High-dose-rate interstitial computed tomography-based brachytherapy for the treatment of cervical cancer: Early results

PurposeThere is limited published data on high-dose-rate interstitial brachytherapy (HDRBT) for cervical cancer resulting in no consensus on a fractionation schedule. This study reports our experience of CT-based HDRBT for treating locally advanced cervical cancer.Methods and MaterialsForty-seven patients diagnosed with Stage IIB–IVA cervical cancer not suitable for intracavitary brachytherapy were treated with HDRBT from March 2005 to November 2010. All patients received external beam radiation therapy with a median dose of 45 Gy and all had one interstitial implantation followed by 3.75–5 Gy × 5 fractions in a twice daily (BID) schedule. Total doses for clinical target volume and organs at risk, including rectum, bladder, and sigmoid, were summated and normalized to a biologically equivalent dose of 2 Gy per fraction. At 3 months posttherapy, early response was assessed with clinical examination and positron emission tomography (PET/CT) imaging.ResultsMedian clinical target volume D₉₀ (dose delivered to 90% of the clinical target volume) was 76.3 (59.0–86.9) Gy and the 2 cc dose to the bladder, rectum, and sigmoid colon organs were 70.2 (55.9–77.7), 65.8 (54.9–80.6), and 56.5 (45.0–71.2) Gy, respectively. Posttreatment, 12 patients had evidence of persistent disease on PET/CT. Eleven of the 35 patients who had complete response developed recurrences. Two patients developed late Radiation Therapy Oncology Group ≥3 rectal toxicities. Two-year actuarial local control, disease-free survival, overall survival, and Grade ≥3 toxicities were 61%, 43%, 59%, and 10%, respectively.ConclusionOur approach of a single implantation procedure followed by five fractions of HDRBT was well tolerated with early results demonstrating a moderate response and local control rate with acceptable toxicities.     

The comparison of ruthenium brachytherapy and simultaneous transpupillary thermotherapy of choroidal melanoma with brachytherapy alone

PurposeTo compare the outcomes of combined treatment of choroidal melanoma with ruthenium brachytherapy (BT) simultaneously with transpupillary thermotherapy (TTT) and treatment with BT alone.Methods and MaterialsTwo matched groups of patients, one treated with BT and simultaneous TTT (Group BT + TTT, n = 63), the other treated with BT alone (Group BT, n = 70) were analyzed retrospectively. The main outcome measures were rate of tumor regression, recurrences, enucleations, metastases, recurrence-free and overall survival rate, and visual acuity, assessed by Kaplan–Meier analysis.ResultsPatients were matched according to mean age (p = 0.22), mean tumor thickness (6.4 vs. 6.25 mm, range 2.5–10.8 mm, p = 0.59), and mean length of followup (42 vs. 34.4 months, range 3–109, p = 0.052). Tumor largest basal diameter (13.0 vs. 12.9 mm), tumor location, and mean radiation dose (apical 135 vs. 136 Gy and scleral 1294 vs. 1438 Gy) were also similar in both groups (p > 0.1). Treatment with BT + TTT resulted in higher rate of tumor regression (63% vs. 49%, respectively, p = 0.036), lower 5-year tumor recurrence rate (96% vs. 83%, p < 0.034), and higher eye-globe preservation (98% vs. 87%, p < 0.024) and recurrence-free survival rates (89% vs. 67%, p < 0.017) than treatment with BT alone. There was no difference in complications (p > 0.5), metastasis-free (93% vs. 81%, p > 0.22) and overall survival rates (91% vs. 81%, p > 0.39), or in visual outcomes.ConclusionCombined treatment of choroidal melanoma with ruthenium BT and simultaneous TTT seems to provide higher local control, eye-globe preservation, and recurrence-free survival rates than treatment with BT alone and results in similar rates of metastases and overall survival.     

