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Sample records for 3d-mri-based pulsed-dose-rate intracavitary

  1. Physics Contributions and Clinical Outcome With 3D-MRI-Based Pulsed-Dose-Rate Intracavitary Brachytherapy in Cervical Cancer Patients

    Purpose: To assess the physics contributions and clinical outcome with three-dimensional magnetic resonance imaging-guided pulsed-dose-rate (PDR) intracavitary brachytherapy in cervical cancer patients. Methods and Materials: The data from 45 patients with primary locally advanced cervical carcinoma were analyzed. The median tumor cervical volume was 64.0 cm3 (range, 3-178). Of the 45 patients, 24 (53%) had histologic and/or radiologic pelvic involvement. After pelvic with or without para-aortic concomitant chemoradiotherapy, a PDR brachytherapy boost was delivered to a three-dimensional magnetic resonance imaging-based clinical target volume, taking into account the dose-volume constraints for critical organs and optimization of the target volume coverage. Results: At a median follow-up of 26 months (range, 9-47), the 2-year overall survival and disease-free survival rate was 78% and 73%, respectively. At the last follow-up visit, the disease of all patients remained locally controlled. Adding external beam radiotherapy and PDR using the equivalent dose in 2-Gy fractions model, the median dose received by 100% and 90% of the target was 54.4 Gyα/β10 and 63.5 Gyα/β10 for the intermediate-risk clinical target volume and 61.6 Gyα/β10 and 74.9 Gyα/β10 for the high-risk clinical target volume, respectively. Of the 45 patients, 23 and 2 developed acute Grade 1-2 and Grade 3 complications, respectively; 21 patients presented with delayed Grade 1-2 complications. One other patient presented with Grade 3 vesicovaginal fistula. No Grade 4 or greater complications, whether acute or delayed, were observed. Conclusion: Magnetic resonance imaging-guided PDR brachytherapy with optimization integrating the limits of tolerance to critical organs allows for excellent local control rates. Moreover, the present results have confirmed that the ability to optimize dwell times can contribute to an improvement in local control rates with a low level of late side effects.

  2. Time-resolved in vivo luminescence dosimetry for online error detection in pulsed dose-rate brachytherapy

    Andersen, Claus E.; Nielsen, Soeren Kynde; Lindegaard, Jacob Christian; Tanderup, Kari [Radiation Research Division, Risoe National Laboratory for Sustainable Energy, Technical University of Denmark, DK-4000 Roskilde (Denmark); Department of Medical Physics, Aarhus University Hospital, DK-8000 Aarhus C (Denmark); Department of Oncology, Aarhus University Hospital, DK-8000 Aarhus C (Denmark); Department of Medical Physics, Aarhus University Hospital, DK-8000 Aarhus C (Denmark)

    2009-11-15

    Purpose: The purpose of this study is to present and evaluate a dose-verification protocol for pulsed dose-rate (PDR) brachytherapy based on in vivo time-resolved (1 s time resolution) fiber-coupled luminescence dosimetry. Methods: Five cervix cancer patients undergoing PDR brachytherapy (Varian GammaMed Plus with {sup 192}Ir) were monitored. The treatments comprised from 10 to 50 pulses (1 pulse/h) delivered by intracavitary/interstitial applicators (tandem-ring systems and/or needles). For each patient, one or two dosimetry probes were placed directly in or close to the tumor region using stainless steel or titanium needles. Each dosimeter probe consisted of a small aluminum oxide crystal attached to an optical fiber cable (1 mm outer diameter) that could guide radioluminescence (RL) and optically stimulated luminescence (OSL) from the crystal to special readout instrumentation. Positioning uncertainty and hypothetical dose-delivery errors (interchanged guide tubes or applicator movements from {+-}5 to {+-}15 mm) were simulated in software in order to assess the ability of the system to detect errors. Results: For three of the patients, the authors found no significant differences (P>0.01) for comparisons between in vivo measurements and calculated reference values at the level of dose per dwell position, dose per applicator, or total dose per pulse. The standard deviations of the dose per pulse were less than 3%, indicating a stable dose delivery and a highly stable geometry of applicators and dosimeter probes during the treatments. For the two other patients, the authors noted significant deviations for three individual pulses and for one dosimeter probe. These deviations could have been due to applicator movement during the treatment and one incorrectly positioned dosimeter probe, respectively. Computer simulations showed that the likelihood of detecting a pair of interchanged guide tubes increased by a factor of 10 or more for the considered patients when

  3. Brachytherapy. Pulsed dose rate brachytherapy - Radiation protection: medical sheet ED 4250

    After having indicated the required authorization to implement brachytherapy techniques, this document presents the various aspects and measures related to radiation protection when performing pulsed-dose-rate brachytherapy treatments. It presents the concerned personnel, describes the operational process, indicates the associated hazards and the risk related to ionizing radiation, and describes how the risk is to be assessed and how exposure levels are to be determined (elements of risk assessment, delimitation of controlled and monitored areas, personnel classification, and choice of the dose monitoring method). It describes the various components of a risk management strategy (risk reduction, technical measures regarding the installation and the personnel, training and information, prevention and medical monitoring). It briefly presents how risk management is to be assessed, and mentions other related risks (biological risk, handling and posture, handling of heavy loads, mental workload, chemical risk)

  4. Pulsed dose rate brachytherapy (PDR): an analysis of the technique at 2 years

    A total of 154 applications was analysed using a pulsed dose brachytherapy technique for 138 patients over a 2 year period with emphasis on technical aspects influencing the overall treatment time. Vaginal ovoids were used in 59 cases, plastic tubes in 52, a Fletcher-type in 18, vaginal cylinders in 14 and a perineal template in 11 cases. Pulses were given at hourly intervals with a median dose rate of 0.6 Gy per pulse (range 0.4 to 3 Gy). The number of pulses per application varied from 3 to 134 (median 32). The number of dwell positions varied from 1 to 542 over 1 to 18 catheters. Patient related problems were few. The room was entered almost every 77 minutes. We noted 561 status codes in 147 applications. Of the 25 different codes, the most frequent one was due to the door left open when a pulse had to be given (35%) or due to constriction of the plastic catheters at the transfer tube junction (26%). However, the median total treatment time was increased by only 5 minutes. With pulsed dose rate brachytherapy at hourly pulses we can treat our patients within the planned time despite frequent room entrance and occurrence of an appreciable number of status codes. This technique seems to fulfill its promise to replace low dose rate brachytherapy

  5. Pulsed dose rate brachytherapy (PDR): an analysis of the technique at 2 years

    Thienpont, M. [Ghent Rijksuniversiteit (Belgium). Kliniek voor Radiotherapie en Kerngeneeskunde; Van Eijkeren, M.; Van Hecke, H.; Boterberg, T.; De Neve, W.

    1995-12-01

    A total of 154 applications was analysed using a pulsed dose brachytherapy technique for 138 patients over a 2 year period with emphasis on technical aspects influencing the overall treatment time. Vaginal ovoids were used in 59 cases, plastic tubes in 52, a Fletcher-type in 18, vaginal cylinders in 14 and a perineal template in 11 cases. Pulses were given at hourly intervals with a median dose rate of 0.6 Gy per pulse (range 0.4 to 3 Gy). The number of pulses per application varied from 3 to 134 (median 32). The number of dwell positions varied from 1 to 542 over 1 to 18 catheters. Patient related problems were few. The room was entered almost every 77 minutes. We noted 561 status codes in 147 applications. Of the 25 different codes, the most frequent one was due to the door left open when a pulse had to be given (35%) or due to constriction of the plastic catheters at the transfer tube junction (26%). However, the median total treatment time was increased by only 5 minutes. With pulsed dose rate brachytherapy at hourly pulses we can treat our patients within the planned time despite frequent room entrance and occurrence of an appreciable number of status codes. This technique seems to fulfill its promise to replace low dose rate brachytherapy.

