ABSTRACT
The treatment of head and neck cancers can have a significant impact on function and appearance, which results in impairment of quality of life. Various long-term sequelae of treatment include speech and swallowing difficulty, oral incompetence, trismus, xerostomia, dental caries and osteoradionecrosis. Management has evolved from single modality treatment of either surgery or radiation to multimodality treatment to attain acceptable functional outcomes. Brachytherapy, also known as interventional radiotherapy, with its ability to deliver high doses centrally to the target, has been shown to improve local control rates. Due to the rapid fall-off of the dose of brachytherapy there is better organ at risk sparing as compared with that of external beam radiotherapy. In the head and neck region, brachytherapy has been practiced in various sites, including the oral cavity, oropharynx, nasopharynx, nasal vestibule and paranasal sinuses. Additionally, brachytherapy has also been considered for reirradiation as a salvage. Brachytherapy can also be considered as a perioperative technique together with surgery. Close multidisciplinary cooperation is required for a successful brachytherapy programme. In oral cavity cancers, depending on the location of the tumour, brachytherapy has been shown to preserve oral competence, maintain tongue mobility, maintain speech, swallowing and the hard palate. Brachytherapy in oropharyngeal cancers has been shown to reduce xerostomia and also reduce dysphagia and aspiration post-radiation therapy. For the nasopharynx, paranasal sinus and nasal vestibule, brachytherapy preserves the respiratory function of the mucosa. Despite such an incomparable impact on function and organ preservation, brachytherapy is an underutilised technique for head and neck cancers. There is a strong need to improve brachytherapy utilisation in head and neck cancers.
Subject(s)
Brachytherapy , Carcinoma, Squamous Cell , Dental Caries , Head and Neck Neoplasms , Xerostomia , Humans , Quality of Life , Carcinoma, Squamous Cell/pathology , Head and Neck Neoplasms/radiotherapy , Brachytherapy/methods , Radiotherapy DosageABSTRACT
Radiotherapy (RT) is commonly used as adjuvant treatment following hysterectomy and double oophorectomy in endometrial carcinoma. Prophylactic vaginal brachytherapy (BT) is the most common treatment in BT units. The PORTEC and GOG 99 studies have attempted to clarify the indications of BT and postoperative external RT, changing treatment standards. However, prophylactic BT regimens are very varied and there is currently no consensus on how to treat patients in terms of dose per fraction and number of fractions. Moreover, unoperated cases of endometrium are uncommon and there is limited experience in their treatment with BT. The 9th Consensus Meeting of the SEOR and SEFM Brachytherapy Group, held in Malaga on 11 March 2011, was therefore dedicated to "Brachytherapy in Endometrial Carcinoma". This article presents the consensus on treatment of endometrial carcinoma in operated (prophylactic vaginal BT) and unoperated (endouterine BT) patients.
Subject(s)
Brachytherapy/methods , Endometrial Neoplasms/radiotherapy , Combined Modality Therapy/methods , Consensus , Endometrial Neoplasms/surgery , Female , Humans , Medical Oncology/methods , Radiometry/methods , Risk , Treatment Outcome , Vagina/radiation effectsABSTRACT
Radiotherapy (RT) is commonly used as adjuvant treatment following hysterectomy and double oophorectomy in endometrial carcinoma. Prophylactic vaginal brachytherapy (BT) is the most common treatment in BT units. The PORTEC and GOG 99 studies have attempted to clarify the indications of BT and postoperative external RT, changing treatment standards. However, prophylactic BT regimens are very varied and there is currently no consensus on how to treat patients in terms of dose per fraction and number of fractions. Moreover, unoperated cases of endometrium are uncommon and there is limited experience in their treatment with BT. The 9th Consensus Meeting of the SEOR and SEFM Brachytherapy Group, held in Malaga on 11 March 2011, was therefore dedicated to "Brachytherapy in Endometrial Carcinoma". This article presents the consensus on treatment of endometrial carcinoma in operated (prophylactic vaginal BT) and unoperated (endouterine BT) patients (AU)
