Sexual function and the use of medical devices or drugs to optimize potency after prostate brachytherapy.

PURPOSE: Prospective evaluation of sexual outcomes after prostate brachytherapy with iodine-125 seeds as monotherapy at a tertiary cancer care center. METHODS AND MATERIALS: Subjects were 129 men with prostate cancer with I-125 seed implants (prescribed dose, 145 Gy) without supplemental hormonal or external beam radiation therapy. Sexual function, potency, and bother were prospectively assessed at baseline and at 1, 4, 8, and 12 months using validated quality-of-life self-assessment surveys. Postimplant dosimetry values, including dose to 10% of the penile bulb (D10), D20, D33, D50, D75, D90, and penile volume receiving 100% of the prescribed dose (V100) were calculated. RESULTS: At baseline, 56% of patients recorded having optimal erections; at 1 year, 62% of patients with baseline erectile function maintained optimal potency, 58% of whom with medically prescribed sexual aids or drugs. Variables associated with pretreatment-to-posttreatment decline in potency were time after implant (p = 0.04) and age (p = 0.01). Decline in urinary function may have been related to decline in potency. At 1 year, 69% of potent patients younger than 70 years maintained optimal potency, whereas 31% of patients older than 70 maintained optimal potency (p = 0.02). Diabetes was related to a decline in potency (p = 0.05), but neither smoking nor hypertension were. For patients with optimal potency at baseline, mean sexual bother scores had declined significantly at 1 year (p < 0.01). Sexual potency, sexual function, and sexual bother scores failed to correlate with any dosimetric variable tested. CONCLUSIONS: Erections firm enough for intercourse can be achieved at 1 year after treatment, but most men will require medical aids to optimize potency. Although younger men were better able to maintain erections firm enough for intercourse than older men, there was no correlation between potency, sexual function, or sexual bother and penile bulb dosimetry.

Ewing tumors of the head and neck.

PURPOSE: Retrospective review describing the 40-year University of Florida experience treating Ewing tumors of the head-and-neck region with a summary of the pertinent literature. PATIENTS AND METHODS: Nine patients were diagnosed and treated for Ewing sarcoma of the head and neck at our institution between 1965 and 2007. Primary sites included: mandible (3 patients), calvarium (2 patients), paranasal sinus (2 patients), oral cavity (1 patient), and the extraosseous soft tissue of the neck (1 patient). The median age at diagnosis was 13.0 years (range, 6.3-20.1 years). The median observed follow-up was 10.2 years (range, 1.5-37 years). RESULTS: All patients received multiagent chemotherapy and radiation therapy to a median dose of 55.8 Gy (range, 36-67.2 Gy). Three patients also underwent wide local excision. The actuarial 10-year overall survival, cause-specific survival, event-free survival, and local control probabilities were 66%, 66%, 56%, and 89%, respectively. Late complications included poor dentition, mild xerophthalmia, cataract, and mandibular hypoplasia. A literature search revealed 8 previous series with Ewing tumors of the head and neck analyzed as subsets of larger studies. CONCLUSIONS: In the context of limited data on head and neck Ewing tumors, combined modality therapy provides excellent local control with reasonable acute and late toxicity. Large tumors were associated with poor disease control.