini, D. F. S. / Hospital de Amor Barretos ; Renato de Castro Capuzzo / Capuzzo, R. de C. / Hospital de Amor Barretos; Diogo

Dias do Prado / Do Prado, D. D. / Hospital de Amor Barretos; José Milton Vidal / Vidal, J. M. / Hospital de Amor Barretos; Rafael Cardoso Pires / Pires, R. C. / Hospital de Amor Barretos; Pedro De Marchi / De Marchi, P. / Hospital de Amor Barretos; Maria Carolina Budib / Budib, M. C. / Hospital de Amor Barretos; Camila Bogoni Budib / Budib, C. B. / Hospital de Amor Barretos; Renata Vilar Ponte / Ponte, R. V. / Hospital de Amor Barretos; Alexandre Arthur Jacinto / Jacinto, A. A. / Hospital de Amor Barretos;

Introduction: Conservative treatment of locoregionally advanced squamous carcinoma of the larynx and hypopharynx (LRASCLH) with chemoradiotherapy protocols is an option aimed at preserving the function of the larynx. However, this may also lead to the need of a laryngectomy or functional sequelae in the preserved larynx. Objective: To evaluate the overall survival of the patients with locoregionally advanced laryngeal and hypopharyngeal cancer, the organ preservation rate and functionality in patients with LRASCLH. Methods: A single institution retrospective study that evaluated patients with LRASCLH, undergoing cancer treatment from 2008 to 2015. Results: A total of 212 patients were included, of which 47.2% had larynx-supraglottic, 36.3% larynx-glottis and 16.5% hypopharynx. 39.2% had stage III, 48.6% stage IVa and 12.3% stage IVb. 82.5% of the cases were considered resectable. In regards to pre-treatment laryngeal function, 26.9% were tracheostomized and 7.1% required an alternative feeding route (AFR). The initial treatment in 56 (26.4%) of the patients was surgery, preceded or not by neoadjuvant chemotherapy in 17 (30.3%)%, and radiotherapy associated or not with chemotherapy in 156 (73.6%). Among patients that initially received organ preservation treatment, 28 (17.9%) required salvage surgery. In 81 (38.2%) of the cases, a total laryngectomy was performed and partial laryngectomy in 3 (3.6%). With a median follow-up of 42 months, the overall survival at 3 years was 58.2%. At the end of the follow-up, 54 (25.5%) required AFR and 36 (19%) a definitive tracheostomy with larynx. The rate of a functional and disease-free preserved larynx was 42% and that of disease-free, non-functional larynx was 4.7%. Conclusion: In our field, treatment with chemoradiotherapy for LRASCLH, even outside of randomized clinical trials, represents an excellent option when in selected cases, the goal is to preserve a functioning and disease-free larynx.

Contato: Daniel Felipe Souza FantiniE-mail: [email protected]


INTENSITY MODULATE RADIOTHERAPY OR OLDER RADIATION TECHNIQUES FOR NASOPHARYNGEAL CANCER: DOES THE OUTCOMES DEPEND ON WHERE PATIENTS ARE LIVING?Autores: Gustavo Viani arruda / Viani, Gustavo Arruda / Usp; Anielle Freitas Bendo Danelichen / Danelichen, A.F. B / Usp; Leonardo Vicente Fay Neves / Neves, Leonardo F. V. / Usp; Ana Carolina Hamamura / Hamamura, Ana

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


3

C. / Usp; Alexandre Faustino Ciuffi / Ciuffi, Alexandre F. / Usp; Fernando kojo Matsuura / Matsuura, Fernando K. / Usp;

Purpose: To compare the efficacy in terms of local control (LC) and survival (OS) of intensity modulate radiotherapy (IMRT) with conventional (2D) or conformational (3D) radiotherapy for nasopharyngeal cancer from endemic or non-endemic area. Materials and Methods: Records of patients from our institutional database were retrospectively assessed. A paired comparison analysis was used to evaluate the oncological outcomes between patients treated with IMRT or 2D3D RT (control). The endpoints were LC, and OS. A systematic review of the literature and meta-analysis was also performed to evaluate LC, and OS. Results: Our cohort included 57 patients, 29 IMRT and 28 3DRT in each Group. The median follow-up time was 48 months. IMRT produced better local control rate (85 vs. 60 %, p =0.01) with no impact on OS (52 vs. 58 %, p =0.92). The meta-analysis included 8 retrospective studies (12771 patients), 6 from endemic and 2 from non-endemic areas revealed that IMRT had a higher LC (OR=2; CI=1.7-2.3, p=0.004) independently of subgroup area. However, the IMRT had better OS only for NPC from endemic areas (OR=1.46; CI=1.3-1.6, p=0.0001). Conclusions: IMRT is the better technique to treated locally advanced NPC in patients from endemic or non-endemic area. The survival benefit from IMRT treatment for NPC detected in the meta-analysis was restricted only to patients from the endemic area and can be related to differences of histological subtypes.

Contato: Anielle Freitas Bendo DanelichenE-mail: [email protected]


INTRAOPERATIVE BREAST RADIOTHERAPY: A LOOK BEYOND THE THERAPEUTIC BENEFITAutores: Lais Tomaz Maya / Maya, L.T. / AC Camargo Cancer Center; Guilherme Rocha Melo Gondim / Gondim, G.R.M. / AC Camargo Cancer Center; Felipe Conde / Conde, F. / AC Camargo Cancer Center; Rivaldo Serrano / Serrano, Rivaldo / AC Camargo Cancer Center; Ricardo Cesar Fogarolli / Fogaroli, R.C. / AC Camargo Cancer Center; Antonio Cássio Assis Pellizzon / Pellizzon, A.C.A. / AC Camargo Cancer Center; Fabiana Baroni Alves Makdissi / Makdissi, F.B.A. / AC Camargo Cancer Center;

Introduction: The success of cancer treatment requires patient adherence and easy access to the treatment center. Intraoperative radiotherapy (IORT) reduce the duration of treatment, to a single dose during surgery, and IORT with eletrons or with the Intrabeam ®, can be, indicated for selected women diagnosed with early stage breast cancer. In a country like Brazil where just 50.8% of the required amount of radiotherapy equipment is avaiable, IORT could provide acess to radiotherapy to many women. Objectives: Calculate the distance, the time of travel and the amount of

money saved by patients with IORT instead of External Radiotherapy (EBRT). Methods: This study was based on the AC Camargo Cancer Center database with 259 women diagnosed with breast cancer, treated with IORT from 2005 to 2019. 27 patients living in cities more than 100km from the Hospital were excluded. To calculate the distance between the house and the hospital, by public or automobile, the Google Maps® tool was used. For all patients, treatments were prescribed with the number of EBRT sessions that would be necessary, using the current protocol of the Institution (2019). Based on this prescription, we performed the analysis of daily travel time, and money spent for the treatment and for the simulation. The criteria for selecting low-risk patients was equivalent to those established by the consensus of the ESTRO and ASTRO. Results: The mean age was 65 years. If EBRT were indicated, an average of 17 sessions would be performed. The distance to a single day of treatment with IORT was 35.05 km to reach the institution (round trip), and if EBRT was performed, it could reach a total of up to 545 km for all treatment days. The mean daily travel time was 137 minutes by car and 129 minutes by pubic transport, with a transit time spent ranging from 2204.6 at 2557.6 minutes respectively for the entire treatment. The cost with the journey for single dose treatment would be approximately 3,13 dolars. Conclusion: For selected patients with early breast cancer, a single dose of radiotherapy delivered at the time of surgery with IORT should be considered as an alternative to external beam radiotherapy. It was demonstrated that the time spent, as well as the distance traveled, is much lower in the IORT treatment. And it can improve patients‘ adherence and quality of life and reduce the number of patients that cant receive the radiotherapy due to the lack of equipment in Brazil.

Contato: Lais Tomaz MayaE-mail: [email protected]


PALIATIVE RADIOTHERAPY FOR GASTRIC CANCER: IS THERE A RELATIONSHIP BETWEEN DOSE AND BLEEDING STOP?Autores: Gustavo Viani Arruda / Viani, Gustavo Arruda / Usp; Anielle Freitas Bendo Danelichen / Danelichen, Anielle F. B. / Usp; Leonardo Vicente Fay Neves / Neves, Leonardo V. F. / Usp; Ana Carolina Hamamura / Hamamura, Ana C. / Usp; Alexandre Faustino Ciuffi / Ciuffi, Alexandre F. / Usp; Fernando Kojo Matsuura / Matsuura, Fernando K. / Usp;

Objective: To evaluate if there is a relationship between radiotherapy dose and response to bleeding in palliative patients with local relapse or disease progression in gastric cancer. Methodology: It was conducted a systematic meta-analysis review of observational studies evaluating bleeding response in a gastric cancer (GC) patient with local relapse or disease progression. A meta-regression was performed between biological effective dose (BED) and complete bleeding response (CBR). A subgroup analysis was performed stratifying

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 4

studies by BED level and radiotherapy technique (RT). A value of p <0.05 was significant. Results: Ten non-comparative retrospective studies and one prospective study were included. Overall, RT was an effective treatment for CBR, the CBR rate was 0.77 (95% CI 0.73-0.81). The meta-regression showed a linear relationship between BED Gy 10 and CBR (p = 0 <0001). Studies using conformational RT obtained a significant difference in the rate of CBR when compared to RT2D (0.79 CI95% 0.74 -0.84 vs 0.65 CI95% 0.56 - 0.75, p = 0.021). In subgroup analysis dividing the studies into 3 levels of BED and assessing the CBR rate, a higher response was obtained in studies with BED> = 30Gy10; BED Gy 10 ≥40 (0.79 CI95% 0.7-0.8), BED Gy10 30-39 (0.79 CI95% 0.71-0.86) and BED Gy10 <30 (0.64 CI95% 0.5-0.7, p = 0.0001). The median survival was 3.31 months (95% CI 2.73 - 3.9), and response to treatment had a significant increase in survival compared to non-response 2.5 months (95% CI 1.7 - 3.3, p <0.0001). Conclusion: Palliative RT is effective in controlling bleeding by local control / local progression of gastric cancer. There is a relationship between CBR and BED. Our data show that BED <30Gy 10 should not be recommended, and for best results the 3D technique should be indicated.

Contato: Anielle Freitas Bendo DanelichenE-mail: [email protected]


RADIOTHERAPY FRACTIONATIONS IN SKIN LESIONS TREATMENTS AT HOSPITAL ERASTO GAERTNER FROM 2015 TO 2019Autores: Maíra Neves / Neves, M.F.R / Hospital Erasto Gaertner; Gabriel Faquetti Morandini / Morandini, G.F. / Hospital Erasto Gaertner; Bianka Monalisa Vendrame Reis / Reis, B.M.V. / Hospital Erasto Gaertner; Jose Carlos Gasparin Pereira / Pereira, J.C.G / Hospital Erasto Gaertner;

Objective: This study aims to analyze radiotherapy fractionation at Hospital Erasto Gaertner regarding skin lesions, toxicity, and compliance. Material and Methods: The study was the retrospective analysis of data from patients submitted to radiotherapy for malignant neoplasm of skin and benign lesions. From 2015 to 2019, there were 687 radiotherapy treatments for skin lesions, and the techniques applied were orthovoltage, betatherapy, electron-beam radiotherapy, and external beam radiotherapy. Results: 226 patients were submitted to radiotherapy for basal cell carcinoma (33%); among them, 84% received electron-beam radiotherapy and 14% received orthovoltage. The applied fractionation varied from 5Gy in five fractions to 2Gy in 35 fractions. The patients who received radiotherapy up to 55Gy in 20 fractions have completed the treatment during the estimated time (99%). The group of patients that received radiotherapy superior to 30 fractions has completed the treatment in two weeks beyond the estimated (35%). The group that received more than 30 fractions showed higher skin toxicity (RTOG 2 or superior) than the one that received up to 20 fractions (65% vs 24%). Similar results

were seen in patients submitted to treatment due to squamous cell carcinoma, total of 177 patients (25%), the same fractionation dose was applied, however, 67% of the patients in this group received radiotherapy more than 30 fractions, with toxicity RTOG 2 or superior in 44% of them. Only 2% of the group have been treated with external beam radiotherapy (60Gy in 30 fractions). 20 patients were in the Merkel cell carcinoma group (3% of them) with no difference in the fractionation of the results compared to the previous groups. Concerning benign lesions, 37 % (254 patients) were treated: 218 patients received orthovoltage and fractionation of 20Gy in 10 fractions, in 65% of cases (141 patients); 27% with 18Gy in 6 fractions or 20Gy in 5 fractions, and 1% up to 10Gy in one fraction. Patients treated with electron-beam radiotherapy got the same fractionation variation (36% of the patients). Discussion: Besides healing, aesthetic results are also expected in skin lesions treatment, whether benign or malign. There was more compliance and less aesthetic complication rates in the group of patients who received up to 20 fractions. Conclusion: the radiotherapy treatment to those lesions showed itself to be safe in less fractions than the conventional ones, with more treatment compliance rates.

Contato: Gabriel Faquetti MorandiniE-mail: [email protected]


RARE CASE OF NASAL CAVITY MELANOMAAutores: Nyandra Cardoso Theodózio Lemos / Lemos, N. C. T. / Hospital Regional do Câncer de Passos ; Maysa Lemos Simosono / Simosono, M. L. / Hospital Regional do Câncer de Passos; Marcos José de Oliveira Junior / Junior, M. J. O. / Hospital Regional do Câncer de Passos; Monique Rosa Godinho / Godinho, M. R. / Hospital Regional do Câncer de Passos; Livia Andrade Pimenta / Pimenta, L. A. / Hospital Regional do Câncer de Passos; Vinícius César Furquim / Furquim, V. C. / Hospital Regional do Câncer de Passos; Petriane Rocha Mendes Chaves / Chaves, P. R. M. / Hospital Regional do Câncer de Passos; Rodrigo Calixto Mattar / Mattar, R. C. / Hospital Regional do Câncer de Passos; Marília Maria Miguel / Miguel, M. M. / Hospital Regional do Câncer de Passos; Lívia Silveira Almeida / Almeida, L. S. / Hospital Regional do Câncer de Passos; Eduardo Guidi Francisco dos Reis / Reis, E. G. F. / Hospital Regional do Câncer de Passos; Paulo César Felipe Franco / Franco, P. C. F. / Hospital Regional do Câncer de Passos;

Case report: A 74-year-old man started an investigation for epistaxis, nasal obstruction, and left facial pain. A sinus computed tomography (CT) scan showed an expansive lesion affecting the entire left nasal cavity to the base of the skull. The patient underwent biopsy of the lesion, whose anatomopathological and immunohistochemical study confirmed nasal cavity melanoma. Subsequently, he underwent treatment with exclusive radiotherapy (RT), due to the extent of the disease and patient performance, in tumor bed, 30 sessions, daily dose of 2 Gy, totaling 60 Gy. Significant improvement of symptoms, without

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


5

obstructive complaints, after 9 months of treatment, has stable disease and exclusive clinical follow-up - CT of the abdomen and chest without evidence of disease; Bone scintigraphy with little likelihood of secondary involvement. Discussion: Nasal mucosa melanoma is an extremely rare and aggressive tumor, corresponding to 1.3% of melanomas; the first case was published in 1869; peak incidence is between the 6th decade of life. Risk factors are exposure to ultraviolet rays and tobacco. The case clinic corresponds to the main symptoms shown in studies, and the standard treatment is surgery followed by RT, but articles show good local control with only RT, as seen with our patient. The average survival in patients who underwent both treatments is 18 months, our case remains without evidence of distant metastasis and disease evolution, 9 months after the treatment. Final Comments: We present a case of nasal cavity melanoma, as it is a rare and very aggressive malignant neoplasm. Although there was no standard treatment, surgery followed by RT, the patient remains asymptomatic and without metastatic evolution of the disease, as shown by tests. Further studies should be conducted for treatment improvements.

Contato: Nyandra Cardoso Theodózio LemosE-mail: [email protected]


STEREOTACTIC BODY RADIATION THERAPY (SBRT) FOR CLINICALLY INOPERABLE EARLY STAGE NON SMALL CELL LUNG CANCER (NSCLC). RETROSPECTIVE ANALYSIS OF OUTCOMES AND RADIATION DOSE EFFETIVENESSAutores: Maria Thereza Mansur Starling / STARLING, M.T.M. / Beneficência Portuguesa de São Paulo; Camila Mari Mizobukchi Kawamoto / KAWAMOTO, C.M.M / Beneficência Portuguesa de São Paulo; Maiara Lima Oliveira / OLIVEIRA, M.L. / Beneficência Portuguesa de São Paulo; Ihan Costa / COSTA, I. / Beneficência Portuguesa de São Paulo; Robson Ferrigno / FERRIGNO, R. / Beneficência Portuguesa de São Paulo;

Purpose: SBRT has been considered as standard treatment for early stage clinically inoperable NSCLC. Some retrospective series showed better local control with Biologic Efective Dose (BED) ≥ 100 Gy10. This retrospective series aims to report the uni Institutional clinical results with SBRT using two fractionation schedules. Methods: Retrospective analysis of 76 patients with NSCLC stages IA - IIA (T1aN0M0 - T2bN0M0) - AJCC 2017. All patient were staged with PET/CT and considered clinically inoperable. The median age was 78 years old and median tumor size was 2.2cm (range: 0.70cm to 5.0cm). Histological type was adenocarcinoma in 50 patients (68.5%), squamous cell carcinoma in 23(31.5%) and 3(4%) had no biopsy. Forty nine(64.5%) patients were treated with 48 Gy in 4 fractions(BED=105.6Gy10) and 27(35.5%) with 40 Gy in 4 fractions (BED=80Gy10). Radiation fractions were delivere twice a week. The use of lower dose was a physician decision for some patients with central

located tumor or lesions close to the thoracic wall. The SBRT technique was performed using Novalis Classic Linac model and IGRT ExacTrac® system. Tumor size, hystological type and radiation dose were factors analysed for outcomes.Overall Survival, Disease Free Survival and Local Control were calculated by Kaplan-Meier method. Chi-squared testing was used to verify the significance of the factors. Results: With a median follow up of 19 months, the 2-year local control, disease free survival and overall survival were 83.1%, 60.3%, and 68.8%, respectively. Patients treated with BED=80Gy10 had inferior 2-year local control (70.7% Vs 90.7%; p=0.047). Tumor size and histology were not significant factors for local control. Patients with adenocarcinoma had better 2-year disease free survival compared with those with squamous cell (60.3% Vs 38.3%; p=0.023). Grade 1 and 2 pneumonitis occurred in 20 (23.2%) and 4 (5.3%) patients, respectively. Tumor larger than 3 cm was the only factor related to the incidence of grades 1 and 2 pneumonitis (52.2% Vs 22.6%; p=0.036). One patient developed rib fracture. No other late toxicity was observed. Conclusions: This retrospective analysis confirms that SBRT with BED larger than 100Gy10 is more effective for local control than lower level for early stage NSCLC. Patients with squamous cell tumors had worse disease free survival compared with adenocarcinoma. Late toxicity was low and comparable with the literature. The dose of 48 Gy in 4 fractions was effective and safe.

Contato: Camila Turchetti Bacan GabiattiE-mail: [email protected]


THE IMPACT OF LATE INITIATION OF TREATMENT ON ESOPHAGEAL CANCER PATIENTS UNDERGOING DEFINITIVE CHEMORADIOTHERAPYAutores: Mateus Bringel Oliveira Duarte / Duarte, M. B. O. / Universidade Estadual de Campinas; Camila Turchetti Bacan Gabiatti / Gabiatti, C. T. B. / Universidade Estadual de Campinas; Mariane Candido de Lima Martins / Martins, M. C. L. / Universidade Estadual de Campinas; Daniela de Lima Miyazaki / Miyazaki, D. L. / Universidade Estadual de Campinas; Leandro Pereira da Silva / Silva, L. P. / Universidade Estadual de Campinas; Ligia Traldi Macedo / Macedo, L. T. / Universidade Estadual de Campinas; Eduardo Baldon Pereira / Pereira, E. B. / Universidade Estadual de Campinas; Jose Barreto Campello Carvalheira / Carvalheira, J. B. C. / Universidade Estadual de Campinas;

Introduction: Managing esophageal cancer patients is still a major challenge. Delay in starting esophageal cancer treatment is an uncertain topic. In our study, we proposed an evaluation of the influence of delayed initiation of treatment in esophageal cancer patients undergoing definitive chemoradiotherapy. Methods: We conducted a retrospective study of esophageal cancer patients diagnosed between 2000 and 2016 and treated at the Hospital de Clínicas da UNICAMP and began treatment within 90 days of histological

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 6

diagnosis. We analyzed only patients without metastasis in the diagnoses and who underwent definitive chemoradiotherapy. Patients were grouped at the beginning of treatment in less than 60 days and between 60 and 90 days (with delay). Both groups were compared with age, sex, body mass index, weight loss at diagnosis, histology, topography, ECOG scale, chemotherapy scheme, high-grade toxicity during treatment, presence of comorbidities (hypertension, dyslipidemia, diabetes, cirrhosis and COPD) and delay in starting treatment. The variables were initially compared in the chi-square and t-student tests. Overall survival (OS) and progression-free survival (PFS) were compared in a Cox multivariate proportional hazard proportional regression, with a previous selection of variables with a minimum significance of P <0.10 in a previous univariate analysis. Results: A total of 152 patients were analyzed, 71 (46.7%) without delay and 81 (53.3%) with delay. Only high-grade toxicity showed a significant difference in the groups, 50.7% in those without delay and 33.3% in the delay group (P = 0.03). Patients without delay had a median PFS of 9.2 months (95% confidence interval [CI]: 5.1 - 11.3) versus 5.1 months (95% CI: 3.9 - 6.5) in the group with delay (P = 0.024). The group with no delay had a OS of 13.6 months (95% CI: 10.5 - 21.7) versus 9.4 months (95% CI: 6.7 - 11.1) in the delay group (P = 0.013). In multivariate analysis, delayed initiation of treatment was associated with worse risk of progression (HR: 1.58 95% CI: 1.10 - 2.29, P = 0.015) and death (HR: 1.76 95% CI: 1.21 - 2.58, P <0.001). Conclusion: Delay in starting treatment was associated with a higher risk of progression and death. Strategies to reduce this delay represent great potential for health promotion.