Phase I–II trial of perioperative high-dose-rate brachytherapy in oral cavity and oropharyngeal cancer

BackgroundTo determine the feasibility of combined perioperative high-dose-rate brachytherapy (PHDRB) and intermediate-dose external beam radiation therapy (EBRT) as an alternative to full-dose adjuvant EBRT in patients with unirradiated squamous cell cancer (SCC) of the oral cavity and oropharynx.Methods and MaterialsForty patients were treated with surgical resection and PHDRB. PHDRB dose was 4 Gy b.i.d. × 4 (16 Gy) for R0 resections and 4 Gy b.i.d. × 6 (24 Gy) for R1 resections, respectively. External beam radiotherapy (45 Gy in 25 fractions) was added postoperatively. Patients with Stage III, IVa tumors, and some recurrent cases received concomitant cisplatin–paclitaxel chemotherapy during EBRT.ResultsThe rate of protocol compliance was 97.5%. Eleven patients (27.5%) developed RTOG Grade 3 or greater toxicity. Four patients (10%) presented complications requiring a major surgical procedure (RTOG 4), and one patient died of bleeding (RTOG 5). Three complications (7.5%) occurred in the perioperative period, and 8 (20.0%) occurred more than 3 months after the completion of the treatment program. Severe complications were more frequent in posteriorly located implants than in anterior implants (p = 0.035). After a median follow-up of 50 months for living patients (range, 2.5–86.1+), the 7-year actuarial rates of local and locoregional control were 86% and 82%, respectively; and the 7-year disease-free survival and overall survival rates were 50.4% and 52.3%, respectively.ConclusionsPHDRB can be integrated into the management of patients with resected cancer of the oral cavity who are candidates to receive postoperative radiation or chemoradiation. The local control and toxicity rates were similar to those expected after standard chemoradiation. PHDRB was associated with high toxicity in posterior locations, and the scheduled PHDRB dose was shifted to the closest lower level.     

Treatment of recurrent vaginal melanoma with external beam radiation therapy and palladium-103 brachytherapy

BackgroundMucosal melanoma of the female genital tract that recurs locally after definitive surgery presents difficult challenges for salvage therapy.Methods and MaterialsA 71-year-old female was diagnosed with a 4.5-cm × 4.1-cm × 2.8-cm vaginal recurrence of genital tract mucosal melanoma after definitive vulvectomy, distal vaginectomy, and distal urethrectomy. She refused surgery and underwent combination external beam radiation therapy (46 Gy) and an ultrasound-guided palladium-103 brachytherapy implant (100 Gy).ResultsThe patient experienced complete resolution of the gross tumor and was asymptomatic with a sustained response for over a year before developing metastatic disease.ConclusionsMucosal melanoma of the female genital tract is an aggressive and often fatal disease. Radical surgical excision is an option for some patients but may require pelvic exenteration and is rarely curative. In selected cases, high-dose conformal radiation therapy delivered by a combination of external beam radiation therapy and interstitial brachytherapy may be an excellent alternative, achieving local control without loss of organ function.     

Three-dimensional image-based high-dose-rate interstitial brachytherapy for vaginal cancer

PurposeTo evaluate dosimetric and clinical outcomes of three-dimensional (3D) image–based high-dose-rate (HDR) interstitial brachytherapy (HDRB) in patients with vaginal cancers.Methods and MaterialsThirty patients with vaginal cancers were treated with HDRB using Syed-Neblett template. CT scan was done after placement of needles for confirmation of placement and treatment planning. The target volume and organs at risk, including clinical target volume (CTV), rectum, bladder, and sigmoid colon, were contoured on CT scans. Twenty-eight (93.3%) patients received external beam radiation therapy at a median 45 (24.0–50.4) Gy in 12–28 fractions, followed by HDRB at 3.75–5.0 Gy per fraction in five fractions. Total doses for CTV and organs at risk from external beam radiation therapy and HDRB were summated and normalized to a biologically equivalent dose of 2 Gy per fraction.ResultsSeventeen patients (56.7%) with primary vaginal cancer and 13 patients (43.3%) with recurrent vaginal cancers were treated with 3D HDRB. The mean CTV was 39.3 ± 25.7 cm³, and the median tumor diameter was 3.3 (1.3–8.0) cm. The median biologically equivalent dose of 2 Gy per fraction for 2 cc of bladder, rectum, and sigmoid was 55.0, 56.3, 50.0 Gy, respectively. The median D₉₀ for high-risk CTV was 74.3 (36.3–81.1) Gy. The mean volume receiving 100%, 150%, and 200% of prescribed dose was 90.7 ± 10.0%, 41.3 ± 14.6%, and 17.7 ± 8.3%, respectively. With a median followup of 16.7 months, the respective 1-/2-year locoregional and overall survival rates were 84.4%/78.8% and 82.1%/70.2%, respectively. There were no Grade ≥3 gastrointestinal complications. Late complications of Grade 3 vaginal ulceration and Grade 4 vaginal necrosis were seen in two cases.ConclusionsInitial results of 3D HDRB using our fractionation schedule in the treatment of vaginal cancers showed good local response with acceptable morbidities.     