  6. Preliminary report of pulsed dose rate brachytherapy in head-and-neck cancer

    Ziemlewski, A.; Zienkiewicz, J. [Medical Univ. of Gdansk (Poland). Dept. of Oral and Maxillofacial Surgery; Serkies, K.; Badzio, A. [Medical Univ. of Gdansk (Poland). Dept. of Oncology and Radiotherapy

    2007-09-15

    Purpose: To assess the feasibility and acute/delayed toxicity of pulsed-dose-rate brachytherapy (PDR BT) in head-and-neck tumors. Patients and Methods: 45 head and neck cancer patients underwent interstitial or contact PDR BT at a dose of 10.2-70 Gy (median, 70 Gy) and 0.6 or 1.0 Gy/pulse/h. 42 patients were administered BT as part of their curative treatment; 32 of them had sole BT. Three reirradiated patients with recurrent tumor had palliative BT. Results: PDR BT was well tolerated. Intense bleeding was the only complication associated with catheter removal from the tongue and bucca. 44 patients who completed BT experienced acute mucositis. Grade 3 toxicity of skin and oral mucosa occurred in three (6.8%) and six patients (13.6%), respectively. At a median follow-up of 22 months (range, 2-67 months), late serious toxicity (grade 4, for soft tissue and bone) was seen in seven patients (15.9%). Among the parameters analyzed, only dental care performed before BT had a significant impact on mucosal side effects. Acute severe mucositis was observed in 23% of patients without dental care compared to 0% of those with dental care (p = 0.044). Late severe mucositis occurred in 17.7% and 26.9% of the respective patients (p = 0.035), overall in 23%. The larger the volume encompassed by the reference isodose, the more late (p = 0.004) mucosal reactions were observed. Conclusion: PDR BT continued over a few days is a feasible and safe approach in head-and-neck tumors; however, it is accompanied by some toxicity. Dental care should precede isotope application. (orig.)

  7. Pulsed-dose-rate brachytherapy: design of convenient (daytime-only) schedules

    Purpose: To design pulsed-brachytherapy (PDR) protocols that are expected to be at least as clinically efficacious (in terms of both tumor control and late sequelae) as continuous low-dose-rate (CLDR) regimens, but that involve irradiation only during extended office hours. Both interstitial and intracavitary brachytherapy protocols are considered. Methods and Materials: The linear quadratic formalism was used in which the late normal tissue damage and tumor control for one protocol relative to another are assumed to be determined primarily by the level of cellular survival. PDR schedules were designed in which pulses are delivered during 'extended office hours' (8 A.M. to 8 P.M.) with no irradiation overnight. Generally, the proposed PDR regimes last the same number of treatment days as the corresponding CLDR regimen, but the PDR treatment lasts longer on the final day (i.e., until 8 P.M.). PDR doses were calculated such as to produce a tumor control which is equivalent to standard CLDR protocols, and the corresponding predicted late complication rate was compared with that for CLDR. Ranges of plausible values for the half-times of sublethal damage repair for tumors and for late-responding normal tissues were considered. Results: As has been previously shown, the efficacy of PDR relative to CLDR depends considerably on the repair rates for sublethal damage repair. Clinical and experimental evidence suggests that average repair half-times for early effects (e.g., tumor control) are less than about a half hour, and for late sequelae are more than about an hour. If these estimates are correct, daytime PDR regimes can usually be designed which take the same number of days as the corresponding CLDR regimen, but have comparable or better therapeutic ratios than CLDR. Conclusion: Protocols for PDR can be designed to involve irradiation only during extended office hours, that are likely to result in clinical results comparable or better than CLDR, for any expected

  8. Tumor and normal tissue dosimetry changes during MR-guided pulsed-dose-rate (PDR) brachytherapy for cervical cancer

    Background and purpose: To analyze systematic changes in tumor and normal tissue anatomy and dosimetry using serial MR imaging during pulsed dose rate brachytherapy (PDR BT) for cervical cancer. Material and methods: Forty-three patients with cervical cancer underwent MR-guided PDR BT using an intrauterine applicator alone after external beam radiotherapy. MR imaging was repeated on days 2 and 3 of treatment and the day 1 plan was applied to the re-contoured volumes. Results: The mean uterine volume and mean HR CTV increased during treatment. This resulted in a decrease in the mean HR CTV D90 relative to the day 1 planned dose. There was no change in the mean bladder volume during treatment but the mean rectal volume increased. This correlated with an increase in the mean rectal dose. There were four local recurrences. There was no apparent relationship between either the planned or the delivered HR CTV D90 and local recurrence. There was only one case of late bladder toxicity but nine patients developed late rectal toxicity. The cumulative rectal dose during treatment was a better predictor of late rectal toxicity than the planned dose. Conclusions: Significant changes in tumor and normal tissue anatomy and dosimetry can occur during PDR BT and should be tracked and corrected using serial imaging and plan adaptation, especially when the day 1 tumor or normal tissue doses are close to the planning constraints

  9. Radiobiological responses for two cell lines following continuous low dose-rate (CLDR) and pulsed dose rate (PDR) brachytherapy

    The iso-effective irradiation of continuous low-dose-rate (CLDR) irradiation was compared with that of various schedules of pulsed dose rate (PDR) irradiation for cells of two established human lines, T-47D and NHIK 3025. Complete single-dose response curves were obtained for determination of parameters α and β by fitting of the linear quadratic formula. Sublethal damage repair constants μ and T1/2 were determined by split-dose recovery experiments. On basis of the acquired parameters of each cell type the relative effectiveness of the two regimens of irradiation (CLDR and PDR) was calculated by use of Fowler's radiobiological model for iso-effect irradiation for repeated fractions of dose delivered at medium dose rates. For both cell types the predicted and observed relative effectiveness was compared at low and high iso-effect levels. The results indicate that the effect of PDR irradiation predicted by Fowler's model is equal to that of CLDR irradiation for both small and large doses with T-47D cells. With NHIK 3025 cells PDR irradiation induces a larger effect than predicted by the model for small doses, while it induces the predicted effect for high doses. The underlying cause of this difference is unclear, but cell-cycle parameters, like G2-accumulation is tested and found to be the same for the two cell lines

  10. Development of late toxicity and International Prostate Symptom Score resolution after external-beam radiotherapy combined with pulsed dose rate brachytherapy for prostate cancer

    B.R. Pieters; E. Rezaie; E.D. Geijsen; K. Koedooder; J.N.B. van der Grient; L.E.C.M. Blank; T.M. de Reijke; C.C.E. Koning

    2011-01-01

    To investigate the development of gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, erectile dysfunction, and International Prostate Symptom Score (IPSS) resolution in a cohort of patients treated with external-beam radiotherapy (EBRT) followed by a brachytherapy pulsed dose rate (PDR) bo

  11. Reirradiation for recurrent head and neck cancer with salvage interstitial pulsed-dose-rate brachytherapy. Long-term results

    Strnad, Vratislav; Lotter, Michael; Kreppner, Stephan; Fietkau, Rainer [University Hospital Erlangen, Dept. of Radiation Oncology, Erlangen (Germany)

    2015-01-10

    To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy as reirradiation combined with simultaneous chemotherapy and interstitial hyperthermia in selected patients with recurrent head and neck tumors. A total of 104 patients with biopsy-proven recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Salvage surgery had also been undergone by 53/104 (51 %) patients (R1 or R2 resection in > 80 % of patients). Salvage brachytherapy alone was administered in 81 patients (78 %), with a median total dose of 56.7 Gy. Salvage brachytherapy in combination with external beam radiotherapy (EBRT) was performed in 23/104 patients (32 %), using a median total dose of D{sub REF} = 24 Gy. Simultaneously to PDR brachytherapy, concomitant chemotherapy was administered in 58/104 (55.8 %) patients. A single session of interstitial hyperthermia was also used to treat 33/104 (31.7 %) patients. The analysis was performed after a median follow-up of 60 months. Calculated according to Kaplan-Meier, local tumor control rates after 2, 5, and 10 years were 92.5, 82.4, and 58.9 %, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 10-year local control rates were 76 vs. 39 % (p= 0014), respectively. No other patient- or treatment-related parameters had a significant influence on treatment results. Soft tissue necrosis or bone necrosis developed in 18/104 (17.3 %) and 11/104 (9.6 %) patients, respectively, but only 3 % of patients required surgical treatment. PDR interstitial brachytherapy with simultaneous chemotherapy is a very effective and, in experienced hands, also a safe treatment modality in selected patients with head and neck cancer in previously irradiated areas. (orig.) [German] Es erfolgte die Analyse der Langzeitergebnisse einer protokollbasierten interstitiellen Brachytherapie (Re-Bestrahlung) mit simultaner Chemotherapie und interstitieller Hyperthermie