Contato: Mateus Bringel Oliveira DuarteE-mail: [email protected]


TOTAL SCALP IRRADIATION - DOSIMETRIC COMPARISON BETWEEN DIFFERENT TECHNIQUESAutores: Carolina Humeres Abrahão / Abrahão, C.H. / AC Camargo Cancer Center; Fernando Henrique de Souza / Souza, F.H. / AC Camargo Cancer Center; Adriana Aparecida Flosi / Flosi, A.A. / AC Camargo Cancer Center; Antônio Cássio Assis Pellizzon / Pellizzon, A.C.A. / AC Camargo Cancer Center;

Introduction: Scalp skin malignancies usually have poorly defined borders and multifocal dissemination. Extensive basal cell carcinomas, especially the desmoplastic and angiosarcoma subtypes are the most frequent etiologies. Extensive dissemination in this topography present a challenge in planning, due to their convex surface and adjacent organs at risk (OAR). Available modalities include high dose rate brachytherapy (HDR), conformational teletherapy with photons and electrons beams (3D) and photon beams with modulated intensity (IMRT). Objective: To identify the best therapeutic option for total scalp irradiation, several techniques have been tested. The goal of this

study is to perform a dosimetric comparison between different techniques, aiming at the interpretation of treatment volume coverage (PTV) and dose in OAR. Methods: A phantom was used, in ventral decubitus, with a bolus attachment of 0.5 cm of wax throughout the scalp and a thermoplastic mask with 18 catheters distally 1.2 cm between them. The fusion tool with magnetic resonance (MRI) and computed tomography (CT) of the skull was used for the design of CTV, PTV and OAR. In the HDR option was used 192Ir source. In the conformational plane (3D), a combination of 6MV photons and 9 MeV electrons (2 lateral) was performed. Static IMRT Planes (IMRT-7 coplanar fields), modulated volumetric arch (VMAT-2 arches) and tangential modulated volumetric arch (TVMAT-4 half arches) were generated. Dose measurements were performed with dosimetric films in 5 different positions on the surface of the phantom, under the bolus. Results: The TVMAT plan granted better PTV coverage and increased dose homogeneity within it. The HDR plan did not significantly spare the OAR, as the 3D planes, IMRT and VMAT did, but the 3D plane presented the highest maximum dose. The dose in the OAR was lower in the TVMAT plane when compared with the others. The values measured through the radiochromic film, within the uncertainty interval, are coincident with the values calculated by the planning system, which demonstrates its reliability. Conclusion: IMRT planes, especially TVMAT, are suitable for targets with convex surface, offering better PTV coverage and higher dose distribution, with the advantage of offering lower punctual doses in the central nervous system OAR.

Contato: Carolina Humeres AbrahãoE-mail: [email protected]

TEMÁRIO: FÍSICA MÉDICA (SUBMISSÃO PARA A XIX JORNADA DE FÍSICA MÉDICA) CÓDIGO: 87241

ANALYSIS OF POSITIONING UNCERTAINTY AND PTV MARGIN OBTAINED WITH THE USE OF A PELVIC IMMOBILIZING DEVICE IN THE TREATMENT OF PROSTATE CANCERAutores: Pericles Crisostomo de Sousa / Sousa, P. C. / Instituto Sul Mineiro de Oncologia; Livia Camargos Cruz / Cruz, L. C. / Instituto Sul Mineiro de Oncologia; Priscilla Furtado Souza Pasquinelli / Pasquinelli, P. F. S. / Instituto Sul Mineiro de Oncologia; Daniela de Souza da Mota e Camanducaia / Camanducaia, D. S. M. / Instituto Sul Mineiro de Oncologia; Lucas Alves Bartelega / Bartelega, L. A. / ;

Objectives: To evaluate positioning uncertainty and PTV margins in the treatment of prostate cancer with and without the use of a pelvic immobilizing device. Methods and Materials: The clinical trial evaluated 127 patients with prostate cancer treated with Image Guided (EPID) Intensity Modulated Radiation Therapy. Patients were split in two arms: First arm with 67 patients who did not use the pelvic immobilizing device and second arm with 60 patients who used the device. In average, eight pairs of portal images (Anterior and Lateral) were acquired per patient during the course of Radiotherapy. Planning Target Volume (PTV) margins were calculated

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


7

using Van Herks formula so that 99% of patient would receive 95% coverage. Results: The group of patients using the pelvic device showed slightly less uncertainty in positioning (lateral, vertical and longitudinal) than the group that did not use it. Furthermore, the staff had the impression that the positioning process became more robust and standardized with the device. Population PTV margin dimensions for the 67 patients who did not used the pelvic device were 0.73, 0.75 and 0.47-cm in the lateral, vertical and longitudinal directions, respectively. Population margins for the 60 patients evaluated with the use of the pelvic device were 0.64, 0.69 and 0.46-cm in the same directions. A slight margin reduction was observed for the arm using the device, especially in the lateral direction (12,3%). Conclusion: Immobilization using the pelvic device had only a small contribution in treatment precision and accuracy. Even though the treatment table has digital millimeter resolution, the study did not show statistically significance in margin reduction and positioning reproducibility with the use of pelvic devices for prostate patients, for which PTV margins are as big as 1.0-cm. The numerical results did not proportionally reflect the staff impressions.

Contato: Pericles Crisostomo de SousaE-mail: [email protected]


AVALIAÇÃO DE PLANEJAMENTOS DE IRRADIAÇÃO DE CRÂNIO TOTAL COM PRESERVAÇÃO DE HIPOCAMPOAutores: Amanda Burg Rech / Rech, A. B. / AC Camargo Cancer Center; Cássio de Queiroz Tannous / Tannous, C. Q. / AC Camargo Cancer Center; Laís Tomaz Maya / Maya, L. T. / AC Camargo Cancer Center; Michael Jenwei Chen / Chen, M. J. / AC Camargo Cancer Center;

Introdução: A irradiação de crânio total (WBRT) é proposta para o tratamento de múltiplas lesões cerebrais, proporcionando paliação rápida com melhora na sobrevida livre de doença e qualidade de vida. Esta conduta pode resultar em toxicidade cognitiva, especialmente funções associadas às atividades do hipocampo, como memória recente e orientação espacial. De modo a diminuir a toxicidade neurológica, o RTOG 0933 (Mehta et al, 2011) propôs a WBRT com preservação do hipocampo. Dentre as técnicas propostas encontram-se a arcoterapia de intensidade modulada (VMAT) e a radioterapia de intensidade modulada com campos estáticos (IMRT), em aceleradores lineares com diferentes configurações de colimador multi-lâminas (MLC). Objetivo: Comparar planos de WBRT com preservação de hipocampo com técnicas de VMAT e IMRT para dois aceleradores lineares com diferentes MLC e configuração de feixes de radiação. Métodos: Foram utilizadas imagens de tomografia de 10 pacientes tratados previamente com radiocirurgia, fundidas com imagem de ressonância magnética para delineamento do hipocampo, conforme atlas do RTOG. A região de controle do hipocampo corresponde a expansão da margem do hipocampo em 5 mm, sendo o PTV determinado como todo o

parênquima menos a região de controle e o hipocampo. Os planejamentos foram realizados com o software Eclipse®, para os aceleradores TrueBeam® com HD MLC e 6EX® 120MLC, com fótons de 6 MV e utilizando mesma configuração de feixe para todos os pacientes e mesmo modelo de otimização com o algoritmo Photon Optimizer e cálculo de dose pelo algoritmo Acuros® XB. Os limites de dose foram estabelecidos conforme o RTOG, avaliando as estruturas: PTV, hipocampo, nervos ópticos e quiasma. Para avaliação dos planos de tratamento foi calculado o índice de homogeneidade (IH) (ICRU 83, 2010) e o número de conformidade (NC) (vant Riet et al, 1997). Resultados: As técnicas apresentaram resultados semelhantes, dentro dos limites ideal/aceitável do RTOG. A técnica com menor IH foi o IMRT com 9 campos (0,21), e com maior NC foi o VMAT (0,92). A largura da lâmina variou em menos de 5% a avaliação dos planos. Conclusão: A mudança de máquina, espessura de lâmina ou configuração de feixe não apresentaram variações em planejamento de WBRT com preservação do hipocampo quando aplicado mesmos parâmetros de otimização e cálculo. A experiência mostrou a viabilidade de preservar o hipocampo com diferentes equipamentos estando dentro do critério proposto pelo RTOG.

Contato: Amanda Burg RechE-mail: [email protected]


CHARACTERIZATION OF BEO DETECTORS USING OPTICALLY STIMULATED LUMINESCENCE TECHNIQUE FOR RADIOTHERAPY APPLICATIONSAutores: Ana Clara Araújo Camargo / Camargo, A. C. A. / Universidade Tecnológica Federal do Paraná; Anna Luiza Metidieri Cruz Malthez / Malthez, A. L. M. C. / ; Giule Martins / Martins, Giulie / ;

The Optically Stimulated Luminescence (OSL) technique is widely applied in various areas for ionizing radiation dosimetry such as dating and health. Its main advantage over the thermoluminescence (TL) technique is the optical nature of the process; For dose-associated luminescent emission, optical rather than thermal stimulation is employed, leading to rapid and simple reading. Beryllium oxide (BeO) detectors have several intrinsic characteristics for clinical dosimetry such as tissue equivalence, linear dose response range, low energy dependence and angular in radiodiagnostic range. Considering the advantages of the OSL technique and the properties of BeO, the objective of this study was to characterize the detectors using the OSL technique for radiotherapy using photon beam and electrons. BeO detector (Thermalox 995 - Materion Co) readings were taken on an automated Risø TL / OSL reader (DTU). To evaluate the dose response and energy response of the BeO detectors, 6 and 15 MV photon beams and 6, 9, 12 MeV electrons (2100SC Varian linear accelerator) were used. Angular dependence was verified for photon incidence of 6 MV at 45º. The energy response was obtained by

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 8

sensing the detectors for the different photon and electron energies by making a linear adjustment of type y = bx of OSL intensity as a function of dose. The detectors presented linear response dose up to 3.5 Gy and saturation for doses above this value, low energy dependence for photons and electrons and showed no significant variations in response considering the incidence of the beam at 45º. Thus, we conclude that BeO, together with the OSL technique, is adequate for radiotherapy dosimetry considering the linear dose response range and can be used for both photons and electrons.

Contato: Ana Clara Araújo CamargoE-mail: [email protected]


COMMISSIONING A VIENNA APPLICATOR FOR INTERSTITIAL GYNECOLOGICAL BRACHYTHERAPYAutores: João Manuel Oliveira / Oliveira, J. M. / Hospital das Clínicas da Faculdade de Medicina da USP; Silmara Luci Vernucio / Vernucio, S. L. / Instituto do Câncer do Estado de São Paulo; Larissa Frediani / Frediani, L. / Instituto do Câncer do Estado de São Paulo;

Cervical cancer is the 4th most prevalent cancer in women worldwide. Brachytherapy alone, or combined with teletherapy is a standard treatment modality for this kind of cancer. Several gynecological applicators, such as ring and intrauterine tube, can be used for treatment delivery, resulting in a pear-shaped dose distribution. Although this distribution is generally used, its radial symmetry in the most distal part of the applicator becomes inadequate when treating a lateralized lesion, due to the fact that increasing the dose in any direction results in greater bladder and rectal irradiation. To overcome this limitation, intracavitary brachytherapy with needle insertion is used. The Vienna Applicator is a modified ring applicator that allows combined intracavitary and interstitial treatment of gynecological tumors. The applicators ring is serves as a template for needle insertion, which are inserted parallel to the intrauterine tube. The present work aims to commission a Vienna applicator for interstitial brachytherapy of gynecological tumors. As most medical devices, to use an applicator, tests must be performed to ensure the accuracy of the patient‘s treatment. These tests are called commissioning tests and have been grouped into the following categories: Visual and integrity, safety, and source positioning tests. Visual and integrity tests include radiography and computed tomography of each component intended to detect signs of mechanical shock, rupture, cracking, deterioration or other signs of impairment; Safety tests include verifying the connection between the applicator and transfer tubes, plus checking for the absence of obstructions in the source passage; The source positioning tests includes verification of source placement with autoradiographs to minimize dosimetric errors, as differences in duel positions imply differences between planned and delivered dose. No

signs of mechanical damage were detected in the visual tests or images of each applicator component. In addition, the applicator when assembled is robust enough to withstand vaginal canal pressure and has a good connection to the guide tubes. Furthermore, we conclude that source positioning is accurate and corresponds to the programmed position in the planning as well, so all tests are within the expected tolerances.

Contato: João Manuel OliveiraE-mail: [email protected]


COMPARISON BETWEEN MEASURED AND CALCULATED DOSE WITH IPLAN PENCIL BEAM ALGORITIMS AND ECPLIPSE AAA FOR SMALL FIELDS USED IN FRACTIONED STEREOTAXIA RADIOTHERAPYAutores: Luiz F K telles / Luiz F K telles / Liga Contra o Câncer; Ricardo Reis / Ricardo resi / Liga Contra Câncer;

Radiosurgery is indicated for the treatment of small intracranial lesions with small radiation fields. International Commission on Radiation Units and Measures (ICRU) No. 91 cites recent incidents that relate to small field dosimetry. The objective of this study is to experimentally compare dose delivery for small field planning calculated by TPS Eclipse and Iplan by using an anthropomorphic simulator, considering the tolerance of TRS 430. The entire procedure with all radiosurgery steps was performed, from tomography to delivery of the dose to the device. Two methodologies were used for small field dose measurement, one with an ionization chamber and another for the film. 3D, IMRT techniques were used for both softwares, but dynamic arc and cone arc only for the iPlan® RT software. Plans were made to cover 95% of PTV with 95% of the prescribed dose. Target volumes were plotted from the sensitive ionization chamber volume (Exradin A16 0.007 cc) to obtain equivalent fields ranging from 0.5 cm to 3.8 cm, and the PTV was formed by multi-leaf collimators ( MLC) with a planned dose of 300 cGy. For films, the appropriate dose for better sensitization in photographic dosimetry was 400 cGy and with a calibration curve raised from measurements taken at 1.5 cm depth in solid water. Error was considered to be the difference between the measured and the calculated dose, with tolerance of 3% (TRS 430). The planning results with equivalent fields smaller than 2 cm2 had differences greater than 3% and smaller than this value for larger fields when compared the measured dose with ionization chamber and the calculated dose. In photographic dosimetry, the differences between measured and calculated values were above 3% only for a field equivalent to 0.5 cm2. In this case, the measurements were around 60% of the calculated value for both TPS. The results of the measurements with films were better than those with ionization microchamber for fields smaller than 2 cm2 and larger than 0.5 cm2. The IPLAN was able to calculate the dose with error below 3% for the cone

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


9

arch from 0.75 to 3 cm in diameter. For mlc plannings, 3% tolerance for error was achieved in the 0.85 cm and larger fields. For the 0.5 cm2 field the error was much larger than the tolerance. ECLIPSE obtained the same result.

Contato: Luiz F K tellesE-mail: [email protected]


COMPARISON OF DOSE CALCULATION ALGORITHMS MONTE CARLO, AAA AND ACUROS XB IN FRACTIONATED STEREOTACTIC RADIOSURGERY PLANNINGAutores: Leonardo Ferreira da Silva / Ferreira, L. S. / Hospital de Amor de Barretos; André Banhate Silva / Banhate, A. S. / Hospital de Amor de Barretos; Geraldo Gabriel Perez / Perez, G. G. / Hospital de Amor de Barretos; André Vinícius de Camargo / Camargo, A. V. / Hospital de Amor de Barretos; Anderson Sorgati de Souza / Sorgati, A. S. / Hospital de Amor de Barretos; Mariana Marcondes / Marcondes, M. / Hospital de Amor de Barretos; Nelson Júnior Gonçalves / Gonçalves, N. J. / Hospital de Amor de Barretos;

Dose calculation algorithms differ in their calculation methods and are relevant in radiotherapy planning. In this work, three algorithms were used: Monte Carlo (MC), which uses computational models to simulate the interactions of particles with the matter, and were considered as the gold standard; AAA, which is a superposition / convolution algorithm whose modeling is separated for primary photons, scattered photons and electrons; and Acuros XB (ACX) which uses analytical methods to solve the Boltzmann transport equation, which governs the macroscopic behavior of particles in the medium. The objective of this work was to compare the behavior of MC, AAA and ACX algorithms by evaluating dosimetric parameters and dose distribution. Ten single-lesion radiosurgery with PTV volumes between 0.5-37.4cm³ were optimized in the treatment planning system (TPS) Elements using the MC algorithm. The plans were exported to TPS Eclipse, where the dose distribution was calculated using the AAA and ACX algorithms without new optimization. Plans were normalized to have the same dose at 95% of volume. The comparison was made by assessing the dosimetric parameters: conformity index (CI), homogeneity index (HI), maximum dose (Dm) and the brain volume minus PTV receiving 12Gy (V12). The correlation of the parameters with the PTV volume and their distance to the skullcap were also analyzed. Through the Kruskal-Wallis statistical test, a significant variation (p <0.05) was observed between the calculation algorithms for the HI, not being statistical significant for the CI, Dm and V12. Using peer-to-peer comparison using the Mann-Whitney test, it was observed that ACX differs from MC, whereas the comparison between AAA and MC did not differ. Through graphical analysis, it was seen a correlation between the variation of the HI and the volume of the PTV that, the smaller its volume,

the greater the variation of the HI. It can be verified that the only dosimetric parameter with statistical significant difference was the HI between MC and ACX, and a graphical analysis suggests a relationship between the volume of PTV and the difference between the HI. Therefore, it can be concluded that the three algorithms have a high agreement in stereotactic radiosurgery treatments.

Contato: Leonardo Ferreira da SilvaE-mail: [email protected]


COMPARISON OF RADIOTHERAPY TREATMENT TECHNIQUES IN PATIENTS WITH LEFT BREAST CANCER BY ASSESSING AB-SORBED DOSE IN DIFFERENT STRUCTURES OF THE HEARTAutores: Laila Galvão Almeida / Almeida, L. G. / Departamento de Radioterapia do Oncobeda; Carlos Eduardo Soares / Soares, C. E. / Departamento de Radioterapia do Oncobeda; Ronaldo Cavalieri Varges Filho / Cavalieri, R. / Departamento de Radioterapia do Oncobeda; Laélia Campos / Campos, L. / Universidade Federal de Sergipe; Esdras Santos / Santos, E. / Universidade Federal de Sergipe; Ana Figueiredo Maia / Maia, A. F. / Universidade Federal de Sergipe;

The most common type of cancer among women is breast cancer. Due to the anatomical position of the breast, radiotherapy may cause side effects to adjacent normal tissues, especially the heart. The severity of radiation-induced toxicity is closely linked to volume and dose of radiation received by cardiac tissue and its substructures. The aim of this study is to evaluate the dose distribution received by the breast and by organs at risk, with emphasis on individual heart structures, for 2 different radiotherapy treatment techniques (Field-in-Field and 3D) in patients undergoing conservative surgery of left breast. After injection of iodinated contrast medium in 18 patients, tomographic images were acquired on a 64-channel multislice tomograph synchronized to the electrocardiogram. The following contours of the target volumes and heart substructures were outlined: pulmonary trunk, heart, right and left ventricles, right and left atria, left anterior descending artery (LAD), right coronary artery, circumflex artery and aorta. For each patient, treatment plans were performed using the 3D and Field-in-field (FiF) techniques in a treatment planning system. From the dose-volume histogram information, the volumes for different doses (V2, V5, V10, V20, V25 and V30) and the average and maximum doses received for each outlined structure were determined. Means and respective standard deviations were calculated. The FiF technique, in comparison to 3D, showed an 18% percentage reduction in the average dose received by the heart and 11% lower V25. The LAD and left ventricle substructures also presented lower irradiated volumes for the FiF technique. The average dose of LAD was much higher than that of the heart. It was concluded in the study that angiotomography

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 10

effectively assists in the precise delineation of each heart substructure during the planning process. In addition, for dose distribution, benefits on FiF technique were found when compared to 3D for radiotherapy treatment of patients with left breast cancer. Almost all analyzed substructures were less irradiated with the FiF technique compared to 3D, and all p-values were significant. The average heart dose was not a representative parameter of the average LAD dose, and it is common for this substructure to receive high doses even though the heart dose limits are being respected.

Contato: Laila Galvão AlmeidaE-mail: [email protected]


DATA COLLECTION FORMS TO FMEA OF LUNG SBRTAutores: Geraldo Gabriel Perez / Perez, G. G. / Hospital de Amor de Barretos; André Banhate Silva / Banhate, A. / Hospital de Amor de Barretos; Leonardo Ferreira Silva / Silva, L. F. / Hospital de Amor de Barretos; André Vinícius de Camargo / Camargo, A. V. / Hospital de Amor de Barretos;

Lung SBRT is a highly complex procedure consisting of delivering high doses in a few fractions in a small volume. For safe treatment using SBRT, process quality management becomes necessary. A quality management tool is Failure Mode and Effect Analysis (FMEA), for the purpose to prevent error by creating barriers that precede it. However, the construction of the FMEA requires the formation of a qualified multidisciplinary team. This study objective to develop a simple and effective form of data collection for FMEA of SBRT, involving the participation of all professionals in the radiotherapy sector, thus avoiding any inattention in the FMEA process. To make the form more didactic and practical for application in different centers, a digital platform was used, with the intention of the participants to ask in a more comfortable and interactive environment. For the presentation and explanation of the FMEA quality tool a character was developed, which uses its own narrative to explain the tool with practical examples. The purpose of this character is to make the form self-explanatory. The form was structured as follows: presentation and explanation of the FMEA; flow of process steps that will be included; assessment of failure modes at each stage of the process; form and effectiveness evaluation questionnaire. For satisfaction assessment the method used was the Net Promoter Score (NPS). Currently, the form is ready for your application and is hoped that it will be possible to develop an effective and practical methodology for collecting data for performing FMEA, thus being able to exchange quality experiences with other centers using the SBRT technique.