Comparison of efficacy and safety of low-dose-rate vs. high-dose-rate intraluminal brachytherapy boost in patients with superficial esophageal cancer

PurposeTo compare the efficacy and the incidence of complications of high-dose-rate (HDR) and low-dose-rate (LDR) intraluminal brachytherapy (IBT) boost after external beam radiation therapy in patients with superficial esophageal cancer.Methods and MaterialsFifty-four consecutive patients with Stage I thoracic esophageal squamous cell carcinoma who were treated with definitive radiotherapy using IBT between 1991 and 2007 were studied retrospectively. LDR-IBT and HDR-IBT were performed for 19 and 35 patients, respectively. After external beam radiation therapy of 56–60 Gy with a conventional fractionation, LDR-IBT (5 Gy × 2) or HDR-IBT (3 Gy × 3) was given within 2 weeks. The median follow-up was 47 months (7–151 months).ResultsOverall, the 5-year overall survival, cause-specific survival (CSS), and locoregional control (LRC) rates were 61%, 86%, and 79%, respectively. The 5-year overall survival, CCS, and LRC rates did not differ significantly between the LDR-IBT and HDR-IBT groups (68% vs. 58% (p = 0.50), 83% vs. 85% (p = 0.63), and 84% vs. 75% (p = 0.42), respectively). Salvage treatment was given in 8 locally recurrent patients, and 6 patients were rescued. The Grade ≥2 late morbidities of esophagus and heart/lung were observed in 5 patients (4 in the LDR-IBT group and 1 in the HDR-IBT group) and 2 patients (one from each group), respectively.ConclusionsIn view of the safety profile and effectiveness, our results encourage the continued adoption of HDR-IBT as radiation boost in medically inoperable or elderly superficial esophageal cancer patients undergoing definitive radiotherapy.     

Three-year clinical outcome using the Contura multilumen balloon breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI): improving radiation standards for the optimal application of APBI

PurposeWe reviewed our institution’s 3-year clinical experience in treating patients with the Contura multilumen balloon (SenoRx, Inc., Aliso Viejo, CA) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI).Methods and MaterialsForty-six patients treated with breast-conserving therapy received adjuvant radiation using the Contura catheter (34 Gy in 3.4 Gy fractions). Fourteen patients had Stage 0, 24 had Stage I, and 8 had Stage II breast cancer. Median follow-up was 36 months (range, 1–44 months).ResultsOnly one local recurrence developed (2%). The rate of persistent seroma formation at latest reported follow-up was 4.3% (2 patients) and the incidence of any clinically detectable telengiectasias was 2.2%. No major toxicities (0% Grade III) have occurred. The median skin dose (% of the prescribed dose) was 99.7. The median dose to 95% of the planning target volume for evaluation was 98.8%. The percentage of patients with excellent/good cosmetic results at 24 (n = 23) and 36 (n = 22) months was 100% and 97%, respectively.ConclusionAdjuvant APBI using the Contura multilumen balloon catheter exhibited similar locoregional control, cosmesis, and toxicities to other forms of APBI with similar lengths of follow-up. In addition, improved radiation standards for the delivery of APBI were demonstrated.     

