Longer time to testosterone recovery impacts favorably on outcomes for prostate cancer following androgen deprivation and radiotherapy.

PURPOSE: To evaluate the impact of sustained hypogonadism after androgen deprivation therapy (ADT) associated with radiotherapy in prostate cancer (PCa) patients with biochemical relapse-free survival (bRFS). METHODS: A retrospective cohort analysis of 213 consecutive PCa patients referred for radiotherapy plus ADT was carried out. Follow-up times including time to testosterone recovery (TTR) and bRFS were calculated from the end of ADT. Univariate and multivariate Cox regression analyses predicting bRFS were used. The optimal cutoffs for TTR and duration of ADT were determined using the maximally selected rank statistics (MSRS). RESULTS: After a median follow-up of 104 months, 18 patients relapsed among those who had recovered testosterone levels and 9 among those who did not. Median ADT duration was 36 months. The optimal cutoff for TTR was determined using MSRS. TTR >48 months was significantly associated with better bRFS (logrank, p < 0.0027). Five-year bRFS was 100% for >48 months vs. 85% for <48 months. TTR was the only significant variable for bRFS in multivariate Cox analysis. CONCLUSION: Our data show an association between longer TTR and bRFS values among PCa patients treated with ADT.

Does postoperative irradiation improve survival in early-stage endometrial cancer?

Endometrial cancer is the most common gynecological cancer in developed countries. Postoperative irradiation has been shown to lower locoregional relapses among high-intermediate risk endometrial cancer patients. In addition, vaginal cuff brachytherapy has demonstrated similar control to external beam radiotherapy but with lower toxicity. Although randomized trials have failed to translate that into better overall survival, reports from large databases, such as the National Cancer Database and the Surveillance, Epidemiology, and End Results database, have shown evidence of a statistical relationship between postoperative irradiation and survival in the intermediate- and high-risk groups. This review will address the risk groups that have led the therapeutic decisions and then we will review the clinical results accordingly. Special attention will be paid to the survival results based on the data presented through an analysis of the large databases that suggest a possible survival benefit.

The influence of the image registration method on the adaptive radiotherapy. A proof of the principle in a selected case of prostate IMRT.

PURPOSE: To analyse the influence of the image registration method on the adaptive radiotherapy of an IMRT prostate treatment, and to compare the dose accumulation according to 3 different image registration methods with the planned dose. MATERIAL AND METHODS: The IMRT prostate patient was CT imaged 3 times throughout his treatment. The prostate, PTV, rectum and bladder were segmented on each CT. A Rigid, a deformable (DIR) B-spline and a DIR with landmarks registration algorithms were employed. The difference between the accumulated doses and planned doses were evaluated by the gamma index. The Dice coefficient and Hausdorff distance was used to evaluate the overlap between volumes, to quantify the quality of the registration. RESULTS: When comparing adaptive vs no adaptive RT, the gamma index calculation showed large differences depending on the image registration method (as much as 87.6% in the case of DIR B-spline). The quality of the registration was evaluated using an index such as the Dice coefficient. This showed that the best result was obtained with DIR with landmarks compared with the rest and it was always above 0.77, reported as a recommended minimum value for prostate studies in a multi-centre review. CONCLUSIONS: Apart from showing the importance of the application of an adaptive RT protocol in a particular treatment, this work shows that the election of the registration method is decisive in the result of the adaptive radiotherapy and dose accumulation.

Vaginal cuff brachytherapy in endometrial cancer - a technically easy treatment?

Endometrial cancer (EC) is one of the most common gynecological cancers among women in the developed countries. Vaginal cuff is the main location of relapses after a curative surgical procedure and postoperative radiation therapy have proven to diminish it. Nevertheless, these results have not translated into better survival results. The preeminent place of vaginal cuff brachytherapy (VCB) in the postoperative treatment of high- to intermediate-risk EC was given by the PORTEC-2 trial, which demonstrated a similar reduction in relapses with VCB than with external beam radiotherapy (EBRT), but VCB induced less late toxicity. As a result of this trial, the use of VCB has increased in clinical practice at the expense of EBRT. A majority of the clinical reviews of VCB usually address the risk categories and patient selection but pay little attention to technical aspects of the VCB procedure. Our review aimed to address both aspects. First of all, we described the risk groups, which guide patient selection for VCB in clinical practice. Then, we depicted several technical aspects that might influence dose deposition and toxicity. Bladder distension and rectal distension as well as applicator position or patient position are some of those variables that we reviewed.

Rectal contrast increases rectal dose during vaginal cuff brachytherapy.

PURPOSE: To evaluate the impact of rectal dose on rectal contrast use during vaginal cuff brachytherapy (VCB). METHODS AND MATERIALS: A retrospective review of gynecology patients who received some brachytherapy fractions with and without rectal contrast was carried out. Rectal contrast was instilled at the clinician's discretion to increase rectal visibility. Thirty-six pairs of CT scans in preparation for brachytherapy were analyzed. Pairs of CTs were segmented and planned using the same parameters. The rectum was always defined from 1 cm above the cylinder tip up to 1.5 cm below the last activated dwell source position. An individual plan was computed at every VCB fraction. A set of values (Dmax, D(0.1cc), D(1cc), and D(2cc)) derived from dose-volume histograms were extracted and compared according to the rectal status. RESULTS: Rectal volume was 26.7% larger in the fractions with rectal contrast. Such an increase in volume represented a significant increase from 7.7% to 10.4% in all parameters analyzed except Dmax dose-volume histogram. CONCLUSIONS: Avoiding rectal contrast is a simple way of decreasing the rectal dose parameters of VCB, which would mean a better therapeutic ratio. Results also suggest that action directed at maintaining the rectum empty might have the same effect.