Contato: Geraldo Gabriel PerezE-mail: [email protected]


DESENVOLVIMENTO DE UM DOSÍMETRO TRIDIMENSIONAL A PARTIR DO POLÍMERO BIODEGRADÁVEL PBAT((BUTILENO ADIPATO-CO-TEREFTALATO ) PARA CONTROLE DE QUALIDADE E VERIFICAÇÃO DE TRATAMENTOS RADIOTERÁPICOSAutores: Arnie Verde Nolasco / Nolasco, A.V. / Instituto de Radioterapia São Francisco;

A tecnologia associada aos tratamentos radioterápicos tem crescido aceleradamente nas últimas décadas, contribuindo para a oferta de serviços clínicos cada vez mais eficientes e seguros. Nesse sentido, a construção de ferramentais dosimétricos adequados para cada contexto está no bojo deste desenvolvimento. Seja para a aceitação de uma técnica, seja para o controle de qualidade ou avaliação de casos específicos, a dosimetria do estado sólido faz-se extremamente fulcral para a consecução de procedimentos confiáveis em Radioterapia. O polímero alifático-aromático poli(butileno adipato-co-terephtalato), conhecido como PBAT, recentemente tem recebido grande interesse da academia em função de suas propriedades fotoluminescentes depois de exposto a radiação ionizante. Esta última, induz fotoluminescencia no PBAT na faixa de 200 a 700 nm proporcional a dose absorvida, conforme (Schimitberger, Bianchi, Curti, & Faria, 2009), ver gráfico no fim deste rsumo . Nesse sentido, a caracterização do PBAT para doses radioterápicas e o seu emprego para o desenvolvimento de um gel ou um sólido será útil para a confecção de um dosímetro com capacidade de resolução tridimensional, de grande aplicação na área médica. O desenvolvimento de um gel dosimétrico de boa resolução será extremamente útil para verificação de tratamentos radioterápicos, uma vez que diversos protocolos de radioterapia, como o TECDOC 989 (IAEA, 1997), recomendam que todos os pacientes devam ser submetidos a uma dosimetria in vivo (Campos & Bardella, 2009). Usualmente, as verificações in vivo são feitas com dosímetros pontuais, como os diodos, Mosfets e até mesmo TLDs. No entanto, faz-se extremamente necessário em alguns casos conhecer distribuições bidmensionais e tridmensionais das isodoses de tratamento. Nessa perspectiva, a confecção de um gel dosimétrico possibilitaria o conhecimento de tais distribuições. O gel também poderá ser empregado para o controle de qualidade de equipamentos de radioterapia, servindo como sensor para detectar possíveis fugas consideráveis de radiação. Outra perspectiva plausível estará na viabilidade de utilizar o gel em acessórios de armazenamento e transporte de materiais radioativos, indicando quão blindado está a fonte.

Contato: Arnie Verde NolascoE-mail: [email protected]

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


11


DETERMINATION AND DOSIMETRIC EVALUATION OF HU CALIBRATION CURVES IN EXTENDED ACQUISITION FOR THE ACUROS XB ALGORITHMAutores: Leonardo Ferreira da Silva / Ferreira, L. S. / Hospital de Amor de Barretos; André Banhate Silva / Banhate, A. S. / Hospital de Amor de Barretos; Geraldo Gabriel Perez / Perez, G. G. / Hospital de Amor de Barretos; Guilherme Alexandre Pavan / Pavan, G. A. / Hospital de Amor de Barretos; Celso Roberto Ribeiro / Ribeiro, C. R. / Lemm - Laboratório de Ensaios Mecânicos e Metalográficos;

The dose calculation algorithms used in radiotherapy use a calibration curve to convert HU (Hounsfield Unit) to mass and electronic density, making it possible to differentiate tissues in interaction with the beam. The maximum HU value for normal CT image acquisitions is 3071, which is the value reached for all high density materials due to saturation, not allowing the differentiation of, for example, metallic materials. Currently, CT scanners allow extended mode CT acquisition, which features a larger HU scale, differentiating high density materials in the calibration curves. In the Eclipse planning system, Acuros XB is available, which is very accurate and close to Monte Carlo simulations, having advantages in its application in clinical radiotherapy. The objective of this work was to determine the HU calibration curve for CT Optima (GE) CT by varying image parameters such as normal and extended acquisition, beam energy, electrical current generated in tube, Field-of-View (FOV) and axial resolution, evaluating the dosimetric impact caused. CT images of two simulator objects containing different materials were acquired: titanium, cobalt chromium, stainless steel, aluminum, acrylic, polystyrene; and the HU number of each structure was determined for each CT acquisition, varying the parameters mentioned. From this, the HU calibration curve was determined by plotting HU number by mass density. Dosimetric comparison was made using the Acuros XB algorithm in a phantom with titanium, cobalt chromium and aluminum metal insertion in normal and extended CT acquisition modes, analyzing the dose distribution with the two calibration curves. There was a significant variation in the number of HU for different energies, FOVs and the normal to extended acquisition mode. Extended acquisition has HU values equal to normal acquisition for materials with density <3g / cm³. For higher densities, there is a differentiation of HU, where the mean value for titanium was 9018 ± 784 and for cobalt chromium 27500 ± 2500, being up to ten times higher than the maximum HU value of normal acquisition. Acuros XB therefore predicts a 4.4% higher dose absorption in aluminum volume, 15% higher in titanium and 10% higher in cobalt chromium when using the extended CT calibration curve compared with the normal CT calibration.

Contato: Leonardo Ferreira da SilvaE-mail: [email protected]


EFFECTIVENESS WITH THE USE OF A CUSTOM-MADE NECK SUPPORT CUSHION IN IMAGE GUIDED RADIATION THERAPY FOR HEAD AND NECK PATIENTSAutores: Pericles Crisostomo de Sousa / Sousa, P. C. / Instituto Sul Mineiro de Oncologia; Livia Camargos Cruz / Cruz, L. C. / Instituto Sul Mineiro de Oncologia; Priscilla Furtado Souza Pasquinelli / Pasquinelli, P. F. S. / Instituto Sul Mineiro de Oncologia; Daniela de Souza da Mota Camanducaia / Camanducaia, D. S. M. / Instituto Sul Mineiro de Oncologia; Nadia Bueno de Assis / Assis, N. B. / ;

Objectives: To evaluate the reproducibility of the use of a personalized neck support cushion for Head and Neck patients under Image Guided (EPID) Intensity Modulated Radiation Therapy. Methods and Materials: Positioning variations of 64 Head and Neck patients were acquired from comparison between Digitally Reconstructed Radiographs (DRR) and Portal images. Position uncertainty was accessed and analyzed using Van Herks formula, so that 99% of patients would receive minimum coverage of the 95% isodose. An average of seven pairs of Portal images (Anterior and Lateral) per patient were acquired. Uncertainty in positioning in the Lateral, vertical and longitudinal directions were compared with and without the use of the personalized neck support, which is positioned between the neck and standard Head pillows. Results: For a total of 32 patients evaluated without the use of the custom-made neck support cushion, PTV population margins of 0.27, 0.44 and 0.38-cm in the lateral, vertical and longitudinal directions, respectively. For the other 32 patients using the personalized neck support cushion, results for PTV margin were 0.27, 0.35 and 0.31-cm in the same directions. The comparison of the results show a reduction in positioning uncertainty in the lateral and longitudinal directions of 18% and 18,5%, respectively. There was no difference in the lateral direction. Conclusion: The study demonstrates that thermoplastic mask immobilization complemented with the use of a personalized neck support cushion presents better results in terms of positioning reproducibility. Considering that the current Head and Neck PTV institutional margin is 0.5-cm, reductions on the order of 0.1-cm were considered statistically significant. Therefore, there is better agreement between planned and delivered radiation doses with better treatment accuracy and potential toxicity reduction.

Contato: Pericles Crisostomo de SousaE-mail: [email protected]


END-TO-END METHOD FOR INTEGRATED ASSESSMENT OF DIFFERENT IGRT Methods: CBCT, OSMS, CALYPSO AND IMAGES PLANS KV AND MVAutores: Otávio Henrique Ramos Sasseron / Sasseron, O.H.R. / Hospital Sírio Libanês; Gustavo Bonfilho

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 12

Squarizzi Ferreira / Ferreira, G.B.S. / Hospital Sírio Libanês; Anselmo Mancini / Mancini, A. / Hospital Sírio Libanês; Carlos Eduardo Veloso de Almeida / de Almeida, C.E. / UERJ; Cecília Maria Kalil Haddad / Haddad, C.M.K. / Hospital Sírio Libanês; Wellington Furtado Pimenta Neves Junior / Neves-Junior, W.F.P. / Hospital Sírio Libanês;

This paper aims to establish a method for simultaneous evaluation of different IGRT systems present in TrueBeam STx / Edge. Thus, Surface Guidance methods (OSMS), Cone Beam CT (CBCT), Planar Images MV-KV and Calypso are tested and compared on a single phantom, allowing the determination of positioning accuracy relative to the radiative isocenter. The sensitivity of each system to detect submillimeter displacements was also evaluated. The phantom consists of a solid water cube with three beacons and an 8 mm diameter metal sphere. From it, a CT and a RT plan with square fields centered on the sphere were made - simulating a Winston-Lutz (WL) type test. The experiment was divided into 2 parts: (i) the phantom was positioned with CBCT (0.5x0.5x1.0 mm³ resolution, 6D and 3D manual and automatic recording methods). From this point, the displacement indicated by the other methods was recorded: OSMS, Calypso and kV / MV pairs (2D-3D method). The actual displacement from the radioactive isocenter was found through the planned field gateways (WL test) - this step was repeated 10 times. (ii) Then table displacements (minimum pitch: 0.1mm, total of 25 positions) were applied along each axis (lateral, longitudinal and vertical) and the displacement indications detected by each IGRT method were recorded. The following mean vector deviations from radiative isocenter were found for CBCT (manual fusion, 6D and 3D), OSMS, Calypso, pairs (MV-MV, KV-KV and MV-KV) respectively: 0.43 ± 0 .09; 0.48 ± 0.09; 0.47 ± 0.09; 0.69 ± 0.10; 0.92 ± 0.35; 0.64 ± 0.10; 0.61 ± 0.10 and 0.62 ± 0.10 mm. The sensitivity results in detecting table displacements (in any direction) of OSMS (N = 75), CBCT (N = 51), planar KV / MV (N = 51) and Calypso (N = 75) systems were, respectively: 0.04 ± 0.05; 0.08 ± 0.08; 0.24 ± 0.43 and 0.07 ± 0.12mm. No significant differences were observed along a specific direction. With these results, it is possible to obtain confidence intervals of less than 1 mm to verify the calibration of each IGRT system. Therefore, the presented method is satisfactory for periodic QA, and allows simultaneous verification of all systems.

Contato: Otávio Henrique Ramos SasseronE-mail: [email protected]


END-TO-END VALIDATION OF TREATMENTS OF MULTIPLE METASTASIS WITH RADIOSURGERY USING SINGLE ISOCENTER AND ANTHROPOMORPHIC PHANTOMAAutores: Thais Pires Flores / Flores, T / Hospital Mãe de Deus; William Correia Trinca / Trinca, W / Hospital Mãe de Deus; Ademar Marques Caldeira Filho / Caldeira,

AM / Hospital Mãe de Deus; Andréa Barleze da Costa / Costa, AB / Hospital Mãe de Deus;

Introduction: Technological advances in radiotherapy allow treatments with higher doses in the target volumes and saving more healthy tissues, which proves to be efficient for central nervous system disease control. The use of VMAT with mMLC for the treatment of metastases makes the procedure faster and ensures greater reproducibility. Objective: To validate multiple brain metastasis treatments with the use of VMAT and single isocenter. Methodology: Ten acrylic rods were attached to an anthropomorphic skull-shaped phantom filled with bolus. These rods served to simulate intracranial lesions and to fix the PinPoint 3D Ionization Chamber (PTW 30016, 0.016cc). Using immobilization supports (mask, base and head support) the phantom was submitted to a tomography with radiosurgery protocol. A dose of 24Gy was prescribed in 8 lesions, 9Gy in one lesion and 2Gy in another. The latter served to evaluate the modulation capacity of the beam at low doses. Absolute dose measurements were made with the ionization chamber and beam fluence measurements with Dosimetry Portal. The positioning of the phantom was verified by planar images and CBCT. Results: The doses obtained from the IC measurements differed between 0.1% and 5.8%, with standard deviations of up to 2.9 cGy, and the analysis of the gamma index values by the PD passed above 95.7% (γ <1, 3% DTA / 3mm). Conclusion: Despite the differences found, the end-to-end evaluation result validated the protocol with acceptable values, based on the literature, considering the test uncertainties as well as the measurement instruments used.

Contato: Thais Pires FloresE-mail: [email protected]


IMPLEMENTATION OF END TO END QUALITY CONTROL AND EVALUATION OF THE IMPACT OF DEVIATION IN IGRT CLARITY SYSTEM REFERENCE IMAGE RECORDAutores: Nelson Júnior Gonçalves / GONÇALVES, N. J. / Hospital de Amor de Barretos; André Vinicius de Camargo / CAMARGO, A. V. / Hospital de Amor de Barretos; Leonardo Ferreira da Silva / Silva, L. F. / Hospital de Amor de Barretos; André Banhate / Banhate, A. / Hospital de Amor de Barretos; Geraldo Gabriel Perez / Perez, G. G. / Hospital de Amor de Barretos;

The Clarity system is an IGRT system that uses ultrasound imaging to locate the target before starting treatment. The objectives of this work were: to implement an END TO END quality control (QC) for the Clarity IGRT system that does not depend on the characterization of the phantom provided by the manufacturer; To evaluate the impact of systematic image registration errors on treatment and the impact of image acquisition used for reference in anatomical conditions different from simulation. The first step was to position the phantom aligned to the simulation room lasers. At this stage,

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


13

tomographic (CT) and ultrasound (US) images were acquired. To simulate different anatomy, the phantom was shifted 2 cm vertically and a new US image was acquired. In the planning system, the CT origin was defined exactly where the isocenter was located in the phantom, which are the coordinates used as reference in the US image. Imported US images at the Clarity workstation, CT fusions were performed without US deviations and with displacements of 2, 4, 6, 8 and 10 mm on the lateral, 1 and 5 mm on the vertical and 2 and 5 mm in the longitudinal. For all fusions a reference was generated. In the Linear Accelerator (LINAC), the phantom was positioned similar to the simulation. For the QC, the table was displaced by 20 mm in all directions, from vertical, longitudinal and lateral, and verified the corrections suggested by the system. To assess the impact of registration errors, references with errors were selected and their respective corrections analyzed. Finally, with the reference generated from the other US, it was verified which correction the system indicated. The following results were obtained for QC: vertical, 18.9 and 20.7 mm; longitudinal, 21.2 and 18.2 mm; and lateral 19.6 and 19.9 mm. The values obtained for references with fusion errors were: lateral, 2.2, 4.4, 6.5, 8.1 and 10.4 mm; vertical 0.8 and 3.4 mm; longitudinal, 3.1 and 6.1 mm. The image acquired for different anatomical condition presented vertical displacement of 1.2 mm. With the results obtained, the conclusion was that the whole system is calibrated and that QC can be routinely used as an independent test of the Clarity system. It is also possible to state that errors in the fusion of US with CT will be reflected as systematic errors in the corrections suggested in LINAC. Finally, acquiring reference US under conditions other than CT does not generate displacement errors in LINAC.

Contato: Nelson Júnior GonçalvesE-mail: [email protected]


INITIAL EXPERIENCE USING BRAINLAB ELEMENTS CRANIAL SRSAutores: Ana Maria Cardona / A Cardona / Instituto Zunino; Carlos Daniel Venencia / C Venencia / Instituto Zunino; Albin Ariel Garcia / A Garcia / Instituto Zunino;

Purpose: Cranial SRS uses non-coplanar fixed IMRT beams or arc to reach clinically acceptable radiosurgery plans. Elements cranial SRS software uses a 4Pi optimization algorithm and clinical Protocols for couch angle selection, start /stop gantry angle and trajectory optimization. The objective of this work was to evaluate the initial experience using Elements cranial SRS software v1.5. Methods: The first 39 SRS treatment plans were selected. The pathologies associated were acoustic neurinomas (#7, 13Gy - 1 fraction, #2, 25Gy - 5 fractions and #5, 18Gy - 3 fraction), pituitary macroadenoma (#1, 25Gy - 1 fraction and #4, 27Gy - 5 fractions), meningioma (#1, 13Gy - 1 fractions; #1, 16Gy - 1 fraction; #1, 18Gy - 3 fraction and #2, 30Gy - 5 fractions), cavernoma (#2, 16Gy - 1 fraction), hamartoma (#2, 22Gy - 1 fraction), metastasis (#1, 25Gy - 1 fraction, #2, 30Gy - 3 fractions and #2, 27Gy - 3 fractions), craniopharyngioma (#1,

27Gy - 5 fractions and #1, 21Gy - 3 fractions), capillary hemangioma (#1, 21Gy - 3 fractions) and glioblastoma (#3, 36/25Gy - 5 fractions). Clinical protocols were created for each treatment. Plans were evaluated by monitor units (MU), conformity index (CI) and gradient index (GI). Patient specific QA was done by EBT3 film (global gamma, 2%- 2mm analyzed by RIT software v6.7), Delta4 (local and global gamma, 2%-2mm, ScandiDos), ion chamber measurement (PinPoint chamber within and in-house head phantom) and independent MU calculation (RadCalc v6.3). Results: All plans fulfil the clinical plan quality and OARs dose constraints. The average PTV volume was 6.0cc [0.5, 33.2], MU needed to deliver 10 Gy was 2756MU [1682, 6092], CI 1.2 [1.1, 1.7] and GI 3.0 [2.1, 5.2]. EBT3 film global gamma was better than 97.6% and for 88% of the plans better than 99.4%. Delta4 local gamma was better than 92.7% and global gamma better than 96.2%. The average ion chamber dose variation was 1.2% [-3.5, 5.4] and independent MU calculation variation was 3.1% [0.1, 8]. Conclusion: The implementation of Elements Cranial SRS present good results for CI, GI and patient specific QA. According to the previous results, it is concluded that Elements Cranial SRS is a tool that comply the requirements for its continuous use in the clinic.

Contato: Carlos Daniel VenenciaE-mail: [email protected]


INTERFERÊNCIA DA INSERÇÃO DA MESA NOS PLANEJAMENTOS DE LOJA PROSTÁTICA COM VMATAutores: Fernando Henrique de Souza / Souza, F. H. / AC Camargo Cancer Center; Adriana Aparecida Flosi / Flosi, A. A. / AC Camargo Cancer Center; Jeam Haroldo Barbosa / Barbosa, J. H. O. / AC Camargo Cancer Center; Ana Paula Vollet Cunha / Cunha, A. P. V. / AC Camargo Cancer Center;

Introdução: Com a técnica de tratamento de Arcoterapia Volumétrica Modulada (VMAT), uma grande parcela da dose é entregue nas incidências posteriores, provocando interesse no efeito que a mesa e seus trilhos tem na dose entregue ao paciente, efeitos esses que são uma combinação do aumento de dose na pele, de dose reduzida entregue ao tumor e alterações na distribuição de dose. Objetivo: Este trabalho tem como objetivo avaliar a interferência na distribuição dosimétrica que a mesa de tratamento provoca nos planejamentos de VMAT para pacientes com câncer de próstata. Métodos: Foram selecionados 13 pacientes que passaram por tratamento de loja prostática 70 Gy em 35 frações. As tomografias originais de tratamento foram utilizadas para gerar novos planejamentos. A primeira análise utilizará um planejamento otimizado e calculado sem a estrutura da mesa, em seguida a mesa será inserida em outros dois planejamentos e será recalculado a distribuição de dose mantendo as mesmas UM do plano otimizado, um com os trilhos da mesa para fora (TF) e outra para dentro (TD). Um outro cenário, irá avaliar o quanto

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 14

influencia se o planejamento for realizado na posição TD e tratado na posição TF. Todos os planejamentos serão feitos no sistema Eclipse v13.7 (Varian Medical Systems) com algoritmo de cálculo Acuros XB v13.7.20, para o acelerador linear Truebeam e a mesa utilizada será a kVue Qfix com os valores de HU definidos pelo fabricante. Para os resultados foram analisados o DVH, as doses do PTV e dos órgãos de risco (OAR). Resultados: Os planos calculados com a mesa possuem uma perda similar de dose possivelmente por conta da mesa e o trilho serem irradiados completamente pelo feixe em ambas configurações. Para os planejamentos otimizados sem mesa e calculados com a mesa em ambas as configurações de trilho (TF e TD), a diferença média de dose resultou em menos 1,06% e menos 1,25%, respectivamente. Conclusão: Como a entrega do tratamento é realizado com a mesa, os resultados mostram que os planejamentos otimizados sem a mesa apresentam uma perda de dose de cerca de 1,2% para o trilho em ambas as configurações. Um cenário menos preocupante se dá quando o plano é otimizado com a mesa, mas o tratamento acontece com o trilho na posição contrária ao que foi planejado, onde a diferença de dose fica abaixo de 0,1%. A atenuação da mesa de tratamento pode provocar perdas inaceitáveis de dose e cobertura no PTV, quando não levada em conta no planejamento e no cálculo de dose.

Contato: Fernando Henrique de SouzaE-mail: [email protected]


MANAGEMENT OF A ROTATIONAL DETECTOR ARRAY IN IMRT COMMISSIONING TESTSAutores: Scharles Tressmann / Tressmann, S. / ONCOMED; Petrus Paulo Combas Eufrazio da Silva / Silva, P. P. C. E da / ONCOMED;

Introduction: After an instalation of a radiotherapy machine, physicists need to perform some procedures known as commissioning test. To become available to be used in a IMRT planning system, these results need to be fited through a process called modelling. This step ends when the difference between modellings and direct measurements become lower than specific values accepted by international commitees. Goal. Use a Rotational Detector Array to perform an Acceptance Modelling Test of a linear accelerator using standard irradiation fields provided from factory. Methods: The archive is named FullPackage and includes 34 standard statics and dynamics fields. All of them were tested in a calibrated Rotational Detector Array. The heterogeneity of layers was taked in consideration. Two energies of photons were validated, 6 and 10 MV. Results and Conclusion: The origin of measurements both the commissioning measurements and calibration of detector array come from the same set up in linear accelerator vertically down. So, this array is elegible to quickly do this essencial job. The used Rotational Array take all the measurements in a perpendicular incidence, decreasing of this way the influence of uncertainties from oblique irradiation of detectors. The size of calculation matrix in Treatment Planning

System is also crucial in results, considering that the device has a fixed space among detectors. Small grid size increases uncertainties in comparision analysis, because it generates a lot of virtual check dose points that couldn‘t be verified at the same time in device. Take it in consideration, 70% of comparision were approved with gamma index 3%/3mm. Weak points showed in this methodology can be corrected through the interpolation of some measurements shifted a known distance from center of device. Therefore, we consider it approved for intended goal.