Long-term results of 1-week intravaginal high-dose-rate brachytherapy alone for endometrial cancer

ObjectiveTo compare the biologic equivalence in terms of local control and toxicity of a short course of high-dose-rate intravaginal brachytherapy alone (IVBa) delivered over five consecutive days (25 Gy/5 Rx/5 days) to other more protracted classical schemes 21 Gy/3 Rx/14–28 days (Postoperative Radiation Therapy in Endometrial Carcinoma [PORTEC]-2/Memorial Sloan-Kettering Cancer Center).Methods and MaterialsFrom February 2001 to May 2008, 122 patients with International Federation of Gynecology and Obstetrics Stage IaG3–IIIaG2 endometrial adenocarcinoma were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by postoperative IVBa. Seventy-seven patients (63.1%) underwent surgical staging. Total IVBa dose was 25 Gy in five consecutive daily fractions prescribed at 0.5-cm depth.ResultsAfter a median followup of 4.1 years, the rates of Radiation Therapy Oncology Group Grades 1, 2, and ≥3 complications were 12.9%, 3.4%, and 0.8%, respectively. Five patients (4.1%) presented locoregional failures: two isolated nodal pelvic failures, one vaginal pelvic relapse (intra-abdominal lymph node metastases), one vaginal distant failure, and one combined locoregional and distant failure. The 8.5-year actuarial vaginal control rate was 97.5%, and the pelvic control rate was 94.3%. Six other patients developed distant metastases alone. The 8.5-year actuarial overall and disease-free survival rates were 90.3% and 87.2%, respectively. Univariate analysis revealed that histologic grade, deep myometrial invasion, advanced age, and categorization as high intermediate–risk patient according to the PORTEC-2 and the Gynecologic Oncology Group (GOG)-99 stratifications were statistically significant prognostic factors. After multivariate analysis, histologic grade (p = 0.001) and high intermediate risk according to GOG-99 (p = 0.004) and PORTEC-2 (p = 0.001) remained significant.ConclusionsThe proposed scheme reproduces the excellent results obtained with more protracted schemes and has the added advantage of shortened overall treatment time.     

Differentiation of prostate cancer from benign lesions using strain index of transrectal real-time tissue elastography

ObjectiveThis study was to assess the diagnostic value of strain index (SI) for transrectal real-time tissue elastography (TRTE) on differentiating malignant from benign lesions in the prostate peripheral zone.Methods83 patients suspected of having prostate cancer (PCa) underwent transrectal ultrasonography (TRUS) and TRTE examinations. The lesions in the prostate peripheral zone detected by TRTE were set as the regions of interest (ROI) for strain ratio (SR) measurement (SRA). The moderate texture tissues without lesion were set as the reference ROI for SR measurement (SRB). Then, SI (SRB/SRA) of total lesions (ASI) and local lesion (PSI) were calculated, and the diagnostic values of ASI and PSI on differentiating benign from malignant lesions were assessed respectively.ResultsThe range of PSI was 2.23–67.21 (29.97 ± 15.58) in malignant tumors and 0. 4–43.6 (7.79 ± 8.75) in benign lesions (AUC = 0.90), while the range of ASI was 2.84–47.9 (8.38 ± 12.20) in malignant tumors and 0.4 –2.79 (5.85 ± 7.29) in benign lesions (AUC = 0.62). There was significant difference of PSI values between the benign and malignant lesions (P < 0.01). At the cutoff value of 17.44, PSI yielded the highest sensitivity (74.5%) and specificity (83.3%) for discriminating PCa from benign lesions. The capability of PSI in the diagnosis of PCa improved with the increase of Gleason scores.ConclusionPSI is one of the elasticity parameters obtained easily by TRTE, it can provide more information in the differentiation of prostate peripheral zone lesions.     

