Nineteen-year single-center experience in 76 patients with penile cancer treated with high-dose-rate brachytherapy.

PURPOSE: To report the outcomes for 76 patients with penile cancer treated with high-dose-rate brachytherapy (HDR-BT) at a single institution. METHODS: Seventy-six patients with penile cancer treated with HDR-BT in our department between October 1998 and September 2018 were analyzed. Seventy underwent interstitial HDR-BT (fractionation dose range of 3-3.5 Gy given twice a day with an interval of at least six hours between the fractions), and six underwent superficial treatment with mold applicators (fractionation dose range of 4-7 Gy given once or twice a week). RESULTS: Median follow-up was 76 months (7-204 months). In the whole group, 22/76 local failures (28.9%) were observed: 14/76 (18.4%) local recurrences and 8/76 (10.5%) cases of persistent disease. Median time to recurrence was 24 months (9-54 months). Inguinal lymph node metastases were observed in 18/76 cases (23.7%). Distant metastases occurred in 12/76 (15.8%) cases. Patients with local recurrence and persistent disease underwent salvage penectomies, except four who refused surgery and underwent a second course of interstitial HDR-BT. Five- and 10-year cause-specific survival were 85.0% and 77.8%, respectively. Local control at 5 and 10 years was 65.6%. Five- and 10-year penile preservation were 69.5% and 66.9%, respectively. There was no G3 or G4 acute toxicity. One urethral stenosis (1.3%) occurred in a patient with a T3 tumor and was treated successfully with dilatation. CONCLUSIONS: HDR-BT provides good local control of penile cancer and is a good option for penis preservation therapy and in our experience achieves a penile preservation rate at 10 years of 66.9%.

Salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after primary radiotherapy failure.

BACKGROUND AND PURPOSE: To evaluate high-dose-rate brachytherapy (HDR BT) as a salvage modality for locally recurrent prostate cancer after primary radiotherapy failure. MATERIALS AND METHODS: Eighty-three prostate cancer patients, who locally relapsed after radiotherapy, were treated with salvage HDR BT. The schedule was three implantations, every two weeks, with 10Gy per implant, to a total dose of 30Gy. Acute and late toxicity rates were evaluated. Overall survival (OS) and biochemical control were calculated using Kaplan-Meier method. RESULTS: Median follow-up after salvage HDR was 41months. The 3-year and 5-year OS were 93% and 86%, respectively. The 3-year and 5-year biochemical disease-free survival (bDFS) were 76% and 67%, respectively. The single factor associated with biochemical control was time to achieve salvage PSA nadir (p-.006). OS was linked significantly with primary nadir level (p-.001) while primary biochemical relapse interval was of borderline significance (p-.07). CONCLUSIONS: Salvage HDR BT is a promising treatment option for patients with localized relapse of previously irradiated prostate cancer. Lower PSA nadir after primary radiotherapy and longer primary disease-free interval influence the outcome.

Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer.

PURPOSE: The aim of the study was to report our experience with high-dose-rate interstitial brachytherapy (HDR-ISBT) in locally advanced and recurrent vulvar cancer. MATERIAL AND METHODS: Between 2004 and 2014, fourteen women with locally advanced or recurrent vulvar cancer were treated using HDR-ISBT in our Centre. High-dose-rate interstitial brachytherapy was performed as a separate treatment or in combination with external beam radiotherapy (EBRT) (given prior to brachytherapy). RESULTS: Patients were divided into: group I (n = 6) with locally advanced tumors, stages III-IVA after an incisional biopsy only, and group II (n = 8) with recurrent vulvar cancer after previous radical surgery. In group I, median follow up was 12 months (range 7-18 months); 1-year overall survival (OS) was 83%. Transient arrest of cancer growth or tumor regression was noticed in all patients but 4/6 developed relapse. Median time to failure was 6.3 months (range 3-11 months). The 1-year progression-free survival (PFS) was 33%. In group II, median follow up was 28 months (range 13-90 months). The 1-year and 3-year OS was 100% and 80%, respectively. The arrest of cancer growth or tumor regression was achieved in all patients. In 4/8 patients neither clinical nor histological symptoms of relapse were observed but 4/8 women experienced relapse. Median time to failure was 31 months (range 13-76 months). The 1-year and 3-year PFS was 100% and 62.5%, respectively. Two patients (14.3%) in group II had severe late toxicity (G3). CONCLUSIONS: High-dose-rate interstitial brachytherapy is a well-tolerated treatment option in selected patients with advanced or recurrent vulvar cancer. It is a safe and effective treatment modality for advanced and recurrent vulvar cancer, yielding good local control with acceptable late treatment related side effects. In our study, patients with recurrent vulvar cancer had better results in HDR-ISBT treatment, probably because of the smaller tumor volume. This hypothesis should be verified in a larger group of patients.