Subject(s)
Humans , Female , Brachytherapy/methods , Endometrial Neoplasms/radiotherapy , Combined Modality Therapy/methods , Endometrial Neoplasms/surgery , Medical Oncology/methods , Radiometry/methods , Risk , Vagina/radiation effectsABSTRACT
PURPOSE: We present the results of a prospective ten-year follow-up study to prove the effectiveness of a single fraction of 192-Ir high-dose-rate (HDR) brachytherapy (BT) as a boost. PATIENTS AND METHODS: Between 1999 and 2000, 84 consecutive patients with invasive breast carcinoma, with over 4 mm free margins after conservative surgery, were treated. All cases were stages T1-2, except for one case, a stage T3, 81% pN0, 19% pN1-2. Chemotherapy was used in 47% and hormonal therapy in 87%. Whole breast external beam radiotherapy (46 Gy) was followed 1-2 weeks later by an implant with metallic needles. A 7 Gy single dose of HDR BT to the 90% isodose line was delivered on an outpatient basis. Dosimetry was performed theoretically. This technique is called FAST-boost because the whole treatment is delivered in about two hours. RESULTS: With a median follow-up of 120 months, three patients relapsed in the margin of the implant and two in a different quadrant (5/84, 6%). Actuarial local control at five and ten years was 98.5% and 95.6%. Overall survival was 92.7% and 90.2%, and disease-free survival 90.2% and 79.9%. Cosmetic results were good or excellent in 92.5%. CONCLUSIONS: A single-fraction HDR boost with rigid needles (FAST-boost) is a good, quick, simple technique when surgical margins are free (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Clinical Trials as Topic/methods , Clinical Trials as Topic , Brachytherapy , Breast Neoplasms/radiotherapy , Carcinoma, Ductal, Breast/radiotherapy , Carcinoma, Lobular/radiotherapy , Carcinoma, Papillary/radiotherapy , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/mortality , Carcinoma, Ductal, Breast/pathology , Carcinoma, Lobular/mortality , Carcinoma, Lobular/pathology , Carcinoma, Papillary/mortality , Carcinoma, Papillary/pathology , Follow-Up Studies , Prospective StudiesABSTRACT
Objetivo: Revisar la experiencia con implantes permanentes de semillas de I-125 en carcinoma de próstata y el resultado a los 8 años de comenzar la técnica. Material y métodos: De 2002 a 2007 hemos realizado 250 implantes con braquiterapia de baja tasa con RapidStrand® y sistema de preplanificación. La edad media fue 68 años (49-78). El PSA medio fue 7,32 (2,31-14,6), 98% T1-T2a, 96% Gleason ≤ 6, 81% de bajo riesgo y 19% de riesgo intermedio (10 de estos últimos recibieron 46 Gy de radioterapia externa). Un 42% recibieron hormonoterapia. Resultados: Con seguimiento medio de 48 meses, 14 pacientes (5,7%) tuvieron recaída bioquímica (RB). En 11 pacientes (4,5%) con teórica RB el PSA descendió espontáneamente sin tratamiento. La supervivencia actuarial sin recaída bioquímica a 5 años fue del 91% (92% bajo riesgo, 86% riesgo intermedio); 92 vs 81% en pacientes con PSA < 10 vs > 10 (p < 0,05). Hubo complicaciones rectales G2 en el 0,6%, sondaje vesical en un 6,5%; el 60% conservaron la función sexual. El V100 medio fue del 89% y el D90 143 Gy. Conclusión: El resultado en carcinoma de próstata de bajo riesgo mediante semillas de Iodo-125es muy bueno con muy pocas complicaciones. Las elevaciones de PSA deberían ser controladas antes de dar tratamiento de rescate (AU)
