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PURPOSE: Our purpose was to evaluate the usage and perceived benefit of surgical clips for breast radiation therapy planning in Canada, focusing on partial breast irradiation (PBI) after breast-conserving surgery. METHODS AND MATERIALS: A retrospective institutional review identified patients eligible for PBI based on clinicopathologic criteria, and tumor bed visualization was determined from computed tomography-planning scans. An online survey was subsequently distributed to Canadian radiation oncologists addressing the usage and added value of surgical clips for breast radiation therapy planning purposes. The survey also evaluated PBI usage and regimens. Responses were collected over a 4-week period. PBI regimen usage at our institution was also reviewed from May 1 to December 18, 2020. RESULTS: Based on clinicopathologic criteria, 306 patients were identified between 2013 and 2018 who were eligible for PBI. However, only 24% (72/306) of cases were noted to have surgical clips, of which over 50% did not assist in tumor bed localization due to inconsistent clip positioning. Similarly, nearly two-thirds (28/43) of survey respondents indicated that surgical clips are placed in the tumor bed in less than 50% of cases. Almost all respondents (42/43) indicated that surgical clips facilitate breast radiation therapy planning and favor the development of guidelines to increase the consistent placement of surgical clips in the tumor bed after breast-conserving surgery. Approximately two-thirds of respondents (28/43) offer PBI to eligible patients as routine treatment, with moderate hypofractionated regimens most commonly recommended. However, the 1-week daily regimen of 26 Gy in 5 fractions is now offered to the majority (77%) of patients at our institution. CONCLUSIONS: There was strong agreement among Canadian radiation oncologists that surgical clip placement facilitates breast radiation therapy planning, and most favor the development of surgical guidelines for the consistent placement of surgical clips in this setting. With the growing use of PBI, accurate localization of the tumor bed is extremely important.
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PURPOSE: To document the current prostate brachytherapy practice across the UK and Ireland and compare with previously published audit results. MATERIAL AND METHODS: Participants from 25 centers attending the annual UK & Ireland Prostate Brachytherapy Conference were invited to complete an online survey. Sixty-three questions assessed the center's experience and staffing, clinician's experience, clinical selection criteria and scheduling, number of cases per modality in the preceding three years, low-dose-rate (LDR) pre- and post-implant technique and high-dose-rate (HDR) implant technique. Responses were collated, and descriptive statistical analysis performed. RESULTS: Eighteen (72%) centers responded with 17 performing LDR only, 1 performing HDR only, and 6 performing both LDR and HDR. Seventy-one percent of centers have > 10 years of LDR brachytherapy experience, whereas 71% centers that perform HDR brachytherapy have > 5 years of experience. Thirteen centers have 2 or more clinicians performing brachytherapy with 61% of lead consultants performing > 25 cases (LDR + HDR) in 2016. The number of implants (range), that includes LDR and HDR, performed by individual practitioners in 2016 was > 50 by 21%, 25-50 by 38%, and < 25 by 41%. Eight centers reported a decline in LDR monotherapy case numbers in 2016. Number of center's performing HDR brachytherapy increased in last five years. Relative uniformity in patient selection is noted, and LDR pre- and post-implant dosimetry adheres to published quality guidelines, with an average post-implant D90 of > 145 Gy in 69% of centers in 2014 and 2015 compared to 63% in 2016. The median CT/US volume ratios were > 0.9 ≤ 1.0 (n = 4), > 1.0 ≤ 1.1 (n = 7), and > 1.1 (n = 2). CONCLUSION: There is considerable prostate brachytherapy experience in the UK and Ireland. An apparent fall in LDR case numbers is noted. Maintenance of case numbers and ongoing compliance with published quality guidelines is important to sustain high quality outcomes.
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BACKGROUND: The purpose of this study was to compare the prostate-specific antigen (PSA) response to either neoadjuvant bicalutamide (BC) monotherapy or neoadjuvant luteinizing hormone-releasing hormone agonist (LHRHa) monotherapy and the subsequent effect on biochemical failure-free survival (BFFS) in men receiving radical radiotherapy (RT) for localized prostate cancer. PATIENTS AND METHODS: This was a retrospective review of consecutive men treated with BC monotherapy before radical prostate RT who were individually case-matched to men treated with neoadjuvant LHRHa monotherapy. PSA kinetics and absolute pre-RT posthormone PSA (PRPH-PSA) level and subsequent BFFS were analyzed. RESULTS: Sixty-five men treated with BC monotherapy with a median follow-up of 44 months were individually matched with 65 men treated with LHRHa with a median follow-up of 54 months. Statistically significant differences were noted between groups in the PRPH-PSA, with a mean of 2.9 ng/mL (0.1-11.2 ng/mL) for patients receiving BC treatment and 1.8 ng/mL (0.1-11.1 ng/mL) for patients receiving LHRHa treatment (P < .001). A PRPH-PSA of < 1.0 and < 0.1 ng/mL was seen in 16 (24.6%) and 2 (3%) of the patients receiving BC and 34 (52.3%) and 3 (4.6%) patients receiving LHRHa, respectively. There were no significant differences between groups in either PSA halving time or velocity. Phoenix biochemical failure occurred in 10 (15.4%) and 8 (12.3%) patients receiving BC and patients receiving LHRHa, respectively. Neither PRPH-PSA level nor PSA kinetics during the neoadjuvant period predict for subsequent BFFS at this duration of follow-up. CONCLUSIONS: Although neoadjuvant BC therapy did not result in equivalent PRPH-PSA suppression when compared with neoadjuvant LHRHa alone, there was no difference in biochemical failure rates between cohorts at 50 months' median follow-up. Longer follow-up is required.
