Ten-year results of a phase II study with a single fraction of high-dose-rate brachytherapy (FAST-boost) after whole breast irradiation in invasive breast carcinoma

PURPOSE: We present the results of a prospective ten-year follow-up study to prove the effectiveness of a single fraction of 192-Ir high-dose-rate (HDR) brachytherapy (BT) as a boost. PATIENTS AND METHODS: Between 1999 and 2000, 84 consecutive patients with invasive breast carcinoma, with over 4 mm free margins after conservative surgery, were treated. All cases were stages T1-2, except for one case, a stage T3, 81% pN0, 19% pN1-2. Chemotherapy was used in 47% and hormonal therapy in 87%. Whole breast external beam radiotherapy (46 Gy) was followed 1-2 weeks later by an implant with metallic needles. A 7 Gy single dose of HDR BT to the 90% isodose line was delivered on an outpatient basis. Dosimetry was performed theoretically. This technique is called FAST-boost because the whole treatment is delivered in about two hours. RESULTS: With a median follow-up of 120 months, three patients relapsed in the margin of the implant and two in a different quadrant (5/84, 6%). Actuarial local control at five and ten years was 98.5% and 95.6%. Overall survival was 92.7% and 90.2%, and disease-free survival 90.2% and 79.9%. Cosmetic results were good or excellent in 92.5%. CONCLUSIONS: A single-fraction HDR boost with rigid needles (FAST-boost) is a good, quick, simple technique when surgical margins are free (AU)

Resultados de implante de semillas de iodo-125 con sistema de preplanificación en 250 pacientes con carcinoma de próstata / Results of 125-Iodine seed implant with preplanning system in 250 patients with prostate cancer

Objetivo: Revisar la experiencia con implantes permanentes de semillas de I-125 en carcinoma de próstata y el resultado a los 8 años de comenzar la técnica. Material y métodos: De 2002 a 2007 hemos realizado 250 implantes con braquiterapia de baja tasa con RapidStrand® y sistema de preplanificación. La edad media fue 68 años (49-78). El PSA medio fue 7,32 (2,31-14,6), 98% T1-T2a, 96% Gleason ≤ 6, 81% de bajo riesgo y 19% de riesgo intermedio (10 de estos últimos recibieron 46 Gy de radioterapia externa). Un 42% recibieron hormonoterapia. Resultados: Con seguimiento medio de 48 meses, 14 pacientes (5,7%) tuvieron recaída bioquímica (RB). En 11 pacientes (4,5%) con teórica RB el PSA descendió espontáneamente sin tratamiento. La supervivencia actuarial sin recaída bioquímica a 5 años fue del 91% (92% bajo riesgo, 86% riesgo intermedio); 92 vs 81% en pacientes con PSA < 10 vs > 10 (p < 0,05). Hubo complicaciones rectales G2 en el 0,6%, sondaje vesical en un 6,5%; el 60% conservaron la función sexual. El V100 medio fue del 89% y el D90 143 Gy. Conclusión: El resultado en carcinoma de próstata de bajo riesgo mediante semillas de Iodo-125es muy bueno con muy pocas complicaciones. Las elevaciones de PSA deberían ser controladas antes de dar tratamiento de rescate (AU)

Introduction: We review the experience with prostate carcinoma patients treated with permanent implants of 125-I seeds and the outcome eight years after the beginning of this technique. Material and methods: From 2002 to 2007 we have performed 250 implants with LDR brachytherapy with RapidStrand® and preplanning system. Mean age was 68 (49-78). Mean PSA was 7.32 (2.31 - 14.6). T1-T2a was the stage in 98%, and Gleason ≤ 6 in 96%. Low risk cases were 81% and intermediate risk 19% (ten of them received 46 Gy EBRT). Hormonal treatment was used in 42%. Results: With a mean follow-up of 48 months, 14 patients (5.7%) showed biochemical failure (BF). Eleven patients (4.5%) with theoretical BF were observed and PSA decreased without treatment. Actuarial PSA relapse-free survival at 5 years was 91%, (92% low risk, 86% intermediate cases), and 92% vs 81% with PSA <10 vs >10 (p < 0.05). Rectum complications were G2 in0 .6%. A urinary catheter was necessary in 6.5%. Sexual function was conserved in 60%. Mean V100 was 89% and D90 143 Gy. Conclusion: The outcome of patients with low risk prostate carcinoma treated with I-125 seed is very good with very low complications rate. Cases with PSA bounces should be controlled before starting a salvage treatment (AU)

[Results of 125-iodine seed implant with preplanning system in 250 patients with prostate cancer]. / Resultados de implante de semillas de iodo-125 con sistema de preplanificación en 250 pacientes con carcinoma de próstata.