  12. Reirradiation for recurrent head and neck cancer with salvage interstitial pulsed-dose-rate brachytherapy. Long-term results

    To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy as reirradiation combined with simultaneous chemotherapy and interstitial hyperthermia in selected patients with recurrent head and neck tumors. A total of 104 patients with biopsy-proven recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Salvage surgery had also been undergone by 53/104 (51 %) patients (R1 or R2 resection in > 80 % of patients). Salvage brachytherapy alone was administered in 81 patients (78 %), with a median total dose of 56.7 Gy. Salvage brachytherapy in combination with external beam radiotherapy (EBRT) was performed in 23/104 patients (32 %), using a median total dose of DREF = 24 Gy. Simultaneously to PDR brachytherapy, concomitant chemotherapy was administered in 58/104 (55.8 %) patients. A single session of interstitial hyperthermia was also used to treat 33/104 (31.7 %) patients. The analysis was performed after a median follow-up of 60 months. Calculated according to Kaplan-Meier, local tumor control rates after 2, 5, and 10 years were 92.5, 82.4, and 58.9 %, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 10-year local control rates were 76 vs. 39 % (p= 0014), respectively. No other patient- or treatment-related parameters had a significant influence on treatment results. Soft tissue necrosis or bone necrosis developed in 18/104 (17.3 %) and 11/104 (9.6 %) patients, respectively, but only 3 % of patients required surgical treatment. PDR interstitial brachytherapy with simultaneous chemotherapy is a very effective and, in experienced hands, also a safe treatment modality in selected patients with head and neck cancer in previously irradiated areas. (orig.)

  13. ENT interstitial pulse dose rate curietherapy: using dose-volume histograms; Curietherapie interstitielle de debit pulse ORL: utilisation des histogrammes dose-volume

    Le Bourhis, J.; Moreira, J.F.; Chassin, V.; Donnarieix, D.; Lapeyre, M. [Centre jean-Perrin, Clermont-Ferrand (France)

    2011-10-15

    The authors report a study which aimed at analysing dosimetric results on different dose-volume histograms obtained during a three-dimensional pulse dose rate curie-therapy. Six patients have been treated by post-operative curie-therapy of a tongue cancer. Using dose-volume histograms allows the dose delivered to organs at risk and to the target volume to be controlled. Short communication

  14. Impact of treatment time and dose escalation on local control in locally advanced cervical cancer treated by chemoradiation and image-guided pulsed-dose rate adaptive brachytherapy

    Purpose: To report the prognostic factors for local control in patients treated for locally advanced cervical cancer with image guided pulsed-dose rate brachytherapy. Materials/methods: Patients treated with curative intent by a combination of external beam radiotherapy and pulsed-dose rate brachytherapy were selected. Local failure was defined as any relapse in the cervix, vagina, parametria, or uterus during follow-up. Prognostic factors were selected based on log rank tests and then analyzed with a Cox model. Dose/effect correlations were performed using the probit model. Results: Two hundred and twenty-five patients treated from 2006 to 2011 were included. According to the FIGO classification, 29% were stage IB, 58% stage II, 10% stage III, and 3% stage IVA; 95% received concomitant chemotherapy. Thirty patients were considered having incomplete response or local failure. Among the selected parameters, D90 for HR-CTV, D90 for IR-CTV, the overall treatment time, the TRAK, and the HR-CTV volume appeared significantly correlated with local control in univariate analysis. In multivariate analysis, overall treatment time >55 days and HR-CTV volume >30 cm3 appeared as independent. The probit analysis showed significant correlations between the D90 for both CTVs, and the probability of achieving local control (p = 0.008 and 0.024). The thresholds to reach to warrant a probability of 90% of local control were 85 Gy to the D90 of the HR-CTV and 75 Gy to 90% of the IR-CTV (in 2 Gy equivalent, α/β = 10). To warrant the same local control rate, the D90 HR-CTV should be significantly increased in stage III–IV tumors, in case of HR-CTV >30 cm3, excessive treatment time, or tumor width at diagnosis >5 cm (97, 92, 105, and 92 Gy respectively). Conclusions: Overall treatment time and HR-CTV volume were independent prognostic factors for local control. The D90 for HR and IR CTV were significantly correlated with local control, and D90 HR-CTV should be adapted to clinical

  15. Intracavitary therapy of craniopharyngiomas

    Craniopharyngiomas are benign cystic para-hypophyseal tumors often associated with hypopituitarism and visual-field abnormalities. Their therapy by surgery and external beam radiotherapy is imperfect. The intracavitary instillation of beta-emitting colloid radiopharmaceuticals into the cysts permits the delivery of far higher radiation doses to the cyst lining than is possible by external beam radiotherapy. This technique permits destruction of the lining epithelium with resultant elimination of cyst fluid formation and cyst shrinkage in up to 80% of cases

  16. 5-Year results of pulsed dose rate brachytherapy applied as a boost after breast-conserving therapy in patients at high risk for local recurrence from breast cancer

    Purpose: The aim of this study was to evaluate effect, toxicity, and cosmesis of a prospectively applied pulsed dose rate (PDR) brachytherapy boost schedule in patients with stage I/II/IIIa invasive breast cancer. Patients and Methods: A total of 113 patients were treated after breast-conserving surgery (BCS) and external beam radiotherapy (median 50 Gy, range 46-52). The boost dose was graded in accordance to the pathologic tumor characteristics: 20-25 Gy: incomplete resection (n=34), vascular invasion (n=27), close margin resection (n=41); 15 Gy: T2G3 stage (n=11). PDR brachytherapy (37 GBq, 192Ir source) was carried out after geometric volume optimization with 1 Gy/pulse/h. The implantation and dose specification were performed similar to the rules of the Paris system. Results: The overall local failure rate after a median follow-up of 61 months was 4.4% (5/113). The actuarial 5- and 8-year local recurrence-free survival rates were 95% and 93%, respectively. Cosmesis was rate by 90% of the patients as excellent or good. 14/113 patients experienced grade III (all caused by planar telangiectasia) and none of the patients grade IV late toxicity of the skin (RTOG/EORTC). A boost dose of 25 Gy resulted in a significantly higher rate of late toxicity (Fisher's exact test, p<0.01). Conclusions: PDR brachytherapy is safe, effective, and provides good cosmesis. A CLDR breast boost can be replaced by PDR brachytherapy without significant loss of therapeutic ratio. (orig.)

  17. Development of Late Toxicity and International Prostate Symptom Score Resolution After External-Beam Radiotherapy Combined With Pulsed Dose Rate Brachytherapy for Prostate Cancer

    Purpose: To investigate the development of gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, erectile dysfunction, and International Prostate Symptom Score (IPSS) resolution in a cohort of patients treated with external-beam radiotherapy (EBRT) followed by a brachytherapy pulsed dose rate (PDR) boost. Methods and Materials: Between 2002 and 2008, 110 patients were treated with 46-Gy EBRT followed by PDR brachytherapy (24.96-28.80 Gy). The investigated outcome variables, GI toxicity, GU toxicity, erectile dysfunction, and IPSS were prospectively scored at several time points during follow-up. Association between time (as continuous and categorical variable) and the outcome variables was assessed using generalized linear models. Results: No statistically significant association was found between time (continuous) and GI toxicity (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.89-1.06), GU toxicity (OR, 0.97; 95% CI, 0.91-1.03), erectile dysfunction (OR, 1.06; 95% CI, 0.99-1.11), and IPSS (-0.11; 95% CI, -0.41-0.20). Also, no statistically significant association was found between these variables and time as a categorical variable. GU toxicity was associated with IPSS resolution (OR, 1.16; 95% CI, 1.09-1.24). Posttreatment IPSS was associated with pretreatment IPSS (0.52; 95% CI, 0.25-0.79). Conclusions: No accumulation of high-grade toxicity over time could be established for a group of patients treated with EBRT and PDR brachytherapy for prostate cancer, probably because high-grade late toxicity resolves with time. Also, differences in IPSS values among patients are smaller after treatment than before treatment.