Contato: Scharles TressmannE-mail: [email protected]


PTV MARGIN EVALUATION FOR TREATMENT OF PROSTATE CANCER WITH IGRTAutores: Priscila Silva Raupp / RAUPP, P. S. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.; Dr. Mirko Salomón Alva Sánchez / ALVA, M. / UFCSPA - Universidade Federal de Ciências da Saúde de porto Alegre; Thatiane Pianoschi / PIANOSCHI, T. / UFCSPA - Universidade Federal de Ciências da Saúde de porto Alegre; Jackson Argenta / ARGENTA, J. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.; Magali Carvalho Borges / BORGES, M. C. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.; Maiara Oliveira Dalenogare / DALENOGARE, M. O. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.; Rômulo Rocha Santos / SANTOS, R. R. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.; Samira Junges / JUNGES, S. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.; Neiro Waechter da Motta / MOTTA, N. W. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.; Bruno Jacques Barreto / BARRETO, B. / ISCMPA - Irmandade da Santa Casa de Misericórdia de Porto Alegre.;

Introduction: Conformational radiotherapy planning is performed in pre-defined volumes. According to ICRU (International Commission on Radiation Units and Measurements), volumes are defined as GTV (Gross Tumor Volume) - the visible extent of the tumor; Clinical Target Volume (CTV) - margin comprising GTV, a region where subclinical involvement usually exists; and PTV (Planning Target Volume) - a geometric concept that encompasses CTV, defined from the positioning uncertainties and internal movements of organs. IGRT (Image Guided Radiotherapy) allows a correction of possible positioning variations through image acquisition mechanisms such as EPID (Electronic Portal Imaging Device). These corrections are usually based on bone structures. Another mechanism is the OBI (On-Board Imager) device, where Cone Beam Computed Tomography (CBCT) images are obtained allowing an analysis of the organs internal movements. The use of this system ensures a reduction of random and systematic errors, allowing an evaluation of PTV margin sizes. Objective: Evaluate PTV margins for prostate cancer patients treated with the IMRT technique

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


15

associated with IGRT. Method: 730 CBCT images were evaluated with the Offline Review tool, available in the Eclipse planning system version 13.6; 54 patients in total; all of them with prostate present; treated with 74 Gy; irradiated with the IMRT technique with IGRT; 6MV photon beam energy of the Trilogy linear accelerator (Varian Medical Systems) with integrated OBI. Results: The displacements were statistically evaluated (mean and standard deviation), then these values were applied in the Van Herk equation, obtaining 0.9 cm vertical, 0.6 cm longitudinal and 0.9 cm lateral as mean values for margins. Furthermore, considering vertical direction individually, values of 0.6 cm anterior and 0.7 cm posterior were obtained. Conclusion: It was found that the PTV margin size adopted by the institution is sufficient to guarantee CTV coverage. From this study, taking into account the current imaging protocol, it is possible to suggest an adaptation of PTV margins adjusting them in different directions. These adjustments make it is possible to improve adjacent tissue dose control maintaining CTV coverage.

Contato: Priscila Silva RauppE-mail: [email protected]


RELIABILITY EVALUATION OF SNC 3DVH® SOFTWARE FOR QUALITY ASSURANCE OF IMRT TECHNIQUESAutores: Júlio César Somazz / Somazz, J. C. / GRAACC; Leandro dos Santos Baptista / Baptista, L. S. / GRAACC; Fernanda Salheb Belletti / Belletti, F. S. / GRAACC;

Introduction: Treatments using Intensity-Modulation techniques (IMRT) will become the common form of Radiotherapy planning soon. Thus, a patient-specific quality assurance (QA) routine is going to be necessary given the complexity of the plans. The usual QA methods are the Gamma index passing rate (using either a matrix of detectors or film) and punctual measurements with the ionization chamber. Despite those methods assure the planned dose accuracy in the treatment planning system (TPS), they fail to convey any form of volumetric information about the dose distribution. The SNC 3DVH® system gives the possibility of comparing the dose-volume histogram (DVH) calculated by the TPS and the one irradiated by the Linear Accelerator. Objective: The purpose of this work is to study the reliability of SNC 3DVH® system by checking the possible limitations in a way to validate the software for an IMRT QA routine. Methodology: We irradiated the detector SNC ArcCheck® diode array in an Elekta Synergy® linear accelerator. The plans were created in the Elekta Monaco® TPS to guarantee a maximum Homogeneity Index (HI) of 1,02 around the studied areas. We acquired punctual measurements with a PTW TN30013 ionization chamber. Three studies were made to verify the volumetric aspect of the analysis made by the 3DVH system: (i) plans with similar DVHs, but distinct fluence maps; (ii) alterations in the dose calculation grid and (iii) linear alterations on the Monitor Units (MU) of the plan. Each plan was based in the SNC ArcCheck® phantom

tomography. Results: The different fluence maps study (i) identified the differences between plans, allowing the user to locate the error in the irradiated plan. In the study with the alteration in the dose calculation grid (ii), the SNC 3DVH® showed an average deviation of 0,5% about the ionization chamber, the deviation between the 3DVH and the TPS was close to 0,0%. The linear MU study (iii) was made to verify the linear response of the system. The linear correlation presented by the 3DVH was 1,0 for every group of measures.

Contato: Fernanda Salheb BellettiE-mail: [email protected]


TIME DELAY EVALUATION AND DOSE REPRODUCIBILITY USING THE VARIAN BREATHING PHANTOM WITH DIFFERENT GATING INTERVALS FROM THE TRUEBEAM STX LINEAR ACCELERATORAutores: Leticia / Leticia, M.S. / CRIO; Milena Giglioli / Milena Giglioli / Barretos; Lucas Francisco Guimaraes / Lucas F. C. Guimarães / BARRETOS; Geraldo Gabriel Perez / Geraldo G. Perez / Barretos; Gustavo Donisete Fioravanti / Gustavo D. Fioravante / Barretos;

In current radiotherapy the tendency to hypofraction brings the need to increase treatment accuracy and use imaging methods to localize the treatment region. One approach to increasing treatment accuracy is to consider intrafraction movements. The present work analyzes the Time Delay which would be the time between the system detecting that the beam should be turned on / off in the Gating system and the beam actually being turned on / off, the dose reproducibility, if really the planned dose is being delivered to us. defined gating intervals. TrueBeam STx Linear Accelerator (AL) was evaluated using automatic Varian Breathing Phantom (VBP) motion. Time Delay was obtained for both MV images with different energies with and without Flattening Filter (FF) and for images. For reproducibility, direct field planes, Volumetric Modulated Arc Therapy (VMAT - RapidArc ) and dynamic conformational arc with different gating intervals were used. The results were satisfactory, showing that the measured delay is in agreement with the values found in the literature and that the method used is adequate. The dose reproducibility obtained at different gating intervals was also satisfactory. One approach to increase treatment accuracy is to consider intrafraction movements. The present work analyzes the Time Delay which would be the time between the system detecting that the beam should be turned on / off in the Gating system and the beam actually being turned on / off, the dose reproducibility, if really the planned dose is being delivered to us. defined gating intervals. TrueBeam STx Linear Accelerator (AL) was evaluated using the automatic Varian Breathing Phantom (VBP) object movement, using an accessible equipment. Time Delay was obtained for images using different energy MV with and without Flattening Filter (FF) and kV for reproducibility, direct field planes, Volumetric Modulated Arc Therapy (VMAT - RapidArc ) and dynamic

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 16

conformational arc were used. , with different gating intervals. The results were satisfactory, showing that the measured delay is in agreement with the values found in the literature and that the method used is adequate. The dose reproducibility obtained at different gating intervals was also satisfactory.

Contato: Leticia Medeiros SantoniE-mail: [email protected]


TRIDIMENSIONAL QUALITY CONTROL OF THE CRANIOSPINAL IMRT JUNCTION USING GEL DOSIMETER AND OPTICAL CTAutores: Matheus Antonio da Silveira / Silveira, M. A. / Faculdade de Filosofia Ciência e Letras de Ribeirão Preto - USP; Alexandre Colello Bruno / Colello Bruno, A. / Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto -USP; Gustavo Viani Arruda / Arruda, G. V. / Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto -USP; Juliana Fernandez Pavoni / Pavoni, J. F. / Faculdade de Filosofia Ciência e Letras de Ribeirão Preto - USP; Oswaldo Baffa Filho / Baffa, O. / Faculdade de Filosofia Ciência e Letras de Ribeirão Preto - USP;

Introduction: With the evolution of technologies for cancer treatment planning, the demand for quality control methodologies that provide three-dimensional information for dose distribution measurements also increased. In this context, gel dosimeters combined with an imaging technique are of great interest because they can perform three-dimensional dosimetry of the entire volume planned treatment. In this study, a Fricke - FX xylenol gel dosimeter (FXO) and an optical tomography using cone-beam geometry (optical CT) were used to evaluate the 3D dose distribution of two IMRT field junction used in craniospinal irradiation. Methods: Craniospinal irradiation was planned using two IMRT fields, one for the cranium and the other for the cervical region, the junction of these fields was evaluated in this study. A Unique LINAC (Varian Medical Systems) was used and a fraction dose of 2.1Gy was delivered to the phantom. The phantom was a cylinder of 12.5 cm diameter and 15 cm high, it was filled with the FXO gel dosimeter. Two other similar cylinders were irradiated in order to acquire a percent depth dose measurement with maximum doses of 3Gy and 1.5Gy to provide the data used in the association of the optical attenuation coefficient to the known absorbed dose, to calibrate the gel batch. The optical CT images were acquired with 360 ° phantom rotation in 0.5 ° steps. The images reconstruction were performed using the combination of FDK and SIRT-TV algorithms for noise removal. The reconstructed images were converted to dose and compared to the planning dose distribution using gamma analysis (3%/3mm) using in-house developed software. Results: By evaluating the gamma index images in the junction region only the edges presented values greater than 1, which failed in the evaluation. In the central region, inside the target volume, 96.5% of the points were approved in the gamma analyses. Considering all the volume, an average approval of 90.3% of the analyzed pixels was achieved. Conclusion:

Gel dosimetry using FXO gel combined with CT-optics can be used for three-dimensional quality control in a complex procedure such as craniospinal irradiation.

Contato: Alexandre Colello BrunoE-mail: [email protected]


USO DE FEIXES FLATTENING FILTER FREE PARA PLANEJAMENTO DE SBRT DE PULMÃO: UMA ANÁLISE DOSIMETRICAAutores: Mylena Queiroz Saraiva / Saraiva, M.Q / AC Camargo Cancer Center; Adriana Aparecida Flosi / A. Flosi / AC Camargo Cancer Center; Cassio De Queiroz Tannous / C. Tannous / AC Camargo Cancer Center; Ana Paula Vollet / A.P. Vollet / AC Camargo Cancer Center;

A radioterapia estereotáxica extracraniana, do inglês, Stereotactic Body Radiotherapy (SBRT) tornou-se um padrão para o tratamento do câncer de pulmão de não pequenas células inoperável em estágio inicial, demonstrando altas taxas de controle local e toxicidade limitada para os pacientes. Esta técnica caracteriza-se pela entrega de uma alta dose de radiação hipofracionada em um alvo pequeno e precisamente localizado. Recentemente, feixes flattening filter free (FFF) caracterizados pela ausência do filtro aplanador e por altas taxas de dose foram introduzidos na prática clínica. Isto combinado com a Arcoterapia Volumetricamente Modulada (VMAT) resulta em maior rapidez e eficiência do tratamento. Entretanto, o perfil não uniforme, menor energia média e menor espalhamento lateral dos feixes FFF podem influenciar a distribuição de dose. O objetivo deste trabalho é comparar dosimetricamente planejamentos VMAT para SBRT de pulmão com feixe de fótons de energias de 6MV, 6MV-FFF e 10MV-FFF. Foram otimizados três planejamentos em um phantom antropomorfico de torax, nos quais foram avaliados os parâmetros de índice de conformidade (IC), heterogeneidade (IH), número de unidades monitoras (UM), tempo de tratamento e dose nos órgãos de risco (OAR). Os planejamentos apresentaram resultados quantitativamente semelhantes em termos de dose nos OAR e IH. Entretanto, o planejamento com feixe de 6MV-FFF apresentou melhor conformação de dose ao volume-alvo. Considerando o IC para as isodoses de 100, 98 e 50%, número de UM e tempo de tratamento, o feixe de 6MV-FFF mostra-se mais adequado,visto que além de apresentar melhor conformidade para os índices citados (1,01; 1,1; 4,98, respectivamente) apresenta uma redução de 57% do tempo de feixe ligado quando comparado ao feixe de 6MV, devido à menor quantidade de UM e alta taxa de dose. Como conclusão, nossos achados sugerem que a energia de 6MV-FFF é mais adequada para a técnica SBRT de pulmão. Etapas futuras do trabalho envolvem a validação dos resultados fornecidos pelo sistema de planejamento através de uma verificação dosimétrica.

Contato: Mylena Queiroz SaraivaE-mail: [email protected]

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


17


VALIDATION OF A QUALITY ASSURANCE METHODOLOGY IN SMALL FIELD IRRADIATIONAutores: Tiago Batista de Oliveira / Oliveira, T. B. / Fundação São Francisco Xavier; André Ezequiel Lobo de Abreu / Abreu, A. E. L. / Fundação São Francisco Xavier; Gerson Hiroshi Yoshinari Júnior / Yoshinari Júnior, G. H. / Fundação São Francisco Xavier; Mariana Paranhos Alvarenga / Alvarenga, M. P. / Fundação São Francisco Xavier; James Wagner Morais / Morais, J. W. / Fundação São Francisco Xavier; Harley Francisco de Oliveira / Oliveira, H. F. / Fundação São Francisco Xavier;

Introduction: The TRS-483/IAEA publication purposes a new method for dosimetry in small field irradiation (SF). Nevertheless, we observe a lack of recommendations in quality assurance (QA) protocols of SF, usually used in stereotactic radiosurgery (SRS). We proposed a QA methodology for SF dosimetry comparing measured dose with calculated dose in Treatment Planning System (TPS). Methodology: For nine SRS treatment plans, we irradiated all treatment fields (TF) together (Method 1), measuring the total dose. The dose was measured with a pinpoint ionization chamber (IC). We then applied the influence factors and the correction factors proposed by TRS-483. These irradiations were realized in distinct days, with different ambient conditions. After that, in a single-day event (with stable ambient conditions), again for all nine SRS plans, we irradiated the IC with the TFs, but this time field by field (Method 2). The measured doses were corrected by specific influence quantities for each TF. Results: The mean number of TFs per treatment plan was 17.1 (SD: 3.1), and the total mean dose was 15.0 Gy (SD: 4.0 Gy). The mean difference between the total measured dose, and the total calculated dose was 2.04% (SD 0.76 %). In one of the plans, the difference was 3.8 %. In this specific plan, the mean field size was bigger than 3.0 cm. This difference was observed only in Method 1. We hypothesized that the methodology would not be suitable for TFs bigger than 3.0 cm. However, when we irradiated the individual TFs and applied the specific influence quantities and correction factors, field by field, we did not found a difference greater than 3.0 %. Conclusion: We observed that the methodology is reproducible and consistent. We recommend Method 2, including for TFs bigger than 3.0 cm. The quality of measurement is hugely dependent on Ktp, so the setup shall be settled in stable ambient condition to minimize differences in measurements.

Contato: Tiago Batista de OliveiraE-mail: [email protected]

TEMÁRIO: TÉCNICOS EM RADIOTERAPIA (SUBMISSÃO PARA O XVI ENCONTRO DE TÉCNICOS EM RADIOTERAPIA) CÓDIGO: 88005

COMPARATIVE STUDY OF THERMOLU-MINESCENT RESPONSE OF Α-AL2O3 AND LIF-MTS CERAMIC DETECTORS IN HIGH ENERGY BEAMSAutores: Anna Luiza F. Silveira / Anna Luiza F. Silveira / CDTN-Centro de desenvolvimento de Tecnologia

Nuclear; Bárbara Brenda de Almeida Costa / Bárbara Brenda de Almeida Costa / Radiocare -Centro Especializado em Radioterapia; Luiz C. Meira-Belo / Luiz C. Meira-Belo / CDTN-Centro de desenvolvimento de Tecnologia Nuclear;

Radiotherapy is an area that is primarily dealt with using clinical protocols as well as delivering high doses of radiation for therapy. To check the dose that the patient actually receives in radiotherapy treatments, in vivo dosimetric techniques are used to evaluate the doses being delivered using specific dosimeters for this use, such as thermoluminescent (TL) dosimeters, radiochromic films, gel dosimeters, semiconductor dosimeters, etc. The aluminum oxide ceramic dosimeters (α-Al2O3) developed at the CDTN by the sol-gel process were characterized for their morphology and dosimetric properties at energies up to 662 keV (137Cs). The use of these ceramic detectors in radiotherapy applications opens a new perspective for their practical use. The aim of this paper is to carry out a preliminary study of characterization of these ceramic detectors in high energy beams commonly used in radiotherapy treatments, aiming to determine the technical feasibility of their use in this application. For this, the integrals of the thermoluminescent response curves as a function of the absorbed dose in solid water were obtained for the α-Al2O3 ceramic detectors and lithium fluoride detectors (LiF-MTS) for comparison purposes. For this purpose, homogeneous lots of these detectors were selected and both lots were irradiated with doses between 0.5-2.5 Gy, in 6 MV photon and 6 MeV electron beams with 10 x 10 cm dimension fields. Elekta Synergy Linear Accelerator, installed at Radiocare Centro Especializado em Radioterapia, located at Felício Rocho Hospital. For LiF-MTS detectors, the TL response was linear over the entire dose range studied in both beams used. For LiF-MTS detectors, the TL response was linear over the entire dose range studied in both beams used. For the alumina ceramic detectors, the TL response obtained showed linear behavior up to a dose of 1.0 Gy, for both beams, and above this dose value, the response increased, following a nonlinear behavior, typical of the saturation regime. The results obtained with this study indicate that LiF-MTS has technical feasibility in radiotherapy, in all studied dose range, without the need to use correction actors, as well as for α-Al2O3 detectors, in doses up to 1.0 Gy. However, for higher doses, α-Al2O3 detectors need more careful studies to characterize them.

Contato: Fernanda da Silva Gonçalves AraujoE-mail: [email protected]


DESENVOLVIMENTO DE UMA CARTILHA INFORMATIVA DE PROTEÇÃO RADIOLÓGICA PARA O APRIMORAMENTO DAS CONDUTAS DE SEGURANÇA EM SERVIÇOS DE RADIOTERAPIAAutores: Isabella Maria Ribeiro Silva / Ribeiro,I.M / INSTITUTO DE RADIOTERAPIA SÃO FRANCISCO; ARNIE VERDE NOLASCO / NOLASCO,A.V / INSTITUTO DE RADIOTERAPIA SÃO FRANCISCO;

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 18

Introdução: A radioterapia é uma modalidade terapêutica que representa um recurso bem estabelecido para o tratamento de doenças malignas ou não. É capaz de destruir células tumorais, empregando feixes de radiações ionizantes. Nos serviços de radioterapia o uso da radiação para fins médicos acaba sendo um risco se não aplicada corretamente. No entanto, o uso imprudente das radiações ionizantes podem produzir efeitos prejudiciais que resultarão em consequências que comprometem o bem estar das pessoas envolvidas. Portanto é de extrema importância entender e aplicar o conhecimento da radioproteção junto aos profissionais da área radiológica, para que sejam capazes de realizar procedimentos de forma correta, em benefício da sociedade, sem riscos à saúde do público, paciente, meio ambiente e dos proprios profissionais da radiologia. Objetivo: Elaboração de uma cartilha informativa com o intuito de reforçar os conceitos de Radioproteção no âmbito da radioterapia e a importância de se evitar exposições indevidas visando à saúde dos pacientes, dos profissionais envolvidos e do público em geral. Métodos: Com a finalidade de instruir mais adequadamente os profissionais de um serviço de radioterapia no âmbito da proteção radiológica, foi desenvolvida uma cartilha informativa ressaltando conceitos e condutas de proteção radiológicas concernentes à prática radioterápica. O material foi elaborado com base na estruturação temática do plano de proteção radiológica do serviço de radioterapia. Fez-se oportuno enfatizar os protocolos de conduta em resposta a incidentes de menor ou maior gravidade. Em adição, procurou-se simplificar conceitos e diretrizes para assegurar uma melhor assimilação das responsabilidades dos colaboradores. A cartilha foi diagramada em uma única folha, para fomentar a leitura do conteúdo. Resultados: Segue os tópicos descritos no conteúdo da cartilha informativa: Radioproteção Princípios Básicos da Proteção Radiológica: Formas de radioproteção Responsabilidades dos IOE da instalação Segurança e acidentes Conclusão: A radioproteção tem a principal finalidade de certificar atividades seguras que envolvam radiações ionizantes. Condições básicas de segurança devem ser primordiais na atividade profissionais. Com a proposta de distribuição da cartilha informativa pelos profissionais da radioterapia foi possível enfatizar e ampliar ainda mais os princípios de proteção radiológica e aprimorar formas de radioproteção aplicáveis na rotina do serviço.

Contato: Isabella RibeiroE-mail: [email protected]


DOSIMETRIC EVALUATION IN RADIOTHER-APY PLANS FOR TREATMENT OF LEFT BREAST CANCER WITH THREE-DIMENSIONAL TECHNIQUE CONFORMED TO FREE BREATH-ING AND MODERATE DEEP INSPIRATION (DIBH) WITH ACTIVE BREATHING COORDINATING SYSTEMAutores: Juliane Dias de Lima / Lima, J.D / Instituto do Câncer do Estado de São Paulo; Daniele Santiago dos Santos / Santos, D.S. / Instituto do Câncer do Estado de

São Paulo; Elaine Silvana Valeriano Rios / Rios, E.S.V. / Instituto do Câncer do Estado de São Paulo; Daniele Alessandra Cuba dos Santos / Santos, D.A.C. / Instituto do Câncer do Estado de São Paulo;

Currently the standard treatment for early stages in breast cancer is to combine surgery and adjuvant external radiotherapy. The function of breast irradiation is to consolidate the treatment, avoiding relapses or metastases. However, its benefits may present long-term risks and complications. Recent studies have shown increased cardiac and pulmonary complications for the treatment of left breast with increased absorbed dose. Recently, new techniques have been introduced to radiotherapy in order to minimize cardiac and pulmonary doses through Deep Inspiration Breath Hold (DIBH) breath control. This study aims to present a dosimetric evaluation of three-dimensional (3D) left breast planning using a conventional free-breathing technique and moderate deep-breathing (DIBH) with the active breathing coordinating system. In a retrospective study, 11 patients with early stage left breast cancer with a prescribed dose of 50 Gy in 25 fractions were selected, whose conventional 3D free-breathing planning did not reach the acceptable constraints, and were submitted to planning with DIBH. All patients received training on the functioning of the active breathing coordinator system prior to performing the new deep-inspired computed tomography simulation, with the same positioning as the previous DIBH simulation. After acquisition of the exam, and delineation of the OARs and target volumes bypassed by the radiologist, physicists elaborated the plans with tangent fields and subfields (field in field). The average of the results found in the planning for the conventional technique with free breathing compared to DIBH, dose reduction in DIBH, with cardiac average dose from 7.5 Gy to 5Gy, V25 <5% from 10% to 5%, V10 <6 % / 35% from 19% to 10%; and for pulmonary volume mean dose from 14.5% to 12.9%, V20 <30% from 28% to 26%, V10 <40% from 39% to 34%, V5 <50% from 50% to 44%. Even better V90 tumor volume coverage> 90% from 93% to 95%. Considering the results, the DIBH technique is a tool capable of reducing absorbed doses in the heart and lung, due to the increase in parasagital distance from the cardiac area to the chest wall, minimizing lung density, allowing margins reduction and better target volume coverage.

