Should high-dose-rate brachytherapy boost be used in early nasopharyngeal carcinomas?

BACKGROUND: Radiation with or without chemotherapy is the main treatment of nasopharyngeal carcinomas (NPC). Local recurrence is difficult to manage. Local control is dose-dependent. AIM: To analyze the effect of an endocavitary brachytherapy boost after external beam radiation (EBRT) to decrease local recurrence. MATERIAL AND METHODS: Thirty patients with T0-T2 NPC were treated: 70% T1, 20% T2 and 10% T0; 33.3% N0, 20% N1, 43.3% N2 and 3.3% N3; 90% were undifferentiated carcinoma. All they received a 192-Ir high dose rate brachytherapy (HDR-BT) boost after 60 Gy of EBRT. The Rotterdam applicator was used in most cases, 3-4 fractions of 3.75-3 Gy in two days. RESULTS: With median follow-up (FU) of 63 months, a single parapharyngeal failure resulted in local control of 100% at 3 years and 95% at 5 years. Local control for T0-1 was 100% and for T2 67% at five years (p = 0.02). Regional-free recurrence survival was 92% at 5 years. Metastasis-free survival was 84% at 5 years. All cases of metastasis had histopathology of undifferentiated. The overall and cause-specific survival was 96% and 86% at 3 and 5 years. No late complications related to brachytherapy were described. CONCLUSION: A HDR-BT boost is useful to decrease the incidence of local recurrence of NPC to 5%. With a fractionated schedule of 3-4 fractions in two days, Rotterdam applicator and 3-D planning, no late complications are described. Therefore we recommend to use brachytherapy boost in all early NPC.

Is perioperative brachytherapy effective in carcinoma of the tongue?

Purpose: To analyze the results of patients treated with perioperative interstitial brachytherapy (ISBT) in tongue carcinoma (TC). Material and methods: From April 2009 to May 2015, 43 squamous cell carcinoma consecutive patients diagnosed with TC were treated with limited partial glossectomy and perioperative ISBT, using high-dose-rate (HDR). Twenty- seven patients were treated by brachytherapy (BT), and sixteen received BT as a complement to subsequent external beam radiotherapy (EBRT) after results of lymph node dissection. Median age was 66 years. Distribution by stage, included 10 patients stage I, 14 stage II, 10 stage III, and 9 stage IV. Eighteen patients had negative margins, nineteen margin involvement, and in six cases, the margin was < 5 mm. Results: With a median follow-up of 54 months, LC at 3 and 5 years was 87% and 84%, respectively. LC was 95% at five years in patients with clear margins, and 75% with involved margins. LC in N0 patients treated with BT was 83% at 5 years, and in patients N+ with posterior EBRT treatment, LC was 86%. By tumor size, we found one local relapse in 13 cases T1, in 5 of 27 patients T2 was found, and no local relapse T3 with LC of 87%, 70%, and 100% respectively at five years. Regional control (RC) was 81% at 3 and 5 years. We found a metastasis-free survival of 91% at 3- and 5-year. Twenty-three patients have died, 11 of them due to other causes, with overall survival of 56% at three years and 53% at five years. Conclusions: Combined treatment with conservative surgery and ISBT shows similar results to radical surgery or RT alone, allowing a more patient-tailored approach, with good organ function preservation and cosmetic outcomes.

Choroidal Melanoma with Ultrasound-Guided Episcleral Brachytherapy: Long-Term Results and Risk of Metastasis.

INTRODUCTION: The aim of this study was to elucidate the long-term outcomes in patients with choroidal melanoma who received episcleral brachytherapy with 125-I seeds; analyse cause-specific survival (CSS), metastasis-free survival (MFS), and local control; and establish the relationship between tumour size and metastases. METHODS: From May 2007 to February 2013, 88 patients classified according to the American Joint Committee on Cancer guidelines underwent ultrasound-guided episcleral brachytherapy with a total prescribed dose of 72.40 Gy to the apex. RESULTS: Among the included cases, 47.7 and 44.3% had a clinical tumour stage of T2 and T3, respectively. With a median follow-up of 84 (range 7-153) months, local control at 5 and 10 years was 100 and 95%, respectively. Among the 88 patients, 9 (10.2%) were enucleated after brachytherapy. Those with T1-T2 and T3-T4 disease had a 10-year CSS of 100 and 87.3%, respectively (p = 0.017). MFS at 5 and 10 years was 100% in those with T1-T2 disease and 92.1 and 83.1% in those with T3-T4, respectively (p = 0.016). Five patients had liver metastases, all of whom had T3-T4 disease. CONCLUSION: Ultrasound-guided episcleral brachytherapy with 125-I seeds yielded excellent local control for choroidal melanoma, with low complication rates and 90% eye preservation. Given the association between tumour stage and liver metastases, which remain the main cause of death, stricter control should be employed for T3-T4 tumours for the early detection and treatment of relapses.