Introduction: We review the experience with prostate carcinoma patients treated with permanent implants of 125-I seeds and the outcome eight years after the beginning of this technique. Material and methods: From 2002 to 2007 we have performed 250 implants with LDR brachytherapy with RapidStrand® and preplanning system. Mean age was 68 (49-78). Mean PSA was 7.32 (2.31 - 14.6). T1-T2a was the stage in 98%, and Gleason ≤ 6 in 96%. Low risk cases were 81% and intermediate risk 19% (ten of them received 46 Gy EBRT). Hormonal treatment was used in 42%. Results: With a mean follow-up of 48 months, 14 patients (5.7%) showed biochemical failure (BF). Eleven patients (4.5%) with theoretical BF were observed and PSA decreased without treatment. Actuarial PSA relapse-free survival at 5 years was 91%, (92% low risk, 86% intermediate cases), and 92% vs 81% with PSA <10 vs >10 (p < 0.05). Rectum complications were G2 in0 .6%. A urinary catheter was necessary in 6.5%. Sexual function was conserved in 60%. Mean V100 was 89% and D90 143 Gy. Conclusion: The outcome of patients with low risk prostate carcinoma treated with I-125 seed is very good with very low complications rate. Cases with PSA bounces should be controlled before starting a salvage treatment (AU)
Subject(s)
Humans , Male , Middle Aged , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , Prostatic Neoplasms/psychology , Brachytherapy/instrumentation , Brachytherapy/trends , Prostatic Neoplasms/complications , Prostatic Neoplasms/mortality , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms , Brachytherapy/methods , Brachytherapy , Dosimetry/analysis , Dosimetry/methods , Dosimetry/statistics & numerical dataABSTRACT
INTRODUCTION: We review the experience with prostate carcinoma patients treated with permanent implants of 125-I seeds and the outcome eight years after the beginning of this technique. MATERIAL AND METHODS: From 2002 to 2007 we have performed 250 implants with LDR brachytherapy with RapidStrand(®) and preplanning system. Mean age was 68 (49-78). Mean PSA was 7.32 (2.31 - 14.6). T1-T2a was the stage in 98%, and Gleason ≤ 6 in 96%. Low risk cases were 81% and intermediate risk 19% (ten of them received 46 Gy EBRT). Hormonal treatment was used in 42%. RESULTS: With a mean follow-up of 48 months, 14 patients (5.7%) showed biochemical failure (BF). Eleven patients (4.5%) with theoretical BF were observed and PSA decreased without treatment. Actuarial PSA relapse-free survival at 5 years was 91%, (92% low risk, 86% intermediate cases), and 92% vs 81% with PSA <10 vs >10 (p<0.05). Rectum complications were G2 in 0.6%. A urinary catheter was necessary in 6.5%. Sexual function was conserved in 60%. Mean V100 was 89% and D90 143 Gy. CONCLUSION: The outcome of patients with low risk prostate carcinoma treated with I-125 seed is very good with very low complications rate. Cases with PSA bounces should be controlled before starting a salvage treatment.
Subject(s)
Adenocarcinoma/radiotherapy , Brachytherapy , Iodine Radioisotopes/therapeutic use , Prostatic Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted , Adenocarcinoma/blood , Adenocarcinoma/drug therapy , Aged , Anilides/therapeutic use , Antineoplastic Agents, Hormonal/therapeutic use , Combined Modality Therapy , Computer Systems , Humans , Iodine Radioisotopes/administration & dosage , Male , Middle Aged , Nitriles/therapeutic use , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/drug therapy , Radiography, Interventional , Retrospective Studies , Tosyl Compounds/therapeutic use , Treatment OutcomeABSTRACT