  18. Percutaneous intracavitary treatment of aspergillomas

    We have recently treated two patients having pulmonary aspergillomas and complaining recurrent hemoptysis by using a percutaneous intracavitary instillation of antifungal agent and mucolytics. These were a 49 year old and a 50 year old man in each and had aspergillomas in previous tuberculous cavities. The technique and the method, which are simple and effective, are described with the review of the literatures

  19. Metastatic right ventricular mass with intracavitary obliteration

    Kalvakuri, Kavitha; Banga, Sandeep; Upalakalin, Nalinee; Shaw, Crystal; Davila, Wilmer Fernando; Mungee, Sudhir

    2016-01-01

    Metastatic cardiac tumors are more common than the primary cardiac tumors. Cervical cancer metastasizing outside of the pelvis is commonly spread to the lungs, liver, bones and lymph nodes than to the heart. Right-sided metastasis to the heart is more common than to the left side. Intramural spread is more common than intracavitary growth of metastatic cardiac tumors leading to delayed clinical presentation. Intracavitary mass can be confused with intracavitary thrombus which can be seen in t...

  20. Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1-T2 breast cancer: First long time results from a clinical study

    Background and purpose: To evaluate the long time outcome with regard to local tumour control, cosmetic outcome and side effects of a short (5 days) accelerated interstitial brachytherapy treatment delivered to the surroundings of the operated sector. Patients and methods: Between 1993 and 2003 we treated 50 women with early T1 and T2 breast cancer. Radical sector resection was performed and followed later with an interstitial pulsed dose rate (PDR) brachytherapy of 50 Gy in 5 days. The treatment was centred on the tumour with a margin of 30 mm. One patient was treated bilaterally. The patients were followed for a median of 86 (32-126) months. Results: Ipsilateral breast cancer recurrence was seen in 3 patients (6%). Two of them occurred outside the treated volume. The 5- and 7-year rates of actuarial local control were 96% and 96%, respectively, overall survival 88% and 85%, disease free survival 88% and 88%, respectively. A dosimetrical analysis showed that the partial breast irradiation covered a median of 31% of the total breast volume. Fat necrosis was seen in 12% and local (moderate-strong) fibrosis in 26% of the patients. Independent cosmetic scoring showed good or excellent result in 56% of the patients. Conclusions: Local outcome is favourable and very similar to other published studies of accelerated partial breast irradiation. Our long time cosmetic results are lower than other published results

  1. Feasibility study of a dose increase by a boost of curietherapy in pulse dose rate associated with external radiotherapy in a medium-risk prostate cancer; Evaluation de la faisabilite d'une escalade de dose par un boost de curietherapie de debit pulse associe a la radiotherapie externe dans le cancer de la prostate de risque intermediaire

    Courtecuisse, A.C.; Loiseau, C.; Silva, M.; Lerouge, D.; Barraux, V.; Iesaunier, F. [Centre Francois-Baclesse, 14 - Caen (France)

    2010-10-15

    As a dose increase beyond 70 Gy has demonstrated a benefit in terms of local control for medium-risk prostate cancer, an optimal method of dose escalation is however unknown. The authors report a feasibility study of a boost of curietherapy in pulse dose rate associated with an external radiotherapy. Curietherapy is performed by implantation of ten to twelve parallel needles under echography. The final dosimetry is performed after a scanography merged with the pre-implantation prostatic MRI. Only two patients have been treated, but the boost of curietherapy allows breaking free from organ movements and a more important dose escalation in relationship with the dose gradient. Short communication

  2. CT based HDR brachytherapy for intracavitary applications

    Brachytherapy is most commonly used in combination with external radiotherapy for gynecological cancers of cervix, vagina and endometrium. The characteristic rapid fall off of the dose in brachytherapy makes it useful to deliver a localized high dose to tumor. In gynecological applications the dose limiting critical structures are bladder and rectum. The dose received by rectum and bladder has been an interesting issue all these decades. This work presents the dosimetric and planning aspects of CT based High Dose Rate brachytherapy for intracavitary applications

  3. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  4. 3D MRI-based predictive control of a ferromagnetic microrobot navigating in blood vessels

    Belharet, Karim; Folio, David; Ferreira, Antoine

    2010-01-01

    This paper presents an endovascular navigation of a ferromagneticmicrodevice using a MRI-based predictive control. The concept wasstudied for future development of microrobot designed to performminimally invasive interventions in remote sites accessible throughthe human cardiovascular system. A system software architecture ispresented illustrating the different software modules to allow 3Dnavigation of a microdevice in blood vessels, namely: (i) vesselpath extraction, (ii) magnetic gradient s...

  5. Biological effect of Pulsed Dose Rate brachytherapy with stepping sources

    Purpose: To explore the possible increase of radiation effect in tissues irradiated by pulsed brachytherapy (PDR), for local tissue dose-rates between those 'averaged over the whole pulse' and the instantaneous high dose rates close to the dwell positions. An earlier publication (Fowler and Mount 1992) had shown that, for dose rates (averaged for the duration of the pulse) up to 3 Gy/h, little change of isoeffect doses from continuous low dose rate (CLDR) are expected, unless larger doses per fraction than 1 Gy are used, and especially if components of very rapid repair are present with half-times of less than about 0.5 hours. However, local and transient dose rates close to stepping sources can be up to several Gy per minute. Methods: Calculations were done assuming the linear quadratic formula for radiation damage, in which only the dose-squared term is subject to repair, at a constant exponential rate. The formula developed by Dale for fractionated low-dose-rate radiotherapy was used. A constant overall time of 140 hours and constant total dose of 70 Gy were assumed throughout, the continuous low dose-rate of 0.5 Gy/h (CLDR) providing the unitary standard effects for each PDR condition. Effects of dose-rates ranging from 4 Gy/h to 120 Gy/h (HDR at 2 Gy/min) were studied, and T (1(2)) from 4 minutes to 1.5 hours. Results: Curves are presented relating the ratio of increased biological effect (proportional to log cell kill) calculated for PDR relative to CLDR. Ratios as high as 1.5 can be found for large doses per pulse (> 1 Gy) at high instantaneous dose-rates if T (1(2)) in tissues is as short as a few minutes. The major influences on effect are dose per pulse, half-time of repair in the tissue, and - when T (1(2)) is short - the instantaneous dose-rate. Maximum ratios of PDR/CLDR effect occur when the dose-rate is such that pulse duration is approximately equal to T (1(2)) of repair. Results are presented for late-responding tissues, the differences from CLDR being 2 or 3 times smaller for early-responding tissues and most tumors. Conclusions: Restricting the dose per pulse to 0.5 or 0.6 Gy should avoid ratios of increased effect larger than about 1.1, which is a 10 % increase in log cell kill compared with CLDR, probably clinically detectable. Ratios increase rapidly as instantaneous dose rate is increased, tending towards a plateau at dose-rates above about 20 Gy/h, with which a substantial proportion of the dose in PDR is given. Therefore PDR delivered by stepping source might behave more like HDR than LDR, especially for tissues with a substantial component of repair of very short half time. That is why using small doses per pulse is important

  6. Syndromes Of Intracavitary And Intraorgan Hypertension In Surgical Practice

    V Timerbulatov

    2012-10-01

    Full Text Available Background: Pathological conditions caused by intraorgan and intracavitary hypertension have shown to be common in medical practice. Syndromes of intraabdominal, intracranial hypertension in limb fracture cases are most thoroughly studied and best characterized. Nevertheless, the significance of the above syndromes to the entire body has not been efficiently defined.Methods: The implication of excessive pressure has been studied by direct and indirect measuring of pressure inside organs and body cavities in cases of brain injury, lung disease, and various conditions of abdominal cavity organs, including severe abdominal pathologies and traumas, injuries to the limbs.Results: Interorgan, intracavitary and intertissular hypertension syndromes were found to be characterised by polyetiologic nature, similar pathogenesis mechanisms and accompanied by organ dysfunction or multiorgan insufficiency, based on examination data obtained from 1955 patients, including 70 craniocerebral injury patients, 296 severe abdominal pathology patients, 316 pulmonary pathology patients, 336 Mallory-Weiss syndrome patients, 524 complicated diverticular colon disease patients, 213 acute intestinal obstruction patients, 200 severe shin-bone fracture patients.Conclusion: Interorgan, intracavitary and intertissular hypertension syndromes can be defined as a uniform (model  pathological process caused by traumatic, infectious, metabolic, vascular factors and conditioned by a disparity between the contents volume and the volume-capacity of the organ cavity, increased pressure inside of them (>10mm Hg and a pronounces disturbance in interorgan and intertissular perfusion. The authors consider intracavitary, interorgan and intertissular pressure of ≤10 mm Hg to be accepted as the constant value for a human body.