Alpha/beta (α/ß) ratio for prostate cancer derived from external beam radiotherapy and brachytherapy boost.

OBJECTIVE: There is disagreement regarding the value of the α/ß ratio for prostate cancer. Androgen deprivation therapy (ADT) may dominate the effects of dose fractionation on prostate-specific antigen (PSA) response and confound estimates of the α/ß ratio. We estimate this ratio from combined data on external beam radiation therapy (EBRT) and brachytherapy (BT)-treated patients, providing a range of doses per fraction, while accounting for the effects of ADT. METHODS: We analyse data on 289 patients with local prostate cancer treated with EBRT (2 Gy per fraction) or EBRT plus one or two BT boosts of 10 Gy each. The timing of ADT was heterogeneous. We develop statistical models to estimate the α/ß ratio based upon PSA measurements at 1 year as a surrogate for the surviving fraction of cancer cells as well as combined biochemical + clinical recurrence-free survival (bcRFS), controlling for ADT. RESULTS: For the PSA-based end point, the α/ß ratio estimate is 7.7 Gy [95% confidence interval (CI): 4.1 to 12.5]. Based on the bcRFS end point, the estimate is 18.0 Gy (95% CI: 8.2 to ∞). CONCLUSION: Our model-based estimates of the α/ß ratio, which account for the effects of ADT and other important confounders, are higher than some previous estimates. ADVANCES IN KNOWLEDGE: Although dose inhomogeneities and other limitations may limit the scope of our findings, the data suggest caution regarding the assumptions of the α/ß ratio for prostate cancer in some clinical environments.

The effectiveness and side effects of conformal external beam radiotherapy combined with high-dose-rate brachytherapy boost compared to conformal external beam radiotherapy alone in patients with prostate cancer.

BACKGROUND: Clinical data that compare external-beam radiotherapy (EBRT) combined with high-dose-rate brachytherapy (HDR-BT) boost versus EBRT alone are scarce. The analysis of published studies suggest that biochemical relapse-free survival in combined EBRT and HDR-BT may be superior compared to EBRT alone. We retrospectively examined the effectiveness and tolerance of both schemes in a single center study. METHODS: Between March 2003 and December 2004, 229 patients were treated for localized T1-T2N0M0 prostate cancer. Median age was 66 years (range, 49 - 83 years). PSA level ranged from 0.34 to 64 ng/ml (median 12.3 ng/ml) and Gleason score ranged from 2 to 10. The analysis included 99 patients who underwent EBRT with HDR-BT (group A) and 130 patients who were treated with EBRT alone (group B). RESULTS: Median follow-up was 6 years. Biochemical relapses occurred in 34% vs. 22% (p = 0.002), local recurrences in 17% vs. 5% (p = 0.002), and distant metastases in 11% vs. 6% (p = 0.179) of patients in groups A and B, respectively. Five-year biochemical relapse-free survival was 67% vs. 81% (p = 0.005), local recurrence-free survival 95% vs. 99% (p = 0.002), metastases-free survival 95% vs. 94% (p = 0.302) for groups A and B, respectively. Five-year overall survival was 85% in both groups (p = 0.596). Grade 2/3 late GI complications appeared in 9.2% and 24.8% (p = 0.003), respectively. Grade 2/3 late GU symptoms occurred in 12% in both groups. CONCLUSIONS: Although because of the retrospective character of the study and nonrandomized selection of fractionation schedule the present conclusions had limitations EBRT alone appeared more effective than EBRT combined with HDR-BT. It was likely the result of the less frequent use of androgen deprivation therapy (ADT) for combined scheme group, too low dose in a single BT fraction or inadequate assumptions regarding fractionation sensitivity of prostate cancer.

The importance of the implant quality in APBI - Gliwice experience. Dosimetric evaluation.