Objetivo: Realizamos un estudio fase I-II con braquiterapiaperioperatoria (BTPO) con Ir-192 de alta tasa de dosis (ATD)en estadios iniciales de cáncer de mama para saber si la técnicaes factible y si reduce el fracaso local.Pacientes y métodos: Entre 1997 y 1999, 24 pacientesen estadios I-II entraron en este estudio prospectivo. Durantela cirugía conservadora, tras la extracción del tumor primario,se insertaron agujas rígidas en el lecho tumoral en dosplanos. Se administraron dos sesiones de 4,7 Gy de braquiterapiacon ATD al día siguiente de la cirugía. A los 39 díasde media desde la cirugía iniciaron radioterapia externa sobrela mama, 46 Gy con márgenes libres y 50 Gy + 6 Gy deelectrones, con un borde afecto. Diez pacientes recibieronquimioterapia (QT) (8 pacientes eran pN+).Resultados: Con una media de seguimiento de 117 meses,el control local fue 100%, permaneciendo 23 libres de enfermedad.La AP describió en 15 casos bordes libres y en 9 bordesafectos. Se realizó una rerresección en 4 pacientes, quedando3 con bordes libres; en un caso se realizó mastectomía.No aparecieron complicaciones relacionadas con el implanteni retrasos en la cicatrización. Las complicaciones tardías fueronG1-2. La estética fue buena o excelente en 16 pacientes.Conclusiones: La BTPO produce unas tasas de control localexcelentes, con reducción del tiempo total de tratamiento,y es el mejor método de irradiación del lecho quirúrgico. Serequiere una selección de pacientes para evitar el retraso de laQT(AU)
Objective: We started a phase I-II study with perioperative192-Ir high dose rate (HDR) brachytherapy in early breast carcinomato know if this technique was feasible, and if it coulddecrease the local failure.Patients and methods: Between 1997 and 1999, 24 patientswith clinical stage I-II entered in this prospective study.Just during the conservative surgery, after removing the primarytumour, several rigid needles in two planes were insertedon the tumour bed. The next day after surgery two fractions4.7 Gy of HDR brachytherapy were administered. Externalbeam radiotherapy (EBRT) on the whole breast started at amean of 39 days. If one margin was involved, 50 Gy to thewhole breast plus 6 Gy with electrons were given. Only 46 Gyif margins were free. Ten patients received chemotherapy(CT) at the end of EBRT (8 patients were pN+).Results: With a follow-up of 117 months, the local controlis 100% and 23 out of 24 patients remain tumor free. Surgicalfindings showed free margins in 15 cases and involvedmargins in 9 cases. Four out of 9 received a second resection,3 achieved free margins and one a mastectomy. There was nodelay in the scar nor complications related to the implant. Latecomplications were G1-2. Cosmetic results were good or excellentin 16 cases.Conclusions: BTPO contributes to achieve excellent longtermlocal control in breast carcinoma, decreases the totaltime of treatment and is the best method to radiate the bed tumour.A selection of patients is requiered to avoid a delay ofthe sistemic therapy(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Brachytherapy/instrumentation , Brachytherapy/methods , Breast Neoplasms/therapy , Neoplasm Staging/instrumentation , Neoplasm Staging/methods , Neoplasm Staging/statistics & numerical data , Neoplasm Staging/trends , Breast Neoplasms/radiotherapyABSTRACT
OBJECTIVE: To retrospectively evaluate the toxicity of low-dose-rate brachytherapy and to relate it to the dose-volume to organs at risk. MATERIAL AND METHODS: We study 160 patients with early prostate cancer, treated with (125)-I implants. Most of them were T1c (63.1%), T2a (35.6%) and Gleason < or =6 (96.2%). Median PSA was 7.2 ng/ml (2.3-13.5); 85.6% were lowrisk cases and 14.4% high-risk cases. Mean follow-up was 24 months (7-48). RESULTS: Acute urinary toxicity related to urological quality of life (UQL=CVU) was tolerable in 75% and unsatisfactory in 25%. Urinary retention was present in 6.9%. IPSS, V100 and D90 were related to the urinary toxicity grade. Rectal toxicity (RTOG) G2 was 0.6%. Sexual potency showed no changes with regard to the basal in 69%. Actuarial biochemical control was 89.8% at four years. CONCLUSIONS: Brachytherapy with (125)-I seeds yields acceptable toxicity and excellent biochemical control.