  7. Afterloading intracavitary irradiation and expanding stent for malignant biliary obstruction

    A double lumen catheter was developed as an apllicator for the remote afterloading (RALS) of 60Co source for the intracavitary irradiation of an obstructed common bile duct caused by carcinoma of the gallbladder. This was followed by the placement of nylon-covered expandable metallic stents to maintain patency. This combination effectively provided palliation. (author)

  8. Dosimetric provision of intracavitary radiotherapy pf gynecological cancer

    An economic method of dosimetric provision of intracavitary exposure of oncogynecological patients has been developed making use of KRDV-1 equipment designed for the treatment by simple afterloading (two-staged administration of endostats and low-active gamma-sources in succession). The gist of the method consists in obtaining dosimetric information provided in great amounts by a computer including all possible variants of radioactive agents localization in endostats represented in the form of tables and curves. Compact tables and curves help the physician radiologist solve the problem of dosimetric validation of an exposure session without resorting to traditional atlases of dose distribution

  9. Radiotherapy for cancer of the maxillary sinus, with boost therapy by low dose rate intracavitary irradiation

    Prognosis of cancer of the maxillary sinus markedly depends on its local control. In order to increase the local control rate for cancer of the maxillary sinus, low dose rate intracavitary irradiation of the maxillary sinus was performed as boost therapy of external irradiation. During the period from January 1975 through September 1982, 87 patients with cancer of the maxillary sinus were treated by radiotherapy at the Department of Radiology, The Jikei University School of Medicine, and 43 out of these 87 cases were treated with intracavitary irradiation as boost therapy of external irradiation. The 3-year and 5-year cumulative survival rates of the 43 cases treated with intracavitary irradiation were 44% and 39%, respectively. The same two rates of the 44 cases without intracavitary irradiation were both 47%. Considering that tumor foci still persisted in the maxillary sinus in almost all of the 43 intracavitary irradiation cases and that 34 of them were of the postero-superior type (according to Oehngren's classification), which generally results in poor prognosis, intracavitary irradiation as boost therapy can be assumed to be one of the effective therapeutic techniques for cancer of the maxillary sinus. (author)

  10. Geometrical considerations in dose volume analysis in intracavitary treatment

    Deshpande, D.D. [Dept. of Medical Physics, Tata Memorial Hospital, Bombay (India); Shrivastava, S.K. [Dept. of Radiation Oncology, Tata Memorial Hospital, Bombay (India); Pradhan, A.S. [Bhabha Atomic Research Centre, Bombay (India); Viswanathan, P.S. [Dept. of Medical Physics, Tata Memorial Hospital, Bombay (India); Dinshaw, K.A. [Dept. of Radiation Oncology, Tata Memorial Hospital, Bombay (India)

    1996-06-01

    The present work was aimed at to study the relationship between the volume enclosed by reference iodose surface and various geometrical parameters of the intracavitary applicator in treatment of carcinoma of cervix. Pearshape volume of the reference isodose derived from the Total Reference Air Kerma (TRAK) and the product of its dimensions, height H, width W and thickness T which is dependent on the applicator geometry, were estimated for 100 intracavitary applications treated by Selectron LDR machine. Orthogonal radiographs taken for each patient were used for measurement of actual geometric dimensions of the applicator and carrying out the dosimetry on TP-11 treatment planning system. The dimensions H, W and T of reference isodose surface (60 Gy) were also noted. Ratio of the product HWT and the pearshape volume was found mainly to be a function of colpostat separation and not of other geometrical parameters like maximum vertical and anterio-posterior dimension of the applicator. The ratio remained almost constant for a particular combination of uterine tandem and colpostat. Variation in the ratios were attributed to the non-standard geometry. The ratio of the volume of reference isodose surface to the product of its dimensions in the applicator depends upon the colpostat separation. (orig./MG) [Deutsch] Die vorliegende Arbeit hatte zum Ziel, die Beziehung zwischen dem von der Referenzisodose umhuellten Volumen und verschiedenen geometrischen Parametern bei der intrakavitaeren Applikation in der Behandlung des Zervixkarzinoms zu untersuchen. Ein birnenfoermiges Volumen, welches von der Referenzisodose umhuellt und von der Total Refernce Air Kerma (TRAK) und dem Produkt der aus der Applikatorgeometrie ableitbaren Dimensionen Hoehe, Breite und Dicke (H, W, T) bestimmt wurde, wurde bei 100 Applikationen (Selectron LDR) abgeschaetzt. Zur Messung der geometrischen Anordnung des Applikators wurden orthogonale Roentgenbilder, die bei jedem Patienten angefertigt wurden

  11. Intracavitary mould brachytherapy in malignant tumors of the maxilla

    Purpose: To integrate brachytherapy in the combined modality management of malignant tumors of the maxilla, as a means of increasing the radiotherapy dose to the tumor bed while avoiding high doses to the orbital contents. Materials and methods: Following a partial or total maxillectomy, a duplication of the interim surgical obturator was created using a wash of vinyl polysiloxane. This mould was used as a carrier for afterloading nylon catheters through which 192-Iridium seed-ribbons were inserted. Following brachytherapy, selected patients also received external beam irradiation. Results and discussion: After a median follow-up of 36 months, 9 out of 11 patients are alive and disease-free; 1 developed a local recurrence and another relapsed at another site in the oral cavity. Transient grade 1 - 2 mucositis at the implant site was observed in all patients. The review of computer isodose distributions showed that the average dose received by the homolateral eyeball was 10% (range 9,2 - 10.0) of the prescribed surface dose to the surgical cavity. Conclusions: Brachytherapy can be integrated in the management of patients with malignant tumors of the maxilla in the form of a custom-made intracavitary mould carrying 192-Iridium sources. We found this technique particularly useful in cases with close or positive surgical margins

  12. Holmium-166-chico intracavitary radiation therapy for cystic brain tumors

    Holmium-166-chitosan complex (Ho-166-chico) is injected into the unresectable seven cystic brain tumors (2 cases of metastatic brain tumors from lung cancer, 1 case of recurrent trigeminal neurinoma, 3 cases of recurrent low grade cystic astrocytomas, and 1 case of craniopharyngioma). The Ommaya reservoir was installed stereotactically. The cyst volume and wall thickness were measured by MRI before Ho-166-chico injection. The thickness of the cyst wall is up to 4 mm. Ho-166-chico (555-740 MBq) injected into the cyst to result in 25 Gy of dose to a cyst wall at a depth of 4 mm. Dose to the cyst wall was estimated by Monte Carlo simulation using the EGS4 code. All Ho-166-chico injected was assumed to be uniformly distributed in the spherical cyst. After Ho-166-chico injection, the distribution of isotopes was monitored by gamma camera. Two injections were administrated in two cases, and one injection in all the others. The response was evaluated with MRI. Four of 7 cases were shrunk in size with thinning of the cyst wall, 2 of 7 cases showed growth arrest, and one case showed progression. Estimated surface dose of cyst wall was between 78 and 2566 Gy. No one showed systemic absorption of Ho-166-chico, and specific complication associated with isotope injection. Ho-166-chico intracavitary radiation therapy for cystic brain tumor may be safe, and reliable method and deserves further evaluation

  13. Value and importance of intracavitary therapy in uterine cervix carcinoma

    The guiding topic of this report was 'the value and importance of intracavitary therapy in uterine cervix carcinoma'. This implies first of all the task to assess the importance of contact therapy within the scope of all therapeutic measures taken in case of uterine cervix carcinoma. Furthermore it was necessary to compare the importance of the different methods of contact therapy: conventional radium therapy as well as low dose rate and high dose rate afterloading techniques. As to surgical intervention, it is clear that only favorable stages can be taken into consideration for this treatment. It is shown by means of data taken from the Annual Report, Vol. 18, that a considerable number of patients with uterine cervix carcinoma I are irradiated even in hospitals whose field of activity lies preponderantly in surgery, and that by far most of the patients cured from uterine cervix cancer owe their recovery to contact therapy. The consideration of contact therapy methods show clearly that radium should no longer be used in clinical practice. Psychological doubts often hinder the decision if long-term or short-term afterloading therapy is to be applied. It is therefore shown that the very different forms of radium therapy with their chronological and spatial dose distribution were due to the characteristics of radium (e.g. little specific activity) or to other compelling features and that they were not based on radiobiological aspects. The radium dose values obtained by empirical research and the resulting spatial and chronological dose distribution are therefore not imperative. So it is not inevitable to choose the low dose rate afterloading method. On the contrary, the high dose rate technique with an adequate fractionation is very probably the method of choice. To sum up it can be said that contact therapy is still the most important therapeutic method in uterine cervix cancer. (orig.)