This study includes four years of our clinical trials to improve implant quality in multicatheter accelerated partial breast irradiation (APBI). The progress in dosimetric and volumetric parameters of the treatment plans was evaluated. One hundred and ninety-one women, for whom treatment plans were made based on three dimensional imaging, were selected for the study. To evaluate progress made in our APBI procedure, following parameters and indices were taken into account: percentage of the target volume receiving the reference dose (PTVref), minimum dose in the target volume expressed as a percentage of reference dose (PTVmin), dose homogeneity index (DHI), and conformity index (COIN). Additionally, the plan quality index was calculated for every group as the sum of mean values of four evaluated parameters. PTVref have increased from the mean value of 83.4% at the beginning to recent 94.8%. The maximum value equals to 95.4%. The same trend can be observed with PTVmin value, which has been improved from 51.7% to 70.1%, maximally. DHI and COIN mean values present similar progress. DHI value increased from 0.53 level to 0.68, and COIN from 0.58 in 2009 to 0.74. Plan quality index has increased from 2.46 in 2009 to 3.06, recently. The implant quality is crucial for the accurate dose distribution. This paper shows the progress that was made in APBI procedure to improve implant quality. Nowadays, our implant technique is based on three-dimensional CT imaging results in acceptable dose distributions.

High-dose-rate interstitial brachytherapy for mucinous adenocarcinoma endocervical-type--a case study.

BACKGROUND: Adenocarcinoma in cervical cancer has poorer response rate to treatment and requires longer time to achieve complete remission than squamous cell carcinoma [1]. Lower response to chemotherapy and radiotherapy is observed [2,3,4,5] and the optimal management remains undefined [1,4,6,7]. CASE: We report a case of a 58-year-old woman with bulky mucinous adenocarcinoma endocervical-type G1, treated previously with radiochemotherapy with no visible response. After subsequent interstitial HDR brachytherapy (iHDR-BT) complete local remission was achieved. CONCLUSION: Interstitial HDR brachytherapy in bulky mucinous adenocarcinoma endocervical-type may be the best treatment choice that allows to receive a complete local response.

Prostate cancer brachytherapy: guidelines overview.

Prostate cancer, due to wide availability of PSA tests, is very often diagnosed in early stage, nowadays. This makes management of this disease even harder in every day oncology care. There is a wide range of treatment options including surgery, radiotherapy and active surveillance, but essential question is which treatment patient and oncologist should decide for. Due to recent publication of Prostate Cancer Results Study Group, in which brachytherapy is one of supreme curative options for prostate cancer, we decided to overview most present european and north american recommendations. National Comprehensive Cancer Network, American Society for Radiation Oncology, American Brachytherapy Society, European Association of Urology and Groupe Européen de Curiethérapie of European Society for Therapeutic Radiation Oncology guidelines are overviewed, particularly focusing on HDR and LDR brachytherapy.

Adjuvant vaginal brachytherapy as a part of management in early endometrial cancer.

Endometrial cancer is the most frequent cancer of female genital tract. Metro- and menorrhagia or postmenopausal bleeding results in its early presentation. It allows radical treatment. However, controversies remain on surgery coverage or adjuvant therapies in early endometrial women cancer. Optimal management should minimize intervention instead of aggressive approach, as showed by recent studies. There is a role for brachytherapy as an adjuvant irradiation. Crucial publications including PORTEC-1, GOG 99, MRC ASTEC, ASTEC/EN.5, PORTEC-2 or Italian lymphadenectomy trial are discussed. Moreover, there is attention paid on adjuvant vaginal brachytherapy analyses for the past fifteen years.

Perioperative high dose rate (HDR) brachytherapy in unresectable locally advanced pancreatic tumors.

