Quality Assurance Procedures based on Dosimetric, Gamma Analysis as a Fast Reliable Tool for Commissioning Brachytherapy Treatment Planning Systems.

BACKGROUND: Fast and easily repeatable methods for commissioning procedures for brachytherapy (BT) treatment planning systems (TPS) are needed. Radiochromic film dosimetry with gamma analysis is widely used in external beam quality assurance (QA) procedures and planar film dosimetry is also increasingly used for verification of the dose distribution in BT applications. Using the gamma analysis method for comparing calculated and measured dose data could be used for commissioning procedures of the newly developed TG-186 and MBDCA calculation algorithms. The aim of this study was dosimetric verification of the calculation algorithm used in TPS when the CT/MRI ring applicator is used. MATERIALS AND METHODS: Ring applicators with 26 and 30 mm diameters and a 60 mm intra-uterine tube with 60° angle were used for verification. Gafchromic® EBT films were used as dosimetric media. Dose grids, corresponding to each plane (dosimetric film location), were exported from the TPS as a raw data. Gafchromic® films were digitized after irradiation. gamma analysis of the data were performed using the OMNI Pro I'mRT® system, as recommended by the AAPM TG-119 rapport criterion for gamma analysis of 3%, 3 mm and a level of 95%. RESULTS: For the 26 mm and 30 mm rings, the average gamma ranged, respectively, from 0.1 to 0.44 and from 0.1 to 0.27. In both cases, 99% of the measured points corresponded with the calculated data. CONCLUSIONS: This analysis showed excellent agreement between the dose distribution calculated with the TPS and the doses measured by Gafchromic films. This finding confirms the viability of using film dosimetry in BT.

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations for malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliative treatment of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass (strong recommendation, high quality evidence). 2 For patients with longer life expectancy, ESGE recommends brachytherapy as a valid alternative or in addition to stenting in esophageal cancer patients with malignant dysphagia. Brachytherapy may provide a survival advantage and possibly a better quality of life compared to SEMS placement alone. (Strong recommendation, high quality evidence.) 3 ESGE recommends esophageal SEMS placement as the preferred treatment for sealing malignant tracheoesophageal or bronchoesophageal fistula (strong recommendation, low quality evidence). 4 ESGE does not recommend the use of concurrent external radiotherapy and esophageal stent treatment. SEMS placement is also not recommended as a bridge to surgery or prior to preoperative chemoradiotherapy. It is associated with a high incidence of adverse events and alternative satisfactory options such as placement of a feeding tube are available. (Strong recommendation, low quality evidence.) Main recommendations for benign disease 1 ESGE recommends against the use of self-expandable stents (SEMSs) as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and costs (strong recommendation, low quality evidence). 2 ESGE suggests consideration of temporary placement of SEMSs as therapy for refractory benign esophageal strictures (weak recommendation, moderate evidence). Stents should usually be removed at a maximum of 3 months (strong recommendation, weak quality evidence). 3 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures, because of their lack of embedment and ease of removability (weak recommendation, low quality evidence). 4 For the removal of partially covered esophageal SEMSs that are embedded, ESGE recommends the stent-in-stent technique (strong recommendation, low quality evidence). 5 ESGE recommends that temporary stent placement can be considered for treating esophageal leaks, fistulas, and perforations. The optimal stenting duration remains unclear and should be individualized. (Strong recommendation, low quality evidence.) 6 ESGE recommends placement of a SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive esophageal variceal bleeding (strong recommendation, moderate quality evidence).

Brachytherapy in the treatment of skin cancer: an overview.

The incidence of skin cancer worldwide is constantly growing and it is the most frequently diagnosed tumor. Brachytherapy (BT) in particular localizations is a valuable tool of the exact radiation depot inside the tumor mass. In localizations such as the face, skull skin and inoperable tumors, relapses after surgery, radiotherapy are usually not suitable for primary or secondary invasive treatment. Brachytherapy is a safe procedure for organs at risk according to rapid fall of a dose outside the axis of the applicator with satisfactory dose localization inside the target. The complications rate is acceptable and treatment costs are low. In some tumors (great skin lesions in the scalp, near eyes or on the nose) BT allows for a great dose reduction in surrounding healthy tissues. Brachytherapy provides minimal dose delivery to surrounding healthy tissue, thus enabling good functional and cosmetic results. Treatment is possible almost in all cases on an outpatient basis.

