Impact of magnetic resonance imaging (MRI) in the local staging, risk group classification, and treatment of patients with prostate cancer with combination of high dose rate (HDR) brachytherapy and external beam radiotherapy (EBRT).

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 202-202
Author(s):  
Alfonso Gomez-Iturriaga ◽  
Francisco Casquero ◽  
Claudia Carvajal ◽  
Arantxa Urresola ◽  
Begona Canteli ◽  
...  
Keyword(s):  
Risk Group ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
High Dose ◽  
Hdr Brachytherapy ◽  
Resonance Imaging ◽  
Mri Staging ◽  
Local Staging ◽  
Magnetic Resonance Imaging Mri ◽  
Classification And Treatment

202 Background: To assess the impact of magnetic resonance imaging (MRI) staging for patients undergoing High Dose Rate (HDR) brachytherapy with external beam radiotherapy (EBRT). Methods: Fifty consecutive patients with intermediate risk and high risk prostate cancer underwent staging MRI. The MRI findings were used to guide stage-appropriate treatment recommendations, and to assist in the preplanning and optimization of the brachytherapy isodose distributions. Results: Median age of the patients was 71 years (range 58-78), median pre-treatment PSA was 10.15 ng/ml (3.3-66), median prostate volume was 35cc (14-58). Eighty-four percent of the patients were Gleason ≥ 7. Fifty-two percent had ≥ 50 of cores involved. Fifty four percent of patient’s PSA was ≥ 10 ng/ml. Pre-MRI staging was T1 in 70% of the patients, T2 in 30 %. Of the 50 patients staged by MRI, 70% were upstaged from the digital rectal examination-based clinical stage; 46% of cT1- T2 patients were upstaged to cT3. This upstaging changed the risk group in 56% of the patients while using the NCCN classification and in 24% when the D’Amico classification was used. The treatment reccomendation was modified in 26% and 20% of the patients using the NCCN and the D’Amico classification respectively. Conclusions: Staging MRI impacts in the assessment of the local staging, leading to changes in risk group classification and treatment decision in intermediate and high risk patients undergoing HDR brachytherapy and EBRT.

scholarly journals Interstitial HDR Brachytherapy in the Treatment of Non-Melanocytic Skin Cancers around the Eye

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1425
Author(s):  
Paweł Cisek ◽  
Dariusz Kieszko ◽  
Mateusz Bilski ◽  
Radomir Dębicki ◽  
Ewelina Grywalska ◽  
...  
Keyword(s):  
External Beam Radiotherapy ◽  
Late Complication ◽  
Target Volume ◽  
Lower Eyelid ◽  
High Dose Rate ◽  
High Dose ◽  
Hdr Brachytherapy ◽  
Lateral Canthus ◽  
Skin Cancers

Background: Eyelid tumors are rare skin cancers, the most common of which is basal cell carcinoma characterized primarily by local growth. In addition to surgery, radiotherapy is among the basic methods of treatment. External beam radiotherapy is associated with the risk of complications within ocular structures, especially the lens. In the case of interstitial brachytherapy, it is possible to administer a high dose to the clinical target volume (CTV), while reducing it in the most sensitive structures. Methods: This paper presents the results of an analysis of 28 patients treated with interstitial high dose rate (HDR) brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral canthus; and the cheek, nose and temples with the infiltration of ocular structures. The patients were treated according to two irradiation schedules: 49 Gy in 14 fractions of 3.5 Gy twice a day for 7 days of treatment, and 45 Gy in 5 Gy fractions twice a day for 5 days. The mean follow-up was 22 months (3–49 months). Results: two patients (6%) had a relapse: a local recurrence within the irradiated area in one of them, and metastases to lymph nodes in the other. The most common early complication was conjunctivitis (74%), and the most common late complication was dry eye syndrome (59%). Conclusions: Interstitial HDR brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral cants; and the cheek, nose and temples with infiltration of ocular structures is a highly effective, short and relatively low burden type of treatment.