PURPOSE: The aim of the study was to present an original technique of catheter implantation for perioperative HDR-Ir192 brachytherapy in patients after palliative operations of unresectable locally advanced pancreatic tumors and to estimate the influence of perioperative HDR-Ir192 brachytherapy on pain relief in terminal pancreatic cancer patients. MATERIAL AND METHODS: Eight patients with pancreatic tumors located in the head of pancreas underwent palliative operations with the use of HDR-Ir192 brachytherapy. All patients qualified for surgery reported pain of high intensity and had received narcotic painkillers prior to operation. During the last phase of the surgery, the Nucletron® catheters were implanted in patients to prepare them for later perioperative brachytherapy. Since the 6th day after surgery HDR brachytherapy was performed. Before each brachytherapy fraction the location of implants were checked using fluoroscopy. A fractional dose was 5 Gy and a total dose was 20 Gy in the area of radiation. A comparative study of two groups of patients (with and without brachytherapy) with stage III pancreatic cancer according to the TNM scale was taken in consideration. RESULTS AND CONCLUSIONS: The authors claim that the modification of catheter implantation using specially designed cannula, facilitates the process of inserting the catheter into the tumor, shortens the time needed for the procedure, and reduces the risk of complications. Mean survival time was 5.7 months. In the group of performed brachytherapy, the mean survival time was 6.7 months, while in the group of no brachytherapy performed - 4.4 months. In the group of brachytherapy, only one patient increased the dose of painkillers in the last month of his life. Remaining patients took constant doses of medicines. Perioperative HDR-Ir192 brachytherapy could be considered as a practical application of adjuvant therapy for pain relief in patients with an advanced pancreatic cancer.

[Comparison of quantitative computerized angiography and intravascular ultrasound in assessment of renal artery stenosis in patients with renovascular hypertension treated with percutaneous transluminal angioplasty with concomitant intravascular brachytherapy]. / Porównanie ilosciowej angiografii i ultrasonografii wewnatrznaczyniowej w ocenie zwezenia resztkowego i restenozy u chorych z nadcisnieniem naczyniowo- nerkowym leczonych metoda przezskórnej angioplastyki tetnicy nerkowej i brachyterapii sródnaczyniowej.

UNLABELLED: Renal Angiography and IntraVascular UltraSonography (IVUS), are valuable diagnosis methods for assessment of renovascular hypertension (RVH). Endovascular techniques employing percutaneous transluminal renal angioplasty (PTRA) are effective for therapy of ischaemic nephropathy in patients with RVH. Success of PTRA is limited by a significant rate of restenosis. THE AIM OF STUDY was to compare the assessment of residual stenosis and restenosis with angiography and IVUS. MATERIAL AND METHODS: Residual stenosis after PTRA (combine with intravascular brachyterapy in 33 patients--group I) were assessed in 62 RVH patients with angiography and IVUS techniques. Both baseline and 9-month follow-up quantitative computerized angiography (QCA) and intravascular ultrasound (IVUS) analysis were performed to assess restenosis. RESULTS: Residual stenosis after PTRA of atherosclerotic lesions was slightly lower with QCA than IVUS (in group I 15.49 +/- 4.69% and 18.81 +/- 4.81% and in group II 15.36 +/- 4.68% and 18.43 +/- 4.69%, respectively). The loss of lumen area in QCA assessment was slightly greater than in IVUS measurement (1.2 +/- 0.7 mm vs. 0.9 +/- 0.8 mm in group I i 1.7 +/- 0.7 mm vs. 1.5 +/- 0.8 mm in group II). The angiographic measurements of late lumen loss, diameter stenosis, and minimal lumen diameter correlated well with IVUS measurements (r = 0.81, r = 0.89 and r = 0.89 respectively). CONCLUSIONS: Angiography and IVUS are equally effective methods for diagnosis and assessment of residual stenosis and restenosis after endovascular renal artery revascularisation.

Interstitial HDR brachytherapy (HDR-BT) in early stage mobile tongue cancers in young patients - Gliwice experience.