Brachytherapy in breast cancer: an effective alternative.

Breast conserving surgery (BCS) with following external beam radiation therapy (EBRT) of the conserved breast has become widely accepted in the last decades for the treatment of early invasive breast cancer. The standard technique of EBRT after BCS is to treat the whole breast up to a total dose of 42.5 to 50 Gy. An additional dose is given to treated volume as a boost to a portion of the breast. In the early stage of breast cancer, research has shown that the area requiring radiation treatment to prevent the cancer from local recurrence is the breast tissue that surrounds the area where the initial cancer was removed. Accelerated partial breast irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1-2 cm margin rather than the whole breast and as a result allows accelerated delivery of the radiation dose in four to five days. There has been a growing interest for APBI and various approaches have been developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy (3D-EBRT) and intra-operative radiation therapy (IORT). Balloon-based brachytherapy approaches include MammoSite, Axxent electronic brachytherapy, Contura, hybrid brachytherapy devices. Another indication for breast brachytherapy is reirradiation of local recurrence after mastectomy. Published results of brachytherapy are very promising. We discuss the current status, indications, and technical aspects of breast cancer brachytherapy.

Brachytherapy in the therapy of prostate cancer - an interesting choice.

Brachytherapy is a curative alternative to radical prostatectomy or external beam radiation [i.e. 3D conformal external beam radiation therapy (CRT), intensity-modulated radiation therapy (IMRT)] with comparable long-term survival and biochemical control and the most favorable toxicity. HDR brachytherapy (HDR-BT) in treatment of prostate cancer is most frequently used together with external beam radiation therapy (EBRT) as a boost (increasing the treatment dose precisely to the tumor). In the early stages of the disease (low, sometimes intermediate risk group), HDR-BT is more often used as monotherapy. There are no significant differences in treatment results (overall survival rate - OS, local recurrence rate - LC) between radical prostatectomy, EBRT and HDR-BT. Low-dose-rate brachytherapy (LDR-BT) is a radiation method that has been known for several years in treatment of localized prostate cancer. The LDR-BT is applied as a monotherapy and also used along with EBRT as a boost. It is used as a sole radical treatment modality, but not as a palliative treatment. The use of brachytherapy as monotherapy in treatment of prostate cancer enables many patients to keep their sexual functions in order and causes a lower rate of urinary incontinence. Due to progress in medical and technical knowledge in brachytherapy ("real-time" computer planning systems, new radioisotopes and remote afterloading systems), it has been possible to make treatment time significantly shorter in comparison with other methods. This also enables better protection of healthy organs in the pelvis. The aim of this publication is to describe both brachytherapy methods.

Thermal boost combined with interstitial brachytherapy in breast conserving therapy - Assessment of early toxicity.

