Toxicity and outcomes associated with high-dose rate brachytherapy for medically inoperable endometrial cancer.

PURPOSE: To evaluate toxicity in inoperable endometrial cancer (EC) treated with definitive radiation therapy (RT). MATERIALS AND METHODS: Patients treated with definitive RT for EC were retrospectively reviewed. EQD2 values were calculated for bladder, rectum, and sigmoid. Acute and late toxicities were retrospectively graded. Descriptive statistical analysis was performed. RESULTS: Fifty-one patients were included. The majority of patients had endometrioid histology (N = 46, 90.2%) and Grade 1 disease (N = 32, 62.75%). Thirty-seven patients (72.5%) were treated with image-guided BT (IGBT) and 14 (27.5%) with two-dimensional BT. Forty patients (78.4%) received EBRT + BT and 11 (21.57%) received BT alone. No grade 2 (G2) or higher toxicities were reported with BT alone. G2 or higher acute toxicities with EBRT + BT were G2 proctitis (N = 2, 5.0%) and G3 proctitis (N = 1, 2.5%). Late toxicities included G3 vaginal stenosis (N = 1, 2.5%), proctitis (N = 1, 2.5%), enteritis (N = 1, 2.5%), and one G4 gastrointestinal bleed. One- and 2-year local control were 100% with BT alone and 93% and 89%, respectively, with EBRT + BT. One- and 2-year locoregional control were 100% with BT and 97% and 93%, respectively, with EBRT + BT. Recurrence-free survival was 89% at 1 and 2 years with BT alone compared to 87% and 80% with EBRT + BT. One- and 2-year overall survival were 88% and 72% with BT alone compared to 94% and 84% with EBRT + BT. There were no statistically significant differences in cancer control between the two groups. CONCLUSIONS: Women with inoperable EC treated with definitive RT have low toxicity rates and durable local control.

Treatment of locally advanced cervical cancer in a patient with a bicornuate uterus with MRI-guided intracavitary/interstitial brachytherapy.

PURPOSE: Definitive treatment for locally advanced cervical cancer (LACC) includes external beam radiation therapy (EBRT) with concurrent cisplatin and brachytherapy. Image-guided intracavitary brachytherapy utilizes CT and/or MRI for target and organ at risk delineation and has been shown to improve local control rates and decrease toxicity. Hybrid intracavitary/interstitial applicators can be used to improve tumor coverage in certain cases. We describe the use of combined intracavitary/interstitial brachytherapy to treat a cervical cancer patient with a bicornuate uterus. CASE PRESENTATION: A 30-year-old female with bicornuate uterus and FIGO IB2 adenocarcinoma of the cervix was treated with 45 Gy of EBRT to the pelvis with concurrent weekly cisplatin. An examination after EBRT demonstrated a persistent bulky tumor covering most of the cervix. Brachytherapy was delivered via a combined intracavitary/interstitial approach, using a tandem and ring applicator and an interstitial needle. The placement of the tandem was alternated between uterine cornua with each fraction, and the interstitial needle was placed on the side opposite the tandem. CT and MRI were obtained with each fraction. The patient completed the treatment without complications. Three-month restaging PET-CT showed significant interval improvement in the cervix, with a complete clinical response on physical examination. The patient is without evidence of disease 18 months after the treatment. CONCLUSIONS: We found that the use of the hybrid applicator allowed for adequate target coverage in a patient with unusual anatomy. The patient tolerated treatment well and demonstrated favorable response on follow-up exam and imaging. The long-term curative result needs to be further evaluated.

Interatrial Bronchogenic Cyst Resection.

Interatrial bronchogenic cysts are rare entities, and the long-term clinical sequelae are unknown. This case report details the removal of a large (>4 cm) interatrial bronchogenic cyst that had been present for more than 10 years. Surgical resection remains the current standard of therapy when encountering an interatrial mass.

Postoperative radiation therapy for parotid mucoepidermoid carcinoma.

Salivary gland cancers are rare and represent approximately 5% of all head and neck cancers and only 0.3% of all malignancies. The majority (75%) of salivary gland tumors occur in the parotid gland, and while benign lesions are more common, mucoepidermoid carcinoma (MEC) makes up 40-50% of malignant parotid gland tumors. No randomized controlled trials exist regarding the role of adjuvant radiation for patients who undergo surgical resection of low-grade MECs. Herein, we report two cases of successful postoperative radiation therapy in low-grade, pT2N0 MEC of the parotid gland. The role of adjuvant radiation therapy for patients with MEC of the parotid gland is based on data from institution reviews and lacks data from randomized controlled trials. Per our review of the literature, the pathological findings of positive surgical margins and/or perineural invasion in two patients with low-grade MEC of the parotid gland warranted adjuvant radiation for improved local control after partial parotidectomy. Both patients tolerated postoperative radiation therapy with only mild side effects and, at last follow-up, five years after completion of therapy, had no clinical or radiographic evidence of either local recurrence or distant metastasis.