Consensus and recommendations on vaginal-cuff Brachytherapy of the Spanish Brachytherapy Groups of SEOR and SEFM

Purpose/objective(s) On October 5, 2018, a meeting of the Spanish Society of Radiation Oncology (SEOR) Brachytherapy Group was held, in collaboration with the Spanish Society of Medical Physics (SEFM), with the aim of preparing a consensus document on postoperative vaginal-cuff brachytherapy (VCBT). Materials/methods A survey including 42 questions was sent to Spanish Radiation Oncology Centres before the meeting. The survey items included: experience in VCBT, technique indications, previous patient preparation, applicator type, implant procedure, computerized tomography (CT) simulation, definition of target volumes and organs at risk (OAR), dose prescription, fractionation, treatment planning, dosimetric parameters and constraints to OAR. Thirty-three centres answered the survey. Statistical analysis of the survey considered that there was consensus when there was ≥ 85% of agreement related to a survey item, otherwise an item with < 85% of agreement would be discussed during the meeting to reach consensus. Results The results of the survey are reported here. The mean number of patients treated per centre in 2017 was 52 ± 41 (range 7–175), and the mean number of procedures per centre was 175 ± 150 (range 24–701).There was consensus on: the indications, applicator type, the OAR to be considered, the prescription point, standardisation and dosimetric quality parameters. There was no consensus on: patient preparation for the implant, the need for performing CT simulation and the frequency, the length of the vagina to be treated, if CTV should be delimited, the definition of the clinical target volume, fractionation, overall EQD2, active source length, separation between dwelling stepping source positions, if considering the uniformity/maximum values for dwelling stepping sources, the optimization mode, and the limiting doses to the OAR (AU)

Consensus and recommendations on vaginal-cuff Brachytherapy of the Spanish Brachytherapy Groups of SEOR and SEFM.

PURPOSE/OBJECTIVE(S): On October 5, 2018, a meeting of the Spanish Society of Radiation Oncology (SEOR) Brachytherapy Group was held, in collaboration with the Spanish Society of Medical Physics (SEFM), with the aim of preparing a consensus document on postoperative vaginal-cuff brachytherapy (VCBT). MATERIALS/METHODS: A survey including 42 questions was sent to Spanish Radiation Oncology Centres before the meeting. The survey items included: experience in VCBT, technique indications, previous patient preparation, applicator type, implant procedure, computerized tomography (CT) simulation, definition of target volumes and organs at risk (OAR), dose prescription, fractionation, treatment planning, dosimetric parameters and constraints to OAR. Thirty-three centres answered the survey. Statistical analysis of the survey considered that there was consensus when there was ≥ 85% of agreement related to a survey item, otherwise an item with < 85% of agreement would be discussed during the meeting to reach consensus. RESULTS: The results of the survey are reported here. The mean number of patients treated per centre in 2017 was 52 ± 41 (range 7-175), and the mean number of procedures per centre was 175 ± 150 (range 24-701).There was consensus on: the indications, applicator type, the OAR to be considered, the prescription point, standardisation and dosimetric quality parameters. There was no consensus on: patient preparation for the implant, the need for performing CT simulation and the frequency, the length of the vagina to be treated, if CTV should be delimited, the definition of the clinical target volume, fractionation, overall EQD2, active source length, separation between dwelling stepping source positions, if considering the uniformity/maximum values for dwelling stepping sources, the optimization mode, and the limiting doses to the OAR. After presenting the results of the survey, the consensus meeting discussion focused on the issues for which there was no consensus. CONCLUSION: A consensus document on postoperative VCBT of the Spanish Brachytherapy Groups of SEOR-SEFM was elaborated.

Vesical instillations of hyaluronic acid to reduce the acute vesical toxicity caused by high-dose brachytherapy do not affect the survival: a five-year follow-up study

OBJECTIVE: To determine whether the intravesical use of hyaluronic acid (HA) reduces acute and late vesical toxicity induced by radiotherapy. METHODS: Single-centre retrospective study of patients diagnosed with cervical and endometrial cancer treated with brachytherapy (BT) with or without intravesical instillation of HA. Patients were assigned consecutively to the two treatment groups. Forty milligrams of HA was instilled intravesically for approximately 30 min prior to each BT session. Rates of acute and late vesical toxicity were recorded using the RTOG criteria. RESULTS: Ninety-five clinical histories were reviewed (48 with HA instillation and 47 without). Surgery had been performed in 85.3% of cases, external radiotherapy in 76.8% and chemotherapy in 25.3%. There were no significant differences between groups with regard to the total number of BT sessions, dose per session, total dose or biological equivalent dose. In all the sessions the percentage of patients presenting acute vesical toxicity was lower in the HA group, the differences being statistically significant (p<0.05) after the 2nd (20.8% vs. 40.4%) and 4th sessions (10.9% vs. 31.9%). No patients in the HA group presented vesical toxicity after six months of follow-up. Over the whole study period, the percentage of patients presenting vesical toxicity of degree 2 or more was significantly lower in the HA group (2.08% vs. 12.8%; p<0.05). CONCLUSION: Vesical instillations of HA decrease the incidence and the degree of acute vesical toxicity induced by high-dose BT, and reduce the percentage of patients that develop toxicity of degree 2 or more (AU)

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Granulocytic sarcoma of the right humerus in a non-leukaemia patient

Granulocytic sarcoma (GS), an uncommon solid extramedullary tumour, should be considered even in the absence of leukaemia, as delay in diagnosis and treatment worsens the prognosis. We present a GS (single humeral bone lesion) in a non-leukaemia patient, treated with intensive AML (Acute Myeloid Leukaemia) chemotherapy and sequential radiotherapy, in complete response 26 months after diagnosis, confirmed by histopathology and without leukaemia progression (AU)

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High dose rate brachytherapy (HDR-BT) in locally advanced oesophageal cancer. Clinic response and survival related to biological equivalent dose (BED)

INTRODUCTION: Ninety percent of oesophageal cancers are locally advanced at diagnosis, and treatment yields discouraging results. High dose rate brachytherapy (HDR-BT) permits an increment of local doses without a significant increment of toxicity. The goal of our study is to compare different HDR-BT fractions and assess global survival (GS) and cause-specific survival (CSS). MATERIAL AND METHODS: Twenty-six patients were treated for locally advanced oesophageal cancer with chemotherapy concomitant with conformal three-dimensional radiotherapy (C3DR) from January 1994 to December 2000. Of this group, 96.2% were males, mean age 63.08 years; the most frequent location was medium third, for 50% of cases. Eighty-four percent of cases were G2-3 epidermoid carcinomas. The administration consisted of 44.2 Gy with C3DR and 5 applications of HDR-BT of 500 cGy each. RESULTS: Actuarial GS and CSS at 5 years is 10.18% and 12.96%, a mean survival of 25.68 and 29.14 months respectively. The following factors (C3DR total dose, fraction dose and total dose of HDR-BT, number of applications, active length of application, total dose of C3DR plus HDR-BT, and BED of HDR-BT) are evaluated to find if they have an influence on treatment response, GS and actuarial CSS. The only result that yields statistical significance, in univariant analysis, is the active length in HDR-BT, thus for a greater active length of application, a minor response is obtained and GS diminishes (p=0.05). We grouped BT fractions on biological equivalent dose (BED) into: <28, 28-33 and >33 Gy; mean survival and GS at 5 years increases with BED>or=28 Gy (p=0.016). CONCLUSION: Tumour response increases (complete and partial) when BED on HDR-BT is increased, regardless of the fraction employed. A BED higher than 28 Gy yields a significant increase of mean survival and GS at 5 years (p=0.016) (AU)