  14. Medium-dose-rate intracavitary brachytherapy for cervical cancer

    The purpose of this study was to evaluate the results of medium-dose-rate (MDR) intracavitary brachytherapy (ICRT) for cervical cancer. Between May 1991 and March 2001, 80 patients with cervical cancer were treated with external radiotherapy combined with MDR-ICRT. Two patients were excluded from this study. The median age of patients was 61 years (range: 30-87 years). Seventy-five patients had pathologically proved squamous cell carcinoma, and 3 had adenocarcinoma. The patients were staged by Union Internationale Contre le Cancer (UICC) classification as follows: Stage IA (2), Stage IB (4), Stage IIA (5), Stage IIB (22), Stage IIIA (1), Stage IIIB (32), Stage IVA (5), Stage IVB (7). Median follow-up for survivor was 68 months (range: 12-131 months). The radiation therapy was based on a combination of ICRT and external pelvic irradiation. Patients with stages II, III and IVA were treated with whole-pelvic irradiation with respective total doses of 20, 30, and 40 Gy. Doses of 40, 30, 20, and 20 Gy parametrial irradiation were added with central shield pelvic irradiation for stages IB, II, III and IVA lesions respectively. For MDR-ICRT, from May 1991 to December 1995, point A dose were 40 Gy/4 fractions for stages I and II, 38 Gy/4 fractions for stage III, and 28.5 Gy/3 fractions for stage IVA. And from January 1996 to March 2001, point A dose of 36 Gy/4 fractions for stages I and II, 34 Gy/4 fractions for stage III, and 25.5 Gy/3 fractions for stage IVA. The median dose rate at point A was 1.7 Gy/hour (range: 1.3-2.2 Gy/hour). The 5-year cause-specific survival rates were 100%, 76%, 51% and 40% for stages I, II, III and IVA respectively. All patients with stage IVB died from the tumor with a median survival time of 12 months. The 5-year pelvic control rates were 100%, 88%, 69% and 40% for stages I, II, III and IVA respectively. Major late complications occurred in 2 patients (3%). One patient developed vesico- and recto-vaginal fistulae, and died of pelvic infection

  15. A phantom for measuring the isodose distribution in intracavitary radiotherapy of cervical carcinoma

    A nonuniform tissue equivalent anthropomorphic phantom of female hip, which was intended for measuring the isodose distributions in intracavitary radio therapy of cervical carcinoma, was developed. It was made of bone and muscle equivalent materials. CT number of normal organs and tissues in pelvis cavity and lower abdomen of the female were measured with CT scanner and compared with those values obtained from home-made phantom under same scan conditions. The electron density effective atomic number, mass density and CT number of equivalent muscle were as essentially same as real muscle. The clinical application of this phantom showed that its construction is reasonable, convenient in use and suitable for measuring isodose distributions for different programs of intracavitary radio therapy of cervical carcinoma

  16. Radiological safety problems in intracavitary brachytherapy using the manual afterloading in Venezuela

    In three venezuelan public hospitals it was detected radioactive contamination for Cs-137 during inspection with the wipe test technique in areas where is applied intracavitary brachytherapy using manual afterloading. This caused a condition of great stress in the personal engaged the treatments. In each Cs-137 source in these hospitals was tested leakage. The source plastic holder was analysed. The authors were able to demonstrate: a) The radioactive contamination found in the treatment area had its origin in the Cs-137 capsule corrosion and b) The corrosion in the source capsule was produced by the radiolytic degradation of the PVC tube used as source-holder in the intracavitary treatments. (authors). 3 refs., 1 tab

  17. Dosimetry of intracavitary applications in carcinoma of the cervix: rectal dose analysis

    The International Commission on Radiation Units and Measurements (ICRU), in its Report-38, has given certain recommendations regarding the specifications of bladder and rectal reference points in the intracavitary treatment of carcinoma of the cervix. Conforming to this report, 182 intracavitary applications performed in stage I and II cervix cases were analyzed. In 113 applications, the maximum rectal dose was found to be in a point on the anteroposterior line drawn through the centre of colpostat sources. However, for our type of applications, the point on the anteroposterior line drawn through the lower end of the uterine tube seldom gets maximum dose. In addition, it was observed that there are other dose points than the ICRU reference point receiving doses close to maximum dose. It was concluded that doses to multiple rectal reference points should be recorded, in addition to the ICRU-defined rectal reference point

  18. Intracavitary Irradiation as a Safe Alternative for Cystic Craniopharyngiomas: Case Report and Review of the Literature

    Enriquez-Marulanda, Alejandro; Sierra-Ruiz, Melibea; Pabón, Luz Maritza; Lobato-Polo, Javier

    2016-01-01

    Craniopharyngioma treatment remains a challenge for clinicians and patients. There are many treatment alternatives; however one of them (intracavitary irradiation) seeks to control this type of benign brain tumor using minimally invasive techniques, with the specific aim of avoiding causing significant damage to important structures surrounding the sellar/suprasellar region. We present the case of a 3-year-old patient with a predominantly cystic craniopharyngioma who underwent intracavitary irradiation by stereotactic placement. Using this approach, the patient showed a successful response with remission of headaches and hydrocephalus. A reduction in the size of the cyst was achieved, without deterioration of visual fields, with no hormonal supplementation being needed, and with no evidence of focal neurological signs. PMID:27366151

  19. Pulsed dose rate (PDR) brachytherapy as salvage treatment of locally advanced or recurrent gynecologic cancer

    Jensen, P T; Roed, H; Engelholm, S A; Rosendal, F

    1998-01-01

    presents the first clinical results from The Finsen Center with PDR-brachytherapy in patients with locally advanced or recurrent gynecologic cancer. METHODS AND MATERIALS: Between June 1993 and August 1996, 34 patients with gynecologic malignancies (22 pelvic recurrences, 12 primary locally advanced) have...... recurrent gynecologic cancer, although substantial toxicity is observed in patients with large treatment volumes and recurrent disease....

  20. Intracavitary after loading techniques, advantages and disadvantages with high and low dose-rate methods

    Even though suggested as early as 1903, it is only when suitable sealed gamma sources became available, afterloading methods could be developed for interstitial as well as intracavitary work. Manual afterloading technique can be used only for low dose rate irradiation, while remote controlled afterloading technique can be used for both low and high dose-rate irradiation. Afterloading units used at the Karolinska Institute, Stockholm, are described, and experience of their use is narrated briefly. (M.G.B.)

  1. Treatment for resistant subphrenic abscess by combined intracavitary doxycycline and cyanoacrylate injection

    Hussein Okasha; Mohammed Mahmoud

    2013-01-01

    We report the case of a male patient with resistant subphrenic abscess complicating radiofrequency ablation (RFA) of two left lobe hepatocellular carcinoma (HCCs). The causative organism was multidrug resistant Escherichia coli. Percutaneous pigtail drainage together with IV antibiotics failed to resolve the abscess which persisted for 4 months. Intracavitary doxycycline injection causes moderate reduction in the volume of the drained fluid. This was followed by percutaneous cyanoacrylate inj...

  2. A case in optimization of intracavitary irradiation of maxillary sinus cancer

    In our hospital, intracavitary irradiation with the high dose-rate remotely controlled afterloading system is utilized to treat the local recurrence of maxillary sinus cancer after external irradiation. Now, we employ CT views and a unit of personal computer to reproduce applicators set up to the same point in patient at each time and to decide source positions and irradiation time and the results was improved. (author)

  3. Determination of exit skin dose for 192Ir intracavitary accelerated partial breast irradiation with thermoluminescent dosimeters

    Raffi, Julie A.; Stephen D. Davis; Hammer, Cliff G.; Micka, John A.; Kunugi, Keith A.; Musgrove, Jana E.; Winston, John W.; Ricci-Ott, Terresa J.; DeWerd, Larry A.

