A Survey of Radiation Therapy Utilization in Korea from 2010 to 2016: Focusing on Use of Intensity-Modulated Radiation Therapy.

BACKGROUND: This study aimed to assess the recent changes of radiation therapy (RT) modalities in Korea. In particular, we focused on intensity-modulated radiation therapy (IMRT) utilization as the main index, presenting the application status of advanced RT. METHODS: We collected information from the Korean Health and Insurance Review and Assessment Service data based on the National Health Insurance Service claims and reimbursements records by using treatment codes from 2010 to 2016. We classified locating region of each institution as capital vs. non-capital areas and metropolitan vs. non-metropolitan areas to assess the regional difference in IMRT utilization in Korea. RESULTS: IMRT use has been steadily increased in Korea, with an annual increase estimate (AIE) of 37.9% from 2011 to 2016 (P < 0.001) resulting in IMRT being the second most common RT modality following three-dimensional conformal radiotherapy. In general, an increasing trend of IMRT utilization was observed, regardless of the region. The rate of AIE in the capital areas or metropolitan areas was higher than that in non-capital areas or non-metropolitan areas (40.7% vs. 31.9%; P < 0.001 and 39.7% vs. 29.4%; P < 0.001, respectively). DISCUSSION: The result of our survey showed that IMRT has become one of the most common RT modalities. IMRT is becoming popular in both metropolitan and non-metropolitan areas, while metropolitan area has faster AIE possibly due to concentration of medical resources and movement of advanced patients.

The rise and fall of prostate brachytherapy: use of brachytherapy for the treatment of localized prostate cancer in the National Cancer Data Base.

BACKGROUND: Brachytherapy has been shown to be an efficacious and cost-effective treatment among patients with localized prostate cancer. In this study, the authors examined trends in brachytherapy use for localized prostate cancer using a large national cancer registry. METHODS: In the National Cancer Data Base (NCDB), a total of 1,547,941 patients with localized prostate cancer were identified from 1998 through 2010. Excluding patients with lymph node-positive or metastatic disease, the authors examined primary treatment trends focusing on the use of brachytherapy over time. Patients with available data (2004-2009) were stratified by National Comprehensive Cancer Network risk criteria. Controlling for year of diagnosis and demographic, clinical, and pathologic characteristics, multivariate analyses were performed examining the association between patient characteristics and receipt of brachytherapy. RESULTS: In the study cohort, brachytherapy use reached a peak of 16.7% in 2002, and then steadily declined to a low of 8% in 2010. Of the 719,789 patients with available data for risk stratification, 41.1%, 35.3%, and 23.6%, respectively, met low, intermediate, and high National Comprehensive Cancer Network risk criteria. After adjustment, patients of increasing age and those with Medicare insurance were more likely to receive brachytherapy. In contrast, patients with intermediate-risk or high-risk disease, Medicaid insurance, increasing comorbidity count, and increasing year of diagnosis were less likely to receive brachytherapy. CONCLUSIONS: For patients with localized prostate cancer who are treated at National Cancer Data Base institutions, there has been a steady decline in brachytherapy use since 2003. For low-risk patients, the declining use of brachytherapy monotherapy compared with more costly emerging therapies has significant health policy implications.

Mejora en el control local en mujeres jóvenes con cáncer de mama precoz añadiendo una sola fracción de braquiterapia de alta tasa de dosis / Improved local control in young women with early-stage breast cancer by adding a single fraction of high-dose-rate brachytherapy

Objetivo. Evaluar la eficacia de la braquiterapia con iridio-192 de alta tasa de dosis con una sola fracción como sobreimpresión después de irradiar la mama en mujeres de hasta 45 años. Pacientes y métodos. Se estudiaron 167 pacientes consecutivas con tumores T1-2, entre 26-45 años, sometidas a cirugía conservadora con bordes libres y radioterapia (46-50 Gy) por carcinoma de mama infiltrante entre 1999 y 2008. Se realizó implante con agujas metálicas paralelas bajo anestesia local y sedación de forma ambulatoria. La quimioterapia se utilizó en el 85% (66% adyuvante, 19% neoadyuvante) y la hormonoterapia en el 77%. Se administró una dosis única de 7 Gy con braquiterapia de alta tasa de dosis (fast-boost). Resultados. El seguimiento mediano fue de 69 meses. Ocho pacientes recayeron en el lecho o en el margen tumoral con un control actuarial local de 95,6% a 10 años (tasa de recaída 4,4%). Hubo una recaída en otro cuadrante, por tanto, el control local en la mama fue de 94,1%. Las pacientes hasta 40 años recayeron en la mama en un 6,9% a los 10 años. Ventidós pacientes desarrollaron metástasis. La supervivencia libre de enfermedad y global fue de 85,5 y 92%, respectivamente. Los resultados cosméticos fueron buenos/excelentes en el 97%. La toxicidad aguda y tardía fueron mínimas. Conclusiones. El fast-boost con una sola fracción es una técnica rápida, sencilla y eficaz cuando los márgenes quirúrgicos están libres. El control local en las mujeres jóvenes se ha mejorado respecto a la literatura, por lo que se recomienda la preservación de la mama con este esquema

