Feasibility of electronic brachytherapy in cervix cancer-A dosimetric comparison of different brachytherapy techniques.

INTRODUCTION: This study analyzes cases in which electronic brachytherapy (eBT) led to acceptable treatment plans in cervical cancer. Findings were compared with dosimetry values obtained in 192Ir-based treatments according to the high-risk clinical target volume (HR-CTV) and the disease stage. MATERIAL AND METHODS: We retrospectively analyzed 48 patients with cervical cancer from two centers. The patients were treated with 192Ir based on MRI. It was possible to use interstitial needles via an Utrecht-type applicator. Dosimetry was simulated using eBT and the parameters D90 and D98 (HR-CTV) and D2cc, D1cc, and D0.1cc (bladder, rectum, and sigmoid colon) were evaluated. The Mann-Whitney U test was used for comparison. The overall cohort of patients was analyzed, as were the sub-cohorts based on stage (FIGO stages I+IIA, IIB and III-IV). Finally, the dosimetry of the eBT plans was evaluated, and the plans obtained were classified as "good", "acceptable", or "poor". RESULTS: Statistically significant differences were found between the eBT and 192Ir plans for D98 (HR-CTV), D1cc and D0.1cc (bladder), and D1cc and D0.1cc (sigmoid colon). A total of 31 cases (64.6%) were considered good, seven (14.6%) were considered acceptable, and 10 (20.8%) were considered poor. For volumes <30 cc, all the plans were good or acceptable; for volumes >30 cc, 54.3% were good, and 71.4% were good or acceptable. By stage, eBT plans for patients with stage IB-IIA disease were good in 100%, whereas those for patients with stage IIB were good in 70.6% and III-IV disease were good in 50%. CONCLUSIONS: eBT provides appropriate dosimetry for treatment of cervical cancer in selected cases.

Treatment of cervical cancer with electronic brachytherapy.

PURPOSE: We report the first cervical cancer cases treated with interstitial electronic brachytherapy (eBT) at our hospital and compare them with plans made with high-dose-rate interstitial brachytherapy based on Ir192 (HDR-BT). MATERIALS AND METHODS: Eight patients with cervical cancer were treated with the Axxent eBT device (Xoft, Inc.). Planning was with magnetic resonance imaging and computed tomography following the recommendations of the EMBRACE protocol. The dosimetry parameters of organs at risk (OAR) were evaluated for the bladder, rectum, and sigmoid colon (D2cc, D1cc, and D0.1cc). In addition, the V150 and V200 of irradiated tissue were compared for both eBT and HDR-BT. All patients received intensity-modulated external beam radiation therapy with a regimen of 23 sessions of 2 Gy followed by four sessions of 7 Gy of eBT performed over 2 weeks (two sessions followed by another two sessions a week later) following the EMBRACE recommendations. Each of the eight patients was followed to assess acute toxicity associated with treatment. RESULTS: The doses reaching OAR for eBT plans were lower than for HDR-BT plans. As for acute toxicity associated with eBT, very few cases of mucositis were detected. No cases of rectal toxicity and one case with grade 1 urinary toxicity were detected. The results at 1 month are equally good, and no relapses have occurred to date. CONCLUSIONS: The first results of treatment with the Axxent eBT device are promising, as no recurrences have been observed and toxicity is very low. eBT is a good alternative for treating cervical cancer in centers without access to conventional HDR.

Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy.

