Phase II trial of image-based high-dose-rate interstitial brachytherapy for previously irradiated gynecologic cancer

PurposeTo report the disease-free Grade ≥3 complication-free survival of a Phase II protocol of reirradiation with high-dose-rate (HDR) interstitial brachytherapy (ITB) in previously irradiated gynecologic cancer.Methods and MaterialsFifteen patients with previously irradiated cervical (n = 6), endometrial (n = 6), and vulvovaginal tumors (n = 3) were treated with HDR-ITB alone to a median dose of 38 Gy in 8 b.i.d. fractions over 4 consecutive days. Prior treatments included surgery (n = 12; 80%), external irradiation (n = 15; 100%), and brachytherapy (n = 9; 60%). Average clinical target volume Size was 60.9 cc (range, 14.8–165.3 cc), and median time to reirradiation was 3.9 years (range, 0.4–22.7 years).ResultsWith a median followup of 2.8 years (range, 1.2–9.2 years), 3 patients (20.0%) developed Grade ≥3 toxicity consisting of Grade 3 intestinal obstruction (n = 1), Grade 4 rectovesical fistula (n = 1), and Grade 5 intestinal obstruction (n = 1). Six patients remain alive and without evidence of disease at last followup. Two patients are alive with disease progression, and 7 patients have died, 4 of them from disease progression and 3 from other causes. The 2-year disease-free Grade ≥3 complication-free survival was 40%.ConclusionsHDR-ITB alone is a reasonable salvage treatment option in a significant number of patients with previously irradiated gynecologic tumors.     

两种黑球低温卡他温度计综合评价环境冷强度的探讨

黑球低温卡他温度计是评价环境气温、风速与太阳辐射所形成的综合冷强度的一种仪器,它由玻璃制成,结构简单,不需要电子元件和特殊电源。体积小,重量轻,价格便宜,利于推广使用。提出了由降温时间及其推导出的黑卡等效温度来综合评价环境冷强度的可行性。     

Effective motion-sensitizing magnetization preparation for black blood magnetic resonance imaging of the heart

Purpose

To investigate the effectiveness of flow signal suppression of a motion‐sensitizing magnetization preparation (MSPREP) sequence and to optimize a 2D MSPREP steady‐state free precession (SSFP) sequence for black blood imaging of the heart.

Materials and Methods

Using a flow phantom, the effect of varying field of speed (FOS), b‐value, voxel size, and flow pattern on the flow suppression was investigated. In seven healthy volunteers, black blood images of the heart were obtained at 1.5T with MSPREP‐SSFP and double inversion recovery fast spin echo (DIR‐FSE) techniques. Myocardium and blood signal‐to‐noise ratio (SNR) and myocardium‐to‐blood contrast‐to‐noise ratio (CNR) were measured. The optimal FOS that maximized the CNR for MSPREP‐SSFP was determined.

Results

Phantom data demonstrated that the flow suppression was induced primarily by the velocity encoding effect. In humans, FOS = 10–20 cm/s was found to maximize the CNR for short‐axis (SA) and four‐chamber (4C) views. Compared to DIR‐FSE, MSPREP‐SSFP provided similar blood SNR efficiency in the SA basal and mid‐views and significantly lower blood SNR efficiency in the SA apical (P = 0.02) and 4C (P = 0.01) views, indicating similar or better blood suppression.

Conclusion

Velocity encoding is the primary flow suppression mechanism of the MSPREP sequence and 2D MSPREP‐SSFP black blood imaging of the heart is feasible in healthy subjects. J. Magn. Reson. Imaging 2008;28:1092–1100. © 2008 Wiley‐Liss, Inc.     

Use of a rectal spacer with low-dose-rate brachytherapy for treatment of prostate cancer in previously irradiated patients: Initial experience and short-term results

BackgroundSalvage brachytherapy in patients with prior pelvic radiation carries a risk of rectal injury. Herein, we report our initial experience using a hydrogel spacer between the prostate and the rectum during salvage brachytherapy.Methods and MaterialsA total of 11 patients with prostate cancer and prior radiotherapy (5 prostate brachytherapy, 2 prostate external beam radiation therapy [EBRT], and 4 rectal cancer EBRT) received ¹²⁵I brachytherapy after attempted placement of 10 cc of a diluted hydrogel spacer between the prostate and rectum.ResultsSpacing was achieved in 8 of the 11 (73%) patients but was not possible in 3 (1 prior brachytherapy and 2 prior EBRT) owing to fibrosis and adhesions. For the 8 patients in whom spacing was accomplished, the median space between the prostate and rectum was 10.9 mm (prior EBRT) vs. 7.7 mm (prior brachytherapy), p = 0.048. Median followup was 15.7 months. One patient developed a prostato-rectal fistula requiring a diverting colostomy. The 16-month estimate of late Grade 3 or 4 gastrointestinal or genitourinary toxicity was 26%. One patient developed lymph node–positive recurrence. The 16-month prostate-specific antigen failure-free survival rate was 89%. Compared with baseline, Expanded Prostate Cancer Index Composite for Clinical Practice urinary quality of life (QoL) was significantly worse at 3 and 6 months but not significantly worse by 1 year. There were no significant changes throughout the study period in bowel or sexual QoL.ConclusionHydrogel spacer placements may be feasible in most patients with prior pelvic radiation. Further followup is needed to determine whether spacer placement will produce long-term improvements in toxicity or QoL.     

On the overestimation of early wall thickening at the carotid bulb by black blood MRI,with implications for coronary and vulnerable plaque imaging

Black blood MRI is an attractive tool for monitoring normal and pathological wall thickening; however, limited spatial resolutions can conspire with complex vascular geometries to distort the appearance of the wall in ways hitherto unclear. To elucidate this, a thin‐walled cylinder model was developed to predict the composite effects of obliqueness, in‐plane resolution and voxel anisotropy on the accuracy of MRI‐derived wall thickness measurements. These predictions were validated by means of imaging of a thin‐walled carotid bifurcation phantom. Typical thick‐slice axial acquisitions were found to result in artifactual wall thickening at the carotid bulb, owing to its obliqueness to the nominal imaging plane. Obliqueness was less problematic for near‐isotropic resolutions; however, the obligatory reduction of in‐plane resolution served to inflate wall thicknesses uniformly by up to 50%. Moreover, the nonlinear relationship between wall thickness and its overestimation served to mask genuine differences in wall thickness, an effect predicted to be worse for thinner coronary artery walls and plaque caps. Therefore, care must be taken when interpreting black blood MRI wall thickness measurements in the presence—or absence—of observed differences within or between individuals. Magn Reson Med 60:1020–1028, 2008. © 2008 Wiley‐Liss, Inc.     

The volume of liver irradiated during modern free-breathing breast radiotherapy: Implications for theory and practice

Introduction

Incidental liver irradiation during breast radiotherapy can increase the risk of second primary malignancy and induce adverse inflammatory states. This study establishes the volume of liver irradiated during free-breathing breast radiotherapy. Novel associations between liver dose-volume data and systemic interleukin-6 soluble receptor and blood counts are evaluated.