Four-year results using balloon-based brachytherapy to deliver accelerated partial breast irradiation with a 2-day dose fractionation schedule

PurposeWe present 4-year results from a Phase I/II trial using balloon-based brachytherapy to deliver accelerated partial breast irradiation in 2 days.Materials/MethodsForty-five patients received breast-conserving surgery followed by adjuvant radiation therapy using a balloon-based brachytherapy applicator delivering 2800 cGy in four fractions over 2 days. Outcomes analyzed include toxicities scored using the NCI Common Toxicity Criteria v3.0 scale, ipsilateral breast tumor recurrence, regional nodal failure, distant metastasis, disease-free survival, cause-specific survival, and overall survival.ResultsMedian age was 66 years (range, 48–83 years) and median tumor size was 0.6 cm (range, 0.2–2.3 cm). Five percent of patients were node positive (n = 2), whereas 73% was estrogen receptor positive (n = 33). Median followup was 3.7 years (2.4–7.0 years) with greater than 2 years of followup for all patients. Only Grades 1 and 2 chronic toxicities were noted with fat necrosis (18%) and asymptomatic seromas (42%) being the most common toxicities. Seven percent of patients developed ipsilateral rib fractures (n = 3), although this was not statistically associated with maximum rib dose (p = 0.31). Ninety-eight percent of patients had a good or excellent radiation-related cosmetic outcome at the time of last followup. There were no ipsilateral breast tumor recurrences or regional nodal failures; however, 2 patients developed distant metastases. Four-year actuarial disease-free survival, cause-specific survival, and overall survival were 96%, 100%, and 93%, respectively.ConclusionsTreatment of early-stage breast cancer patients with breast-conserving therapy using a 2-day radiation dose schedule resulted in acceptable chronic toxicity and similar clinical outcomes as standard 5-day fractionation.     

Optical coherence tomography in the assessment of oral squamous cell carcinoma resection margins

BackgroundIncomplete surgical removal of cancer is believed to be the main cause of local recurrence and high mortality. This study assessed the use of optical technology (namely optical coherence tomography [OCT]) in examining oral squamous cell carcinoma (OSCC) resection margins to assess if this modality could guide the surgeon during surgical resections.Materials and methodsTwenty-eight T₁–T₂ N0M0 oral squamous cell carcinoma patients participated in this study. Nineteen patients were males and nine were females. The majority of lesions were in the ventro-lateral tongue, floor of mouth, retromolar trigone and the buccal mucosa.Following tumour resection, the specimen resection margins were optically scanned in the immediate ex vivo phase. Two independent assessors commented on the four resection margins of each specimen. The findings were then compared to the corresponding gold standard histopathology. The average epithelial thickness for both tumor-free and tumor-involved margins was also calculated.ResultsThe pathology reports of the 112 margins revealed 90 tumor-free margins and 22 tumor-involved margins. Examining the data from both senior operating surgeons (assessors), the overall sensitivity and specificity was found to be 81.5% and 87%, respectively. Whilst the positive predictive value was 61.5% and the negative predictive value was 95%. OCT accuracy for the first assessor was 88% and for the second assessor 84%. The assessors’ inter-observer agreement was “very good” for superior, inferior and medial margins; while agreement on the lateral surgical margin status was “good”. Using OCT, the mean epithelial thickness at the tumor-free resection margins was 360 μm; while, it was 567 μm for the tumour-involved margins.ConclusionOCT is a valuable tool in the assessment of surgical margins. Tumour-involved margins can be identified by architectural changes and increase in epithelial layer thickness on the OCT image. Further studies are required to assess tumour margins in vivo.     

Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures

AimTo report our experience of combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures.Patients and methodsEighteen patients (23 kidneys) with non-obstructive uropathy due to urine leaks underwent combined CT- and fluoroscopy-guided nephrostomy. All procedures were indicated as second-line interventions after failed ultrasound-guided nephrostomy. Thirteen males and five females with an age of 62.3 ± 8.7 (40–84) years were treated. Urine leaks developed in majority after open surgery, e.g. postoperative insufficiency of ureteroneocystostomy (5 kidneys). The main reasons for failed ultrasound-guided nephrostomy included anatomic obstacles in the puncture tract (7 kidneys), and inability to identify pelvic structures (7 kidneys). CT-guided guidewire placement into the collecting system was followed by fluoroscopy-guided nephrostomy tube positioning. Procedural success rate, major and minor complication rates, CT-views and needle passes, duration of the procedure and radiation dose were analyzed.ResultsProcedural success was 91%. Major and minor complication rates were 9% (one septic shock and one perirenal abscess) and 9% (one perirenal haematoma and one urinoma), respectively. 30-day mortality rate was 6%. Number of CT-views and needle passes were 9.3 ± 6.1 and 3.6 ± 2.6, respectively. Duration of the complete procedure was 87 ± 32 min. Dose-length product and dose-area product were 1.8 ± 1.4 Gy cm and 3.9 ± 4.3 Gy cm², respectively.ConclusionsCombined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures was feasible with high technical success and a tolerable complication rate.     

