Continuous low dose rate brachytherapy with high activity iodine-125 seeds in the management of meningiomas.

The purpose of this study was to evaluate if meningiomas can be effectively treated with brachytherapy using permanent implantation of high activity I-125 seeds. Thirteen patients with intracranial meningiomas were treated by means of permanent stereotactic implantation of one or more high-activity I-125 seeds. The physical characteristics of I-125 enabled us to deliver a minimum tumor dose ranging from 100 Gy to 500 Gy at a low dose rate of 5 cGy to 25 cGy per hr. Indications for this procedure included recurrence after initial surgery or as primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 25 months. Nine of 13 patients achieved complete resolution of the tumor and in the remaining four, more than 50% reduction in tumor volume was noted at the last follow-up. No late complications were observed. We conclude from this initial data that localized high dose irradiation delivered at a low dose rate using I-125 permanent implantation is an effective, safe, and simple method in the treatment of both recurrent and primary intracranial meningiomas.

Estimation of the mean effective organ doses for total body irradiation from Rando phantom measurements.

For the total body irradiation (TBI) procedure, it is necessary to compare the mean dose obtained from the tissue or organs and the estimated dose equivalent value from the computer program. Due to the easy-access of the Rando phantom and repeatability of TLDs and its output, the results from the experiment are quite encouraging for the verification of the dose distributions from total body irradiation at the given prescribed monitor units. The estimation of effective dose equivalent particularly across the lung sections was studied by combinations of using arms as the scatter volume to compensate for the inhomogeneity across the breast portion, as well as using the spoiler for skin-sparing purposes. The results were based upon various beam quality such as 4 MV, 6 MV, and 10 MV X rays. One series of experiments performed for this survey to ascertain the dose equivalent of the tissues was conducted. This paper describes the method and procedure for comparison between the measured data and computed data as a reference in the dosimetry of total body irradiation. Comparison of the measured and computed data for the largest collimated field shows that the calculated dose rates do not differ by more than 2% from the measured data. Because uncertainty is inherent in non-patient-like phantoms, the calculated data may be served as a reference for the dosimetry. For the total body irradiation setup, considering the radiation field size and treatment distances commonly employed, we conclude that the best combination of the patient setup will be (1) laying both arms down as compensation for lung inhomogeneity, and (2) the spoiler, which is made of acrylic about 8 mm thick and functions like a bolus, is needed to reduce the skin sparing effects and contribute the uniform dose distribution. The beam spoiler with the frame stands near the patient during the treatment.

Brachytherapy: a viable alternative in the management of basal meningiomas.

Thirteen patients with intracranial meningiomas of the skull base were treated with one or more high-activity iodine-125 seeds. In 11 patients, the seeds were implanted stereotactically under local anesthesia. A minimum dose of 100 to 500 Gy was delivered to the tumor at a dose rate of 5 to 25 cGy/h. Indications for this procedure included recurrence after initial surgery or as the primary modality of treatment in patients who were not candidates for surgery. All 13 patients are alive at a median follow-up of 15 months. Nine of 11 patients (82%) without calcification in their meningiomas achieved complete response. The remaining 4 patients-2 with calcification and 2 without--achieved partial response. No early or late complications were observed. We conclude from our experience that both recurrent and primary meningiomas of the skull base can be treated effectively with permanent iodine-125 brachytherapy.

Retreatment of advanced esthesioneuroblastoma with high-activity I-125 endocurietherapy: a case report.

A 67-year-old woman presented with an advanced esthesioneuroblastoma that recurred 2 years following external irradiation. She was successfully retreated with continuous low-dose rate interstitial irradiation from high-activity I-125 seeds implanted permanently into the tumor.

Applicator for use of cesium-137 miniaturized tube sources in the treatment of uterine cervix cancer.

A modified afterloading Kumar Cervical Applicator with a 3 mm diameter central tandem permits insertion of the afterloading tandem into the uterus without need of manual cervical dilatation. While general anesthesia is required for insertion of standard cervical applicators, this is eliminated because the central tandem is no larger than a uterine sound, and the tandem may be painlessly inserted into the uterus while the patient is awake.

Postoperative adjuvant irradiation of rectal and rectosigmoid cancer.

Local recurrence is a major problem for approximately 40% of stage B and C rectal cancer patients following successful complete resection by either anterior (AR) or abdominoperineal resection (APR). We retrospectively analyzed the sites of local recurrence in 138 patients following curative surgery, and evaluated the effect of 5,000 rad adjuvant postoperative pelvic EXRT in reducing the incidence of local recurrence in 40 patients.

TAH and BSO with adjuvant pelvic EXRT and vaginal Cs-137 boost in the management of carcinoma of the endometrium.

