High-dose-rate brachytherapy in symptom palliation due to malignant endobronchial obstruction: a quantitative assessment.

PURPOSE: This study was performed to objectively evaluate the effect of high-dose-rate endobronchial brachytherapy (HDREB) in symptom palliation of patients with malignant airway obstruction and treatment-related toxicity. METHODS AND MATERIALS: Seventy-eight patients were treated with palliative intent according to a prospective observational protocol. HDREB was delivered in three fractions of 7.5 Gy at weekly or fortnightly intervals, associated or not with external beam irradiation. Most patients presented with lung cancer primaries and were treated because of lesions located in the trachea and/or main bronchi. Performance status, degree of obstruction, and symptom palliation were graded according to an objective score index, defined before and after HDREB at the last followup visit. Survival was considered from the end of HDREB for at least 3 years or until death. RESULTS: Overall, there was a 70% improvement, with migration of patients from lower to higher performance status. Bronchial obstruction was improved in 73.4% of the patients. The symptom that presented the better response was hemoptysis (100% complete relief) followed by postobstructive pneumonia (80%), dyspnea (57.4%), and cough (33.9%). Median survival was 6 months and improved in patients with complete response at bronchoscopy (9 months). There were two (2.6%) cases of bronchial fistulae and eight cases (10.2%) of fatal hemoptysis. CONCLUSIONS: HDREB is an excellent modality for palliating malignant airway obstruction resulting in quality of life improvement, with a good tolerance, patient compliance, and low rate of complications.

Irradiated volume and the risk of fatal hemoptysis in patients submitted to high dose-rate endobronchial brachytherapy.

To determine risk factors associated with fatal hemoptysis (FH) in endobronchial high dose-rate brachytherapy (EHDRB) 84 patients treated with EHDRB from January 1991 to June 2002 were studied. Clinical and technical parameters (including treatment volumes) were analyzed. Eight (9.5%) patients died of FH, all but one with recurrent or persistent local disease. Median interval until death due to FH was 4 months versus 6 months for the whole group. The only factor with significant correlation with FH was the 100% isodose volume (V100) (p=0.04). Larger irradiated volumes were related to FH. Analysis of volume parameters is suggested, together with the dose and number of fractions prescribed for each patient.

Treatment of childhood diffuse brain stem tumors: comparison of results in different treatment modalities.

BACKGROUND: Diffuse brainstem tumors in children are rare and its treatment is controversial. Although radiotherapy (RT) used to be the treatment of choice, results remained unsatisfactory. The association of RT with other therapies is common, but lacks scientific data regarding its efficacy. Comparison of results of irradiation alone versus combined treatment modalities is crucial in improving survival. METHOD: The authors reviewed twenty-four patients with diffuse brainstem tumors, with mean age of 7 years, treated from December 90 to November 99, at the University of Sao Paulo, Brazil. These patients were subdivided in four groups according to the treatment option at the onset of symptoms. Four patients were treated with radiation alone (total dose of 50 Gy to 62.4 Gy), 6 patients with chemotherapy and radiation, 8 with tamoxifen and radiation and 6 with tamoxifen, radiation and chemotherapy. The results of the different groups were them compared. FINDINGS: Clinical response was observed in 83.3% of our children, briefly followed by progressive disease. Mean survival was 17 months with no statistically significant differences among the groups. Four patients were alive at the end of the study, with a mean survival of 32.4 months, all of them received combined therapy, but with no statistically significant differences. CONCLUSIONS: Neither the association of radiation therapy with chemotherapy, tamoxifen nor both have showed survival improvement. The prognosis of these patients remains very poor and only investigational trials would justify a highly aggressive approach.

Treatment of childhood diffuse brain stem tumors: comparison of results in different treatment modalities

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Background. Diffuse brainstem tumors in childrenare rare and its treatment is controversial. Althoughradiotherapy (RT) used to be the treatment ofchoice, results remained unsatisfactory. Theassociation of RT with other therapies is common,but lacks scientific data regarding its efficacy.Comparison of results of irradiation alone versuscombined treatment modalities is crucial inimproving survival.Method. The authors reviewed twenty-four patientswith diffuse brainstem tumors, with mean age of 7years, treated from December 90 to November 99,at the University of Sao Paulo, Brazil. These patientswere subdivided in four groups according tothe treatment option at the onset of symptoms.Four patients were treated with radiation alone (totaldose of 50 Gy to 62.4 Gy), 6 patients withchemotherapy and radiation, 8 with tamoxifen andradiation and 6 with tamoxifen, radiation andchemotherapy. The results of the different groupswere them compared.Findings. Clinical response was observed in 83.3%of our children, briefly followed by progressive disease.Mean survival was 17 months with no statisticallysignificant differences among the groups. Fourpatients were alive at the end of the study, with amean survival of 32.4 months, all of them receivedcombined therapy, but with no statistically significantdifferences.Conclusions. Neither the association of radiationtherapy with chemotherapy, tamoxifen nor bothhave showed survival improvement. The prognosisof these patients remains very poor and only investigationaltrials would justify a highly aggressiveapproach

High dose-rate brachytherapy as a treatment option in primary tracheal tumors.