Dosimetric analysis of rectal filling on rectal doses during vaginal cuff brachytherapy.

PURPOSE: Several studies have analyzed the effect of bladder filling during vaginal cuff brachytherapy (VCB), but the effect of rectum filling has not been studied. We sought to evaluate the effects of rectal volume on rectal doses during postoperative VCB. METHODS AND MATERIALS: Brachytherapy planning CT scans (334 sets) obtained from 92 consecutive patients treated with VCB were resegmented (bladder and rectum) and replanned retrospectively using the same parameters to homogenize data and improve analysis. Rectal volume and a set of values derived from dose-volume histograms (DVHs) were extracted (maximal dose [Dmax], D0.1cc, D1cc, and D2cc). Univariate and multivariate analyses were carried out to evaluate the association between rectal volume and DVH metrics after adjusting for other clinical factors. RESULTS: A positive significant correlation was observed between rectal volume correlated and Dmax, D0.1cc, D1cc, and D2cc. Multiple linear regression models found that rectal volume, cylinder angle position, and cylinder diameter variables correlated significantly with the different DVH parameters analyzed. These variables explained the 14.5% and 18% of variance on regression models. CONCLUSIONS: Larger rectal volumes are associated with higher rectal dose parameters during VCB fractions. Prospective studies are needed to investigate whether these data are linked to differences in rectal toxicity.

Hábitos, preferencias y satisfacción sexual en estudiantes universitarios / Habits, preferences and sexual satisfaction in university students

Objetivo. Aproximarnos a las costumbres, preferencias y satisfacción sexual de una muestra de jóvenes universitarios. Diseño. Estudio observacional de carácter transversal. Emplazamiento. El estudio se llevó a cabo en el contexto universitario de Castilla-La Mancha durante el curso 2009/10. Participantes. Participaron 199 estudiantes universitarios con edades comprendidas entre los 18-29 años. Mediciones principales. Se recogieron datos sobre las costumbres sexuales de los participantes, sus preferencias, la satisfacción con su vida sexual y sus datos sociodemográficos. Resultados. La edad media de inicio de las relaciones sexuales es 17,3 años. El 51,9% de los participantes tienen relaciones sexuales entre 3 y 10 veces al mes, aunque en el caso de aquellos sin pareja estable esta frecuencia es menor. Mediante la escala de satisfacción sexual ISS se ha determinado que los participantes están satisfechos con sus relaciones sexuales, y que no existen diferencias estadísticamente significativas en la satisfacción sexual entre hombres (media: 20,1) y mujeres (media: 16,8), t (121) = 1,62, p = 0,11. El 77,1% de la muestra dice alcanzar el orgasmo siempre o casi siempre. La postura preferida para los hombres es la relación sexual con el hombre detrás de la mujer, mientras que las mujeres prefieren estar colocadas encima del hombre. El preservativo masculino es el anticonceptivo más habitual y sólo el 1,1% de la muestra no utiliza habitualmente métodos anticonceptivos. Conclusiones. La edad de la primera relación sexual tiende a disminuir y las personas con pareja estable tienen una mayor frecuencia de relaciones sexuales. Tanto hombres como mujeres se muestran satisfechos con su vida sexual e informan de una elevada frecuencia de orgasmos en sus relaciones sexuales. Existe un elevado uso de anticonceptivos por parte de los jóvenes (AU)

Objective. To investigate the sexual habits, preferences and satisfaction of a sample of young university students. Design. Cross-sectional, observational study. Setting. Performed in a university setting in Castilla-La Mancha during 2009/10. Participants. One hundred and ninety-nine university students aged between 18-29 years. Main Measurements. Data were collected on the sexual habits of the participants, their prefe- rences, satisfaction with their sexual life and sociodemographic data. Results. The mean age at first sexual relation was 17.34 years. Fifty-two percent of participants had sexual relations between 3 and 10 times a month, although in those without a stable partner this frequency was lower. Using the index of sexual satisfaction (ISS) it was found that participants are satisfied with their sexual relations, and that sexual satisfaction did not differ between men (Mean: 20.07) and women (Mean: 16.79), t (121) = 1.62, p = 0.11. Seventy-seven percent of the sample reported achieving orgasm always or almost always. The preferred position for males was sexual intercourse from behind the female, whereas women tended to prefer being on top of the man. The condom was found to be the most common form of contraception and only 1.1% of the sample reported not usually using contraceptive methods. Conclusions. Age of first sexual relation appears to be decreasing and those people with a stable relationship have a higher frequency of sexual relations. Both men and women appear to be satisfied with their sexual lives and report a high frequency of orgasm. It was found that contraceptive use is high among young people in the study population (AU)