INTRODUCTION: The objective was to investigate the possible prognostic value of blood hemoglobin concentration in the outcome of radical treatment for locally advanced esophageal carcinoma. MATERIALS AND METHOD: This was a retrospective analysis of data for 85 patients treated for locally advanced esophageal carcinoma between January 1991 and January 1997 with chemoradiotherapy alone or as neoadjuvant therapy. All patients received chemotherapy (4 cycles of cisplatin 100 mg/m2 on day 1, and continuous infusion 5-fluorouracil 1 g/m2 per day on days 1-5) with concomitant radiotherapy (40 Gy at 2 Gy/session to the esophageal tumor and mediastinum). The response was evaluated after 4 weeks. 69 patients continued to receive chemoradiotherapy only to a total dose of 60-64 Gy to the esophageal tumor with a 2-cm margin. Sixteen patients underwent radical surgery. Hemoglobin levels were measured before combined treatment in all patients. The prognostic value of hemoglobin concentration was analyzed statistically, along with other patient-, tumor- and treatment-related factors. RESULTS: Mean follow-up time: 82 months (range 60- 99 months). Chemoradiotherapy was followed by an overall clinical response of 69.4%, with complete clinical response in 24.7% of the patients. Mean survival time was 12 months, and overall likelihood of survival after 3 years was 13%. Mean time to progression: 5 months. Median survival time was 12 months in the 69 patients who underwent chemoradiotherapy alone, and 26 months in patients who underwent radical surgery. Univariate analysis showed a hemoglobin value of > 13 g/dl to be a prognostic factor for better survival, along with performance status according to the ECOG classification, weight loss < 10%, tumor stage, tumor length, and complete response to chemoradiotherapy. Multivariate analysis showed that only hemoglobin concentration was an independent prognostic factor: for each unit increase in hemoglobin level, the risk of death from esophageal carcinoma decreased by 5%. In the subgroup of patients who did not undergo surgery, hemoglobin concentration was also an independent prognostic factor along with complete clinical response. CONCLUSIONS: As found for other solid tumors, hemoglobin level was a determining factor in the prognosis for treatment outcome in patients with esophageal carcinoma. Our findings require confirmation in randomized studies and further documentation of the probable benefits of correcting hemoglobin levels.

Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy

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Introduction. The objetive was to investigate thepossible prognostic value of blood hemoglobin concentrationin the outcome of radical treatment forlocally advanced esophageal carcinoma.Materials and method. This was a retrospectiveanalysis of data for 85 patients treated for locallyadvanced esophageal carcinoma between January1991 and January 1997 with chemoradiotherapyalone or as neoadjuvant therapy. All patients receivedchemotherapy (4 cycles of cisplatin 100mg/m2 on day 1, and continuous infusion 5-fluorouracil1 g/m2 per day on days 1-5) with concomitantradiotherapy (40 Gy at 2 Gy/session to theesophageal tumor and mediastinum). The responsewas evaluated after 4 weeks. 69 patients continuedto receive chemoradiotherapy only to a total dose of60-64 Gy to the esophageal tumor with a 2-cm margin.Sixteen patients underwent radical surgery. Hemoglobinlevels were measured before combinedtreatment in all patients. The prognostic value ofhemoglobin concentration was analyzed statistically,along with other patient-, tumor- and treatmentrelatedfactors.Results. Mean follow-up time: 82 months (range 60-99 months). Chemoradiotherapy was followed byan overall clinical response of 69.4%, with completeclinical response in 24.7% of the patients. Mean survivaltime was 12 months, and overall likelihood ofsurvival after 3 years was 13%. Mean time to progression:5 months. Median survival time was 12months in the 69 patients who underwent chemoradiotherapyalone, and 26 months in patients whounderwent radical surgery. Univariate analysisshowed a hemoglobin value of > 13 g/dl to be a prognosticfactor for better survival, along with performancestatus according to the ECOG classification,weight loss < 10%, tumor stage, tumor length, andcomplete response to chemoradiotherapy. Multivariateanalysis showed that only hemoglobin concentrationwas an independent prognostic factor:for each unit increase in hemoglobin level, the riskof death from esophageal carcinoma decreased by5%. In the subgroup of patients who did not undergosurgery, hemoglobin concentration was also anindependent prognostic factor along with completeclinical response.Conclusions. As found for other solid tumors, hemoglobinlevel was a determining factor in theprognosis for treatment outcome in patients withesophageal carcinoma. Our findings require confirmationin randomized studies and further documentationof the probable benefits of correcting hemoglobinlevels