Reirradiation salvage radiotherapy for recurrent prostate cancer after primary low-dose brachytherapy / Radioterapia de rescate con reirradiación para el cáncer de próstata recurrente después de braquiterapia primaria de dosis baja

Purpose: Local recurrence of prostate cancer after low-dose rate brachytherapy is a clinical problem with limited salvage treatment options. This prospective study evaluated the tolerability and outcome of salvage external beam radiation therapy (S-EBRT) for locally recurrent prostate cancer after primary low-dose rate prostate brachytherapy (LDR-BT). Materials and methods: Between October 2012 and 2022, 18 patients with biopsy-proven locally recurrent prostate cancer after primary LDR-BT and received S-EBRT. We evaluated biochemical failure (BF), overall survival (OS) and acute/late gastrointestinal and urinary toxicities (CTCAE v5.0 or CTCAE v4, only before 2017). Results: Median follow-up was 32 months (range, 5–124). The median age was at S-EBRT 68 years (range 59–79). 34% (6/18) were low risk, 44% (8/18) intermediate risk, 5% (1/18) high risk, and 17% (3/18) not specified. All patients were treated with IMRT/VMAT and received 60 Gy (2.5 Gy/fraction) to the prostate and 40% (7/18) 55.2 Gy (2,3 Gy/fx) to the seminal vesicles. 56% received ADT The 3-year OS and biochemical relapse-free survival after S-EBRT were 100% and 89%, respectively, with a median PSA nadir 0,035 ng/mL (0,01–0,34). Acute cystitis was present in 72% (13/18) of patients (27% of Grade > 2). Urethritis was present in 78% (14/18) patients (16% of cases Grade > 3), and acute rectitis occurred in 22% (4/18) of patients (no cases Grade > 3). Conclusions: Our data suggest that the treatment of locally recurrent prostate cancer with S-EBRT could provide adequate disease control safely and be used as an additional treatment in the natural history of prostate cancer patients. However, the results are still early and the sample is small; larger studies with longer follow-up would be mandatory.(AU)

Reirradiation salvage radiotherapy for recurrent prostate cancer after primary low-dose brachytherapy.

PURPOSE: Local recurrence of prostate cancer after low-dose rate brachytherapy is a clinical problem with limited salvage treatment options. This prospective study evaluated the tolerability and outcome of salvage external beam radiation therapy (S-EBRT) for locally recurrent prostate cancer after primary low-dose rate prostate brachytherapy (LDR-BT). MATERIALS AND METHODS: Between October 2012 and 2022, 18 patients with biopsy-proven locally recurrent prostate cancer after primary LDR-BT and received S-EBRT. We evaluated biochemical failure (BF), overall survival (OS) and acute/late gastrointestinal and urinary toxicities (CTCAE v5.0 or CTCAE v4, only before 2017). RESULTS: Median follow-up was 32 months (range, 5-124). The median age was at S-EBRT 68 years (range 59-79). 34% (6/18) were low risk, 44% (8/18) intermediate risk, 5% (1/18) high risk, and 17% (3/18) not specified. All patients were treated with IMRT/VMAT and received 60 Gy (2.5 Gy/fraction) to the prostate and 40% (7/18) 55.2 Gy (2,3 Gy/fx) to the seminal vesicles. 56% received ADT The 3-year OS and biochemical relapse-free survival after S-EBRT were 100% and 89%, respectively, with a median PSA nadir 0,035 ng/mL (0,01-0,34). Acute cystitis was present in 72% (13/18) of patients (27% of Grade > 2). Urethritis was present in 78% (14/18) patients (16% of cases Grade > 3), and acute rectitis occurred in 22% (4/18) of patients (no cases Grade > 3). CONCLUSIONS: Our data suggest that the treatment of locally recurrent prostate cancer with S-EBRT could provide adequate disease control safely and be used as an additional treatment in the natural history of prostate cancer patients. However, the results are still early and the sample is small; larger studies with longer follow-up would be mandatory.

Evaluación de la calidad de imagen y de la dosis en exámenes de TC helicoidal de tórax en pacientes con carcinoma de pulmón. Resultados preliminares / Evaluation of image quality and dose in thoracic spiral CT examinations in patients with pulmonary carcinoma. Preliminary results

Hemos aplicado los criterios de calidad de TC definidos en la Guía Europea a una muestra de exámenes de TC de tórax -para la indicación de carcinoma de pulmón- de cinco centros de la Comunidad de Madrid que disponen de equipos de TC helicoidal. Los exámenes seleccionados han sido evaluados independientemente por cinco radiólogos para determinar el grado de cumplimiento de los criterios de calidad de imagen definidos en la Guía para Exámenes de Tórax General. Las medidas dosimétricas efectuadas en paralelo han servido para estimar los valores del índice de dosis de TC (CTDIw), del producto dosis-longitud (DLP) y de la dosis efectiva para cada paciente. Los resultados muestran un alto cumplimiento global de los criterios de calidad (96 por ciento) con promedios por centro entre el 94 por ciento (en dos centros) y el 98 por ciento (en tres centros). Hay 10 de 16 criterios que se cumplen en todos los exámenes de la muestra; los que no se cumplen sistemáticamente son: dos de visualización (1,1 y 1,4), con 92-96 por ciento de cumplimiento, y cuatro de reproducción crítica (2,6; 2,8; 2,9 y 2,10), con porcentajes de cumplimiento entre el 91 por ciento y el 96 por ciento. Los valores medios por centro del CTDIw están en el intervalo 12,9-19,1 mGy; los del DLP entre 263 y 577 mGy-cm y los de la dosis efectiva entre 4,2 y 9,2 mSv. La correlación DLP-calidad de imagen en los centros con mayor calidad de imagen ha sido nula en dos de ellos y moderada directa en el tercero. En los dos centros con menor calidad de imagen la correlación ha sido moderada inversa en uno y débil directa en otro.(AU)