Contato: Elaine Silvana Valeriano RiosE-mail: [email protected]


EVALUATION OF ADDITIONAL SKIN MARK ON THE THORACIC REGION FOR HEAD AND NECK RADIOTHERAPYAutores: Rayane Pinho do Nascimento / Nascimento, R.P. / Hospital Universitário de Brasília; Ricardo Reis / Reis, R. / Hospital Universitário de Brasília; Samuel Avelino / Avelino, S.R. / Hospital Universitário de Brasília; Luis Felipe / Oliveira e Sila, L.F. / Hospital Universitário de Brasília; Jackson Farias / Farias, J. S. / Hospital Universitário de Brasília;

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


19

Introduction: Misalignment between the face and the supraclavicular fossa is usual in head and neck radiotherapy when common thermoplastic masks are used. Since this sort of masks does not provide proper immobilization of the thoracic region, to reproduce the patient position acquired during the CT simulation is a challenging task. In this sense, in addition to the three conventional marks made on the mask, we introduced in the routine of radiotherapy of the University Hospital of Brasília a fourth mark made on the patient‘s chest with the aid of sagittal laser. Objective: The aim of this study was to analyze the effectiveness of additional skin mark on the thoracic region for head and neck radiotherapy on patients alignment. Methods: To see whether the skin mark on the thoracic region have improved day-to-day patient alignment, we carried out a retrospective analysis. Two groups of randomly chosen patients were compared: one group with 15 patients with the three conventional marks and other with 15 patients with the additional thoracic skin mark. During the treatment sessions, CR portal images were acquired to be registered with digitally reconstructed radiographs (DRRs), used as references, in a homemade software previously reported. Thirty portal images were evaluated. Initially, from these images, variations in the lateral-lateral and cranial-caudal coordinates were measured by matching corresponding bony landmarks of the face to the DRR. Then, a new image registration were performed taking into account only the thoracic bony landmarks. The coordinates difference obtained with these two images registration were used to quantify patient misalignment. We used Students t-test to compare the two groups of patients. Results: We observed statically significant difference between the two groups in both directions. The mean absolute variations (±1SD) in lateral-lateral direction were 0.56 (± 0.55) cm vs. 0.27 (± 0.22) cm [p= 0.034] for the group treated with 3 marks and the group with the additional thoracic mark, respectively. In cranial-caudal direction, the variations were 0.45 (± 0.31) cm vs. 0.11 (± 0.2) [p<0.001] for the group treated with 3 marks and the group with the additional thoracic mark, respectively. Conclusion: The patient alignment performed with the aid of the thoracic mark enables greater patient position reproducibility.

Contato: Rayane Pinho do NascimentoE-mail: [email protected]


EXPERIENCE REPORT OF BLOOD COMPONENTS IRRADIATION IN THE RADIOTHERAPY SERVICE OF A PUBLIC UNIVERSITY HOSPITALAutores: Patrícia Araújo / Araújo, P. / Hospital de Clínicas da Universidade Federal do Triângulo Mineiro-HC UFTM;

Introduction: ANVISA gives a high priority to making sure that patients receive irradiated blood, during blood transfusion, in order to prevent Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD).

Such a fatal immune complication in 90% of cases is caused when T lymphocytes, found in red blood cell and platelet concentrate, begin to multiply and attack receptor cells. In the mechanism of bag irradiation, such complication can be prevented by eliminating T-cells from Blood Components before undergoing the transfusion. This irradiation step is performed daily at the UFTM Clinical Hospital, in the Radiotherapy Service, where, through a CLINAC 600 Linear Accelerator, with 6MV energy, the technical team performs the irradiation of Blood Components with a dose of 25 grays, varying accordingly with the volume of bags received on the day. Objective: To describe the process of blood component irradiation in the routine of the Radiotherapy Service of the UFTM Clinical Hospital, using the CLINAC 600 Linear Accelerator, radiation emitter, applying the calculated dose. Methodology: Blood Component irradiation activity occurs daily in the morning or afternoon, according to the demand of the hospital blood center. Blood Component bags are delivered to the Radiotherapy Service in a thermal box to the radiotherapy technician or technologist of the service. The bags are nestled in a 30x30x14cm acrylic box with lid; which contains a ruler that will determine the volume inside the box for later dose calculation with 25 grays. According to the pouch limit, the dose is calculated, with an anterior-AP exposure (Gantry 0º) and another posterior-PA exposure (Gantry 180º), with an average duration of 20 minutes. Results: From January 2018 to June 2019, bags were irradiated with Red Blood Cell Components (CH), Platelets (PQ) and Aphereses, totaling 13,759 Blood Components. The process allowed the referral of blood bags to hospitals connected to the micro-region of Uberaba, and for immediate use in patients who, for various reasons, had indications of transfusions of different Blood Components. Conclusion: It is noteworthy the need and importance of a single process for the irradiation of Blood Components in order to favor the prevention of complications of TA-GVHD, resulting from possible blood transfusions.

Contato: Patrícia AraújoE-mail: [email protected]


IMPLEMENTATION OF THE QUALITY CONTROL PROCESS OF THE RECORDS OF PATIENTS UNDERGOING RADIOTHERAPY TREATMENTAutores: Elaine Silvana Valeriano Rios / Rios, E.S.V. / Instituto do Câncer do Estado de São Paulo; Daniele Alessandra Cuba dos Santos / Santos, D.A.C. / Instituto do Câncer do Estado de São Paulo; Juliane Dias de Lima / Lima, J.D. / Instituto do Câncer do Estado de São Paulo; Daniele Santiago dos Santos / Santos, D.S. / Instituto do Câncer do Estado de São Paulo;

The patient record contains information about the prescription, fractionation and execution of the entire treatment. Some accidental occurrences may occur due to the absence of prescribing protocols in the treatment

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 20

plan as well as in the absence of relevant information in the data sheet. In order to consider some procedures to prevent mistakes in radiotherapy and to follow the standard of CNEN NN 6.10 that aims to ensure the quality control of therapeutic treatments, the Quality Control Process of Medical Records (Technical Data Sheet) was implemented. In this process, a multidisciplinary team (Physician, Physicist-Doctor and Dosimetrist) reviews the technical file for the third time. This study aims to highlight the need to implement quality assurance programs and demonstrate that with the implementation of the Quality Control Process of medical records improved the standardization of protocols of the institution, minimizing possible adverse events in radiotherapy. Data were collected from 2016 December to 2018 December. Serious divergences: Incorrect dose and fractionation; Out-of-protocol contours; Informed Consent with incomplete completion; Description of Treatment Laterality incorrect. Media divergences: Faceless photo management and positioning system; No signatures; Documents without foreseen by the physical physician; No Printed Restrictions. Slight divergences: Notes on the Plan in the Management system; Checklist not completed by Radiotherapy Technicians. From 2016 December to 2018 December, the study analyzed 4,267 medical records and in 94 occurrences, the planning had to be redone. The implementation of the quality control process of medical records in radiotherapy services is another barrier to prevent accidents.

Contato: Elaine Silvana Valeriano RiosE-mail: [email protected]


THE ROLE OF THE TECHNICIAN IN RADIOTHERAPY IN THE TREATMENT OF PATIENTS WITH CHOROID MELANOMA WITH STEREOTAX TELETHERAPYAutores: Anderson Senna Miranda / Miranda, A. S. / Instituto Nacional do Câncer; Jorge Luis Alonso Macambira / Macambira, J. L. A. / Instituto Nacional do Câncer; Edson Santos Silva / Silva, E. S. / Instituto Nacional do Câncer; Bruno Favilla Soares / Soares, B. F. / Instituto Nacional do Câncer;

Introduction Among primary malignant intraocular tumors, uveal melanoma is the most common in adults. It arises from uveal tract melanocytes and most commonly affects the choroid, a vascular layer of the eyeball wall that lies between the white part of the eye (sclera) and the retina (visual membrane). Choroid melanoma has a high incidence of metastasis with an global mortality rate of up to 50% at 10 years (Olsen et al 2000). External radiation is an option that can be used to treat medium-sized lesions (about 2.5 to 10 mm). With technological advances, it has become possible to treat small to medium-sized ocular melanomas using stereotactic radiotherapy. The aim of this study is to emphasize the importance of the radiation therapy technologist at all stages of treatment, since making immobilization accessories, pre- and post-treatment

imaging until dose delivery. Materials and methods A Trilogy linear accelerator with integrated OBI system was used, which allows us to produce volumetric images of the treatment region (Conebeam CT). Immobilization of the patient was achieved by using a BrainLab‘s thermoplastic mask, ensuring an adequate fixation of the treatment site. The CCD camera will be attached to the mask and will monitoring the patient as well as any eye movements. The technician monitors the position of the eyes through the monitor prior to radiation delivery. Any change in eye positioning will generate beam interruption by the technician. Conclusion We conclude that the role of the radiation therapy technologist in the treatment of choroidal melanoma with teletherapy has great importance for the good application of radiotherapy techniques. For this treatment aforementioned is necessary great skill in the delivery of the dose and theoretical domain, this includes perform the treatment as determined in the prescription and simulation form, keep the patient under visual observation throughout the exposure, be responsible for the technical procedures performed in the service, ensure the patient‘s well-being during the treatment period, know and apply the safety and radiological protection rules in accordance with current legislation.

Contato: Anderson Senna MirandaE-mail: [email protected]


VARIAÇÃO ENTRE AS IMAGENS PLANARES E VOLUMETRICAS EM RADIOTERAPIA DE CRÂNIOAutores: ADRIANI APARECIDA DE FREITAS MARTINS / Martins, A.A.F / Hospital Alemão Oswaldo Cruz; Yara Boaventura da Silva / Silva, Y.B. / Hospital Alemão Oswaldo Cruz; Sandra Regina de Oliveira Borges / Borges, S.R. O / Hospital Alemão Oswaldo Cruz;

A irradiação do crânio é utilizada no tratamento de tumores primários e lesões metastáticas cerebrais. Os planejamentos tridimensionais com técnica conformada ou intensidade de dose modulada e radiocirurgia podem ser indicados para o tratamento. Para o planejamento a moldagem do crânio precede a tomografia e garante a imobilização e a reprodutibilidade diária do tratamento. Dentre os avanços na radioterapia, a Radioterapia Guiada por Imagem possibilita a avaliação da imagem da área planejada antes da entrega de dose, permite visualizar as imagens anatômicas do paciente no instante que antecede ao tratamento e possibilita a correção automática da área de tratamento por meio de referências anatômicas ou orgãos. Essas imagens podem ser planar e/ou volumétricas e obtidas por kilovoltagem ou megavoltagem. Em nosso serviço dispomos do sistema de aquisição de imagem On-board Imaging (OBI) e todos os pacientes fazem imagens planares e volumétricas. No entanto, passamos a nos questionar se são necessários as imagens planar e volumétrica para localização do crânio, considerando-se que o molde do crânio garante a imobilização da área e que o cérebro

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


21

não é um orgão movel. Esse trabalho objetivou verificar a variação nas coordenadas (vertical, longitudinal e lateral) entre a imagem planar e volumétrica em irradiação do crânio. Trata-se de estudo retrospectivo de pacientes que irradiaram crânio num serviço de radioterapia no Acelerador Linear 21 EX da Varian no período de junho de 2016 a junho de 2019. Incluíram-se pacientes com câncer primário cerebral e com metástases cerebrais tratados com técnica conformacional ou intensidade de dose modulada com fracionamento convencional ou hipofracionada. Coletou-se os dados do prontuário eletrônico no Sistema Aria e transferidos para planilha Excel e submetidos à análise estatística. A população do estudo constituiu-se de 60 pacientes, sendo 53% do sexo feminino e 47% do sexo masculino, 45% deles tinham entre 41 e 60 anos de idade e 52% tinham tumor primário e 48% tinham lesões metastáticas. Avaliou-se 357 imagens planares e 357 imagens volumétricas. Observou-se em 96% das vezes que a diferença entre as imagens foi de 0, 1 a 0,2 mm em alguma coordenada e em 4% das vezes entre 0,3 e 0,4 mm. O recurso de imagem para avaliação em tempo real do posicionamento do paciente garante a precisão da área de tratamento. Na irradiação do crânio os resultados sugerem que a imagem planar é suficiente para localização da área planejada.

Contato: Yara Boaventura da SilvaE-mail: [email protected]

TEMÁRIO: ENFERMAGEM ONCOLÓGICA (SUBMISSÃO PARA O XVII ENCONTRO DE ENFERMEIROS ONCOLOGISTAS EM RADIOTERAPIA) CÓDIGO: 87521

A IMPORTÂNCIA DA ATUAÇÃO DA FISIOTERAPIA PARA PACIENTES COM CÂNCER DE MAMA EM TRATAMENTO RADIOTERÁPICO: UM RELATO DE EXPERIÊNCIAAutores: Mayara Lindner Brandão / BRANDÃO, M.L. / UFCSPA; Ana Luiza da Silva / SILVA, A.L. / UFCSPA; Daniela dos Santos da Silva / SILVA, D.S. / ISCMPA; Thayla Rafaella Pasa Toebe / TOEBE, T.R.P. / UFCSPA; Bruna Luciano Farias / FARIAS, B.L. / UFCSPA; Jéssica Brinkhus / BRINKHUS, J. / ISCMPA; Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA;

No ano de 2018, estima-se que ocorreram cerca de 60 mil novos casos de câncer de mama no Brasil, sendo o segundo câncer mais frequente na região Sul. Devido à alta incidência, torna-se cada vez mais importante conhecer os vários aspectos relacionados a esta doença. A radioterapia é um dos principais tratamentos, que consiste em expor o sítio à radiação ionizante, com o objetivo de atingir as células malignas, impedindo seu crescimento e/ou ocasionando morte celular. Geralmente, a radioterapia é um tratamento adjuvante realizado após a cirurgia da mama. Esta, por sua vez, pode causar prejuízos funcionais e limitações das amplitudes de movimento (ADM) nestas pacientes, dificultando o posicionamento para a realização do tratamento radioterápico. Objetivo deste trabalho é relatar a necessidade do serviço de fisioterapia dentro de um centro de radioterapia. Trata-se de um relato de experiência vivenciado pela equipe multidisciplinar. Apos a identificação de um caso de uma paciente

pós mastectomia total que teve seu tratamento radioterápico interrompido devido a dificuldade de posicionamento na maca, observou-se a necessidade e importância da atuação fisioterapêutica dentro dos centros de radioterapia. A atuação do fisioterapeuta se dará através de um plano de reabilitação para que pacientes que se encontram nessas condições consigam dar andamento ao tratamento proposto, diminuindo assim a incidência de insucesso devido à falta de mobilidade articular. Considera-se essencial a visão multiprofissional, visto que estas pacientes chegam ao serviço de radioterapia com problemas previamente instalados. A abordagem fisioterapêutica deve iniciar juntamente à primeira consulta médica com vistas à identificação precoce de possível fator limitante para realização do tratamento e criação de um plano terapêutico.

Contato: Aline Moraes de AbreuE-mail: [email protected]


A IMPORTÂNCIA DO LÚDICO: MÁSCARA ESTILIZADA PARA CRIANÇAS EM TRATAMENTO RADIOTERÁPICOAutores: Jéssica Brinkhus / BRINKHUS, J. / ISCMPA; Mayara Lindner Brandão / BRANDAO, M.L. / UFCSPA; Bruna Bastos Giergowicz / GIERGOWICZ, B.B. / UFCSPA; Bruna Schroeder Mello / MELLO, B.S. / UFCSPA/ISCMPA; Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA;

O número crescente da incidência de câncer infantil traz cada vez mais a necessidade de reduzir os traumas causados pelo tratamento. Tornando-se necessário o desenvolvimento de estratégias e ferramentas que aprimorem esta atenção, levando à criação e ao desenvolvimento de atividades e de unidades especializadas em radioterapia oncológica pediátrica. O uso da máscara, um acessório de imobilização para realização do tratamento radioterápico, quando estilizada com um personagem da preferência e escolha da criança, faz com que o tratamento se torne mais humanizado. O objetivo desse trabalho é relatar a intervenção da equipe multiprofissional para a melhoria da qualidade da assistência a pacientes pediátricos durante o tratamento radioterápico. Trata-se de um relato de experiência da equipe multiprofissional de um centro de radioterapia. Os pacientes pediátricos chegam no serviço de radioterapia e são atendidos por diversos profissionais até então desconhecidos para eles. Eles requerem uma atenção especial, permeando o universo infantil, em que os recursos materiais e terapêuticos específicos não sejam seu foco principal. É realizado uma abordagem humanizada que promove a aproximação da criança com a equipe, afim de descobrirmos seus gostos e preferencias sobre os personagens infantis. Após, é realizada a confecção e estilização das máscaras pelo técnico de radioterapia. Quando as crianças veem suas máscaras conseguem exercer seu direito de brincar, encarando o tratamento de uma forma mais lúdica, menos dolorosa, além de desenvolverem interação e

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 22

vínculo com a equipe multiprofissional, facilitando assim o enfrentamento da criança perante ao seu tratamento. O brincar é uma demanda de cuidado que favorece o desenvolvimento infantil e é uma fonte de prazer, transformando-se numa forma de cuidado que ajuda na manutenção da vida dessas crianças. Neste sentido, durante o período de tratamento radioterápico, torna-se relevante aderir cuidados de enfermagem focados não apenas no tratamento da doença, mas também na manutenção dos hábitos de vida da criança. O desenvolvimento de atividades lúdicas, como o uso das máscaras estilizadas, faz com a criança encare o tratamento de maneira mais animada, reduzindo a angústia e aumentando a confiança do paciente em seu tratamento, obtendo uma interação com a equipe, e familiaridade com os procedimentos. Essas práticas constituem um diferencial na assistência especializada.



ANALYSIS OF CAUSES OF INTERRUPTION OF RADIOTHERAPY TREATMENT IN A CANCER CENTERAutores: Katia Cristina Trigo Martiniano / Martiniano. K. C. T. / AC Camargo Cancer Center; Samantha de Campos Gonçalves / Gonçalves, S. C. / AC Camargo Cancer Center; Lais Fernandes da Camara / Camara, L. F, / AC Camargo Cancer Center; Graziela Ferreira Escobar / Escobar; F. E. / AC Camargo Cancer Center;

Many prognostic factors may directly or indirectly affect local cancer control, including discontinuation of radiotherapy treatment, which is an independent and significant factor primarily in the management of lung and head and neck cancer. Interruptions are always consequences of unwanted incidents that may compromise the likelihood of tumor control, are caused by predictable reasons such as preventive maintenance, treatment or unpredictable schedules such as toxicity, clinical complications, and corrective maintenance. This study aimed to analyze the frequency and causes of treatment discontinuation in patients undergoing radiotherapy and it was conducted in the radiotherapy department of the AC Camargo Cancer Center, data were collected through a report extracted from the radiotherapy information system (Aria) and consultation in electronic health record. This study has included patients who were underwent outpatient radiotherapy treatment from January to December 2018, totaling 235 patients. The main reason for discontinuation of treatment it was lack of clinical conditions of the patient, 85% of treatment interruptions were due to toxicity, clinical deterioration or infection-related, 4% had pause related to scheduling brachytherapy sessions, 1% due to planning-related factors, 01% awaiting the result of additional tests, 02% for other reasons and 4% died during treatment, 50% of patients who had their treatment permanently suspended due to lack of clinical conditions died on average 23 days after discontinuation. 58% of the patients had curative therapeutic purpose

and may have had the treatment schedule altered upon discontinuation. The causes of interruption are not widely discussed as their impact on prognosis. Identifying the different causes of interruption has brought us a clear vision to act preventively ensuring safety and quality in the course of radiotherapy. This project has shown us that it is possible to improve the process in several aspects, from interruption prevention to root cause management with the implementation of quality indicators. For more effective analysis it is necessary to evaluate the patient‘s absenteeism, as it appears as a recurrent but it was not addressed in this study.

Contato: Samantha de Campos GonçalvesE-mail: [email protected]


ATUAÇÃO DO ENFERMEIRO NO SETOR DE RADIOTERAPIAAutores: Jéssica Aparecida Vieira Pinheiro Oliveira / Oliveira, J. A. V. P. / Radioserra ;

Temática: o trabalho trata-se da atuação do enfermeiro no setor de radioterapia. Objetivo: Identificar na literatura a atuação do enfermeiro no setor de radioterapia. Método: Trata-se de um trabalho de revisão bibliográfica narrativa. Para o levantamento dos artigos, foram utilizadas as bases de dados BVS, SCIELO, LILACS e BDENF. Após a pesquisa, os artigos foram selecionados pelo resumo. Após a seleção foi realizado um fichamento. E assim, selecionados para o desenvolvimento do trabalho. Desenvolvimento da pesquisa: Foi identificado nos artigos selecionados que o enfermeiro atua em três áreas no setor de radioterapia - na área administrativa, na área educacional e na área assistencial. Considerações finais: O enfermeiro deve atuar de forma comprometida e atualizada no setor de radioterapia para um melhor desempenho nas atividades e um melhor desenvolvimento na atuação com a equipe multidisciplinar e com o paciente. Além de prover toda a parte burocrática do setor, visando o bom funcionamento do local.

Contato: Jéssica Aparecida Vieira Pinheiro OliveiraE-mail: [email protected]


BEGINNING BRACHYTHERAPY PATIENTS: A HUMANIZED MULTI-PROFESSIONAL PROPOSAL FOR A BETTER TREATMENT ADHERENCEAutores: CLAUDIANE / ALVES, C.A / CORB; SIMONE DE BORBA MANTUANI / MANTUANI, S.B / CORB; GISELI DOS SANTOS / SANTOS, G / CORB;

Summary: The cervix cancer is the third most frequent female cancer in the world. In many developing countries it takes the first place in global incidence (SALVAJOLI; ET

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


23

ALL, 2013). The cancer diagnosis and all the process of the disease are experienced by the cancer patient and their family as a moment of intense anguish, suffering, and anxiety (VENÂNCIO, 2004) . People generally have a very limited knowledge about the treatments related to cancer. At most of the times, the acquired knowledge was through experience with other patients or through the media, leading to an information that can often be incorrect, out of date and dramatized (LOURENÇO; COSTA, 2000) Among the therapeutic possibilities of Cervix cancer. We have the Brachytherapy that has been widely used in the treatment of malignant tumors, due the characteristic that discharge a high dose of radiation at the target volume (SALVAJOLI, SOUHAMI E FARIA, 2013). Through the assistance performed by the nursing and Psychology team. There was a need for a proposal of multi-professional action, supportive and humanized in approaching patients that start radiotherapy treatment, in the brachytherapy modality, being the main intention the orientation and demystification of the proposed treatment.