Objective. To evaluate the effectiveness of a single fraction of high-dose-rate iridium-192 brachytherapy as a boost after irradiation of the breast in women aged 45 or less. Patients and methods. We studied 167 consecutive patients with T1-2 tumors, aged between 26 and 45 years undergoing conservative surgery with free margins and radiotherapy (46-50 Gy) for invasive breast carcinoma between 1999 and 2008. Parallel metal needles were implanted under local anesthesia and sedation on an outpatient basis. Chemotherapy was used in 85% (66% adjuvant and 19% neoadjuvant) and hormonal therapy in 77%. A single 7 Gy-dose of high-dose rate brachytherapy ("fast boost") was administered. Results. The median follow-up was 69 months. In 8 patients, recurrences occurred in the tumor bed or in the margin with an actuarial local control of 95.6% at 10 years (relapse rate 4.4%). There was a relapse in another quadrant and therefore breast control was 94.1%. In patients aged up to 40 years, the breast failure rate was 6.9% at 10 years. Metastases developed in 22 patients. Disease-free survival was 85.5% and overall survival was 92%. Cosmetic results were good or excellent in 97% and acute and late toxicity was minimal. Conclusions. The fast boost technique with a single fraction is fast, simple, and effective when surgical margins are free. Local control in young women has improved compared with prior reports in the literature. Therefore, this technique can be recommended for breast preservation

Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011.

OBJECTIVE: To describe patterns of care for men diagnosed with prostate cancer in Victoria, Australia, between 2008 and 2011. DESIGN, SETTING AND PATIENTS: Men who were diagnosed with prostate cancer at 11 public and six private hospitals in Victoria from August 2008 to February 2011, and for whom prostate cancer notifications were received by the Prostate Cancer Registry. MAIN OUTCOME MEASURES: Characteristics of men diagnosed with prostate cancer; details of treatment provided within 12 months of diagnosis, according to National Comprehensive Cancer Network risk categories; and characteristics of men who did not receive active treatment within 12 months of diagnosis. RESULTS: Treatment details were collected for 98.1% of men who were assessed as eligible to participate in the study (2724/2776) and were confirmed by telephone 12 months after diagnosis for 74.4% of them (2027/2724). Most patients (2531/2724 [92.9%]) were diagnosed with clinically localised disease, of whom 1201 (47.5%) were at intermediate risk of disease progression. Within 12 months of diagnosis, 299 of the 736 patients (40.6%) who had been diagnosed as having disease that was at low risk of progression had received no active treatment, and 72 of 594 patients (12.1%) who had been diagnosed as having disease that was at high risk of progression had received no active treatment. Of those diagnosed as having intermediate risk of disease progression, 54.5% (655/1201) had undergone radical prostatectomy. Those who received no active treatment were more likely than those who received active treatment to be older (odds ratio [95% CI], 2.96 [2.01-4.38], 10.94 [6.96-17.21] and 32.76 [15.84-67.89], respectively, for age 65-74 2013s, 75-84 2013s and ≥ 85 2013s, compared with < 55 2013s), to have less advanced disease (odds ratio [95% CI], 0.20 [0.16-0.26], 0.09 [0.06-0.12] and 0.05 [0.02-0.90], respectively, for intermediate, high and very high-risk [locally advanced] or metastatic disease, compared with low-risk disease) and to have had their prostate cancer notified by a private hospital (odds ratio [95% CI], 1.35 [1.10-1.66], compared with public hospital). CONCLUSION: Our data reveal a considerable "stage migration" towards earlier diagnosis of prostate cancer in Victoria and a large increase in the use of radical prostatectomy among men with clinically localised disease.