Rectal toxicity results for patients treated with HDR brachytherapy as monotherapy versus dose-escalated external beam radiotherapy for localized prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 5-5
Author(s):  
Jacob Samuel Parzen ◽  
Hong Ye ◽  
Gary S. Gustafson ◽  
Alvaro Martinez ◽  
Evelyn Sebastian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Bleeding ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
Localized Prostate Cancer ◽  
High Dose ◽  
External Beam ◽  
Hdr Brachytherapy ◽  
Rectal Toxicity ◽  
Rectal Pain

5 Background: We present a large retrospective analysis comparing rectal toxicity following high dose rate (HDR) brachytherapy as monotherapy relative to dose-escalated external beam radiotherapy (EBRT) for patients with localized prostate cancer. Methods: 2683 patients treated with HDR or EBRT between 1994 and 2017 were included. 545 (20.3%) received HDR and 2138 (79.7%) EBRT. HDR fractionation was 38 Gy/4 fractions (n=321), 24 Gy/2 (n=96), or 27 Gy/2 (n=128). EBRT patients received a median dose of 75.6 Gy in 1.8 Gy fractions [range 70.2-82.8 Gy], using either 3D conformal or intensity modulated radiotherapy (IMRT). All EBRT patients underwent 3D image guidance via an off-line adaptive process. Treatment was directed to prostate only (n=780) or prostate and seminal vesicles (n=1351). No nodal therapy was given. Target volume for HDR patients included the prostate with no expansion. Acute and chronic gastrointestinal (GI) toxicity was defined as occurring ≤ 6 and > 6 months, respectively, after radiotherapy and was graded per CTCAE version 3.0. Toxicity variables were analyzed with χ2 test. Results: Median follow-up was 7.5 years (7.4 years for EBRT and 7.9 years for HDR). 69.1% of EBRT patients received IMRT with the remainder treated using 3D conformal technique. Compared to EBRT, HDR was associated with decreased rates of acute grade ≥ 2 diarrhea (0.7% vs. 4.5%, p < 0.001), rectal pain/tenesmus (0.6% vs. 7.9%, p < 0.001), and rectal bleeding (0% vs. 1.6%, p=0.001). Rates of chronic grade ≥ 2 rectal bleeding (1.3% vs. 8.7%, p < 0.001) and radiation proctitis (0.9% vs. 3.3%, p=0.001) favored HDR over EBRT. Rates of any chronic rectal toxicity grade ≥ 2 were 2.4% vs. 10.5% (p < 0.001) for HDR vs. EBRT, respectively. For the 1478 EBRT patients treated with IMRT, acute and chronic rates of any grade ≥ 2GI toxicity were 4.2% and 5.6%, respectively, compared to 1.5% (p=0.002) and 2.4% (p=0.002), respectively, for HDR patients. Conclusions: In appropriately selected patients with localized prostate cancer undergoing definitive radiation therapy, HDR brachytherapy as monotherapy is an effective strategy for reducing acute and chronic rectal toxicity.

Combination external beam radiotherapy and brachytherapy for radical treatment of esophageal carcinoma in patients not suitable for surgery or chemoradiation.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 115-115
Author(s):  
Ajay Aggarwal ◽  
Mark Harrison ◽  
Ricky Sinharay ◽  
Derek Cooper ◽  
Robert Glynne-Jones ◽  
...  
Keyword(s):  
Median Survival ◽  
External Beam Radiotherapy ◽  
Survival Rates ◽  
High Dose Rate ◽  
High Dose ◽  
External Beam ◽  
Hdr Brachytherapy ◽  
Curative Therapy ◽  
Dysphagia Score ◽  
Radical Treatment