Efeito de um Agente Dessensibilizante na Rugosidade do Esmalte Após Clareamento / Effects of Desensitizing Agent on the Enamel Roughness after Bleaching

O objetivo deste estudo foi avaliar a rugosidade superficial do esmalte dental hígido, submetido ao tratamento clareador de consultório e posterior aplicação de um agente dessensibilizante. Para este estudo, foram utilizados 40 incisivos bovinos para a obtenção de 60 fragmentos de esmalte (4 x 4 x 3 mm). Os blocos de esmalte foram preparados para a determinação da rugosidade inicial. Em seguida, as amostras foram dividas em 4 grupos experimentais (n=8): G1 - Grupo controle ? sem tratamento clareador, G2 - Peróxido de Hidrogênio a 35%, G3 - Peróxido de Hidrogênio a 35% + Dessensibilizante, G4 ? Agente dessensibilizante. Foram realizadas 3 aplicações, 15 minutos cada, do gel clareador e em seguida, de acordo com os grupos experimentais foi aplicado o agente dessensibilizante por 10 minutos. No fim dos tratamentos as amostras foram novamente submetidas a leitura da rugosidade de superfície. Os dados foram tabulados e submetidos a ANOVA (2 fatores), considerando os fatores tratamento e tempo. Os valores médios de rugosidade (Ra) obtidos (desvio padrão) foram: G1 inicial 0,17 (0,09) e final 0,18 (0,09); G2 inicial 0,15 (0,06) e final 0,21 (0,06); G3 inicial 0,13 (0,07) e final 0,18 (0,04) e G4 inicial 0,14 (0,08) e final 0,16 (0,08). A análise estatística dos dados revelou que não houve diferença estatisticamente significante antes e após a aplicação do agente dessensibilizante e gel clareador. Desta forma, podemos concluir que o clareamento de consultório, utilizando peróxido de hidrogênio a 35%, e aplicação de um agente dessensibilizante não altera a rugosidade superficial do esmalte dental.

The clinical evaluation of restorations in anterior teeth becomes essential due to the current aesthetic and functional appreciation by patients with regard to the appearance of the smile and oral health maintenance. The aim of this study was to perform a clinical evaluation of direct The aim of this study was to evaluate the intact enamel surface submitted to office bleaching followed by desensitizing agent application. For this study, 40 bovine incisors were used to obtain 60 enamel blocks (4 x 4 x 3 mm). The enamel blocks were prepared to determine initial surface roughness. Then, the samples were divided into four experimental groups (n = 8): G1 ? control group, no bleaching; G2 ? 35% hydrogen peroxide; G3 ? 35% hydrogen peroxide + desensitizing agent; G4 - desensitizing agent. The bleaching agent was applied for three times, 15 min each application and then the desensitizing agent was applied for 10 minutes according to the experimental groups. After treatments, the samples were again subjected to analysis of surface roughness. Data were tabulated and analyzed by ANOVA (two-way), considering the factors: time and treatment. The mean values (standard deviation) of roughness (Ra) were: G1 initial 0.17 (0.09) and final 0.18 (0.09); G2 initial 0.15 (0.06) and final 0.21 (0.06); G3 initial 0.13 (0.07) and final 0.18 (0.04) e G4 initial 0.14 (0.08) and final 0.16 (0.08). Data analysisrevealed no significant difference before and after applications of bleaching agent and desensitizing gel. Thus, we can conclude that office bleaching using 35% hydrogen peroxide and desensitizing agent application does not alter the tooth enamel surface roughness.