    2010-01-01

    Purpose: Intracavitary accelerated partial breast irradiation (APBI) has become a popular treatment for early stage breast cancer in recent years due to its shortened course of treatment and simplified treatment planning compared to traditional external beam breast conservation therapy. However, the exit dose to the skin is a major concern and can be a limiting factor for these treatments. Most treatment planning systems (TPSs) currently used for high dose-rate (HDR) 192Ir brachytherapy overe...

  4. Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children

    Although microsurgery remains the first-line treatment, gross total resection of cystic craniopharyngeomas (CP) is associated with significant morbidity and mortality and the addition of external irradiation to subtotal resection proves to achieve similar tumor control. However, concern regarding long-term morbidity associated with external irradiation in children still remains. With this retrospective analysis, the authors emphasize intracavitary brachytherapy using phosphorus-32 (P-32) as a treatment option for children with cystic CP. Between 1992 and 2009, 17 children (median age 15.4 years; range 7-18 years) with cystic CP underwent intracavitary brachytherapy using P-32. Eleven patients were treated for recurrent tumor cysts; 6 patients were treated primarily. MR imaging revealed solitary cysts in 7 patients; 10 patients had mixed solid-cystic lesions (median tumor volume 11.1 ml; range 0.5-78.9 ml). The median follow-up time was 61.9 months (range 16.9-196.6 months). Local cyst control could be achieved in 14 patients (82 %). Three patients showed progression of the treated cystic formation (in-field progression) after a median time of 8.3 months (range 5.3-10.3 months), which led to subsequent interventions. The development of new, defined cysts and progression of solid tumor parts (out-of-field progression) occurred in 5 patients and led to additional interventions in 4 cases. There was neither surgery-related permanent morbidity nor mortality in this study. The overall progression-free survival was 75, 63, and 52 % after 1, 3, and 5 years, respectively. Intracavitary brachytherapy using P-32 represents a safe and effective treatment option for children harboring cystic CP, even as primary treatment. However, P-32 does not clearly affect growth of solid tumor parts or the development of new cystic formations. (orig.)

  5. Packing effects on the intracavitary radiation therapy of the uterine cervix cancer

    Purpose of the radio-therapy is maximize the radiation dose to the tumor while minimizing the dose to the critical organ. Carcinoma of the uterine cervix treatment are external irradiation or an interstitial brachytherapy make use of isotope. Brachytherapy is a method of radiotherapy in advantage to achieve better local control with minimum radiation toxicity in comparison with external irradiation because radiation dose is distributed according to the inverse square low of gamma-ray emitted from the implanted sources. Authors make use of the patients data which 192Ir gives medical treatment intracavity. Intracavitary radiation of the uterine cervix cancer, critical organ take 20% below than exposure dose of A point in the ICRU report. None the less of the advice, Radiation proctitis and radiation cystitis are frequent and problematic early complications in patients treated with radiation for the uterine cervix cancer. In brachytherapy of uterine cervical cancer using a high dose rate remote afterloading system, it is of prime importance to deliver a accurate dose in each fractionated treatment by minimizing the difference between the pre-treatment planned and post-treatment calculated doses. Use of packing to reduce late complications intracavitary radiation of the uterine cervix cancer. Bladder and rectum changes exposure dose rate by radiotherapy make use of packing.

  6. Evaluation of Rectal Dose During High-Dose-Rate Intracavitary Brachytherapy for Cervical Carcinoma

    Sha, Rajib Lochan [Department of Radiation Physics, Indo-American Cancer Institute and Research Centre, Hyderabad (India); Department of Physics, Osmania University, Hyderabad (India); Reddy, Palreddy Yadagiri [Department of Physics, Osmania University, Hyderabad (India); Rao, Ramakrishna [Department of Radiation Physics, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad (India); Muralidhar, Kanaparthy R. [Department of Radiation Physics, Indo-American Cancer Institute and Research Centre, Hyderabad (India); Kudchadker, Rajat J., E-mail: rkudchad@mdanderson.org [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2011-01-01

    High-dose-rate intracavitary brachytherapy (HDR-ICBT) for carcinoma of the uterine cervix often results in high doses being delivered to surrounding organs at risk (OARs) such as the rectum and bladder. Therefore, it is important to accurately determine and closely monitor the dose delivered to these OARs. In this study, we measured the dose delivered to the rectum by intracavitary applications and compared this measured dose to the International Commission on Radiation Units and Measurements rectal reference point dose calculated by the treatment planning system (TPS). To measure the dose, we inserted a miniature (0.1 cm{sup 3}) ionization chamber into the rectum of 86 patients undergoing radiation therapy for cervical carcinoma. The response of the miniature chamber modified by 3 thin lead marker rings for identification purposes during imaging was also characterized. The difference between the TPS-calculated maximum dose and the measured dose was <5% in 52 patients, 5-10% in 26 patients, and 10-14% in 8 patients. The TPS-calculated maximum dose was typically higher than the measured dose. Our study indicates that it is possible to measure the rectal dose for cervical carcinoma patients undergoing HDR-ICBT. We also conclude that the dose delivered to the rectum can be reasonably predicted by the TPS-calculated dose.

  7. Mis-dose rate intracavitary therapy for cervical cancer with a Selectron

    Our early experience with Selectron MDR in treating cervical cancer patients at Osaka University Hospital is presented. From May 1991 through December 1992, a total of 22 patients (stage Ia, 1; stage Ib, 3; stage IIa, 1; stage IIb, 2; stage IIIb, 13 and stage IVa, 2) with previously untreated uterine cervical cancer and intact uterus were treated with mid-dose rate intracavitary therapy administered with a Selectron. A rigid applicator made of stainless steel for the Selectron was used for the treatment. The 137Cs source had an activity of 1.48 GBq as of reference time. Source loading corresponded to the Manchester System. Early tumor responses for all patients were complete. No acute radiation injury has been observed. There have been two local recurrences in stage IIIb patients. One of them developed para-aortic lymph node metastasis and died from distant metastasis. Another patient in stage IIIb had para-aortic and left supraclavicular lymph node metastasis and died from distant metastasis. Four patients developed rectal bleeding (grade 1, 3; grade 3, 1) . One of them had been treated for aplastic anemia with steroid. The cause of grade 3 rectal bleeding was considered to be technical failure in intracavitary application. The remaining two patients recovered without treatment. From our early experience, it is concluded that Selectron MDR can be used for cervical cancer patients as safely and effectively as our previously used high-dose rate machine. (author)

  8. Intracavitary γ-therapy in combined treatment of cervical cancer with different dose fractionation

    A cooperative study of comparative assessment of the efficacy of 3 dose fractionation regimes in intracavitary γ-therapy used in combined radiation therapy of cervical cancer is presented (5 Gy, 10 fractions, 2-3 times a week; 7 Gy, 7 fractions, once in 5 days; 10 Gy, 4 fractions, once a week). Over the period of 1979-1983 1193 patients were treated by uniform methods of intracavitary and distant irradiation. The groups were identical with relation to the number of patients, stage of disease, histological characterization and growth type. By the end of therapy the cure rate among 1183 patients was 90-3%. In 2-3 months the cure rate in the same group was 97.5%. Delayed regression was most noticeable in stages I and III. The 5-year survival rates in 3 groups were: for stage I - 95.3±2.6%; for stage II - 83.1±2.5%; for stage III - 73.3±4.7%. In stage I and II tumors the 5-year survival rates in different regiments were similar whereas in stage III better results were obtained with a fractional dose of 5 Gy. The frequency and degree of severity of late radiation complications of the rectum, bladder,vaginal mucous membrane grew with an increase in a fractional dose

  9. Intracavitary applicator in relation to complications of pelvic radiation: the Ernst system

    Case studies were reviewed for 100 consecutive patients with carcinoma of the cervix, Stages I to III, who were treated prior to 1968 at a large municipal hospital in New York City. Treatments consisted of orthovoltage therapy prior to or following intracavitary radium. A 250 kV x-ray unit delivered a 3000 rad tumor dose in 3 weeks through four oblique fields. Intracavitary radium delivered 6000 to 7200 mg hr using the Ernst applicator. The 9% incidence of fistulae was 4-fold higher than that found in subsequent years using 60Co teletherapy and the afterloading Fletcher-Suit applicator. A review of the dosimetry relating to the use of the Ernst applicator demonstrates inherent structural characteristics which lend themselves to such complications. Where less than an ideal application is possible, this rigid applicator compacts itself in accordion-like fashion, producing a so-called short-system. Coupled with a reduced source to applicator-surface distance, such applications result in unacceptable dose anisotropy and excessive radiation of critical structures where a predetermined dose is to be delivered to anatomic Point A. Information gleaned from this study can be extrapolated to other rigid unprotected short-surface distance intra-vaginal applicators that have proliferated in recent years