BACKGROUND: Hyperthermia (HT) causes a direct damage to cancerous cells and/or sensitize them to radiotherapy with usually minimal injury to normal tissues. Adjuvant HT is probably one of the most effective radiation sensitizers known and works best when delivered simultaneously with radiation. In breast conserving therapy, irradiation has to minimize the risk of local relapse within the treated breast, especially in an area of a tumor bed. Brachytherapy boost reduces 5-year local recurrence rate to mean 5,5%, so there still some place for further improvement. The investigated therapeutic option is an adjuvant single session of local HT (thermal boost) preceding standard CT-based multicatheter interstitial HDR brachytherapy boost in order to increase the probability of local cure. AIM: To report the short-term results in regard to early toxicity of high-dose-rate (HDR) brachytherapy (BT) boost with or without interstitial microwave hyperthermia (MV HT) for early breast cancer patients treated with breast conserving therapy (BCT). MATERIALS AND METHODS: Between February 2006 and December 2007, 57 stage IA-IIIA breast cancer patients received a 10 Gy HDR BT boost after conservative surgery and 42.5-50 Gy whole breast irradiation (WBI) ± adjuvant chemotherapy. 32 patients (56.1%) were treated with additional pre-BT single session of interstitial MW HT to a tumor bed (multi-catheter technique). Reference temperature was 43 °C and therapeutic time (TT) was 1 h. Incidence, severity and duration of radiodermatitis, skin oedema and skin erythema in groups with (I) or without HT (II) were assessed, significant p-value ≤ 0.05. RESULTS: Median follow-up was 40 months. Local control was 100% and distant metastasis free survival was 91.1%. HT sessions (median): reference temperature 42.2 °C, therapeutic time (TT) 61.4 min, total thermal dose 42 min and a gap between HT and BT 30 min. Radiodermatitis grades I and II occurred in 24 and 6 patients, respectively, differences between groups I and II were not significant. Skin oedema and erythema occurred in 48 (85.7%) and 36 (64.3%) cases, respectively, and were equally distributed between the groups. The incidence and duration of skin oedema differed between the subgroups treated with different fractionation protocols of WBI, p = 0.006. Skin oedema was present up to 12 months. No difference in pattern of oedema regression between groups I and II was observed, p = 0.933. CONCLUSION: Additional thermal boost preceding standard HDR BT boost has a potential of further improvement in breast cancer local control in BCT. Pre-BT hyperthermia did not increase early toxicity in patients treated with BCT and was well tolerated. All side effects of combined treatment were transient and were present for up to 12 months. The increase in incidence of skin oedema was related to hypofractionated protocols of WBI. The study has to be randomized and continued on a larger group of breast cancer patients to verify the potential of local control improvement and to assess the profile of late toxicity.

Benefit of whole pelvic radiotherapy combined with neoadjuvant androgen deprivation for the high-risk prostate cancer.

AIM: To study whether use of neoadjuvant androgen deprivation therapy (N-ADT) combined with whole pelvic radiotherapy (WPRT) for high-risk prostate cancer patients was associated with survival benefit over prostate radiotherapy (PORT) only. MATERIAL AND METHODS: Between 1999 and 2004, 162 high-risk prostate cancer patients were treated with radiotherapy combined with long-term androgen deprivation therapy (L-ADT). Patients were prospectively assigned into two groups: A (N-ADT + WPRT + L-ADT) n = 70 pts, B (PORT + L-ADT) n = 92 pts. RESULTS: The 5-year actuarial overall survival (OS) rates were 89% for A and 78% for B (P = .13). The 5-year actuarial cause specific survival (CSS) rates were A = 90% and B = 79% (P = .01). Biochemical progression-free survival (bPFS) rates were 52% versus 40% (P = .07), for groups A and B, respectively. CONCLUSIONS: The WPRT combined with N-ADT compared to PORT for high-risk patients resulted in improvement in CSS and bPFS; however no OS benefit was observed.

Association of C34T AMPD1 gene polymorphism with features of metabolic syndrome in patients with coronary artery disease or heart failure.

OBJECTIVE: The common C34T polymorphism in the AMP deaminase-1 (AMPD1) gene results in an inactive enzyme in homozygotes for the mutated T allele. Some studies have shown an association of T allele with longer survival in heart failure (HF) and/or coronary artery disease (CAD). The aim of this study was to assess genotype-phenotype correlations in such patients, with emphasis on components of the metabolic syndrome. METHODS: Ninety-seven patients with CAD without HF (CAD+ HF-) and 104 with HF (HF+) were genotyped by PCR-RFLP. The genetic control group comprised 200 newborns. RESULTS: No significant differences were found in the frequency of AMPD1 genotypes between the groups. In the CAD+ HF- group, the carriers of T allele compared to CC homozygotes had significantly lower values of waist circumference (89.5+/-8.5 versus 97.7+/-11.2 cm; p = 0.00029), waist/hip ratio (p = 0.0059) and BMI (p = 0.045). There was no diabetes or fasting glycaemia > or =126 mg/dL in T carriers, while these features were present in 25% of CC homozygotes (p = 0.0024). In the HF+ group, a tendency towards a lower prevalence of diabetes (20 % versus 41%; p = 0.068) and significantly lower systolic blood pressure (p = 0.048) were observed in T allele carriers. CONCLUSIONS: C34T AMPD1 polymorphism may be associated with reduced frequency of obesity in CAD patients and of hyperglycaemia and diabetes in both CAD and HF patients. Morphometric parameters associated with adipose tissue distribution and parameters of glucose metabolism should be analysed as potential confounders in further studies on the role of polymorphisms of AMPD1 and other genes associated with AMP and adenosine metabolism in cardiovascular disease.