Contato: Claudiane Athayde AlvesE-mail: [email protected]


COMPARATIVE STUDY ON THE ACUTE RADIODERMITE DEGREE BETWEEN CONVENTIONAL FRACTIONS AND HY-POFRACIONATION IN BREAST CANCER TREATMENTAutores: Thais Pires Flores / Flores, T / Hospital Mãe de Deus; Andréa Barleze da Costa / Costa, AB / Hospital Mãe de Deus; Maryanna Matos / Matos, M / Hospital Mãe de Deus;

Introduction: Globally, apart from non-melanoma skin cancers, breast cancer is the most common and common type of malignant tumor among women and it is estimated that almost 60,000 new cases are diagnosed each year in Brazil. Breast hypofractionation is already recommended by the Brazilian Society of Radiotherapy as a safe and viable alternative to conventional treatment. Objective: To compare acute toxicity with respect to radiodermatitis between conventional fractionations and hypofractionation in the treatment of breast cancer. Methodology: 95 patients with breast cancer treated with radiotherapy at Hospital Mãe de Deus since the beginning of 2018 were evaluated for radiodermatitis based on the RTOG scale. Evaluations were performed at the middle and end of the course of treatment. Two subgroups were created: patients treated in 15 fractions of 267cGy (with or without simultaneous boost) and those treated with conventional fractionation in 25 fractions of 200 cGy, as clinically indicated. These patients were treated with three-dimensional field in field radiotherapy or, in special cases, with IMRT and all underwent nursing consultation where they were advised on skin care during and after treatment. Results: 55 patients were evaluated during treatment with hypofractionated radiotherapy. Of these,

100% had grade 1 radiodermatitis in the first evaluation. At discharge assessment, 80% had grade 1 and 20% grade 2. 40 patients were treated with conventional fractionation. In the first evaluation, 93% of the patients had radiodermatitis grade 1 and 7% grade 2. At the end of treatment, 35% had grade 1 and 65% grade 2 radiodermatitis. Conclusions: The data obtained in the study corroborate the data present in the literature. When indicated, hypofractionation is better with regard to the degree of acute radiodermatitis.



CONSTRUÇÃO DE CARTILHA EDUCATIVA PARA MULHERES SUBMETIDAS À BRAQUITERAPIA GINECOLÓGICA COM ALTA TAXA DE DOSEAutores: Aline Mayra Lopes Silva / SILVA, A.M.L / CENTRO REGIONAL INTEGRADO DE ONCOLOGIA (CRIO); Mariana Alves Firmeza / FIRMEZA, M.A / UNIVERSIDADE FEDERAL DO CEARA - UFC; Andrea Bezerra Rodrigues / RODRIGUES, A.B / UNIVERSIDADE FEDERAL DO CEARA - UFC; Maria Eduvirges Marques de Melo / MELO, M.E.M / CENTRO REGIONAL INTEGRADO DE ONCOLOGIA (CRIO); Meiriane Lopes Ximenes / XIMENES, M.L / UNIVERSIDADE FEDERAL DO CEARA - UFC;

Introdução: A radioterapia é um dos tratamentos oncologicos e pode ser definida como um método capaz de destruir células, empregando-se feixes de radiação ionizante. A irradiação pode ser aplicada à distância (teleterapia) ou diretamente no tumor (braquiterapia) (ALMEIDA, PEREIRA, OLIVEIRA, 2008). Na braquiterapia com alta taxa de dose (HDR), faz-se a introdução de sementes ou aplicadores em uma cavidade do corpo, tecido ou canal afetado, sendo depois removidas, muito utilizada nos casos de câncer de colo do útero (INCA, 2015). A longo prazo, o HDR pode levar à estenose e ressecamento vaginal. Em função desses e de outros efeitos colaterais, verificam-se muitos problemas a eles relacionados, como dispareunia e abandono de mulheres pelos parceiros, divórcio após o início do tratamento, ansiedade ou depressão (LIU et al, 2014). O material educativo impresso tem sido utilizado na assistência de enfermagem para melhorar o conhecimento, a aderência ao tratamento e o autocuidado de pacientes. A construção e desenvolvimento de cartilhas educativas (CE) no processo de educação em saúde favorecem a abordagem clara e objetiva de informações e orientações, incluindo as práticas de autocuidado durante o tratamento oncológico (VARELA et al, 2017). Objetivo: Descrever o processo de construção de uma CE sobre HDR para pacientes com câncer de colo uterino, com a finalidade de esclarecer de maneira didática o tratamento e manejo dos possíveis efeitos colaterais. Método: Trata-se de estudo metodológico de construção da CE, constituído por duas fases. A primeira relacionou-se com o levantamento bibliográfico (scoping review) e a segunda com a elaboração da CE.

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 24

Resultados: Foram incluídos, nesta scoping review, 5 artigos e 4 publicações geradas pelos guidelines, teses, dissertações, entre outros, que totalizaram uma amostra final de 9 publicações. A CE, em sua versão preliminar antes da validação com juízes, é composta por 18 páginas, tendo como componentes: capa, sumário, apresentação do tratamento: o que é braquiterapia ginecológica (HDR)?; cuidados voltados para os períodos antes, durante e após as sessões de braquiterapia ginecológica (HDR); possíveis efeitos colaterais do tratamento e cuidados relacionados aos mesmos e referências. Conclusão: Espera-se que o processo de construção da cartilha educativa descrito nesse estudo, possa aprimorar a assistência do enfermeiro oncologista durante o tratamento com HDR e assim promover melhor qualidade de vida às pacientes.

Contato: Aline Mayra Lopes SilvaE-mail: [email protected]


CUTANEOUS EVALUATION OF NURSING IN PATIENTS WITH BREAST NEOPLASIA SUBMITTED TO HYPOFRACTED RADIOTHERAPY: A COMPARATIVE STUDYAutores: Lorraine Barreto Morais Fonseca / Fonseca, L. B. M. / Hospital Escola Álvaro Alvim; Mariana Estevão Ferreira Moraes / Moraes, M. E. F. / Hospital Escola Álvaro Alvim;

Introduction: In Brazil, the estimate for the 2018-2019 biennium points to the occurrence of 59,700 new cases of breast cancer each year. Among the therapeutic resources used to treat the disease, external radiotherapy is the modality that uses high technology through beams of ionizing radiation produced by linear accelerator, in order to prevent multiplication, in addition to causing cell death. This exposure to ionizing radiation leads to the destruction of basal cells of the epidermis, resulting in lesions classified as radiodermites. Control of toxicities is still controversial because there is no consensus among studies. Given this, there is a need for validation of effectiveness in the literature. Goal To compare the efficacy of moisturizing creams for radiodermatitis prevention and treatment in patients with breast cancer undergoing volumetric arc modulated hypofractional radiotherapy (RapidArc) on a Linear Accelerator IX. Method: Field research with in loco analysis where the breast skin of two patients submitted to hypofractionated radiotherapy was observed in a clinic in Campos / RJ. The patients‘ participation was based on the informed consent form signed by them. As a prophylactic indication of radiodermatitis, each patient used a type of moisturizing cream, one based on andiroba, and the other using aloe vera nanotechnology gel. To analyze the result, a nursing consultation based on the RTOG protocol was performed. Results: It was observed that both patients had grade I radiodermatitis in the treated region. However, the patient who used the andiroba-based

moisturizer developed hyperemia and approximately 0.5cm lesion with dry peeling near the surgical scar. The patient who used the aloe vera nanotechnology gel showed only hyperemia, maintaining skin integrity and hydration. Conclusion: The two products evaluated had their efficacy proven in minimizing radiodermatitis in patients treated by hypofractionated radiotherapy. However, aloe vera-based nanotechnology gel demonstrated slight therapeutic gain over andiroba-based moisturizer. Given that radiodermatitis is an inherent toxicity to therapy, a more detailed approach to skin care is required, as well as the use of moisturizers to minimize such effects.

Contato: Lorraine Barreto Morais FonsecaE-mail: [email protected]


FONOAUDIOLOGIA E ENFERMAGEM NO ATENDIMENTO A PACIENTES EM TRATAMENTO RADIOTERÁPICOAutores: Bárbara Luísa Simonetti / SIMONETTI, L.B. / UFCSPA; Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA; Mayara Lindner Brandão / BRANDAO, M.L. / UFCSPA; Iasmim Kasprczak / KASPRCZAK, I. / UFCSPA; Danielle Marques de Azevedo / AZEVEDO, D.M. / UFCSPA; Jerusa dos Santos Dames / DAMES, J.S. / UFCSPA; Jéssica Brinkhus / BRINKHUS, J. / ISCMPA; Bruna Bastos Giergowicz / GIERGOWICZ, B.B. / UFCSPA; Bruna Schroeder Mello / MELLO, B.S. / UFCSPA/ISCMPA; Vera Beatris Martins / MARTINS, V.B. / ISCMPA;

Introdução: A radioterapia é uma abordagem terapêutica utilizada no tratamento de neoplasias malignas. Esta por sua vez, pode acarretar nos mais variados efeitos colaterais, dependendo da localização e do estágio do tumor, o que afeta diretamente na qualidade de vida dos pacientes em tratamento. Objetivo: relatar a atuação da equipe de fonoaudiologia e de enfermagem no ambulatório de radioterapia de um hospital oncológico. Método: relato de experiência. Resultados: no ambulatório de radioterapia são realizadas inúmeras consultas diariamente, com diversos especialistas, dentre eles, enfermeiros e fonoaudiólogos. A inserção do fonoaudiólogo no ambulatório de Radioterapia, se deu pela necessidade de atender as demandas relacionadas as alterações de deglutição, de fala, de voz, de mastigação e de audição, que acarretam em prejuízo estético, funcional e na qualidade de vida. Estas alterações podem advir de cirurgias e de tratamentos prévios, pela neoplasia e/ou pela própria radioterapia. Os campos de tratamento de maior risco são cabeça e pescoço, mama, pulmão e sistema nervoso central. O atendimento ao paciente ocorre através de encaminhamentos de outros profissionais, em especial médicos, nutricionistas e enfermeiros. A enfermagem, neste contexto, atua tanto na preparação do paciente para exames, quanto no controle dos seus efeitos adversos por meio de ações preventivas de sofrimento evitável condicionado aos efeitos colaterais deste tratamento e de cuidado.

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


25

Além de ações que envolvem o atendimento das necessidades biopsicossociais de pacientes/familiares/cuidadores. Conclusão: o trabalho multiprofissional ocorre constantemente entre as duas áreas, uma vez que ambas buscam minimizar os efeitos colaterais decorrentes do tratamento oncológico, e assim, contribuir na melhora da qualidade de vida.



GLIOBLASTOMA MULTIFORME EM PACIENTE PEDIÁTRICO. A ABORDAGEM DA ENFERMAGEM NA RADIOTERAPIA: UM RELATO DE CASOAutores: Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA ; Jéssica Brinkhus / BRINKHUS, J. / ISCMPA; Mayara Lindner Brandão / BRANDAO, M.L. / UFCSPA; Bruna Bastos Giergowicz / GIERGOWICZS / UFCSPA; Bruna Schroeder Mello / MELLO, B.S. / UFCSPA/ISCMPA;

Apresentação do caso: Paciente do sexo masculino, 3 anos e 10 meses de idade, encaminhado ao Serviço de Oncopediatria de um hospital referência na cidade de Porto Alegre para investigação de marcha atáxica e de ptose à direita com apresentação subaguda. Realizada ressonância nuclear magnética (RNM), que apresentava lesão expansiva compatível com glioma de tronco encefálico, comprometendo bulbo, ponte e mesencéfalo. Optou-se por biópsia de lesão intracraniana para avaliação do grau histológico e de possível introdução de quimioterápico, sendo confirmando diagnostico de glioblastoma grau IV da OMS. Criança encaminhada para tratamento radioterápico com 54 Gy em 27 frações, incluindo o uso de temozolamida. Discussão : O GBM é um tumor difusamente infiltrativo, envolvendo grandes porções cerebrais, de crescimento rápido. Embora possa ocorrer em qualquer faixa etária é mais comumente observado em adultos entre 50 a 70 anos de idade, o que contrasta com o paciente relatado no presente caso. Ademais, pacientes jovens tendem apresentar um prognóstico mais favorável. Mesmo sendo um tumor relativamente raro é de particular interesse da área, uma vez que a sobrevida média, após o diagnóstico não ultrapassa 20 meses e apenas 5% alcançam os 5 anos de idade. Quando passível de neurocirurgia, esta deve ser a abordagem inicial, objetivando a ressecção completa da lesão por esta melhorar a sobrevida do paciente quando comparada a ressecção parcial ou biópsia, sendo necessário realizar radioterapia e/ou quimioterapia adjuvante. Durante este período, a enfermagem, deve estar presente durante os processos de intervenção e tratamento, interagindo no cuidar da criança e de seus familiares. Comentários Finais: Durante o tratamento radioterápico, a enfermagem tornou-se de grande importância na abordagem e evolução deste paciente e na interação com seus familiares, explicando os cuidados durante o tratamento e a importância da participação dos mesmos neste processo, ouvindo

suas dúvidas e respeitando suas opiniões para o entendimento do tratamento e importância da sua continuidade, estando cientes do prognóstico reservado, assim melhorando a qualidade de vida desta criança. A humanização requer dos profissionais de enfermagem conhecimento, disposição, interesse ativo, afetividade, flexibilidade, busca por aprimorar o cuidado, responsabilidade, sensibilidade, capacidade de escutar oportunizando a expressão de sentimentos sem pré-julgamentos ou censuras.



IIMPLEMENTATION OF THE HOST SERVICE IN THE A.C. CAMARGO CANCER CENTER RADIOTHERAPY DEPARTMENT AND THE REPERCUSSION ON THE PATIENT‘S THERAPEUTIC JOURNEYAutores: Katia Cristina Trigo Martiniano / Martiniano, K.C.T. / AC Camargo Cancer Center; Samantha de Campos Gonçalves / Gonçalves, S. C. / AC Camargo Cancer Center; Graziela Ferreira Escobar / Escobar, G. F. / AC Camargo Cancer Center; Lais Fernandes da Camara / Camara, L. F. / AC Camargo Cancer Center; Antonio Cassio de Assis Pellizzon / Pellizzon, A.C.A. / AC Camargo Cancer Center;

The patient diagnosed with cancer begins the treatment process under the guidance of a specialist and support from a multidisciplinary team. At this early stage, imaging and laboratory examinations, as well as evaluation by other specialists, are often required to complement disease staging (tumor extension and organ and tissue involvement). In addition to being stressful, this step creates difficulty in understanding deadlines and requirements for the patient. Navigation refers to a direct patient care role that provides individualized support, ensuring consistent information about treatment steps and impacts on daily activities. We decided to reconcile navigation requirements in radiotherapy treatment, with the main purpose of reducing the time interval between diagnosis and initiation of treatment and reducing anxiety for patients and families. This study aims to evaluate the impact of the patients care service referred to the A.C.Camargo Cancer Center radiotherapy department in relation to the care flow. Data were collected from November 2017 to December 2018 through an Excel spreadsheet fed daily based on medical schedules and project host instrument generated through the Electronic Record System MV. 2328 patients with treatment indication were included in this study from January to December 2018. The welcoming project starts with Radiotour after medical consultation with the nursing approach and visit to the physical structure and concludes at discharge from treatment. . After implementing the actions of the multidisciplinary team, there was a reduction in the time between the initial consultation (when the therapeutic plan is proposed) and the planning of up

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 26

to 07 days, corresponding to 30% of the initial time. This program showed us that it is possible to improve processes in various aspects, such as the effective management of the process by the multiprofessional team, implementation of 04 assistance / administrative indicators making the flow more agile, less bureaucratic and safer.



IMPACT OF THE RESEARCH NURSE ON PATIENT RECRUITMENT FOR THE STUDY PERTAIN PET RADIOTHERAPY INTERNATIONALAutores: Valdelania Lamounier / Lamounier VA / Instituto do Câncer do Estado de São Paulo (ICESP) Pesquisa Clínica - Departamento de Radiologia e Oncologia da Faculdade de Medicina da USP.; Heloisa A Carvalho / Carvalho HA / Instituto do Câncer do Estado de São Paulo (ICESP) Serviço de Radioterapia - Departamento de Radiologia e Oncologia da Faculdade de Medicina da USP.; Paulo S Duarte / Duarte PS / Instituto do Câncer do Estado de São Paulo (ICESP) Serviço de Medicina Nuclear - Departamento de Radiologia e Oncologia da Faculdade de Medicina da USP.; Flávia C G Gabrielli / Gabrielli FCG / Instituto do Câncer do Estado de São Paulo (ICESP) Serviço de Radioterapia - Departamento de Radiologia e Oncologia da Faculdade de Medicina da USP.; José Flávio G Marin / Marin JFG / Instituto do Câncer do Estado de São Paulo (ICESP) Serviço de Medicina Nuclear - Departamento de Radiologia e Oncologia da Faculdade de Medicina da USP.; Roberto Arai / Arai R / Instituto do Câncer do Estado de São Paulo (ICESP) Pesquisa Clínica - Departamento de Radiologia e Oncologia da Faculdade de Medicina da USP.; Paulo M G Hoff / Hoff PMG / Instituto do Câncer do Estado de São Paulo (ICESP) Serviço de Oncologia Clínica - Departamento de Radiologia e Oncologia da Faculdade de Medicina da USP.;

Introduction: The PERTAIN study is a multicenter, international study, coordinated by the International Atomic Energy Agency (IAEA), still in progress. The primary objective of the study was to assess the impact on 2-year survival of patients with stage III non-small cell lung cancer (NSCLC) using 18F-FDG PET-CT in radiotherapy planning. Each participating institution should include at least 50 patients submitted to concomitant radiochemotherapy, 25 recruited retrospectively and 25, prospectively over 2 years (later extended to 3 years). From 2008 to 2013, 42 patients were included in the retrospective phase: 23 treated with concomitant radiochemotherapy and 19 with neoadjuvant chemotherapy followed by radiotherapy (allowed in this phase). Recruitment for the prospective phase, which should include only concurrent radiochemotherapy candidates, began in February 2016 and was completed in December 2018. In October 2017, a research nurse was assigned

to collaborate with the studies of the Institution‘s Radiotherapy Service. Objective: To evaluate the impact of the research nurse on the recruitment rate for the prospective phase of the PERTAIN study. Methodology: The annual recruitment rate of the patients was recorded. This rate was evaluated before and after the research nurse‘s participation in the study. Through the analysis of patients schedules, the nurse began to actively search patients, control, collect and periodically record patient data. Results: In 2016, 6 patients were recruited and in 2017, only 4. After the nurse‘s intervention, in 2018, 15 patients were recruited, completing the desired number of 25. Therefore, in one year, there was a relative increase of 50% in the recruitment rate in relation to the sum of the previous 2 years. Comparing year by year, in the third year there was an increase of 120% comparing with the first year and almost four times (375%) comparing with the second year. Conclusion: The collaboration of the research nurse was fundamental for the selection and recruitment of patients, avoiding losses of eligible cases and allowing the institution to reach the desired goal on time.

Contato: Heloisa A. CarvalhoE-mail: [email protected]


INTERVENÇÃO TELEFÔNICA PARA O MANEJO DA FADIGA EM RADIOTERAPIA: PROJETO PILOTO DE ENSAIO CLÍNICO RANDOMIZADOAutores: Aline Mayra Lopes Silva / SILVA, A.M.L / CENTRO REGIONAL INTEGRADO DE ONCOLOGIA - CRIO; Heloisa Cristina de Oliveira Couto / COUTO, H.C.O / CENTRO REGIONAL INTEGRADO DE ONCOLOGIA (CRIO); Andrea Bezerra Rodrigues / RODRIGUES, A.B / UNIVERSIDADE FEDERAL DO CEARÁ - UFC; Maria Eduvirges Marques de Melo / MELO, M.E.M / CENTRO REGIONAL INTEGRADO DE ONCOLOGIA (CRIO); Leandro Araújo Carvalho / CARVALHO, L.A / UNIVERSIDADE ESTADUAL DO CEARÁ - UECE;

Introdução: Entre as formas de tratamento do câncer está a radioterapia que se configura como uma das principais modalidades terapêuticas, usada em aproximadamente 60% dos casos. Entretanto, traz alguns efeitos adversos, que podem ocorrer independente da área de tratamento, como a fadiga. Apesar da alta prevalência de fadiga entre os pacientes em tratamento de radioterapia e do alto impacto na qualidade de vida, esta permanece subdiagnosticada e subtratada pela equipe multiprofissional. Segundo guidelines internacionais, todos os pacientes oncológicos devem receber orientações sobre fadiga durante e após o tratamento. Logo, a monitorização telefônica realizada pelo enfermeiro configura-se como uma estratégia eficaz para fornecer informações, dado que a maioria destas preocupações podem ser abordadas no âmbito da prática de enfermagem. Objetivo: avaliar a eficácia de um programa de ensino via telefônica como

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


27

intervenção de enfermagem no controle da fadiga em pacientes oncológicos submetidos à radioterapia. Método: estudo piloto de ensaio clínico randomizado, que utilizou dois instrumentos: escala de fadiga de Piper validada no Brasil e formulário com dados sociodemográficos e clínicos. Foi realizada a alocação aleatória dos pacientes em uma das duas condições do estudo, sendo para o Grupo Controle (GC): avaliação da fadiga e orientações padrões da unidade de tratamento, e Grupo Experimental (GE): orientação sobre manejo da fadiga via intervenção telefônica. O processo de randomização dos participantes foi realizado, com o auxílio de um estatístico, por meio do programa Epi-Info 7.1.4, com permuta em blocos na taxa de 1: 1. A intervenção telefônica efetuou-se por 03 ligações no decorrer de 06 semanas de tratamento radioterápico. Resultados: Os escores de fadiga apresentados pelo GC aumentaram ao longo das semanas de tratamento radioterápico, enquanto que os do GE diminuíram. Evidenciou-se diferença nos escores, entre os GE e GC, nas três dimensões de fadiga: comportamental, afetiva e sensorial, com melhor desempenho no grupo submetido à intervenção telefônica. Conclusão: verificou-se que o programa de ensino por via telefônica se mostrou eficaz no controle da fadiga. Conclui-se, portanto, que a identificação da fadiga como problema relevante nos pacientes oncológicos deve direcionar a atenção dos profissionais no sentido do seu adequado reconhecimento e manejo.