[Evolution of prostate cancer brachytherapy]. / L'évolution de la curiethérapie du cancer de prostate.

Curietherapy, more commonly named brachytherapy, is one of the oldest irradiation techniques used for prostate cancer. Prostate brachytherapy evolved according to the scientific and technological progress. After a historical reminder of the evolution of prostate brachytherapy, different technical aspects are discussed: low-dose rate brachytherapy using permanent or temporary implants, high-dose rate brachytherapy as well as new imaging modalities. Prostate brachytherapy indications are listed regarding to the evidence-based medicine data for low, intermediate and high risks prostate cancers. Potential indications and new research programs (focal therapy, high-dose rate, single-dose brachytherapy) are also presented.

[Evolution of prostatic surgical interventions: analysis of French national coding database]. / Évolution de la prise en charge chirurgicale des pathologies prostatiques : analyse nationale du codage.

INTRODUCTION: Prostatic diseases are very important in urologist's practice. We wanted to study evolution of prostatic procedures using French national coding database. METHODS: We searched the Agence Technique d'Information sur l'Hospitalisation (ATIH) web server for prostatic procedures between 1997 and 2011 for both private and public sectors. RESULTS: The procedures were more often performed in private sector (up to 70%). There was a sustained increase (+332%) of the number of prostatectomies between 1997 and 2007 (more than 27,000 procedures), followed by a slight decrease. There is a rising use of laparoscopic approach from 35% in 2006 up to 58% in 2011. The use of brachytherapy and HIFU was marginal. Transurethral resection of the prostate number was stable between 56,000 and 60,000 procedures a year (for cancer for less than 7%). Adenomectomies number decreased from 9832 to 7963 procedures a year. CONCLUSION: The most noticeable data were upon prostatectomies number, with a peak effect in 2007. Laparoscopic procedures were more and more frequent. TURP number was stable, whereas adenomectomies number decreased.

[Update on interstitial brachytherapy]. / Update interstitielle Brachytherapie.

CLINICAL/METHODICAL ISSUE: Minimally invasive treatment procedures, such as image-guided local tumour ablation have gained increasing relevance in oncologic concepts. Limitations of thermal ablation procedures have led to the development of percutaneous, computed tomography (CT) guided brachytherapy. STANDARD RADIOLOGICAL METHODS: Thermal ablation procedures, such as radiofrequency ablation (RFA) and laser-induced thermotherapy (LITT) show limitations regarding maximum tumour size (<5 cm), cooling effects of adjacent vessels and surrounding risk structures. METHODICAL INNOVATIONS: The image-guided interstitial brachytherapy allows the single application of high-dose rate (HDR) irradiation with an extensive protracted cytotoxic effect. Adjacent risk structures play a minor role due to the steep dose gradient outside the clinical target volume. PERFORMANCE: Studies using CT-guided brachytherapy resulted in a local tumour control rate of approximately 90% after 12 months in the treatment of hepatocellular carcinoma (HCC) and 70-90% in the treatment of colorectal metastases or cholangiocellular carcinoma (CCC). Similar response rates were also seen in the treatment of metastases of renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC) or neuroendocrine tumours. In colorectal liver metastases and HCC the method has proven to have a positive impact on prognosis. ACHIEVEMENTS: In contrast to thermal ablation the method can be used without restriction with respect to tumour location. Cooling effects do not play a role. It has already been applied in more than 5,000 cases and it is used in clinical routine. PRACTICAL RECOMMENDATIONS: Image-guided brachytherapy is safe and effective and has found its way into the clinical routine.

Tratamiento mediante terapia fotodinámica del hemangioma coroideo circunscrito / Treatment with photodynamic therapy of circumscribed choroidal hemangioma

Casos clínicosSe presentan las características clínicas de tres pacientes con hemangioma coroideo circunscrito y exudación subfoveal, detectada mediante tomografía óptica de coherencia, tratados con éxito mediante terapia fotodinámica.DiscusiónLa terapia fotodinámica es actualmente la alternativa terapéutica más efectiva para tratar los hemangiomas coroideos circunscritos asociados a exudación subfoveal. Respecto a la utilización de este tratamiento quedan por definir algunas cuestiones como son si se debe buscar o no la desaparición total de la masa tumoral, los parámetros de láser más adecuados en estos casos o la forma de aplicación de los impactos(AU)