Time to PSA rise differentiates the PSA bounce after HDR and LDR brachytherapy of prostate cancer.

PURPOSE: To investigate the differences in prostate-specific antigen (PSA) bounce (PB) after high-dose-rate (HDR-BT) or low-dose-rate (LDR-BT) brachytherapy alone in prostate cancer patients. MATERIALS AND METHODS: Ninety-four patients with localized prostate cancer (T1-T2cN0), age ranged 50-81 years, were treated with brachytherapy alone between 2008 and 2010. Patients were diagnosed with adenocarcinoma, Gleason score ≤ 7. The LDR-BT total dose was 144-145 Gy, in HDR-BT - 3 fractions of 10.5 or 15 Gy. The initial PSA level (iPSA) was assessed before treatment, then PSA was rated every 3 months over the first 2 years, and every 6 months during the next 3 years. Median follow-up was 3.0 years. RESULTS: Mean iPSA was 7.8 ng/ml. In 58 cases, PSA decreased gradually without PB or biochemical failure (BF). In 24% of patients, PB was observed. In 23 cases (24%), PB was observed using 0.2 ng/ml definition; in 10 cases (11%), BF was diagnosed using nadir + 2 ng/ml definition. The HDR-BT and LDR-BT techniques were not associated with higher level of PB (26 vs. 22%, p = 0.497). Time to the first PSA rise finished with PB was significantly shorter after HDR-BT then after LDR-BT (median, 10.5 vs. 18.0 months) during follow-up. Predictors for PB were observed only after HDR-BT. Androgen deprivation therapy (ADT) and higher Gleason score decreased the risk of PB (HR = 0.11, p = 0.03; HR = 0.51, p = 0.01). The higher PSA nadir and longer time to PSA nadir increased the risk of PB (HR 3.46, p = 0.02; HR 1.04, p = 0.04). There was no predictors for PB after LDR-BT. CONCLUSIONS: HDR-BT and LDR-BT for low and intermediate risk prostate cancer had similar PB rate. The PB occurred earlier after HDR-BT than after LDR-BT. ADT and higher Gleason score decreased, and higher PSA nadir and longer time to PSA nadir increased the risk of PB after HDR-BT.

GEC-ESTRO ACROP recommendations in skin brachytherapy.

PURPOSE: The aim of this publication is to compile available literature data and expert experience regarding skin brachytherapy (BT) in order to produce general recommendations on behalf of the GEC-ESTRO Group. METHODS: We have done an exhaustive review of published articles to look for general recommendations. RESULTS: Randomized controlled trials, systemic reviews and meta-analysis are lacking in literature and there is wide variety of prescription techniques successfully used across the radiotherapy centers. BT can be delivered as superficial application (also called contact BT or plesiotherapy) or as interstitial for tumours thicker than 5 mm within any surface, including very irregular. In selected cases, particularly in tumours located within curved surfaces, BT can be advantageous modality from dosimetric and planning point of view when compared to external beam radiotherapy. The general rule in skin BT is that the smaller the target volume, the highest dose per fraction and the shortest overall length of treatment can be used. CONCLUSION: Skin cancer incidence is rising worldwide. BT offers an effective non-invasive or minimally invasive and relative short treatment that particularly appeals to elder and frail population.

ADA*2 allele of the adenosine deaminase gene may protect against coronary artery disease.

BACKGROUND/AIMS: The common G22A polymorphism in the adenosine deaminase (ADA) gene leads to substitution Asp8Asn. The lower activity of the enzyme encoded by A22 (ADA*2) allele may increase tissue concentrations of adenosine, a potent cardioprotective agent. In a case-control study, we investigated the association between ADA polymorphism and coronary artery disease (CAD). METHODS: A hundred and seventy-one CAD patients from the north-western part of Poland and 200 consecutive newborns from the same population were genotyped by PCR-RFLP. RESULTS: Twenty-five ADA*1/*2 heterozygotes (12.5%) and 2 ADA*2/*2 homozygotes (1%) were found in the control group, while only 10 *1/*2 heterozygotes (5.9%) and no *2/*2 homozygotes were found in the CAD group. Frequencies of ADA*2 carriers (5.9% vs. 13.5%, p = 0.015) and ADA*2 allele (2.9% vs. 7.3%, p = 0.0083) were lower in CAD patients than in controls. Among CAD patients, a significantly lower proportion of *2 allele carriers was treated with diuretics and ACE inhibitors when compared to *1/*1 wild-type homozygotes. CONCLUSION: ADA*2 allele may decrease genetic susceptibility to CAD. ADA should be added to the list of candidate genes modifying the risk of cardiovascular diseases.