Contato: Aline Mayra Lopes SilvaE-mail: [email protected]


MANEJO DE FERIDA NA RADIOTERAPIA: UM ESTUDO DE CASA SOBRE CORDOMA SACRALAutores: Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA ; MARCELA METZDORF / METZDORF, M. / HBB; MAYARA LINDNER BRANDÃO / BRANDAO, M.L. / UFCSPA; Bruna Schroeder Mello / MELLO, B.S. / UFCSPA/ISCMPA;

Apresentação do caso: Estudo de caso de paciente em atendimento no ambulatório de radioterapia de um CACON da cidade de Porto Alegre. Sexo masculino, 53 anos, diagnosticado com cordoma sacral e submetido a sacrectomia, retossigmoidectomia, colostomia terminal e reconstrução com retalho miocutâneo com reto abdominal. Em seguimento, apresentou recidiva tumoral nove meses após a abordagem cirúrgica, sendo contraindicada, nova intervenção. Encaminhado ao serviço de radioterapia onde optou-se por realizar 30 Gy em 10 frações no local da recidiva, objetivando o controle da dor e possível redução da neoplasia. A lesão em região sacral apresentava-se com edema, eritema, área necrótica no centro do glúteo máximo a esquerda, sangrante e fétida. Discussão: O cordoma é uma neoplasia epitelial maligna rara que se origina de remanescentes embriológicos da notocorda primitiva. Cerca de 50% dos casos se localiza na região sacral e

constitui na neoplasia primária mais comum dessa região. Sua evolução desfavorável decorre do seu comportamento local agressivo e de sua proximidade a tecidos nervosos e ao arcabouço ósseo da pélvis, o que dificulta a obtenção de margens de ressecção livres. Tendo em vista que são poucos sensíveis à radioterapia e quimioterapia, o tratamento de escolha consiste na ressecção radical complementada ou não com radioterapia adjuvante. No entanto, a avaliação especializada e a utilização de curativos específicos para cada particularidade da lesão, são fundamentais para o alcance de melhores resultados. Comentários finais: no presente caso, uma vez que o mesmo foi considerado irressecável, optou-se pela radioterapia local como tentativa de diminuir ou estabilizar o crescimento da massa e melhora sintomática da dor. Obtivemos bons resultados, com redução tumoral importante e paciente não necessitando manter analgesia. Foram realizados curativos com hidrofibra com prata a cada 72 horas e desbridamento das áreas necróticas. Conseguimos ao fim do tratamento radioterápico, criação de fibrina e a revitalização do tecido. A radioterapia não é utilizada como tratamento isolado devido às grandes dimensões de tumor ao diagnóstico. Está bem indicada após ressecções subtotais visto que sua função é promover o controle local da neoplasia. Na busca da cirurgia oncologica ideal a abordagem multiprofissional é ideal, ponderando com o paciente possíveis sequelas do tratamento.



MANEJO DE REAÇÃO DE PELE INDUZIDA POR RADIOTERAPIA EM PACIENTE COM MAMA VOLUMOSA: RELATO DE EXPERIÊNCIAAutores: yara boaventura da silva / SILVA, Y.B / Hospital Oswaldo Cruz; elizangela maria da silva neves / Neves, E.M.S / Hospital Alemão Oswaldo Cruz;

A radioterapia é indicada em mulheres com câncer de mama após cirurgia conservadora no intuito de reduzir a recidiva loco-regional. A radiodermite é o principal efeito colateral na mama irradiada e pode ser fator limitante para a continuidade das aplicações. Atribui-se a severidade das reações de pele a fatores relacionados à radiação , entre eles, o volume de tecido irradiado. Mulheres com mama volumosa têm maior probabilidade de ter reação de pele e risco de interrupção de tratamento pela severidade da reação local. Medidas preventivas e monitoramento dessas pacientes são relevantes. . Em nossa instituição estabelecemos protocolo de cuidados com pele segundo o grau de reação na pele. Em mulheres com mama volumosa recomendamos além da hidratação, o uso do Mepilex Lite desde o início do tratamento pois tem baixo risco de irritação cutânea e de alergia e pode ser retirado no momento da aplicação evitando o efeito bolus na pele. Paciente senhora de 64 anos com 140 Kg (IMC 51,1) submetida em 09/02/18 a

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 28

setorectomia por carcinoma ductal, evoluiu com deiscência e submetida em 25/02/18 a debridamento e revisão cirúrgica. Em 02/03/18 linfadenectomia axilar sentinela. Estadiamento anatomopatológico PT1b pN0, linfonodo sentinela negativo. O volume planejado de mama foi de 2079,8 cm² em campo tangente paralelo e oposto, SSD 100 e tratamento em Acelerador Clinac 6 Mev em dose total de 50 Gy , dose dia de 2 Gy de 16/04/18 a 21/05/18. Início da radioterapia em 16/04/18 com uso de mepilex e hidratação com gel de aloe vera. Em 26/04/18 (dose acumulada de 18 Gy) com eritema leve em toda a mama (reação grau 1), iniciou hidrogel com alginato de cálcio 1 vez/dia. Manteve eritema leve até 15/05 (dose acumulada de 42 Gy) quando iniciou eritema leve a moderado e em 21/05/18 (dose total de 50 Gy) ao concluir radioterapia apresentava eritema moderado (reação grau 2), com hipercromia em quadrante superior e aréola. No seguimento após radioterapia nas semanas seguintes, em 29/05/18 com eritema moderado, em 05/06/18 com descamação seca e em 03/07/18 com hipercromia leve e área com epitelização completa. As medidas preventivas adotadas e acompanhamento sistemático desde o início da radioterapia possibilitou que a paciente realizasse a radioterapia no prazo programado e após o término do tratamento com descamação seca sem rompimento de integridade da pele.

Contato: yara boaventura da silvaE-mail: [email protected]


MULHERES COM CÂNCER DE MAMA EM TRATAMENTO RADIOTERÁPICO: UM ESTUDO SOBRE A ASSOCIAÇÃO DA ESPIRITUALIDADE COM A QUALIDADE DE VIDAAutores: Mayara Lindner Brandão / BRANDÃO, M.L. / UFCSPA; Thayla Rafaella Pasa Toebe / TOEBE, T.R.P. / UFCSPA; Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA; Eliane Goldberg Rabin / RABIN, E.G. / UFCSPA;

Estima-se que no ano de 2018 ocorreram cerca de 60 mil novos casos de câncer de mama no Brasil, sendo o segundo câncer mais frequente na região Sul. Devido à alta incidência, torna-se cada vez mais importante conhecer os vários aspectos relacionados a esta doença. A radioterapia é um dos principais tratamentos, que consiste em expor o sítio à radiação ionizante, com o objetivo de atingir as células malignas, impedindo seu crescimento e/ou ocasionando morte celular. Os efeitos colaterais dos tratamento radioterápico acabam por comprometer a qualidade de vida (QV) do paciente nos vários domínios, entre eles o espiritual. Entende-se por QV a percepção do indivíduo sobre o seu estado de saúde bio-psico-social-espiritual, enquanto a espiritualidade é a busca pessoal pelo sentido da vida, que pode ou não, levar a práticas religiosas. Esse estudo busca responder se há associação da espiritualidade com a qualidade de vida de mulheres com câncer de mama em tratamento radioterápico. Trata-se de um estudo

transversal, de caráter quantitativo, desenvolvido em um Serviço de Radioterapia pertencente a um Centro de Alta Complexidade em Oncologia (CACON) de Porto Alegre. A pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Instituição sob o CAAE nº 07381819.5.0000.5335. A amostra se constitui de 110 mulheres com câncer de mama, em tratamento radioterápico, no período de maio a julho de 2019, a partir da 10ª sessão de radioterapia. O cálculo amostral se baseou em estudos anteriores; as variáveis sociodemográficos serão coletadas por meio de um questionário específico para este estudo e os demais dados, pelos instrumentos EORTC-QLQ-C30 e WHOQOL-SRPB já validados para o português do Brasil. Espera-se uma associação positiva da espiritualidade com a qualidade de vida. Compreender a espiritualidade como um recurso terapêutico para diminuição do estresse, superação da doença e alívio do sofrimento, melhora a qualidade de vida. O profissional de saúde que busca o cuidado ampliado tende a valorizar todos os aspectos do paciente, estreitando a relação profissional-paciente e ajudando-o a enfrentar as dificuldades durante o percurso do tratamento.



NURSING CONSULTATION IN RADIOTHER-APY: A RETROSPECTIVE COHORTAutores: Luciane Borelli Finatto / Finatto, L.B. / Hospital Moinhos de Vento; André Fontes Laske / Laske, A. F. / Hospital Moinhos de Vento; Janaína da Silva Flôr / Flôr, J.S. / Hospital Moinhos de Vento; Taiana Kessler Gomes Saraiva / Saraiva, T.K.G. / Hospital Moinhos de Vento; Tássia Amanda May / May, T.A. / Hospital Moinhos de Vento;

Introduction: One of the activities of nurses in radiotherapy is the educational actions aimed at patients and their families. All care and prevention of diseases are mapped and discussed during the nursing consultation, which will be repeated during treatment course according to established protocols, as well as identified individualized needs. The nursing consultation is foreseen by the Brazilian Federal Nursing Council Law No. 7,498 of 1986 which defines nursing consultation as a private activity of the Nurse as well as Resolution No. 211 of 1998 establishes the nursing team‘s role in the areas of ionizing radiation reinforcing the role of the nurse. The first consultation consists of anamnesis, physical examination, preparation of individualized care plan and establishment of therapeutic goals that will be reevaluated in the following treatment days. Objective: To identify the scope of patients evaluated within one year and the opportunities for improvement in order to include all the patients who begin treatment. Method: Retrospective cohort study with analysis of data obtained from the institution‘s management systems database, from January to December 2018. Results: The following parameters were analyzed for this study: number of new patients for radiotherapy and number

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


29

at nursing consultations within the 5th radiotherapy fraction; These data were compared, and it was found that the total number of new patients was 1163 and 1118 nursing consultations in the first week of treatment, corresponding to 96.1% of visits, ie, 45 patients were not attended by the nursing team within the established period. The process has been revised with the inclusion of detailed analysis of unreached patients, anticipation of appointments for the simulation day and reorganization of the nursing team‘s priorities, with the intention that 100% consultations will be performed on new patients. Conclusion: The study allowed us to identify the assertiveness percentile to accomplish with the pre-established routine and demonstrated the potential for generating parallel discussions that contributed to the review of care processes. Was also reaffirmed the role of reception and education of the patient by nurses, as a high point for prevention of injuries during treatment and potential for fulfillment with the established therapeutic plan.

Contato: Luciane Borelli FinattoE-mail: [email protected]


NURSING CONSULTATION: GUIDELINES FOR THE CARE OF CANCER PATIENTS AFTER THE END OF RADIOTHERAPYAutores: Suzy Ramos Rocha / Rocha, S. R / INCA; Fabiana Verdan Simões / Simões, F. V. / INCA; Isabele da Rosa Noronha / Noronha, I. R. / INCA; Allana Karine Aureliano da Silva / Silva, A. K. A / INCA; Valdete Oliveira Santos / Santos, V. O / INCA;

Introduction: Radiotherapy, one of the modalities for cancer treatment, uses ionizing radiation, which can cause some adverse effects, especially on irradiated skin, which may remain for three months until years after the end of treatment. In this sense, during the nursing consultation, care should be given to minimize these late effects at the end of treatment. Objective: To identify the evidence available in the literature about the care of cancer patients after the end of radiotherapy. Method: This is an integrative review, conducted from May to June 2018, in the databases LILACS / BDENF via BVS, SCIELO, MEDLINE via PUBMED and CINAHL via EBSCOhost, considering the controlled descriptors radiotherapy, nursing and the uncontrolled descriptor discharge guidelines. We included studies in English, Portuguese and / or Spanish, without temporal delimitation, that addressed the care at the end of treatment, considering brachytherapy or teletherapy. Editorials, case studies, annals and duplicate samples were excluded. Results: A total of 47 studies were identified and only six were selected. In the CINAHL and BDENF databases, no articles matching the inclusion criteria were identified. From the findings, three categories were defined: Skin Care, whose recommendations were related to hygiene, hydrophilic lotion hydration, nutrition and sun protection of the skin, besides evaluating the development of chronic

dermatitis (recall phenomenom). For the Oral Care category, the recommendations were centered on oral hygiene, hydration, laser therapy and associated dental follow-up to assess the risk of necrosis with or without bone exposure and radioinduced caries. The last category, Gynecological Care, corresponds to guidelines related to post-brachytherapy vaginal dilation exercises, which include the use of vaginal dilator. Conclusion: There was a limitation in the literature regarding the recommendations on care after the end of radiotherapy. Thus, it is suggested the development of more studies on the theme that better guide the practice of nurses.

Contato: Fabiana Verdan SimõesE-mail: [email protected]


PERFIL DOS PACIENTES ATENDIDOS NO SERVIÇO DE RADIOTERAPIA DE UM HOSPITAL PRIVADO DO SUL DO BRASILAutores: Luciane B Finatto / Finatto, L. B. / Hospital Moinhos de Vento; André Fontes Laske / Laske, A. F. / Hospital Moinhos de Vento; Daniela Vargas Barletta / Barletta, D.V. / Hospital Moinhos de Vento; Francine Xavier da Silveira dos Santos / Santos, F.X.S. / Hospital Moinhos de Vento; Janaína da Silva Flôr / Flôr, J.S / Hospital Moinhos de Vento; Taiana Kessler Gomes Saraiva / Saraiva, T.K.G / Hospital Moinhos de Vento; Tássia Amanda May / May, T.A / Hospital Moinhos de Vento;

Introdução: A Organização Mundial da Saúde estima que haverá 18,7 milhões de novos casos diagnosticados com câncer por ano no mundo, sendo 9,6 milhões de morte. A incidência cumulativa mundialmente, aponta que 1/5 dos homens e 1/6 das mulheres irão desenvolver câncer ao longo da vida, sendo que 1/8 homens e 1/10 mulheres irão morrer em decorrência desta doença, porém é importante ressaltar que com os avanços tecnológicos, o índice de curabilidade vem aumentando. A radioterapia é amplamente utilizada como parte do tratamento do paciente oncológico, sendo empregada em aproximadamente 60% de todos os casos de tumores malignos diagnosticados, ou seja, a radioterapia será utilizada em uma das suas etapas evolutivas, seja de forma exclusiva, seja associada à cirurgia ou à quimioterapia. Objetivo: O objetivo deste estudo foi avaliar o perfil epidemiologico dos pacientes submetidos a tratamento radioterápico em um serviço de radioterapia de um hospital privado do sul do Brasil. Método: estudo de coorte retrospectiva com analise de 1.129 prontuários de pacientes tratados no hospital deste estudo, compreendendo o período de janeiro a dezembro de 2018. Resultados: Para este estudo foram analisados os seguintes parâmetros: sexo, idade e área de tratamento. Do total de 1.129 pacientes no ano de 2018, 42% eram do sexo masculino e 58% do sexo feminino; paciente com idade de 0 a 20 anos foram 0,6%; de 21- 40 anos foram 8,7%; de 41-60 anos foram de 28,6%; de 61 80 anos foram de 54%

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 30

e de 81 100 anos foram de 8,1%. O paciente mais novo submetido à radioterapia apresentou idade de 5 anos e o mais velho de 98 anos de idade. As áreas mais tratadas foram mama 33,3% e próstata 19%. De todos os pacientes tratados, 165 fizeram radioterapia em área de metástase, totalizando 14,6% do total de pacientes tratados. Conclusão: Conhecer a população atendida e a prevalência das áreas tratadas neste serviço possibilita implementar medidas qualificadas para atendimento destes pacientes. Uma equipe multidisciplinar comprometida em minimizar os danos e fornecer orientações precisas para que o paciente siga seu tratamento de maneira segura e adequada juntamente com o perfil epidemiologico dos pacientes oncológicos tratados no serviço de radioterapia desde hospital, contribuem para o planejamento das atividades desenvolvidas.

Contato: Luciane Borelli FinattoE-mail: [email protected]


PLANO DE CUIDADO CENTRADO NO PACIENTE EM RADIOTERAPIA: PRODUTO DE MESTRADO PROFISSIONAL EM ENFERMAGEMAutores: Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA; Bruna Bastos Giergowicz / GIERGOWICZS, B.B. / UFCSPA; Duan Renato da Silva Fraga / FRAGA, S.R. / UFCSPA; Mayara Lindner Brandão / BRANDAO, M.L. / UFCSPA; Rosália Figueiró Borges / BORGES, F.R. / UNISINOS; Roberta Waterkemper / WATERKEMPER, R. / UFCSPA;

Introdução: A radioterapia é muito usada no tratamento de neoplasias malignas e, embora possibilite a cura para diversos cânceres em estágios iniciais, ela também possui efeitos adversos de curto, médio e longo prazo. Tais efeitos são os sintomas que afetam a qualidade de vida do paciente de forma significativa e exigem assistência de enfermagem qualificada. São poucos os estudos publicados sobre a implementação e estruturação do processo de enfermagem nesta área. Objetivo: Propor um Plano de Cuidado de Enfermagem Centrado no Paciente oncológico submetido ao tratamento radioterápico. Método: Pesquisa qualitativa do tipo Convergente Assistencial realizada em 5 fases: Concepção; Instrumentação (Dividida em Momento 1 (M1) antes da radioterapia, Momento 2 (M2) metade da radioterapia e Momento 3 (M3) final do tratamento, para a identificação das necessidades de saúde por meio de análise secundária de dados e a revisão sistemática), Perscrutação; Análise e Interpretação. A pesquisa foi aprovada pelo Comitê de Ética da Instituição sob CAAE: 76806317.6.0000.5335. Resultados: Desenvolvido a partir de 223 prontuários de pacientes analisados e fundamentado nos achados da RS. As intervenções enfocaram cuidados com a pele, mucosas, desenvolvimento psicossocial, conforto do paciente e dor aguda. O Plano segue a linha de cuidado desde a primeira consulta de enfermagem, a qual

é direcionada para Educação em Saúde e Cuidados Preventivos a toxicidades até o final do tratamento com sugestões de intervenções para o tratamento de algumas toxicidades. Neste enfoque, pode-se destacar a efetividade/utilização da Calendula officinalis e do mel de tomilho. Conclusão: O cuidado centrado no paciente/família em tratamento radioterápico é uma necessidade para o planejamento de intervenções de enfermagem efetivas, que proporcionem qualidade e segurança. Dentre os problemas da fase inicial do tratamento radioterápico, destaca-se o diagnóstico de enfermagem de Risco de Integridade da Pele Prejudicada. Pela ação do tratamento e prevalência de desenvolvimento de toxicidades a radiodermite é a mais comum quanto a pele e a mucosite na mucosa de todo o trato gastrointestinal. Os efeitos e os graus de toxicidade surgem no decorrer do tratamento (M2 e M3) e intensificam-se no M3 quando fatores psicossociais são envolvidos. A atenção do profissional de enfermagem é fundamental nesse processo, uma vez que existe a tendência de cuidado voltado especialmente para o biológico do paciente.



PREPARATION OF NURSING GUIDES FOR RADIOTHERAPY TOXICITY GUIDELINESAutores: Jéssica Rodrigues Gonçalves / Gonçalves , J.R. / Hospital Imaculada Conceição de Curvelo-MG; Marília Lisboa Roca Santo / Santo, M. L. R. / Hospital Imaculada Conceição de Curvelo-MG; Carla Beatriz da Silva Coura / Coura, C .B. S. C. / Hospital Imaculada Conceição de Curvelo-MG; Rossana Souto Fargnole / Fargnole, R. S. / Hospital Imaculada Conceição de Curvelo-MG; Heriberto Bicalho Martins / Martins, H. B. / Hospital Imaculada Conceição de Curvelo-MG; Stephanie Reis Ramacciotti / Ramacciotti, S. R. / Hospital do Amor; Felipe Teles de Arruda / Arruda, F. T. / Hospital Imaculada Conceição de Curvelo-MG;

Introduction: The nursing team plays a fundamental role in the overall care of patients. In radiotherapy, among several attributions, the nurse plays a very important role in guiding the toxicities that patients may present. Therefore, this article presents the strategies used for the formulation of guidelines. patient guidelines that will undergo radiotherapy. Objective: To demonstrate how the nursing guide for toxicity guidelines for patients undergoing radiotherapy was constructed. Method: The guides were prepared for the radiotherapy service of the Immaculate Conception Hospital of Curvelo-MG, covering the main places commonly irradiated in order to serve as a reference to patients and professionals involved in the patient‘s educational process. Results: A total of 10 guides were developed as follows: Guide for Central Nervous System Radiotherapy Patients, prostate, pelvis, skin, soft tissues or bones, chest, breast, head and neck, abdomen, brachytherapy. The basic information for all guides was: 1. Radiotherapy treatment is outpatient.

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


31

2. Should be done daily from Monday to Friday. The radiotherapy doctor will tell you how many days of treatment will be. 3. Radiation is invisible and causes no pain during treatment. 4. Skin markings should be maintained until the end of treatment. 5. Treatment is localized, so it acts in a specific location, not reaching other locations outside the irradiation field and will be repeated the same every day. 6. No need for fasting before treatment, food or personal medications do not interfere with treatment. 7. Skin reactions may occur at the treatment site, do not apply creams to the area without medical advice. 8. The person does not become radioactive and presents no danger to others. 9. Each patient receives individual treatment and is not the same as another patient. 10. If you need medical certificates, reports and / or prescriptions, please ask our receptionists seven (7) days in advance. Information on the orientation of the treatment steps was inserted: first consultation, nursing guidance, simulation and / or planning, treatment and reviews, and the specific toxicities of each treatment site based on the literature. Conclusion: In addition to patient care, the radiotherapy nursing team needs to have the health education process inserted in their daily lives as an action strategy. This can use reference guides to homogenize information and ensure that it will be transmitted in its entirety.

Contato: Felipe Teles de ArrudaE-mail: [email protected]


PULVERIZED METRONIDAZOLE FOR NEOPLASTIC WOUNDS DURING RADIOTHERAPY TREATMENT : CASE STUDYAutores: ANA KAROLINA ISABEL DE ANDRADE / Andrade, A. K. I. / HOSPITAL SANTA PAULA; DANIELA CARVALHO DA SILVA / Silva, D. C. / HOSPITAL SANTA PAULA; ANDRÉA COLETTI CIGLIO / Ciglio, A. C. / HOSPITAL SANTA PAULA; ADRIA DE MORAIS SOUZA / Souza, A. M. / HOSPITAL SANTA PAULA;

Patients presenting neoplastic wounds during radiotherapy treatment on private hospital at Sao Paulo City. Patient A, an 70 years old patient was diagnosed with stage II squamous cell carcinoma (SCC) of the scalp in December of 2018. 35 sessions of Radiotherapy of head was indicated. Patient completed 30 sessions between January and march of 2019. On first session, presents 16cm x 5cm neoplastic wound, vegetative tissue, stage III purulent exudate with strong odor (score 4). Patient B, an 52 years old patient with GH1GN1 left breast invasive carcinoma. 13 sessions of Radiotherapy was indicated and completed. Since February of 2019 presents neoplastic wound. On first session presents 15cm X 15cm neoplastic wound, vegetative tissue, stage II purulent exudate with moderate odor (score 3). Interventions: Patient A - Crushed Metronidazole 250mg tablets pulverized after each session of radiotherapy. Homecare management with polihexanide associated to silver

hydroalginate dressing was indicated. Patient B - Crushed Metronidazole 250mg tablets pulverized after each session of radiotherapy. Homecare management with polihexanide associated to silver sulfadiazine cream and cerium nitrate was indicated. Outcomes: Patient A - Neoplastic wound presents 10cm x 1cm and no odor (score 1) purulent exudate stage I. Patient B - Neoplastic wound presents 10cm x 10cm and no odor (score 1) purulent exudate stage I. Conclusions: Concerning guidelines to metronidazole administration on neoplastic wounds treatment, and considering low costs and easy accessibility for patients we decide to use pulverized tablets. During treatment was possible to note decrease of wound size and exudate odor and an improvement on patients quality of life.

