Late vascular complications after cranial radiotherapy: A report of two illustrative cases.

Cranial radiotherapy (CRT) is used to treat a large variety of benign and malignant disorders. We present two cases of late neurological complications after CRT and briefly discuss its diagnosis and their shared pathophysiological aspects. The first case is a patient with cognitive impairment associated to mineralizing microangiopathy ten years after CRT for nasopharyngeal carcinoma and the second one is a woman with Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome two years after CRT for anaplastic meningioma. Nowadays, higher survival rates might cause an increase in appearance of late neurological complications after CTR. These reported cases show that late complications can mimic a wide variety of neurological conditions and the importance of magnetic resonance image (MRI) to get a diagnosis.

High-dose-rate intensity modulated brachytherapy with external-beam radiotherapy improves local and biochemical control in patients with high-risk prostate cancer.

Purpose Our aim was to report the 8-year outcome of local dose escalation using high-dose-rate conformal brachytherapy combined with external irradiation for patients with high-risk prostate cancer. Material and methods From June 1998 to June 2007, 134 patients with high-risk localized prostate cancer were prospectively enrolled in the study. The median follow-up was 45 months (12-107). Only patients considered as having high-risk criteria were accepted [prostate-specific antigen (PSA) > or =20 ng/ml and/or Gleason >7 and/or stage > or =T3a or two intermediate-risk criteria: PSA 11-19 ng/ml, Gleason 7, stage T2b-c]. The total dose applied by external beam radiotherapy was 46 Gy in 200-cGy daily fractions. High-dose-rate brachytherapy was performed at the end of weeks 1 and 3 of the 5-week radiotherapy course. The doses administered in each application was 1,150 cGy. Any patient free of clinical or biochemical evidence of disease was termed b-NED. Actuarial rates of outcome were calculated by Kaplan. Meier analysis and compared using the log-rank test. Cox regression models were used to establish prognostic factors of the measures of outcome. Results Mean follow-up for the entire group was 45 months (range 12-107). The overall survival (OS) according to Kaplan-Meier estimates was 85% (+/-5) at 5 and 8 years. The 5 and 8 years for biochemical control were 80% (+/-4%) and 73% (+/-7%), respectively, whereas for failure in tumor-free survival (TFS), they were 82% (+/-3) at 5 and 8 years, respectively. The 8-year cause-specific mortality was 10% (+/-4%). The multivariate Cox regression analyses identified the number of poor prognostic factors as independent for biochemical failure. Our report includes only patients considered as high risk, and the 8-year b-NED survival rate was 83% for patients with two intermediate-risk criteria, 78% for patients with one poor prognostic factor, 56% for two and 35% for all three (p = 0.001). There were no urethral strictures and/or urinary incontinence. Gastrointestinal toxicity grade 2 was 7.5%. Conclusions The 8-year results confirm the feasibility and effectiveness of external-beam radiation therapy with conformal high-dose-rate brachytherapy boost for patients with high-risk tumor. The late toxicity rates were low, corroborating the excellent dose conformity.

[Brachyterapy in localized prostate cancer]. / Braquiterapia en el cáncer de próstata localizado.

INTRODUCTION AND OBJECTIVES: Considering the high frequency of localized prostate cancer in stages, at the moment there are minimally invasive techniques that compete with the classic surgery. One of them is the Low Dose Rate (LDR) Brachytherapy with permanent implants of 1125 seeds. The objective of the present study is to expose our experience from the year 1998, when we made the first treatment, until today. The results and the morbidity of the patients over a 7 and a half years period are analyzed. MATERIAL AND METHODS: A total of 800 patients were treated with LDR brachytherapy, with average age of 68 years and range between 48 and 83 years. In all patients the 1125 seeds were used with Rapid-Strand and peripheral load by means of intraoperative planning. RESULTS: The urinary rate of complications was of 3% of AUR, and 0.2% of urinary incontinence. The morbidity on the digestive apparatus was of a 12% intermittent bleeding, 2% of proctitis, and a 0.3% of rectal fistulas.