Current status of brachytherapy in cancer treatment - short overview.

Cancer incidence and mortality depend on a number of factors, including age, socio-economic status and geographical location, and its prevalence is growing around the world. Most of cancer treatments include external beam radiotherapy or brachytherapy. Brachytherapy, a type of radiotherapy with energy from radionuclides inserted directly into the tumor, is increasingly used in cancer treatment. For cervical and skin cancers, it has become a standard therapy for more than 100 years as well as an important part of the treatment guidelines for other malignancies, including head and neck, skin, breast, and prostate cancers. Compared to external beam radiotherapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time directly to the altered tissue area with the advantage of a rapid fall-off in dose, and consequently, sparing of adjacent organs. As a result, the patient is able to complete the treatment earlier, and the risks of occurrence of another cancer are lower than in conventional radiotherapy treatment. Brachytherapy has increased its use as a radical or palliative treatment, and become more advanced with the spread of pulsed-dose-rate and high-dose-rate afterloading machines; the use of new 3D/4D planning systems has additionally improved the quality of the treatment. The aim of the present study was to present short summaries of current studies on brachytherapy for the most frequently diagnosed tumors. Data presented in this manuscript should help especially young physicians or physicists to explore and introduce brachytherapy in cancer treatments.

Brachytherapy in the treatment of bile duct cancer - a tough challenge.

The majority of patients with bile duct cancer are diagnosed with clinically advanced disease. Most of these patients have a short life expectancy and are treated with palliative aim. Most patients present with locally advanced or metastatic disease, which is not amenable to surgical resection, resulting in poor survival. Adjuvant or definitive radiotherapy, with or without chemotherapy, is therefore used in many centers worldwide for better local control, and with the expectation that it will have a favorable effect on survival. However, the lack of appropriate prospective trials, as well as the small size of the published series and their retrospective nature, has produced insufficient evidence for the best treatment for these patients. Intraluminal brachytherapy is an important component in the multimodality approach to bile duct cancers. The objective of this treatment is to deliver a high local dose of radiation to the tumor while sparing surrounding healthy tissues. The treatment can be safely adapted for right and left hepatic duct, and for common bile duct lesions. Brachytherapy plays a limited but specific role in definitive treatment with curative intent in selected cases of early disease, as well as in the postoperative treatment of small residual disease. Depending on the location of the lesion, in some cases, brachytherapy is a treatment of choice. Clinical indications, different techniques, results, and complications are discussed in this work.

GEC-ESTRO ACROP recommendations for head & neck brachytherapy in squamous cell carcinomas: 1st update - Improvement by cross sectional imaging based treatment planning and stepping source technology.

The Head and Neck Working Group of the GEC-ESTRO (Groupe Européen de Curiethérapie - European Society for Therapeutic Radiology and Oncology) published in 2009 the consensus recommendations for low-dose rate, pulsed-dose rate and high-dose rate brachytherapy in head & neck cancers. The use of brachytherapy in combination with external beam radiotherapy and/or surgery was also covered as well as the use of brachytherapy in previously irradiated patients. Given the developments in the field, these recommendations needed to be updated to reflect up-to-date knowledge. The present update does not repeat basic knowledge which was published in the first recommendation but covers in a general part developments in (1) dose and fractionation, (2) aspects of treatment selection for brachytherapy alone versus combined BT+EBRT and (3) quality assurance issues. Detailed expert committee opinion intends to help the clinical practice in lip-, oral cavity-, oropharynx-, nasopharynx-, and superficial cancers. Different aspects of adjuvant treatment techniques and their results are discussed, as well the possibilities of salvage brachytherapy applications.