PURPOSE: In early stage mobile tongue cancer radical radiotherapy offers good local control and organ preservation, which is especially important in the group of young patients. In our department, for many years HDR-BT has been performed in mobile tongue cancers as a sole treatment or as a "boost" with EBRT. The aim of the study was to show our experience with HDR-BT in early stage mobile tongue cancers among young patients. MATERIAL AND METHODS: From 2001 to 2006 in Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, five patients under 45 years with mobile tongue cancer were treated with HDR brachytherapy (T1N0M0 - 3/5 and T2N0M0 - 2/5); 4 with HDR brachytherapy "boost" and 1 as a sole treatment. One woman was previously treated with tumour resection, but because of positive surgical margins was referred for radiotherapy. All patients had clinically negative lymph nodes, without dissection. They were treated with interstitial HDR-BT (3-8 catheters). In 4 patients treated with HDR-BT as a "boost", total doses ranged from 18 to 21 Gy given in 6-7 fractions (twice a day, 3 Gy per fraction). Total doses in EBRT (to local lymph nodes and tumour bed) ranged from 50 to 60 Gy (1.8-2 Gy per fraction 5 days/week). One patient, treated with radical HDR brachytherapy, received 45 Gy in 10 fractions and 50 Gy in EBRT to regional lymph nodes. RESULTS: We did not notice local recurrences or distant metastases in our group of patients. Median follow-up was 67 months (range 47-79 months). All patients preserved normal tongue function. A severe late complication occurred in 1 patient - fracture of the mandible. CONCLUSIONS: In the analysed group of young patients with mobile tongue cancer interstitial HDR brachytherapy in combination with EBRT was an effective and well tolerated treatment modality which allowed preservation of the tongue and its function.

Comparison of early and late efficacy of percutaneous transluminal renal angioplasty with or without subsequent brachytherapy: the effect on blood pressure in patients with renovascular hypertension.

BACKGROUND: Scarce data exist concerning the long-term effect of percutaneous transluminal renal angioplasty (PTRA) enhanced with intravascular gamma brachytherapy (IVBT) in patients with renovascular hypertension. METHODS: Seventy one patients aged 52 +/- 8 years with refractory renovascular hypertension were randomized to Group I (PTRA + IVBT) or Group II (PTRA). For the IVBT procedure, the PARIS catheter and Microselectron HDR (Nucletron) system was employed. Both baseline and 9-month follow-up quantitative computerized angiography (QCA) and ambulatory blood pressure monitoring analysis was performed to assess luminal parameters of restenosis and the effect of treatment on blood pressure. RESULTS: Thirty three patients from Group I and 29 patients from Group II underwent successful procedure. During nine months of follow-up, three patients died; including two patients in Group I (cardiac causes) and one patient in Group II (stroke). The follow-up lumen diameter stenosis was 30.6 +/- 13.7% and 40.4 +/- 11% in Groups I and II, respectively (p = 0.004). Late lumen loss in quantitative computerized angiography was 1.2 +/- 0.7 mm and 1.7 +/- 0.7 mm in Groups I and II, respectively (p = 0.004). CONCLUSIONS: Intravascular gamma brachytherapy using self-centering source performed after balloon angioplasty is a safe and effective method of prevention of restenosis after PTRA in patients with renovascular hypertension.

Tolerance and efficacy of preoperative intracavitary HDR brachytherapy in IB and IIA cervical cancer.

PURPOSE: The aim of this work is to analyze the efficacy and tolerance of preoperative intracavitary HDR brachytherapy (HDR-BT) in patients with IB and IIA cervical cancer. MATERIAL AND METHODS: 139 patients with cervical cancer IB-IIA with preoperative HDR-BT, out of which 60 patients with cervical cancer IB (43.2%) and 79 with IIA (56.8%) were treated since 1996 to 2002. In preoperative BT total dose to point A ranged from 30-45 Gy in 6-9 fractions twice a week. The fraction dose was 4-5 Gy at point A. Six weeks after BT all patients underwent radical Wertheim-Meigs hysterectomy. Patients with disadvantageous risk factors or with positive specimen histology had a complementary therapy: external-beam radiotherapy (EBRT) given to the whole pelvic volume in daily fractions of 2 Gy up to total dose of 36-52 Gy (20 patients) or EBRT with cisplatin-based chemotherapy with the dose of 30-40 mg/m2 in 5-7 fractions given weekly (7 patients) or chemotherapy (6 patients). Acute and late radiation toxicity was evaluated according to EORTC/RTOG. RESULTS: In postoperative specimen histopathology the number of 114 women (82%) had tumor-free specimen within brachytherapy target (in cervix and cavity), 96 women (60.1%) had tumor-free specimen both in and outside brachytherapy target (lymph nodes, parametra, adnexis). The 5-year and 10-year DFS were 93.8% and 88% for IB and 89.7% and 64.7% for IIA respectively. 7.9% of patients developed acute toxicity both in rectum and bladder (only in I and II grade of EORTC/RTOG). Late severe complication occurred in rectum in 2.2% of patients and in bladder 1.4%. CONCLUSIONS: 1. Preoperative HDR-BT in patients with IB and IIA cervical cancer is an effective and well tolerated therapy with acceptable rate of side effects. 2. Preoperative HDR-BT followed by surgery in a group without risk factors is a sufficient treatment option with no additional adjuvant therapy requirement.