Interstitial brachytherapy in the management of persistent head and neck disease after definitive external beam radiation therapy

PurposePersistent disease after definitive external beam radiation therapy for head and neck (H&;N) malignancies negatively impacts survival. In this series, the effectiveness of low-dose-rate brachytherapy in the management of persistent H&;N disease is explored.MethodsAll patients who received brachytherapy for persistent H&;N disease between 1987 and 2002 were identified. Tumor and treatment characteristics and toxicities were recorded. Progression-free survival and overall survival estimates were generated. The influence of prognostic factors was determined.ResultsTwelve patients were analyzable. Brachytherapy was given curatively (n = 4) in patients not amenable to surgery or in combination with surgical dissection to avoid carotid resection (n = 8). Seven patients had disease progression with a median time to progression of 11 months (95% confidence interval: 0–22.9). The only negative prognostic factor was time to re-treatment (brachytherapy >4 months) after definitive treatment (p = 0.003). Overall survival at 1 and 5 years was 50% and 21%, respectively. Toxicity was limited to one major complication (fistula) and five minor toxicities: low-grade radionecrosis (n = 2), cellulitis (n = 1), and wound dehiscence (n = 2).ConclusionIn patients with persistent disease, brachytherapy is an appealing re-treatment alternative. When combined with neck dissection, brachytherapy yields less morbidity than the surgical alternative of carotid resection.     

Ectopic posterior pituitary high signal in preoperative and postoperative macroadenomas: dynamic MR imaging

Background and purpose:In patients with macroadenoma, posterior pituitary high signal (PPHS) on T1-weighted magnetic resonance (MR) imaging is sometimes observed in an ectopic location. The present study compared incidences of ectopic PPHS before and after macroadenoma surgery using MR imaging, including dynamic MR imaging to ascertain whether this ectopic change is irreversible.Materials and methods:MR imaging was performed preoperatively in 111 cases of macroadenoma, and then repeated more than 1-year postoperatively in 47 patients. Enhancement of PPHS was assessed using dynamic MR imaging. Areas of enhanced hyperintensity were considered true PPHS, and the relationship between presence and location of true PPHS and adenoma volume was analyzed. Moreover, changes in the presence and location of true PPHS were ascertained among the patients who underwent postoperative follow-up MR imaging.Results:Preoperatively, PPHS was seen only in the normal location in 29 patients (Group A: 26.1%). High signal was detected only in an ectopic location in 58 patients, and early enhancement of this ectopic high signal was confirmed by dynamic MR imaging in 56 patients (Group B: 50.5%). No PPHS was observed in 24 patients (Group C: 21.6%). Adenoma volume was significantly greater for Group B than for Group A (p < 0.001). Among the Group B patients who underwent MR imaging postoperatively (n = 31), the location of PPHS was not changed, except for two patients in whom PPHS was absent. Postoperatively, PPHS was not observed in the normal location in any patient in the Group B.Conclusions:Greater volume of adenoma is associated with a higher incidence of ectopic PPHS, and the ectopic change is irreversible.     