[Brachytherapy in the treatment of lung and tracheal cancer: current indications, methods, results]. / Brachyterapia raka pluca i tchawicy--wskazania, metody, wyniki leczenia.

Lack of improvement in treatment results of lung cancer leads to searching for new methods. One of the most distressing symptoms for lung cancer patients is airway obstruction due to the tumor, commonly resulting in dyspnea, postobstructive pneumonia, cough, or hemoptysis. Removal of endobronchial obstruction leads to quick improvement of clinical status and Quality of Life. Brachytherapy HDR of tracheal and lung cancer is a well-established method for the local treatment of patients with inoperable tumors of the tracheobronchial system. It seems that another promising treatment method of lung cancer is interstitial brachytherapy using permanent implants. The paper presents principles of brachytherapy, indications for this treatment and treatment results of tracheal and lung cancer. Indications for radical, palliative and interstitial treatment are discussed, respectively. Selected results of brachytherapy as an independent treatment and that combined with teletherapy, radical and, palliative are presented separately. Most commonly recognized complications are discussed which include: fatal pulmonary hemorrhage and fistula formation.

Film based verification of calculation algorithms used for brachytherapy planning-getting ready for upcoming challenges of MBDCA.

PURPOSE: Well-known defect of TG-43 based algorithms used in brachytherapy is a lack of information about interaction cross-sections, which are determined not only by electron density but also by atomic number. TG-186 recommendations with using of MBDCA (model-based dose calculation algorithm), accurate tissues segmentation, and the structure's elemental composition continue to create difficulties in brachytherapy dosimetry. For the clinical use of new algorithms, it is necessary to introduce reliable and repeatable methods of treatment planning systems (TPS) verification. The aim of this study is the verification of calculation algorithm used in TPS for shielded vaginal applicators as well as developing verification procedures for current and further use, based on the film dosimetry method. MATERIAL AND METHODS: Calibration data was collected by separately irradiating 14 sheets of Gafchromic(®) EBT films with the doses from 0.25 Gy to 8.0 Gy using HDR (192)Ir source. Standard vaginal cylinders of three diameters were used in the water phantom. Measurements were performed without any shields and with three shields combination. Gamma analyses were performed using the VeriSoft(®) package. RESULTS: Calibration curve was determined as third-degree polynomial type. For all used diameters of unshielded cylinder and for all shields combinations, Gamma analysis were performed and showed that over 90% of analyzed points meets Gamma criteria (3%, 3 mm). CONCLUSIONS: Gamma analysis showed good agreement between dose distributions calculated using TPS and measured by Gafchromic films, thus showing the viability of using film dosimetry in brachytherapy.

[Pulsed dose brachytherapy--a review of clinical applications in the treatment of gynecological malignancies]. / Brachyterapia nowotworów ginekologicznych metoda pulsacyjna (pulsed dose rate).

Pulsed Dose Rate (PDR) treatment is a new brachytherapy modality that combines physical advantages of High-Dose-Rate (HDR) technology (isodose optimization, radiation safety) with the radiobiological advantages of Low-Dose-Rate (LDR) brachytherapy. Pulsed brachytherapy consists of using a stronger radiation source than for LDR brachytherapy and is giving a series of short exposures of 10 to 30 minutes in every hour to approximately the same total dose in the same overall as with the LDR. Modern afterloading equipment offers some advantages over interstitial or intracavitary insertion of separate needles, tubes, seeds or wires. Isodose volumes in tissue can be created flexibly by a combination of careful placement of the catheter and adjustment of the dwell times of the computerized stepping source. Automatic removal of the radiation sources into a shielded safe eliminates radiation exposures to staff and visitors. Radiation exposure is also eliminated to the staff who formerly loaded and unloaded a multiplicity of radioactive sources into the catheters, ovoids, tubes etc. This retrospective study based on summarized clinical investigations analyses the feasibility, reasons for introducing PDR brachytherapy, preliminary results of PDR brachytherapy in treatment of gynecological malignancies and proposed treatment schema.

[Prognostic value of low hemoglobin concentration in adjuvant radiotherapy after total laryngectomy in group of patients with laryngeal cancer]. / Rokownicze znaczenie niskiego poziomu hemoglobiny w uzupelniajacej radioterapii u chorych po calkowitym usunieciu krtani z powodu raka krtani.