Subject(s)
Brachytherapy/adverse effects , Prostate-Specific Antigen/radiation effects , Prostatic Neoplasms/radiotherapy , Urination Disorders/etiology , Aged , Humans , Iodine Radioisotopes/therapeutic use , Male , Middle Aged , Prostate-Specific Antigen/blood , Quality of Life , Retrospective Studies , Sexual Dysfunction, Physiological/epidemiology , Sexual Dysfunction, Physiological/etiology , Urinary Tract/radiation effects , Urination Disorders/epidemiologyABSTRACT
OBJECTIVE: To retrospectively evaluate the toxicity of low-dose-rate brachytherapy and to relate it to the dose-volume to organs at risk. MATERIAL AND METHODS: We study 160 patients with early prostate cancer, treated with (125)-I implants. Most of them were T1c (63.1%), T2a (35.6%) and Gleason < or =6 (96.2%). Median PSA was 7.2 ng/ml (2.3-13.5); 85.6% were lowrisk cases and 14.4% high-risk cases. Mean follow-up was 24 months (7-48). RESULTS: Acute urinary toxicity related to urological quality of life (UQL=CVU) was tolerable in 75% and unsatisfactory in 25%. Urinary retention was present in 6.9%. IPSS, V100 and D90 were related to the urinary toxicity grade. Rectal toxicity (RTOG) G2 was 0.6%. Sexual potency showed no changes with regard to the basal in 69%. Actuarial biochemical control was 89.8% at four years. CONCLUSIONS: Brachytherapy with (125)-I seeds yields acceptable toxicity and excellent biochemical control (AU)
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Subject(s)
Humans , Male , Middle Aged , Aged , Brachytherapy/adverse effects , Prostate-Specific Antigen/blood , Prostate-Specific Antigen/radiation effects , Prostatic Neoplasms/radiotherapy , Urination Disorders/epidemiology , Urination Disorders/etiology , Iodine Radioisotopes/therapeutic use , Quality of Life , Retrospective Studies , Sexual Dysfunction, Physiological/epidemiology , Sexual Dysfunction, Physiological/etiology , Urinary Tract/radiation effectsABSTRACT
La irradiación parcial de la mama es un tratamiento de recienteaparición que consiste en la irradiación del cuadrante mamariodonde se encuentra el tumor inicial. Este tipo de tratamientose basa en las pocas recidivas locales que existen despuésde la cirugía fuera del cuadrante donde se encontraba el tumorinicial, sobretodo en lesiones pequeñas y sin factores de mal pronósticolocal. Existen en la literatura numerosos autores que hanpublicado resultados prometedores con dicho tratamiento y actualmenteexisten 2 ensayos fase III, uno en EE.UU. y otro enEuropa, que comparan el tratamiento conservador estándar detumorectomía y radioterapia de toda la mama versus la irradiaciónparcial de la mama.En este artículo se revisan las bases clínicas y bibliográficasde la irradiación parcial de la mama(AU)
Partial breast irradiation is a new treatment which consists inthe irradiation of the quadrant where the initial tumour was located.The basis of such a treatment is that patients with a smalltumour and without bad local prognostic factors have a very lowrate of local relapses out of the involved quadrant. In the literature,a number of authors have published promising results withpartial breast radiotherapy and nowadays 2 phase III trials, onein USA and the other in Europe, are comparing conservativetreatment with partial breast irradiation.In this article we review the clinical and bibliographical basisfor partial breast irradiation(AU)
Subject(s)
Humans , Female , Brachytherapy/methods , Breast Neoplasms/radiotherapy , MastectomyABSTRACT
Propósito: Estudiar los resultados del tratamiento con radioterapia y braquiterapia del carcinoma de cérvix avanzado en función de la afectación ganglionar. Material y métodos: Se analizan 68 pacientes en estadio IIB y IIIB, 16 con ganglios pélvicos afectos por TAC o linfografía, 33 sin afectación y 19 sin estudio previo. Se dieron 50 Gy en pelvis con fotones de 10 MV y dos aplicaciones con braquiteropia de baja tasa. Sólo en 6 casos se hizo RT paraaórtica. Resultados: La supervivencia global a 5 años es 57 por ciento. Con ganglios positivos es 43 por ciento, frente a 60 por ciento sin ganglios afectos (p<0,1). En estadios IIB N + es 15 por ciento frente a 76 por ciento (p<0,01). En estadios IIIB no hay diferencias. El control loco-regional a 5 años es de 60 por ciento en ambos estadios. Con ganglios positivos es 44 por ciento frente a 60 por ciento (p<0,1). En estadio IIB N + es 20 por ciento, y en N - 76 por ciento (p<0,01). En estadio IIIB no hay diferencias significativas. Cuando hay N + hay mayor afectación paraaórtica (44 por ciento frente a 18 por ciento), pero no aumentan las metástasis a distancia (25 por ciento y 24 por ciento), que sí aumentan en estadios IIIB respecto a IIB (29 por ciento frente a 18 por ciento)Conclusiones: Cuando hay ganglios pélvicos afectos se recomienda añadir RT paraaórtica. Con enfermedad voluminosa es preferible asociar RT con QT concomitante para intentar mejorar el control locoregional (AU)