Comparison of 2D- and 3D-guided implantation in accelerated partial breast irradiation (APBI).

PURPOSE: In this study two different pre-planning methods (2D vs. 3D) were compared in respect to the implant quality as judged by volumetric and dose parameters of the treatment plans. The aim of this work was to evaluate the influence of the imaging modalities used for pre-planning purpose to the treatment plan quality. MATERIAL AND METHODS: Twenty-four patients treated with HDR multicatheter implants were randomly selected for experiment. All patients underwent breast conserving surgery. Flexible catheters were implanted into the breast through the template. Inter-catheter distance, number of planes and catheters were adjusted, in respect to the size and location of the target. Pre-planning was used to evaluate the implant geometry in respect to the target. Needles number and position were modified if necessary. There were two experimental subgroups consisted of 12 patients each. Different pre-planning procedure was employed in each group. In the first group 2D X-ray imaging system was used. In the second one the 3D pre-planning method based on CT was performed. Treatment plans were evaluated with parameters calculated based on dose-volume histograms (DVHs). Volumetric and dose parameters were used for comparison of the dose distribution between the two experimental subgroups. RESULTS: The mean value of target coverage VPTV100 is higher for 3D pre-planning than for 2D (91.7% vs. 86.1%). The dose that covers 90% of the PTV (D90) is also higher for 3D pre-planning than for 2D (4.2 Gy vs. 3.6 Gy). Similar relation can be observed for the values of dose homogeneity index where DHI obtained for 3D pre-planning is 0.60 and 0.53 for 2D. All differences were statistically significant with p < 0.05. CONCLUSIONS: Analysis presented in this paper showed that 3D pre-planning method improves the geometrical quality of the implant.

Salvage brachytherapy for local recurrences of prostate cancer treated previously with radiotherapy.

PURPOSE: The aim of the study was to analyze early effects and toxicity of salvage high dose rate brachytherapy for local recurrences of adenocarcinoma of the prostate after external beam radiotherapy (EBRT). MATERIAL AND METHODS: In MCS Memorial Institute of Oncology in Gliwice a research programme on salvage HDR brachytherapy for local recurrences of prostate cancer treated previously with EBRT has been ongoing since February 2008. The treatment consisted of 3 fractions of 10 Gy each given every 14 days. Maximal urethral doses were constrained to be ≤ 120% of the prescribed dose. Maximal bladder and rectum doses were constrained to be ≤ 70% of the prescribed dose. RESULTS: Fifteen eligible patients were treated and analyzed from February 2008. All patients completed the treatment without major complications. The most common early complications were: macroscopic haematuria, pain in lower part of the abdomen, and transient dysuria. During the first week after the procedure a transient increase in IPSS score was noticed. The Foley catheter was removed on day 2 to 5. No complications after spinal anaesthesia were observed. Acute toxicity according to EORTC/RTOG was low. For bladder EORTC/RTOG score ranged from 0 to 2. Only in two patients grade 1 toxicity for rectum was observed. The follow-up ranged from 3 to 9 months. In one patient grade 2 rectal toxicity was observed, and one had urethral stricture. Other patients did not have any other significant late toxicity of the treatment. Two patients developed bone metastases. CONCLUSIONS: Salvage brachytherapy for localized prostate cancer (3 × 10 Gy every 14 days) seems to be a safe and well tolerated procedure. A significant decline in prostate-specific antigen (PSA) level is seen in patients with hormone-responsive cancer. Long-term efficiency and toxicity of the procedure are yet to be established.

Angiographic and intravascular ultrasound assessment of immediate and 9-month efficacy of percutaneous transluminal renal artery balloon angioplasty with subsequent brachytherapy in patients with renovascular hypertension.