PURPOSE: To investigate the impact of hemoglobin concentration (Hb) at the start and end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy on the loco-regional control in postoperative radiotherapy for patients with advanced laryngeal cancer. MATERIALS AND METHODS: Between January 1993 and December 1996, 254 patients with pT3 or pT4 and pN0-pN2 laryngeal cancer were treated with a total laryngectomy and adjuvant radiotherapy (RT). The median age of patients was 56.3 years (range: 30-70 years). The analyzed group consisted of 236 males (92%) and 18 females (8%). In all cases a total laryngectomy was performed. 196 out of 254 patients underwent homolateral neck dissection and 58 out of 254 underwent bilateral neck dissection. The primary tumor bed was irradiated to the median total dose of 61.2 Gy (range: 57 - 64 Gy) and all regional lymph nodes were treated in all patients to a dose of 50 Gy. Indications for postoperative RT were close postoperative margins at the tumor site or pathological status of lymph nodes described as pN1 or pN2. Univariate analyses were used to determine the predictors for locoregional failure. The following factors were studied for prognostic importance of loco-regional outcome: the hemoglobim concentration at the start of radiotherapy, at the end of radiotherapy, and the drop of hemoglobin concentration during radiotherapy, age, sex, pT and pN categories. RESULTS: The actuarial 5-year overall survival was 49%, the actuarial loco-regional control rate was 70%. Univariate analysis, using log-rank test indicated that pN +, Hb level at the end of RT (p = 0.004) and drop during RT (p = 0.038) were predicted for the loco-regional control of postoperative radiotherapy. CONCLUSIONS: Analysis showed that the low level of Hb at the end of radiotherapy and the drop during radiotherapy were correlated with decreasing of the loco-regional control of adjuvant radiotherapy for patients with advanced laryngeal cancer.

Brachytherapy in the treatment of lung cancer - a valuable solution.

The majority of patients with lung cancer are diagnosed with clinically advanced disease. Many of these patients have a short life expectancy and are treated with palliative aim. Because of uncontrolled local or recurrent disease, patients may have significant symptoms such as: cough, dyspnea, hemoptysis, obstructive pneumonia, or atelectasis. Brachytherapy is one of the most efficient methods in overcoming difficulties in breathing that is caused by endobronchial obstruction in palliative treatment of bronchus cancer. Efforts to relieve this obstructive process are worthwhile, because patients may experience improved quality of their life (QoL). Brachytherapy plays a limited but specific role in definitive treatment with curative intent in selected cases of early endobronchial disease as well as in the postoperative treatment of small residual peribronchial disease. Depending on the location of the lesion, in some cases brachytherapy is a treatment of choice. This option is fast, inexpensive, and easy to perform on an outpatient basis. Clinical indications, different techniques, results, and complications are presented in this work.

Physical and psychosocial side-effects of brachytherapy: a questionnaire survey.

PURPOSE: Brachytherapy (BT) plays an important role in cancer treatment. Like any other medical therapy it may, however, induce side effects whose recognition can affect the patient's quality of life. Therefore, the present study evaluated the frequency and severity of physical and psychosocial adverse effects of BT. MATERIAL AND METHODS: Patients (n = 70) undergoing high-dose-rate (HDR) BT or low-dose-rate (LDR) of head and neck, breast, and prostate cancers were interviewed face-to-face at the end of their course of treatment. Interviews concerned the occurrence of 35 physical (dermatological, gastroenterological, neurological, ocular, pulmonological, and urological) and 10 psychosocial side effects of BT. RESULTS: A high percentage of patients reported that BT decreased their life satisfaction (54.3%), sense of security (41.4%), and self-esteem (34.3%). The highest frequency of gastroenterological and urological symptoms was reported by prostate cancer patients. Cigarette smoking increased the frequency of nausea, dyschezia, and weight loss. Overweight patients were characterized by an increased rate of urinary incontinence and dyschezia, as well as more pronounced decrease of self-esteem and sense of security following BT treatment. CONCLUSIONS: These findings are not only highly relevant to the way patients can be prepared for the therapy but also have a bearing on ways to minimize the number and severity of BT side effects.