INTRODUCTION: We review the experience with prostate carcinoma patients treated with permanent implants of 125-I seeds and the outcome eight years after the beginning of this technique. MATERIAL AND METHODS: From 2002 to 2007 we have performed 250 implants with LDR brachytherapy with RapidStrand(®) and preplanning system. Mean age was 68 (49-78). Mean PSA was 7.32 (2.31 - 14.6). T1-T2a was the stage in 98%, and Gleason ≤ 6 in 96%. Low risk cases were 81% and intermediate risk 19% (ten of them received 46 Gy EBRT). Hormonal treatment was used in 42%. RESULTS: With a mean follow-up of 48 months, 14 patients (5.7%) showed biochemical failure (BF). Eleven patients (4.5%) with theoretical BF were observed and PSA decreased without treatment. Actuarial PSA relapse-free survival at 5 years was 91%, (92% low risk, 86% intermediate cases), and 92% vs 81% with PSA <10 vs >10 (p<0.05). Rectum complications were G2 in 0.6%. A urinary catheter was necessary in 6.5%. Sexual function was conserved in 60%. Mean V100 was 89% and D90 143 Gy. CONCLUSION: The outcome of patients with low risk prostate carcinoma treated with I-125 seed is very good with very low complications rate. Cases with PSA bounces should be controlled before starting a salvage treatment.

Braquiterapia perioperatoria en cáncer de mama: resultados a largo plazo de un estudio fase I-II / No disponible

Objetivo: Realizamos un estudio fase I-II con braquiterapiaperioperatoria (BTPO) con Ir-192 de alta tasa de dosis (ATD)en estadios iniciales de cáncer de mama para saber si la técnicaes factible y si reduce el fracaso local.Pacientes y métodos: Entre 1997 y 1999, 24 pacientesen estadios I-II entraron en este estudio prospectivo. Durantela cirugía conservadora, tras la extracción del tumor primario,se insertaron agujas rígidas en el lecho tumoral en dosplanos. Se administraron dos sesiones de 4,7 Gy de braquiterapiacon ATD al día siguiente de la cirugía. A los 39 díasde media desde la cirugía iniciaron radioterapia externa sobrela mama, 46 Gy con márgenes libres y 50 Gy + 6 Gy deelectrones, con un borde afecto. Diez pacientes recibieronquimioterapia (QT) (8 pacientes eran pN+).Resultados: Con una media de seguimiento de 117 meses,el control local fue 100%, permaneciendo 23 libres de enfermedad.La AP describió en 15 casos bordes libres y en 9 bordesafectos. Se realizó una rerresección en 4 pacientes, quedando3 con bordes libres; en un caso se realizó mastectomía.No aparecieron complicaciones relacionadas con el implanteni retrasos en la cicatrización. Las complicaciones tardías fueronG1-2. La estética fue buena o excelente en 16 pacientes.Conclusiones: La BTPO produce unas tasas de control localexcelentes, con reducción del tiempo total de tratamiento,y es el mejor método de irradiación del lecho quirúrgico. Serequiere una selección de pacientes para evitar el retraso de laQT(AU)

Objective: We started a phase I-II study with perioperative192-Ir high dose rate (HDR) brachytherapy in early breast carcinomato know if this technique was feasible, and if it coulddecrease the local failure.Patients and methods: Between 1997 and 1999, 24 patientswith clinical stage I-II entered in this prospective study.Just during the conservative surgery, after removing the primarytumour, several rigid needles in two planes were insertedon the tumour bed. The next day after surgery two fractions4.7 Gy of HDR brachytherapy were administered. Externalbeam radiotherapy (EBRT) on the whole breast started at amean of 39 days. If one margin was involved, 50 Gy to thewhole breast plus 6 Gy with electrons were given. Only 46 Gyif margins were free. Ten patients received chemotherapy(CT) at the end of EBRT (8 patients were pN+).Results: With a follow-up of 117 months, the local controlis 100% and 23 out of 24 patients remain tumor free. Surgicalfindings showed free margins in 15 cases and involvedmargins in 9 cases. Four out of 9 received a second resection,3 achieved free margins and one a mastectomy. There was nodelay in the scar nor complications related to the implant. Latecomplications were G1-2. Cosmetic results were good or excellentin 16 cases.Conclusions: BTPO contributes to achieve excellent longtermlocal control in breast carcinoma, decreases the totaltime of treatment and is the best method to radiate the bed tumour.A selection of patients is requiered to avoid a delay ofthe sistemic therapy(AU)