Comparison of PSA relapse-free survival in patients treated with ultra-high-dose IMRT versus combination HDR brachytherapy and IMRT

PurposeWe report on a retrospective comparison of biochemical outcomes using an ultra-high dose of conventionally fractionated intensity-modulated radiation therapy (IMRT) vs. a lower dose of IMRT combined with high-dose-rate (HDR) brachytherapy to increase the biologically effective dose of IMRT.MethodsPatients received IMRT of 86.4 Gy (n = 470) or HDR brachytherapy (21 Gy in three fractions) followed by IMRT of 50.4 Gy (n = 160). Prostate-specific antigen (PSA) relapse was defined as PSA nadir + 2. Median followup was 53 months for IMRT alone and 47 months for HDR.ResultsThe 5-year actuarial PSA relapse-free survival (PRFS) for HDR plus IMRT vs. ultra-high-dose IMRT were 100% vs. 98%, 98% vs. 84%, and 93% vs. 71%, for National Comprehensive Cancer Network low- (p = 0.71), intermediate- (p < 0.001), and high-risk (p = 0.23) groups, respectively. Treatment (p = 0.0006), T stage (p < 0.0001), Gleason score (p < 0.0001), pretreatment PSA (p = 0.0037), risk group (p < 0.0001), and lack of androgen-deprivation therapy (p = 0.0005) were significantly associated with improved PRFS on univariate analysis. HDR plus IMRT vs. ultra-high-dose IMRT (p = 0.0012, hazard ratio [HR] = 0.184); age (p = 0.0222, HR = 0.965); and risk group (p < 0.0001, HR = 2.683) were associated with improved PRFS on multivariate analysis.ConclusionDose escalation of IMRT by adding HDR brachytherapy provided improved PRFS in the treatment of prostate cancer compared with ultra-high-dose IMRT, independent of risk group on multivariate analysis, with the most significant benefit for intermediate-risk patients.     

Image-guided tumor ablation for the treatment of recurrent non-small cell lung cancer within the radiation field

PurposeThe treatment options for non-small-cell lung cancer (NSCLC) that recurs after irradiation are limited. Image-guided percutaneous thermal ablation is an effective option in treating NSCLC that may provide an alternative to reirradiation. The purpose of this paper is to determine the survival and palliative benefit of image-guided percutaneous thermal ablation in the treatment of NSCLC that recurred within the treatment field of prior external beam radiation therapy.MethodsTwenty patients, median age 70, who had NSCLC recurrences following irradiation were treated with image-guided thermal ablation. Kaplan–Meier analysis was used to assess survival benefit and subjective pain reports were used to investigate pain relief.ResultsThe median survival time was 13.1 ± SE 1.4 months and the median survival time without local recurrence was 8.5 ± 1.6 months. Eight patients (40%) recurred locally after a median of 3.3 months. Seven out of ten patients (70%) presenting with significant pain had decreased pain at initial post-ablation evaluation. Following the 25 ablations, there were no Grade IV or V, 1 Grade III, 3 Grade II, and 23 Grade I complications.ConclusionThermal ablation offers a potential survival benefit compared with other available modalities for the treatment of NSCLC recurring within a previously irradiated field. This promising technique has a good safety profile and may also be useful in providing symptomatic relief.     

Values of biologically equivalent doses in healthy tissues: Comparison of PDR and HDR brachytherapy techniques

PurposeThe aim of this work was to compare the values of doses measured in healthy tissues in chosen pulsed-dose-rate (PDR) brachytherapy (PDRBT) and high-dose-rate (HDR) brachytherapy (HDRBT) fractionation schemas.Methods and MaterialsFifty-one patients treated with PDRBT were qualified for calculations. This group included patients with head and neck cancer, brain tumor, breast cancer, sarcoma, penile cancer, and rectal cancer. The doses were calculated in chosen points in surrounded organs at risk (OaR). The biologically equivalent dose (BED) formula was used to compare doses in PDRBT and HDRBT.ResultsOne ascertained that in biologically equivalent (to PDR) HDRBT, the increase of fractional dose from 4 to 10 Gy caused the necessity to decrease the total dose in treatment target (p < 0.001). The use of HDR instead of PDR essentially caused lower physical and biologic doses in examined OaR. In many examined critical points in OaR where BED in the treatment area was the same, one ascertained the decrease of total physical HDR dose according to the growth of the fractional dose. Similar dependences were observed for BED.ConclusionsThe use of biologically equivalent HDRBT instead of PDRBT caused the decrease of physical doses in the treatment target and the decrease of physical doses and BEDs in OaR. Prolongation of intervals between pulses in PDRBT was connected with lower values of BED doses in healthy tissues.