Contato: Ana Karolina Isabel de AndradeE-mail: [email protected]


RADIODERMATITIS INCIDENCE IN PATIENTS WITH CANCER IN A UNIVERSITY HOSPITAL OF RIO DE JANEIROAutores: DAYSE DO NASCIMENTO WASSITA / WASSITA, D.N / UERJ; Angeli Soares de Souza / Soares, A. S / UERJ; Ciléa do Nascimento Silva Ramos / Ramos, C.N.S / UERJ; Claudete Ferreira de Albuquerque / Albuquerque, C.F. / UERJ; Giselli Baião Ribeiro Silva / Silva, G.B.R / UERJ; Antonio Augusto de Freitas Peregrino / Peregrino, A.A.F / UERJ;

The Radiotherapy consists in a clinical mode, in which it is used ionizing radiation for the purpose of treating cancer. Among the adverse effects arising from treatment, it highlights the radiodermatitis, a skin reaction which is characterized by hyperemia, hypersensitivity, swelling, pain, itching or scaling. According to the side effect, there may be a temporary suspension of treatment, which may impair future quality of life. This study aims to carry out an analysis of radiodermatitis in cancer patients submitted to radiotherapy according to the classification RTOG as the degree of severity having as purpose to survey the indicators to better serve the clients assisted by nursing consultation held weekly. A retrospective documentary research was conducted through the medical records of cancer patients in the radiotherapy sector of UNACON / UERJ. The samples consisted of 394 patients undergoing radiotherapy during the period 4 January 2016 to 07 December 2018, among which 65 patients with head and neck cancer, 168 patients with breast cancer, 65 patients of male pelvis cancer (rectum and anal canal) and 96 female pelvis (anal canal, rectum, cervix and endometrium) . Data were analyzed using the excel spreadsheet. Patients with radiodermatitis in the head and neck area in 2016 totaled ( 50% ) males with radiodermatitis degree 1; female gender (66.7%) degree 1; in 2017 patient male (69.2%) degree 1 and female (66.7%) degree 1; in 2018 male (72 %) degree 1 and female (75%) degree 1; in the breast area was identified in the year 2016 degree

E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 32

0 (51.7%), in 2017 (60%) degree 1; in 2018 (64.1%) degree 1; in the male pelvis area at 2016 (64.7) degree 0; 2017 (80%) degree 0; 2018 (47.4%) degree 0; female pelvis in 2016 ( 57.2%) degree 0, (19.7%) degree 1, (21.8%) degree 2 and (1.4%) degree 3. We conclude that the modality of nursing consultation weekly treatment has been shown to be effective in giving patients the minimization of adverse skin effects from treatment. Words: Radiodermatitis. Nursing Consultation

Contato: Ciléa do Nascimento Silva RamosE-mail: [email protected]


RADIODERMATITIS RISK FACTORS: AN INTEGRATIVE REVIEWAutores: Allana Karine Aureliano da Silva / Silva, A. K. A / INCA; Isabele da Rosa Noronha / Noronha, I. R / INCA; Fabiana Verdan Simões / Simões, F. V. / INCA; Valdete Oliveira Santos / Santos, V. O. / INCA; Suzy Ramos Rocha / Rocha, S. R. / INCA;

Introduction: Radiodermatitis is a common side effect in câncer patients undergoing radioterapy, whose onset and intensity is associate of several risk factors related to the person or treatment. These reactions may affect the therapeutic schedule and the quality of life of patients. Objective: To identify the available evidence in literature about risk factor for radiodermatitis. Method: this is na integrative review, performed in the CINAHL databases through EBSCOhost, MedLine/Pubmed, EMBASE and LILACS, BDENF through BVS, in May and June 2019, using the descriptors risk factor, radiodermatitis. Inclusion criteria were: articles in português, english and spanish, related to the thematic. Review article, case studies, annals and duplicate samples were excluded. There was no temporal delimitation. The articles were reviewed by two authors and when necessary a third was consulted. No critical appraisal of the studies was performed. RESULT: 164 articles were found, of which 3 were delected by duplication and 140 for not answering the research question, and the sample consisted of 21 articles. From the analysis, 3 categories were defined according to the risk factors for acute and late radiodermatitis, related to the individual and treatment, and grouped by irradiated área. In the breast category, risk factors were IMC >25, breast size, volume, height, smoking during radiotherapy, black race, inframammary fold área, post menopause, younger age, bra size, genetic factors, absence of allergy, axillary fat thickness, distance between pectoral muscle and nipple higher disease stage, previous and concomitant hormone therapy, conventional fractionation, beam energy, immobilization device, collimator and physical filter. In the head and neck category: older age, P16 expression, elevated IMC, smoking, anemia, concomitant treatment with chemotherapy and external beam and cumulative doses of skin >7Gy> for

category anoretal correspond to high IMC, smoking, concomitant treatment with chemotherapy and external beam. Conclusion: knowledge of risk factors allowa better planning of nursing interventions and evaluations of unwanted effects of radiotherapy. In this sense, the development of studies on the subject in other irradiated áreas is important.

Contato: Fabiana Verdan SimõesE-mail: [email protected]


RADIODERMITE INCIDENCE IN A RADIOTHERAPY SERVICEAutores: Rhaissa Ferreira de Andrade / ANDRADE, R. F. / Hospital Erasto Gaertner; Ana Paula Carneiro Zacarchuka / ZACARCHUKA, A. P. C. / HOSPITAL ERASTO GAERTNER; Angélica Moura de Oliveira / OLIVEIRA, A. M. / HOSPITAL ERASTO GAERTNER; Bárbara Mancio Santos / SANTOS, B. M. / HOSPITAL ERASTO GAERTNER; Bárbara Reis Braga de Sousa / SOUSA, B. R. B. / HOSPITAL ERASTO GAERTNER; Luana Veloso Santiago / SANTIAGO, L. V. / HOSPITAL ERASTO GAERTNER; Andrea Velasco dos Santos Silva / SILVA, A. V. S. / HOSPITAL ERASTO GAERTNER; Edenice de Oliveira Santana / SANTANA, E. O. / HOSPITAL ERASTO GAERTNER;

Introduction: Radiotherapy is a locoregional treatment modality that can be used exclusively or concomitantly with other treatment modalities. Radiotherapy can cause several side effects, one of the most common being radiodermatitis. Radiodermatitis is an acute skin reaction characterized by a set of external and internal lesions caused by exposure to ionizing rays. It can be classified according to the Radiation Therapy Oncology Group (RTOG) in grades: 0, I, II, III and IV. This acute effect directly affects the patients life quality and may impair their segment in treatment, as in some degrees of radiodermites treatment may be interrupted. Goals and Objectives: To identify the incidence of radiodermatitis by degree in patients undergoing radiotherapy treatment at an oncology hospital in southern Brazil from January 2017 to December 2018. Methodology: Retrospective, quantitative and descriptive study conducted in a cancer hospital in the southern region of the country. Data were obtained from the TasyR institution‘s information system and analyzed within Microsoft Office Excel 2010. Results: We identified 1,776 patients who had radiodermatitis during treatment. Regarding the RTOG classification, the patients presented: 907 (50%) grade 0, 671 (38%) grade I, 154 (9%) grade II, 37 (2%) grade III and 7 (1%) grade IV. Conclusion: The grades 0 and I were the ones with the highest incidence. This incidence may be justified by early evaluation, identification and treatment of lesions in consultations with the cancer nurse.

Contato: Edenice de Oliveira SantanaE-mail: [email protected]

E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


33


RADIODERMITE MANAGEMENT THROUGH EVIDENCE-BASED PRACTICE: A LITERATURE REVIEWAutores: Aline de Oliveira Ramalho / Ramalho, A.O / Hospital Sírio Libanês; Elizabete Duarte Alves / Alves, E. D. / Hospital Sírio Libanês; Eliane Mazocoli / Mazocoli, E. / Hospital Sírio Libanês; Júlia Drummond de Camargo / Camargo, J. D. / Hospital Sírio Libanês;

Being considered by many as inevitable, commonly radiodermatitis is treated empirically or untreated. Thus, the objective of this study was to identify and analyze the available evidence for radiodermatitis prevention and treatment in order to improve the standardization of nursing care and assistance to the population. Methodology: This is an integrative literature review, with qualitative analysis, searching the BVS, LILACS and SCIELO databases and including articles published in the last five years using the following descriptors: radiodermatitis, oncologic nursing, prevention and treatment in Portuguese, English and Spanish. Based on the predefined inclusion and exclusion criteria, 36 articles for discussion were listed. Results: We found a great variability of agents and skin care, however it was possible to identify the most described care and with greater degrees of scientific evidence, thus allowing us to define indications and contraindications of care. Interventions that proved beneficial: Patient education may decrease the incidence of radiodermatitis and its severity. Hygiene and skin hydration measures in acute radiodermatitis. Indication of the use of topical corticosteroids as a treatment for wet peeling. Calendula cream proved to be safe for radiodermatitis management, but with little scientific evidence. For treatment, studies point to the use of silicone dressings and/or polyurethane foams as a contributing factor to improve pain and friction in affected patients. Interventions that have no benefit include the use of essential fatty acid, dexpanthenol or sucralfate cream, aloe vera or trolamine cream, preventive corticosteroids: EGF cream, Hyaluronic acid, Hydrocolloid and hydrogel dressing (may worsen the degree of radiodermatitis). Conclusion: The standardization of care and guidance offered to patients undergoing radiotherapy can contribute to the prevention and effective treatment of this complication, improving the quality and safety of the service provided. It is noteworthy that there are still many experimental studies in the literature, strengthening the need for further research, as well as implementation of evidence-based protocols in health services and monitoring its effectiveness.

Contato: Aline de Oliveira RamalhoE-mail: [email protected]


RADIOTERAPIA: ATUAÇÃO CONJUNTA DA ENFERMAGEM E FONOAUDIOLOGIA EM UM CASO DE GLOSSECTOMIA TOTAL EM PACIENTE JOVEMAutores: Bárbara Luísa Simonetti / SIMONETTI, B.L. / UFCSPA; Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA; Danielle Marques de Azevedo / AZEVEDO, D.M. / UFCSPA; Iasmim Kasprczak / KASPRCZAK, I. / UFCSPA; Jerusa dos Santos Dames / DAMES, J.S. / UFCSPA; Mayara Lindner Brandão / BRANDÃO, M.L. / UFCSPA; Bruna Bastos Giergowicz / GIERGOWICZ, B.B / UFCSPA; Vera Beatris Martins / MARTINS, V.B. / ISCMPA;

Apresentação do caso: trabalho aprovado pelo Comitê de Ética em Pesquisa sob parecer nº 3.109.023. Paciente do sexo feminino, 19 anos, boliviana, submetida a cirurgia de glossectomia total, com esvaziamento cervical bilateral de nível I ao IV e reconstrução com retalho microcirúrgico de músculo antero-lateral da coxa, precisou fazer uso de cânula de traqueostomia, além de sonda nasoenteral para alimentação. Como tratamento adjuvante, foi proposto quimio e radioterapia 66 Gy em 34 sessões. Durante a permanência da paciente no ambulatorio de Radioterapia, a mesma foi acompanhada pelas equipes de enfermagem e fonoaudiologia, concomitante ao atendimento médico. A enfermagem atuou diretamente na orientação e prevenção. Desde a primeira consulta, instruiu paciente e familiar quanto aos cuidados relacionados a cânula de traqueostomia, sonda nasoenteral, cuidados com a pele e aos efeitos da radioterapia no organismo. A fonoaudiologia, por sua vez, realizou avaliação clínica e terapia fonoaudiológica objetivando o restabelecimento da função de comunicação oral efetiva e da alimentação via oral segura. Discussão: o diagnóstico e tratamento de câncer de língua em adultos jovens impacta negativamente na qualidade e estilo de vida. Estes se deparam com o confronto prematuro com a mortalidade, mudanças físicas, efeitos colaterais dos tratamentos oncológicos, aumento da dependência dos pais e alterações na vida familiar, social e escolar. Necessitam assim, de atendimento individualizado com uma equipe multiprofissional. Comentários finais: neste caso, paciente jovem, oriunda de outro país, com outra cultura e sem domínio do idioma local recebeu o atendimento e acolhimento pelas equipes de enfermagem e fonoaudiologia, que contribuíram significativamente no processo de reabilitação funcional das estruturas alteradas durante o tratamento radioterápico.


E-PÔSTER


Braz J Oncol. 2019; 15(Supl.3): 1-82 34


SARCOMA EPITELIÓIDE DE REGIÃO PUBIANA TRATADO COM RADIOTERAPIA: UM ESTUDO DE CASOAutores: Aline Moraes de Abreu / ABREU, A.M. / UFCSPA/ISCMPA; MARCELA METZDORF / METZDORF, M. / HBB; Mayara Lindner Brandão / BRANDAO, M.L. / UFCSPA; Bruna Schroeder Mello / MELLO, B.S. / UFCSPA/ISCMPA;

Apresentação do Caso: Paciente do sexo masculino, 38 anos, portador de sarcoma epitelioide de partes moles em região pubiana, diagnosticado em agosto de 2008. Até a presente data, apresentou três recidivas, com retirada do testículo esquerdo em 2014. Ao todo, realizou sete procedimentos cirúrgicos, dois tratamentos radioterápicos e um tratamento quimioterápico. Lesão inicial no ano de 2008, medindo 8,3 x 6,0 x 6,0 cm e pesando 37 gramas. Na atual recidiva, em outubro de 2016 apresentava lesão ventral à sínfise púbica, medindo cerca de 8,0 x 7,0 x 4,2 cm, e identificaram-se vários linfonodos inguinais à direita sendo o maior medindo 1,6 x 1,0 cm. Discussão: Sarcoma epitelióide é um tipo raro de sarcoma de partes moles, correspondendo a menos que 1% de todos os subtipos. Apresenta-se mais frequentemente em jovens do sexo masculino e acomete principalmente as extremidades dos membros superiores, podendo acometer outros locais, como períneo, vulva e pênis. A recorrência local após ressecção do tumor primário é alta, ocorrendo em torno de 50% dos casos. Apesar da alta taxa de metástase para linfonodos regionais, com dados na literatura variando de 23 a 44%, a linfadenectomia profilática e a radioterapia nas cadeias linfonodais devem ser evitadas. Porém, a linfadenectomia terapêutica está indicada nos casos de metástases linfonodais como tratamento curativo. Porém, a linfadenectomia terapêutica está indicada nos casos de metástases linfonodais como tratamento curativo. Comentários finais: Não existe uma abordagem terapêutica bem definida para o sarcoma epitelioide. Os trabalho publicados na literatura são limitados a pequenas séries, como seguimento curto. A abordagem terapêutica é multidisciplinar e a cirurgia deve ser a ressecção ampla com margens, sempre que factível. O tratamento com radioterapia pode ser empregado na adjuvância ou paliativo, com dose mediana de 50Gy. As orientações fornecidas durante todo o tratamento do nosso paciente pela equipe multidisciplinar que acompanhou o caso, tornaram-o ciente de suas perspectivas negativas com relação ao desfecho do caso, motivando-o a manter-se durante o tratamento, independente dos efeitos colaterais advindos do mesmo. Dessa forma, o paciente teve a oportunidade de organizar-se, planejar e realizar seu desejo de ser pai enquanto havia condições para tal.



THE IMPACT OF REMOTE MONITORING ON PATIENT QUALITY OF LIFE AFTER RADIOTHERAPY TREATMENTAutores: Samantha de Campos Gonçalves / Gonçalves, S. C. / AC Camargo Cancer Center; Lais Fernandes da Camara / Câmara; L. F. / AC Camargo Cancer Center; Katia Cristina Trigo Matiniano / Martiniano; K. C. T. / AC Camargo Cancer Center; Graziela Ferreira Escobar / Escobar; F. E. / AC Camargo Cancer Center;

Patients undergoing outpatient radiotherapy need support to manage the toxicities that affect their well-being. The nurse plays a fundamental role in education and support to patients undergoing radiotherapy, but the impact of care is still poorly reported. Remote assistance, through telecommunication, allows proximity to the patients when they are geographically far away and in need of care that provides comfort, safety and quality of life. This study aimed to evaluate the impact of remote monitoring on patients‘s quality of life in AC Camargo Cancer Center radiotherapy. This is a retrospective analytical study, with data collected through a free-call approach performed after 07 days of discharge. The study included patients who has completed treatment from January to December 2018, underwent nursing discharge and received a call. Inpatients and unsuccessful calls after 03 attempts totaling 1599 patients were excluded. All cases were classified with improved status, unchanged and worse compared to discharge. The identified complaints related to the skin in the worsened group were pain and burning, hyperpigmentation and hyperemia, itching, dry or wet peeling, blisters and dryness of the skin. According to the referred symptoms and the classification of radiodermatitis according to the Radiotherapy Toxicit Oncology Group, 60% did not worsen the lesion, 20% evolved from grade 01 to 02, 16% grade 0 to 01, 3% grade 01 to03 and 2% from grade 02 to 03. Follow-up after discharge enables the early identification of side effects, clinical deterioration and the clarification of doubts offering support. This contact emerges as an amplifier of the patient‘s bond with the team, as well as ensuring follow-up when necessary and increasing quality of life. After contact 52% of patients demanded return for reevaluation of the nurse and 5% were advised to seek emergency care. Remote monitoring has been of great value in caring for patients who feel welcome, safe and in control of their treatment and recovery. With the maturation of the project it was possible to elaborate a structured data collection instrument and actions that include the follow-up from the first contact until the recovery.


E-PÔSTER

Braz J Oncol. 2019; 15(Supl.3): 1-82


35


TOXICITY PROFILE OF HEAD AND NECK CANCER PATIENTS TREATED WITH RADIOTHERAPY AT HOSPITAL MÃE DE DEUSAutores: Thais Pires Flores / Flores, T / Hospital Mãe de Deus; Fabíola Franco Locatelli / Locatelli, F / Hospital Mãe de Deus; Maryana Schwartzhaupt de Matos / Matos, M / Hospital Mãe de Deus; Andréa Barleze da Costa / Costa, AB / Hospital Mãe de Deus;

Introduction: Head and neck cancer represents about 10% of malignant tumors. Most treatment protocols include radiotherapy at some point, and in some cases radiotherapy is performed in conjunction with chemotherapy. Patients undergoing head and neck radiotherapy often have significant acute toxicities that may lead to treatment interruption, a factor that impacts the effectiveness of radiotherapy in combating head and neck cancer. Objective: To describe the toxicity profile of patients treated with radiotherapy at Hospital Mãe de Deus. Methodology: Patients undergoing head and neck radiotherapy since 2018 were evaluated for the main expected effects of treatment. All were treated with VMAT, had dental and nutritional monitoring and underwent daily laser therapy. Clinical conditions regarding mucositis, chewing, swallowing, salivation and taste at the beginning, middle and end of the course of treatment were evaluated. Patients were also classified according to the RTOG toxicity scale. Regarding mucositis, 72% of patients had grade 2 and 28% grade 3. Mucositis patients who had grade 3 underwent radiotherapy and concomitant chemotherapy. 54% of patients had little chewing difficulty at the beginning of treatment, but at discharge 64% of patients had very hard chewing. At the beginning of radiotherapy most patients had little or no difficulty in swallowing (90%) and at the end of radiotherapy about 50% of patients showed difficulty in swallowing. The most relevant factor of toxicity shown in the study was loss of salivation throughout treatment. At first more than 80% of patients had little or no change in salivation, at the end at least 70% had xerostomia. All patients had grade 2 in the RTOG toxicity classification and no patient needed to pause treatment. Conclusion: Although still presenting acute acute toxicities, treatment of head and neck cancer with VMAT and management of the multidisciplinary team is less aggressive and less toxic than in the literature.



USE OF NEOPRENE MASK - Case report: PATIENT AWARENESS DURING OR RADIOTHERAPY TREATMENTAutores: Tance Botelho / Botelho, O. T / Oncoclinicas ; Luciana Cristina Macias Alião / Alião, C. L / Oncoclinicas; Wesley da Costa Viana / Viana. C. W / Oncoclinicas;

Angiosarcoma is a rare and aggressive subtype of vascular sarcoma that affects the head and neck region in more than half of the cases especially the scalp. The case report referred to a 78-year-old male patient diagnosed with scalp epithelioid angiosarcoma with scattered lesions. When diagnosing treatment with systemic chemotherapy and due to a good chemotherapy response concomitance with local radiotherapy throughout the scalp was indicated by IMRT-RapidArc associated with 5mm neoprene mask and immobilization mask. Radiotherapy is one of the forms of treatment particularly the irradiation of the entire scalp due to its infiltrative characteristics and conventionally it uses the combination of photon and electron beams in lateral fields with wax bolus or superflab for dose superficialization. Due to the convexity of the entire scalp this type of bolus has disadvantages in daily reproducibility and air gap formation which may interfere with dose distribution. However, a treatment technique already described in the literature was chosen through IMRT which allows a more precise concave dose distribution, with protection of adjacent structures (brain) associated with a 5mm thick Neoprene mask for bolus effect. Therefore, the patient had to wear both masks (Neoprene + immobilization) during the treatment day which is the great challenge of this new form of treatment. The main of this report was to demonstrate the patient‘s tolerance to the technique employed in face of the daily positioning challenge made by the nursing staff and radiotherapy technicians so that the treatment could be successfully completed. Finally, it was evident that this innovative technique despite its challenges had optimistic results. The nursing team played a fundamental role in sensitizing this patient as well as the technical team in managing it daily.

Contato: Tance Oliveira BotelhoE-mail: [email protected]

BRAIN METASTASIS OF BREAST CANCER TREATED WITH ...

Documents

Transcript of BRAIN METASTASIS OF BREAST CANCER TREATED WITH ...