PURPOSE: To present experience with high dose-rate endobronchial brachytherapy in the treatment of primary tracheal tumors. PATIENTS AND METHODS: Four patients with nonresected primary tracheal tumors are presented: 2 cases of squamous cell carcinoma of the trachea, 1 of recurrent adenoid cystic carcinoma, and 1 with recurrent plasmacytoma. All received brachytherapy, alone or as a boost for primary irradiation, in 3 or 4 fractions of 7.5 Gy, calculated at a depth of 1 cm. Follow-up was considered to start from the end of brachytherapy. RESULTS: Local control was achieved in all cases at the time of first bronchoscopic evaluation. Two patients with squamous cell carcinoma died at 6th and 33rd months after brachytherapy, respectively. The first had no evidence of disease, and the latter had local recurrence. The other 2 patients were alive after 64 and 110 months of follow-up, respectively, both with no evidence of disease. Tracheal stenosis developed in these 2 cases, 22 and 69 months after brachytherapy. Tracheal stent placement was needed only for the patient with an adenoid cystic carcinoma. CONCLUSIONS: Endobronchial high dose-rate brachytherapy may be used for tracheal tumors, even as a boost for external beam irradiation, or in recurrences. Local control in 3 out of 4 patients indicates that individual cases may benefit from the treatment. Long-term survival may also be expected, mainly for tumors with adenoid cystic histology.

High dose-rate brachytherapy as a treatment option in primary tracheal tumors

OBJETIVO: Apresentar a experiência do tratamento de 4 pacientes com tumores primários de traquéia, não operados, submetidos à braquiterapia endobrônquica de alta taxa de dose. PACIENTES E MÉTODOS: Dois casos de carcinoma espinocelular, uma recidiva de carcinoma adenóide cístico e uma recidiva de plasmocitoma primário da traquéia. Todos receberam braquiterapia endobrônquica, exclusiva ou como reforço de dose da radioterapia externa. Foram administradas 3 ou 4 frações de 7,5 Gy cada, calculados a 1 cm de profundidade. O seguimento foi considerado a partir do término da braquiterapia. RESULTADOS: Em todos os casos houve resposta completa. Dois pacientes com carcinoma espinocelular evoluíram a óbito em 6 e 33 meses após a braquiterapia, o primeiro, sem evidência de doença e o outro por recidiva local, respectivamente. As outras 2 pacientes encontravam-se vivas após 64 e 110 meses de seguimento, sem evidência de doença. Esses 2 casos apresentaram estenose traqueal em 22 e 69 meses após a braquiterapia, sendo necessária a colocação de prótese traqueal apenas na paciente com carcinoma adenóide cístico. CONCLUSÕES: A braquiterapia endobrônquica de alta taxa de dose pode ser utilizada tanto como reforço de dose da irradiação externa quanto em recidivas. O controle local obtido em 3 de 4 pacientes indica que casos individuais podem se beneficiar desse procedimento. Sobrevida a longo prazo pode ser observada, principalmente nos casos de histologia adenóide cística.

Braquiterapia de alta taxa de dose no tratamento do câncer do colo uterino: resultados de controle local, sobrevida e complicações / High dose rate brachytherapy in the treatment of the uterine cervix cancer: results of local control, survival and complications

Avaliar os resultados de sobrevida, controle local e complicações do tratamento combinado de radioterapia externa e braquiterapia de alta taxa de dose (BATD) em mulheres portadoras de câncer de colo de útero. Foram analisados retrospectivamente 874 pacientes. Foram avaliadas pacientes dos estádios I a IV classificadas de acordo com a FIGO. A sobrevida livre de doença e a global atuariais calculadas pelo método de Kaplan e Meir foi de 67,3 por cento e de 65,3 por cento sem evidência de doença. Das IIA 84,2 por cento. Das IIB 73,2 por cento. Das pacientes IIIA 50,0 por cento. Das IIIB 51,5 por cento, e das IVA 40,0 por cento estavam sem evidência de doença.Evaluate the results of survival, local control and complications of association of external radiation and high dose rate brachytherapy in the treatment of 874 women with cervix carcinoma. The mean age was 53 years. The clinical stage of the patients range from I-IV (FIGO). The disease free survival and the overall survival calculated by the Kaplan and Meier method were 67.3 per cent and 65.3 per cent respectively. Of clinical stage IB patients, 90.9 per cent were disease free. Of the IIA 84.2 per cent. IIB 73.2 per cent. IIIA 50.0 per cent. IIIB 51.5 per cent, and IVA 40.0 per cent. Sixty one patients presented intestinal complications, and 7 (0.8 per cent) required surgery treatment. Thirty patients (3.4 per cent) presented vesical complications...

