Image-guided Interstitial Brachytherapy in the Treatment of Primary and Recurrent Vulvovaginal Gynaecological Malignancies.

AIMS: To evaluate the use, outcomes and toxicities of high dose rate brachytherapy (HDRB) to the vulvovaginal region in previously irradiated and radiotherapy-naïve patients for primary or recurrent gynaecological malignancies. MATERIALS AND METHODS: From January 2010 to December 2020, 94 women with a median age of 64 years (range 31-88 years) were treated with interstitial HDRB for vulvovaginal disease. Treatment details, including cumulative radiotherapy doses, were recorded together with reported toxicity, using Common Terminology Criteria for Adverse Events (CTCAE) grading. Dosimetric parameters, including D90, V100 and V150 together with treatment response at 3 months, overall survival, relapse-free survival and long-term toxicity data, were collated from referring centres. RESULTS: The median follow-up was 78 months (range 2-301). Primary sites of disease included vagina (37), endometrium (29), vulva (16), ovary (7) and cervix (5). Eighty-six (91.5%) patients were treated with curative intent, eight (8.5%) were palliative treatments. Fifty patients received HDRB for recurrent disease, 39 patients for primary disease and five as part of adjuvant treatment. The anatomical site of disease treated with HDRB ranged from vagina (76), vulva (14) and peri-urethral sites (four). The 2- and 5-year local relapse-free survival rates were 76% and 72%, respectively; 15 patients experienced local failure only, whereas six patients had local and nodal/distant failure. The median time to local recurrence was 8 months (range 2-88 months). The 2- and 5-year overall survival rates for all patients were 67% and 47%, respectively; the median overall survival was 59 months. Seventy-nine (84%) patients had a complete response measured with imaging at 3 months. Grade 3 toxicity was reported in 14 patients (14.8%). CONCLUSION: This retrospective series suggests the use of interstitial brachytherapy for vulvovaginal gynaecological malignancy to be an effective and safe treatment option. Good local control was achieved with a tolerable toxicity profile; it is a valuable treatment modality.

[The treatment of lower limb varicosity under outpatient conditions].

Presented herein is a 7-year experience with the treatment of lower limb varicosity under outpatient conditions according to the authors' technology based on three inventions. The advantages of the given treatment method as compared to the traditional surgical technology are demonstrated as are its simplicity, safety and efficiency.

[Formation of compressive bandage after sclerotherapy for lower limb varices]. / Sposob formirovaniia kompressionnogo bandazha pri skleroterapii varikoznykh ven nizhnikh konechnostei.

Invention concerns compressive sclerotherapy as a treatment modality for lower limb varices. Technical result of investigation is the development of compressive bandage that creates and maintains adequate level of limb compression both in supine position (during bed rest) and standing or walking. Technical result is achieved by formation of two compressive layers of elastic bandage. Highly expansible elastic bandage is used for the first layer aimed for fixation and compression of latex or foam pads at injection sites to create local compression of variceal nodes. Open toe elastic stocking (I compression class) is placed over the bandage to maintain adequate compression during bed rest. The second external layer consists of elastic bandage with moderate expansion (II compression class). It is placed over the first one from toes to thigh upper third and creates optimal compression in patient's vertical position. The patient is permitted to take it off or loose exclusively in supine position, to wash or refresh foot with wet towel, to change it with a new one.