Salvage re-irradiation in non-melanoma skin cancers: A multicenter analysis.

BACKGROUND AND PURPOSE: We conducted a multicentre real-world study to assess the outcomes of radical salvage re-irradiation for non-melanoma skin cancer (nMSC) recurrences following definitive or postoperative radiotherapy. MATERIALS AND METHODS: Data on patients treated between 2006 and 2022 with re-irradiation for nMSCs were retrospectively collected from five high-volume brachytherapy centers. The primary endpoint was local control (LC). Secondary endpoints included overall survival, progression-free survival, and adverse events (AEs). The Kaplan-Meier estimator and Cox Proportional-Hazards Model were utilised in the analysis. RESULTS: A total of 58 patients with a median age of 78.4 years with recurrences of previously irradiated nMSC in the head and neck region were included in the analysis. The majority had cutaneous basal cell carcinoma (BCC; 91.4%), and were irradiated with high-dose-rate brachytherapy (HDR-BT; 91.4%). The most common locations included the nasal region (36.2%) and external ear (18.9%). The 1-year LC was 73.1% and decreased to 41.7% at three years. The size of the re-irradiated lesion was the single independent prognostic factor in Cox analysis (per mm; HR 1.07; 95% CI 1.04-1.11; p < 0.001). Grade 3 or worse AEs were reported in 7 cases (12.1%). CONCLUSION: Re-irradiation for nMSCs, predominantly administered with brachytherapy for radiorecurrent BCC, is associated with high recurrence rates, and the risk of failure significantly increases with the size of the treated lesion. Re-irradiation could be an option for selected elderly patients with small, localised, inoperable recurrences after RT to achieve local control or defer systemic treatment; however, prospective trials are necessary to confirm its safety and efficacy.

The evaluation of treatment plans in high-dose-rate endobronchial brachytherapy by utilizing 2D and 3D computed tomography imaging methods.

PURPOSE: To present comparison of treatment plans made by using 2D and 3D methods in the planning system, as well as to assess the quality of treatment plans using the 2D and 3D methods. MATERIAL AND METHODS: The studies involved a group of 31 patients with advanced lung cancer treated in the Brachytherapy Department of the Subcarpathian Cancer Center in Brzozów from 2011 to 2013. In total, 31 patients and 76 treatment plans were analyzed. We compared coverage of PTV planned in 3D and 2D. In the 3D method of treatment, three-dimensional images from computer tomography were used. In treatment plans performed using the 2D method, images from the simulator were used. RESULTS: The comparison of treatment plans made by using 2D and 3D methods is described. This comparison highlighted the significant differences between these two methods assessing reference dose coverage of the PTV by 100% and 85% isodose. CONCLUSIONS: Reference doses with 100% coverage of the PTV in treatment applied with the 3D method are 31% higher than when applied with the 2D method.

Individual applicator for brachytherapy for various sites of superficial malignant lesions.

The aim of this paper is to discuss brachytherapy treatment and individual applicators suitable for unfavorably localized superficial malignant lesions. Techniques for manufacturing an individual applicator and clinical examples of its use for various locations of cancer are presented. This techniques are based on individual size and shape of the tumour. CT-planning make the technique adequate for individual patient history and type of tumour. Featured techniques seems to be very useful and easy to performed.

Comparison of the GTV coverage by PTV and isodose of 90% in 2D and 3D planning during endobronchial brachytherapy in the palliative treatment of patients with advanced lung cancer. Pilot study.

PURPOSE: Endobronchial brachytherapy (EB) is one way of treatment of patients with advanced lung cancer. Technological progress and the introduction of computed tomography for use in 3D planning allows one to define the area being treated very precisely, which gives an opportunity to extend survival, even in groups of patients receiving palliative care. MATERIAL AND METHODS: In 2011, in the Brachytherapy Department of the Subcarpathian Oncological Center, a group of 12 consecutive patients with advanced cancer of the bronchus underwent palliative EB. We compared the coverage of GTV (gross tumor volume), seen in the computed tomography study with intravenous contrast, by the PTV (planning target volume) planned in 3D and 2D. RESULTS: In 2D planning GTV coverage ranged from 15% to 89%. By analyzing the isodose of 90%, it was found that 2D planning covered GTV in 15-35% of the dose. In 3D planning, this coverage changed positively, and ranged from 85% to 100%. The GTV coverage in 3D planning was 100% by definition. In addition, it should be noted that in the 3D planning one can spare critical organs or pacemakers. CONCLUSIONS: Planning for HDR brachytherapy in all locations should be based on dynamic imaging at present, especially in centers that are equipped with CT. Evaluation should be a routine test in treatment planning. The use of CT, even in palliative treatment planning, allows for much better coverage of GTV areas as well, which is very important to reduce radiation doses to critical organs and thereby reduce the toxic effects of treatment.