BACKGROUND/AIM: Scarce data exist concerning the long-term effect of renal balloon angioplasty (PTRA) enhanced by intravascular gamma-brachytherapy (IVBT) in patients with renovascular hypertension. The aim of this randomized study was to evaluate long-term outcome after PTRA with IVBT in patients with renal artery stenosis. PATIENTS AND METHODS: 71 patients with renovascular hypertension were randomized into group I (PTRA + IVBT) or group II (PTRA). 9 patients who required stent implantation were excluded. Both baseline and 9-month follow-up quantitative computerized angiography and intravascular ultrasound (IVUS) analysis were performed to assess restenosis. During the 9-month follow-up, 3 patients died - 2 from group I and 1 from group II. RESULTS: The restenosis rate was 16.1% in group I and 32.1% in group II. The 9-month lumen loss in angiography was 1.2 +/- 0.7 and 1.7 +/- 0.7 mm (p = 0.004) and the area loss (IVUS) was 6.5 +/- 4.8 and 10.1 +/- 5.6 mm(2) in groups I and II, respectively (p = 0.01). eGFR increased both in group I (from 75 +/- 22 to 84 +/- 31 ml/min/1.73 m(2); p < 0.001) and in group II (from 74 +/- 23 to 77 +/- 23 ml/min/1.73 m(2); p = 0.04). Only the diastolic blood pressure in group I decreased significantly (65 +/- 17 and 77 +/- 18 mm Hg; p = 0.048). The rate of blood pressure normalization was low in both groups (6.1 and 6.9%). CONCLUSIONS: IVBT after PTRA with a self-centering source is a safe and effective method for prevention of restenosis in patients with renovascular hypertension.

Endovascular gamma irradiation of the iliac arteries: 1-year results from a clinical safety and feasibility study.

PURPOSE: To estimate safety and feasibility of vascular brachytherapy in iliac arteries. METHODS: Fourteen patients (11 men; mean age 56.7+/-9.9 years, range 44-81) with occlusive disease in 15 iliac arteries (7 external, 8 common) were treated with balloon dilation followed by irradiation from an iridium 192 source (15 Gy at 3 mm from the inner surface of the artery wall) applied with a PARIS centering catheter and bilateral 10-mm margins. Patients receiving stents for suboptimal angioplasty were prescribed a 6-month course of antiplatelet treatment with ticlopidine. Angiography was routinely scheduled for 6 months after intervention. RESULTS: There were no complications of the angioplasty procedure or EVBT treatment; 7 patients received stents for dissection or residual stenosis. Mean follow-up was 12.4+/-6.0 months. At 6-month angiography, 1 (6.7%) restenosis in a common iliac artery stent was found. Another patient with a common iliac artery stent developed transient lower limb ischemia at 4 months, probably due to temporary suspension of antiplatelet treatment and distal disease. CONCLUSIONS: Brachytherapy in the iliac arteries appears to be feasible and safe; longer follow-up in more patients is needed to determine its clinical utility in the prevention of restenosis.

Vascular brachytherapy after percutaneous transluminal angioplasty of superficial femoral arteries-Polish pilot group.

PURPOSE: The article presents the results of treatment with vascular brachytherapy (VBT) in superficial femoral arteries. This method aims to minimize frequency of restenosis after percutaneous transluminal angioplasty (PTA). METHOD: Treatment was carried out in 20 cases. The patients with severe stenoses or total occlusions verified in angiography were selected. In the group of 19 patients, two were women (the average age of the patients was 58.7 years). VBT was performed immediately after PTA. A 15-Gy dose, with high dose rate, was applied. The dose was calculated based on individually chosen distance from the internal surface of the artery wall, which varied from 2 to 3 mm. The mean observation time after treatment was 8 months. The shortest time was 1 month and the longest 14 months. At the end of the observation time, the control DSA angiography was performed on every patient. RESULTS: During the first 2 months, in three cases, an acute thrombosis in treated artery was observed. In the third month, one treated artery occluded. In the sixth month of observation, one case of acute thrombosis was observed. The rest of the patients were free of restenoses. CONCLUSIONS: (1) In superficial femoral arteries, a low value of ankle brachial pressure index (ABPI; below 0.4) is very probably responsible for acute thrombosis after PTA with or without stent implantation followed by VBT. (2) Diabetes, rest ischaemia before treatment, poor vessel status confirmed in angiography may also be responsible for acute thrombosis after VBT. (3) Anticoagulants or antiplatelet (ticlipidine) treatment must be ordered for 6 months after VBT in patients with implanted stents.