Case reportsThe clinical characteristics of three patients with circumscribed choroidal haemangioma and subfoveal exudation detected by optical coherence tomography are described in this paper. The three patients were successfully treated with photodynamic therapy.DiscussionPhotodynamic therapy is the most adequate therapeutic option for circumscribed choroidal hemangioma associated with subfoveal exudation. Some questions such as whether attempts should be made to obtain a complete tumour regression, laser settings or the way the spots must be applied remain unresolved(AU)

[Retinoblastoma update--therapy (Part II)]. / Siatkówczak--aktualne zalecenia dotyczace leczenia (Czesc II).

The aim of this paper is to present updated data on the treatment of retinoblastoma. The authors describe current management based on the International Intraocular Retinoblastoma Classification (IIRC). They discuss the different methods of treatment, including chemoreduction, subconjunctival carboplatin, transpupillar thermotherapy, cryotherapy, laser photocoagulation, episcleral plaque radiotherapy, external-beem radiotherapy and enucleation.

El proceso tecnológico en Radioterapia. Su relevancia clínica / The technological process in Radiotherapy. Its clinical relevance

El objetivo de este trabajo e sir desarrollando y comentando los diversos avances que se han producido en las fases fundamentales del tratamiento de radioterapia así como señalar cuales pueden ser los futuros posibles desarrollos de los mismos. De una forma clara y simple se abordan los grandes avances tecnológicos producidos en los últimos años y s repercusión en la mejora y precisión de la radioterapia (AU)

This work mentions the different developments produced in the fundamental phases of Radiotherapy treatment, as well as the possible developments which may be produced in the future (AU)

Métodos de terapia intersticial especialmente con radiofrecuencia en el tratamiento de tumores hepáticos malignos / Use of interstitial therapy, especially with radiofrequency, in the treatment of malignant liver tumors

Objetivo: Definir y revisar los métodos principales de terapia intersticial útiles en el tratamiento de tumores hepáticos malignos reconocidos en la bibliografía científica, insistiendo en los métodos de hipertermia antitumoral, especialmente con radiofrecuencia (RF). Estructura: 1.a parte: se justifica el actual interés de estas técnicas. 2.a parte: se exponen las principales condiciones de aplicación de estos métodos. 3.a parte: se clasifican los métodos en atención a la fuente física o química de aplicación. 4.a parte: se revisan los principales métodos de hipertermia antitumoral. 5.a parte: se resumen las principales formas de aplicación de radiofrecuencia como fuente de hipertermia antitumoral. (AU)

Recent developments in the management of retinoblastoma.

The management of retinoblastoma has gradually changed over the past few decades. There is a trend away from enucleation and external beam radiotherapy toward focal conservative treatments. This is primarily because of earlier detection of the disease and more focused treatment modalities. Enucleation is still employed for retinoblastoma that fills most of the eye, especially when there is a concern for tumor invasion into the optic nerve or choroid. After enucleation, an integrated orbital implant, provides improved motility and appearance of the prosthesis. External beam radiotherapy continues to be an important method of treating less advanced retinoblastoma, especially when there is diffuse vitreous or subretinal seeding. Plaque radiotherapy is useful for controlling small- to medium-sized retinoblastomas, even those with focal vitreous seeds. Tumors that recur after failure of other methods are often suitable for plaque treatment. When plaque radiotherapy is employed in a child receiving chemotherapy, eventual radiation retinopathy can occur. Cryotherapy and photocoagulation provide excellent control of selected small tumors. Advanced laser delivery systems, particularly those that have been adapted to the indirect ophthalmoscope, have facilitated the visualization for treatment of tumors. Thermotherapy is the newest focal method for retinoblastoma. When combined with chemotherapy, thermotherapy provides satisfactory tumor control, leaving the child with a reasonably small scar, thus preserving more vision. Chemoreduction, using intravenous or subconjunctival routes, is often employed to reduce initial tumor volume and thus allow for focal treatment to eradicate the residual smaller tumor. Many children with advanced retinoblastoma can be spared external beam radiotherapy and enucleation mostly as a result of chemoreduction and focal methods. Chemoreduction combined with cryotherapy, thermotherapy, and plaque radiotherapy plays an important role in the current management of many children with retinoblastoma.