115 Background: Standard curative therapy for esophageal cancer is surgery or chemoradiotherapy. Many patients are not suitable for this approach due to significant co-morbidity.This study evaluates a combination of external beam radiotherapy and High-Dose-Rate (HDR) brachytherapy as a sole modality of treatment for patients in whom tumour characteristics would indicate radical treatment was appropriate. All patients had previously been discussed in a multi-disciplinary setting in which standard radical therapies had been discounted. Methods: 59 patients were treated between October 2000 and October 2011. 40 (58%) were male. Median age was 77 (53 – 88). 39 (66%) adenocarcinoma, 19 (31%) SCC and 1 undifferentiated tumour. 49 (83%) were lower third esophagus. Tumour stage: 1 12(20%), 2 25(43%), 3 19(32%) and 4 2(3%). 30 (50%) had Adult Comorbidity Score – 27 (ACE) of 2 or 3. External beam radiotherapy was conformally planned. Doses of either 27 Gy/6F or 30 Gy/10F were delivered. HDR brachytherapy was delivered utilising an Ir 192 source dosed at 1cm. Doses of either 10 or 15 Gy were delivered. Results: The Median OS, of all treated patients estimated by the Kaplan Meier methods was 373 days (12.3 months). (Fig 1) The 1-, 2- and 3-year survival rates for treated patients were 51%, 19% and 7% respectively. Patients with stage I disease had a median survival of 16 months compared with 10 months for patients with stage III disease. Review of pre treatment dysphagia score demonstrated that patients with no dysphagia prior to treatment (score =0) had a median survival of 17 months compared to 12.5 months and 10 months for patients with scores of 2 and 3 respectively. Conclusions: This demonstrates the value of a purely radiation based approach in a population unsuited to other radical approaches. The median survival exceeds by several months that seen in patients treated palliatively. Treatment is deliverable without significant co-morbidities and offers a survival advantage comparable to radical chemoradiotherapy.

Pilot study of focal salvage high-dose rate (HDR) prostate brachytherapy in patients with local recurrence after definitive external-beam radiotherapy (XRT).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 264-264
Author(s):  
Hans T. Chung ◽  
D. Andrew Loblaw ◽  
Laura D'Alimonte ◽  
Ananth Ravi ◽  
Masoom A. Haider ◽  
...  
Keyword(s):  
Pilot Study ◽  
Local Recurrence ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
High Dose ◽  
Prostate Brachytherapy ◽  
Intermediate Risk ◽  
Hdr Brachytherapy ◽  
Median Size ◽  
Complication Risk

264 Background: Studies of post-treatment biopsies of the prostate after definitive dose-escalated XRT for intermediate-risk prostate cancer suggest that approximately 20% will be positive. Salvage options include surgery, brachytherapy, cryotherapy or high-frequency ultrasound. However, the complication risk, such as fistula, incontinence or bladder neck contracture, is not insignificant. The objective of this pilot study is to explore the toxicities and efficacy of focal salvage HDR prostate brachytherapy. Methods: This study was approved by the institution’s research ethics board. Eligible patients included those with biopsy-confirmed local recurrence >30 months after completing XRT, MRI of the prostate demonstrating solitary recurrence confined to the prostate, negative metastatic workup, IPSS <15, post-XRT PSA <10ng/mL, prostate volume ≤50cc. Salvage HDR brachytherapy was performed under transrectal ultrasound guidance with a prescription dose of 27Gy divided over two implants separated by 1 week to the target volume (TV) as seen on MRI with dose constraints to the urethra and rectum. Results: Six patients were enrolled in the study. The mean age was 73 years, all had either low- or intermediate-risk disease at presentation, and initial XRT received was 70-78Gy at least 5 years ago. The Gleason score of the local recurrence was 7 and 8-10 in 4 and 2 patients, respectively. The pre-HDR mean PSA was 5.5. The median size of the recurrence on MRI was 9mm and median size of the TV was 5.0cc (2.2-10.2), TV V100% 95.1%, urethral D10% 51.8% and rectal D1cc 39.2%. Four patients have at least 3 months of follow-up, and no acute GU/GI grade 3-5 toxicities were observed, including urinary retention. The most common acute toxicity was frequency and nocturia. Mean IPSS at baseline, 4-weeks, 3-months was 7, 9 and 7. Conclusions: Preliminary data suggests that focal salvage HDR brachytherapy was technically feasible with mild acute toxicities. Clinical trial information: NCT01583920.

Treatment of advanced lung cancer by external beam radiotherapy and high dose rate (HDR) brachytherapy

2001 ◽  
Vol 6 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Janusz Skowronek ◽  
Krystyna Adamska ◽  
Grzegorz Zwierzchowski ◽  
Szczepan Cofta ◽  
Krzysztof Świerkocki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Dose Rate ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
Advanced Lung Cancer ◽  
High Dose ◽  
External Beam ◽  
Hdr Brachytherapy
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