Técnica para tratamento do fundo vaginal com braquiterapia de alta taxa de dose (BATD) / Treatment technique for high dose-rate brachytherapy (HDRB)

Os autores apresentam descriçäo dos protocolos utilizados no Serviço de Radioterapia do HC-FMUSP, bem como detalhes técnicos do tratamento pós-operatório complementar dos tumores de colo uterino e endométrio com braquiterapia de alta taxa de dose. É dada ênfase, principalmente, à prescriçäo e cálculo da dose, com sugestöes práticas e acessíveis

Tratamento do câncer do endométrio com braquiterapia de alta taxa de dose / Treatment of endometrium neoplasm with high dose rate brachytherapy

Cento e quatro pacientes com histologia comprovada de carcinoma do endométrio foram tratadas desde a instalaçao da BATD no Departamento, em 1991. A idade mediana foi de 65,5 anos e o seguimento mediano de 38 meses. Noventa e cinco eram pós-menopausadas, sete peri-menopausadas e duas estavam na pré-menopausa. Dezesseis pacientes eram do estádio clínico (pós-cirúrgico) EC IA, sendo cinco com grau de diferenciaçao Gl, oito G2 e três G3. Trinta e quatro pacientes eram do EC IB, dez com grau de diferenciaçao Gl, 18 G2 e seis G3. Vinte e cinco eram do EC IC, sendo nove Gl, nove G2 e sete G3. Seis eram do EC IIA, duas Gl, três G2 e uma G3. Oito eram do EC IIB, uma Gl, três G2 e quatro G3. Nove eram do EC IIIA, duas Gl, cinco G2 e duas G3. Três eram do EC IIIB, sendo duas Gl e uma G2. Uma era EC IIIC G3 e duas eram IVA G3. Dependendo da extensao da doença, a cirurgia consistiu de pan-histerectomia (Histerectomia total mais salpingooforectomia bilateral), pan-histerectomia mais omentectomia ou Wertheim-Meigs. Todas as pacientes dos estádios clínicos IA e IB apresentam-se sem evidência de doença (SED). As do EC IC 24 estao SED e uma apresentou metástases (MAD). As do EC IIA, cinco estao SED e uma MAD. As do EC IIB, seis estao SED, uma com progressao de doença local (PDL) e uma foi a óbito (OPD). As do EC IIIA, sete estao SED, uma MAD e uma apresentou progressao de doença. As do EC IIIB l está SED e duas apresentam progressao de doença. A paciente IIIC está SED, dois meses após o tratamento, e as IVA se apresentam SED, três e quatro meses após o término do tratamento. Oito pacientes apresentaram complicaçoes leves de tratamento Os resultados sao semelhantes aos dos tratamentos com braquiterapia de baixa taxa de dose, tanto em sobrevida como em complicaçao, com a vantagem de ser realizado em regime ambulatorial , sem os inconvenientes de uma internaçao hospitalar.

Braquiterapia de alta taxa de dose / High dose rate brachytherapy

A braquiterapia de alta taxa de dose utiliza fonte unica de '192 ANT. IND Ir' com atividade nominal inicial de 10Ci em equipamento com controle remoto. Esta tecnica permite que o tratamento seja realizado em regime ambulatorial, sem os inconvenientes da braquiterapia classica, como anestesia geral ou raquidiana, imobilizacao prolongada no leito e exposicao de pessoa a irradiacao. O servico de radioterapia possui cinco protocolos de tratamento em estudo: carcinoma de colo uterino, endometrio, pulmao, esofago e tumores do sistema nervoso central. Desde a instalacao do Micro Selectron HDR foram tratados 90 pacientes, com um total de 257 procedimentos. As aplicacoes sao semanais, perfazendo tres a quatro fracoes. Devido ao pouco tempo de atividade, os resultados sao preliminares, mas perfeitamente comparaveis aos primeiros meses dos tratamenos classicos. Nao tivemos nenhuma complicacao durante os procedimentos ou imediatamente apos. Muitos estudos devem ser realizados para se estabelecer criterios de dose, fracionamento e associacao ideais, a fim de se alcancar um alto nivel de taxa terapeutica.

Otimizaçäo do planejamento radioterápico no câncer de mama / Optimization of radiotherapy planning in breast cancer

Com o intuito de se avaliar mais precisamente a localizaçäo da cadeia ganglionar mamária interna em pacientes portadoras de câncer de mama, os autores realizaram um estudo imagenológico comparativo de 3 métodos: radiografia simples (RX), ultra-sonografia (US) e tomografia computadorizada (TC). Foi obtida variaçäo de medidas em torno de 0,45 cm quando se comparou o RX com a US e o RX com a TC. Até o momento contamos com apenas 8 pacientes que completaram o estudo. Achamos conveniente prosseguir na investigaçäo, a fim de que se possa obter uma melhor avaliaçäo da priofundidade a ser tratada, no caso da cadeia mamária interna, com um método simples e de fácil acesso ao radioterapeuta

Metástase torácica de carcinoma de colo uterino: relato de um caso / Thoracic metastasis of cervix carcinoma: report of a case

Os autores descrevem um caso de lesäo torácica compatível com metástase de carcinoma de colo uterino, escavada e com invasäo de parede torácica. O tumor secundário apareceu por volta de sete anos após tratamento adequado da lesäo primária com radioterapia. O diagnóstico diferencial é discutido