Combined surgery and radiation has become standard therapy for operable endometrial cancer patients with stage IA (grade 2-3 or deep muscle invasion), stage IB, stage II, and selected stage III disease. We discuss the rationale for whole pelvic external-beam radiation therapy (EXRT) followed by vaginal endocurietherapy (ECT) boost, and present the outcome of 43 patients with endometrial cancer treated by combined surgery and radiation.

Low morbidity following 9,000-rad intracavitary endocurietherapy (ECT) using the Kumar Cervical Applicator and external-beam radiotherapy (EXRT) in the management of carcinoma of the uterine cervix.

The Kumar Cervical Applicator minimizes patient discomfort and improves patient mobility while reducing the tendency of the applicator to rotate during the 40 to 50 hours of uterine intracavitary endocurietherapy. Patients with previously untreated invasive carcinoma of the uterine cervix, F.I.G.O. stages IB-IVA, were treated with two Kumar intracavitary endocurietherapy (ECT) applications of 2,500 rad each to point "A," and 4,000 rad external-beam radiotherapy (EXRT) to midplane, for a total dose of 9,000 rad. The major complication rate was 2.7%, and the local control rate was 85% (22/26 patients) for stage I and II, and 91% (10/11 patients) for stage III and IVA.

Spine-sparing postmastectomy irradiation.

Postoperative irradiation of the chest wall and regional lymphatics following mastectomy for operable breast carcinoma is an effective means of reducing the chance of postoperative locoregional recurrence. The majority of patients who fail will ultimately develop bony metastases, especially in the thoracic and lumbar spinal regions. Our technique of postoperative irradiation avoids exit irradiation of the spine. This is important for patients who may later develop bony metastases or epidural spinal cord compression and require spinal irradiation. The details of the technique are presented.

Extended-field isocentric irradiation for Hodgkin's disease.

Extended-field therapeutic irradiation is the treatment of choice for the majority of patients diagnosed with pathologic stages I and II Hodgkin's disease, and total nodal irradiation can be effectively used to treat selected stage III Hodgkin's patients. Standard 100-cm source-to-axis distance extended-field isocentric technique and results are presented.

Survival of patients with unresectable non-small cell lung cancer following 6,000 rad megavoltage radiotherapy.

One hundred and fifty-seven patients with histologically proven, locally advanced, unresectable or inoperable non-small cell lung cancer were treated in a uniform fashion with external-beam megavoltage radiotherapy. Patients received a continuous course of 6,000 rad in 7½ weeks (four fractions of 200 rad per fraction each week). The comparatively high, uncorrected one-year survival rate of 48.7 percent, and uncorrected two-year survival rate of 25.7 percent, would be expected following uniform treatment with a relatively high external-beam tumor dose. The five-year uncorrected actuarial survival rate of 2.7 percent demonstrates that although the median survival can be increased by the use of higher radiation doses and better delivery technique, the ultimate cure rate and prognosis for inoperable and unresectable non-small cell lung cancer remains poor with current equipment and methods of radiotherapy.

A new method for treatment of unresectable, recurrent brain tumors with single permanent high-activity 125iodine brachytherapy.

We describe a new method for treating unresectable recurrent brain tumors in previously-irradiated patients with localized high-dose intracranial brachytherapy of 10,000-30,000 rads using permanent implantation of a single high-activity 125Iodine seed. For unresectable recurrent previously-irradiated pituitary tumors, a single high-activity 125Iodine seed is permanently implanted into the center of the tumor with an interstitial needle inserted under fluoroscopic guidance via a transsphenoidal approach. For unresectable recurrent meningiomas, a single high-activity seed is permanently implanted into the tumor at craniotomy. The clinical course of five patients treated by this method is described. Excellent long-term local control was obtained in all implanted cases. There were no intraoperative, postoperative, or chronic complications.

Intraluminal endocurietherapy of inoperable Klatskin's tumor with high-activity 192iridium.

Five patients with Klatskin's tumor (adenocarcinoma of the hepatic duct bifurcation) were treated with high-activity 192Iridium endocurietherapy [ECT]. Two ribbons containing ten and five seeds of 192Iridium, respectively, were threaded into right and left percutaneous biliary drainage catheters. This "Y-shaped" distribution of iridium seeds irradiates a target volume which corresponds very well to the "Y-shaped" volume of a Klatskin's tumor. With our technique, significantly larger volumes (average 9 X 7 X 5 cm) can be treated to the endocurietherapy target dose of 60.00 Gy in 120 hours. For potentially curable cases, an additional 40.00 Gy in five weeks is delivered to the tumor bed by conventional external-beam radiotherapy (100.00 Gy total dose). For palliative cases, ECT alone is used. This endocurietherapy is an improvement over the current technique using standard strength seeds, which delivers 50.00 Gy to a tumor volume approximately one centimeter in diameter in 100-120 hours.