  10. Effect of chemical composition and density of the pelvic structure in intracavitary brachytherapy dosimetry

    High dose rate (HDR) and low dose rate (LDR) intracavitary brachytherapies dosimetry in clinical practice are typically performed by commercial treatment planning systems. However, these systems do not fully consider the heterogeneities present in the real structure of the patient. The aim of this work is to obtain isodose curves and surfaces around the usual array of sources used in LDR (137Cs) and HDR (192Ir) intracavitary brachytherapy by Monte Carlo simulation, considering the real anatomic structure, density and chemical composition of media and tissues from the female pelvic region. The structural information was obtained from computed tomography images in the DICOM format. A voxel phantom (VP) was developed to perform ionizing radiation transport, considering the gamma spectrum of 137Cs and 192Ir. The absorbed dose was computed within each voxel of 2x2x3 mm3. Four materials were considered in the VP-air, fat, muscle tissue and bone; however, one material per voxel was defined. Results show and quantify the effect of density and chemical composition of the medium on the absorbed dose distribution. According to them, the treatment planning systems underestimate the absorbed dose by 8% approximately for both radionuclides. In a heterogeneous medium, the absorbed dose distribution of 192Ir is more irregular than that of 137Cs but spatially better defined.

  11. Effect of chemical composition and density of the pelvic structure in intracavitary brachytherapy dosimetry

    Chavez-Aguilera, N. [Coordinacion de Investigacion y Estudios de Posgrado, Facultad de Medicina, Universidad Autonoma del Estado de Mexico, Paseo Tollocan s/n Esquina con Jesus Carranza, 50180 Toluca (Mexico); Departamento de Fisica Medica, Instituto Estatal de Cancerologia ' Dr. Arturo Beltran Ortega' , Acapulco, Guerrero (Mexico); Torres-Garcia, E., E-mail: etorresg@uaemex.m [Coordinacion de Investigacion y Estudios de Posgrado, Facultad de Medicina, Universidad Autonoma del Estado de Mexico, Paseo Tollocan s/n Esquina con Jesus Carranza, 50180 Toluca (Mexico); Mitsoura, E. [Coordinacion de Investigacion y Estudios de Posgrado, Facultad de Medicina, Universidad Autonoma del Estado de Mexico, Paseo Tollocan s/n Esquina con Jesus Carranza, 50180 Toluca (Mexico)

    2011-03-15

    High dose rate (HDR) and low dose rate (LDR) intracavitary brachytherapies dosimetry in clinical practice are typically performed by commercial treatment planning systems. However, these systems do not fully consider the heterogeneities present in the real structure of the patient. The aim of this work is to obtain isodose curves and surfaces around the usual array of sources used in LDR ({sup 137}Cs) and HDR ({sup 192}Ir) intracavitary brachytherapy by Monte Carlo simulation, considering the real anatomic structure, density and chemical composition of media and tissues from the female pelvic region. The structural information was obtained from computed tomography images in the DICOM format. A voxel phantom (VP) was developed to perform ionizing radiation transport, considering the gamma spectrum of {sup 137}Cs and {sup 192}Ir. The absorbed dose was computed within each voxel of 2x2x3 mm{sup 3}. Four materials were considered in the VP-air, fat, muscle tissue and bone; however, one material per voxel was defined. Results show and quantify the effect of density and chemical composition of the medium on the absorbed dose distribution. According to them, the treatment planning systems underestimate the absorbed dose by 8% approximately for both radionuclides. In a heterogeneous medium, the absorbed dose distribution of {sup 192}Ir is more irregular than that of {sup 137}Cs but spatially better defined.

  12. A new template for MRI-based intracavitary/interstitial gynecologic brachytherapy: design and clinical implementation

    Sancho, Jose Richart; Palacin, Antonio Otal; Calatayud, Jose Perez; Ortega, Manuel Santos

    2015-01-01

    Purpose To describe the potential clinical use of a new brachytherapy applicator for gynecological tumors, with special attention to locally advanced cervical carcinoma. This device allows the combination of intracavitary radiotherapy and MRI-compatible transperineal interstitial needles. The design of this template addresses the disadvantages of currently commercially available templates: the inability of the intracavitary component to reach deep into the cervix (MUPIT), and the MRI-incompatibility of these templates (MUPIT and Syed), which necessitates use of CT imaging for the dosimetry. Material and methods The newly developed Benidorm Template applicator allows titanium needles in a template with straight and angled holes to provide different angles of divergence to be used with currently existing MRI-compatible intrauterine tubes. It can provide total coverage of the craniocaudal and lateral extension of the tumor (intrautherus, parametrial, and paravaginal). This method is mainly indicated in advanced cervical carcinoma with bulky parametrial invasion (medial or distal), with bulky primary disease that responds poorly to external beam radiotherapy extensive paravaginal involvement (tumor thickness greater than 0.5 cm) extending to the middle or lower third of the vagina, or for disease that has invaded the bladder or rectum (stage IVA). Results Between April 2013 until December 2014, we treated 15 patients with locally advanced cervical carcinoma employing the Benidorm Template. The median dose at D90 for the CTV was 79.8 Gy (71.5-89.9 Gy), at D2cc for the bladder it was 77.6 Gy (69.8-90.8 Gy), and at D2cc for the rectum it was 71.9 Gy (58.3-83.7 Gy). Values expressed in EQD2, assuming α/β of 10 for CTV and 3 for OAR. Conclusions This new applicator allows the use of MRI-based dosimetry, thus providing the advantages of MRI volume definition. As such, it facilitates determination of complete intracavitary and interstitial CTV coverage and the sparing of

  13. Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

    Samia de Freitas Brandao; Tarcisio Passos Ribeiro de Campos

    2013-01-01

    Objective Comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and Methods Simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted int...

  14. High-dose-rate afterloading intracavitary irradiation and expandable metallic biliary endoprosthesis for malignant biliary obstruction

    A double lumen catheter was developed as an applicator for the remote afterloading system (RALS) of 60Co for the intracavitary irradiation of an obstructed common bile duct due to gallbladder cancer in 1 case and by cholangiocarcinoma in 7 cases. This was followed by the biliary endoprosthesis with expandable metallic stents to maintain patency. The mean survival period after treatment was not long (14 weeks). However, removal of the external drainage tube was possible in 7 of the 8 cases, and none of the 8 cases showed dislodgement or deformity of the stent, or obstruction of the bile duct in the stent-inserted area. This combination effectively provided palliation, and has considerable potential for malignant biliary obstruction. (author)

  15. Rectal complication after remote afterloading intracavitary therapy for carcinoma of the uterine cervix

    Teshima, T.; Chatani, M.; Hata, K.; Inoue, Ta.; Inoue, To.; Suzuki, T.

    1985-06-01

    From August 1978 through December 1980, 119 patients of previously untreated carcinoma of the uterine cervix were treated using RALS, remote afterloading high dose rate intracavitary therapy at our department. The data from 92 out of 119 patients were available for analysis of rectal complication. The incidence of major rectal complications was only 2% (2/92). Uni- and multivariate analyses were used based on the external criterion variable of rectal complication which included even minor injuries. By using these methods, it was clearly indicated that these factors such as TDF of rectum, Z-coordinate of weighted geometric center (WGC-Z), the dose of whole pelvic irradiation, history of chemotherapy and Treponema pallidum hemoagglutination test (TPHA) were important for occurrence of rectal complication. According to discriminant score, 71 out of 92 cases (77%) could be correctly discriminated.

  16. Rectal complication after remote afterloading intracavitary therapy for carcinoma of the uterine cervix

    From August 1978 through December 1980, 119 patients of previously untreated carcinoma of the uterine cervix were treated using RALS, remote afterloading high dose rate intracavitary therapy at our department. The data from 92 out of 119 patients were available for analysis of rectal complication. The incidence of major rectal complications was only 2% (2/92). Uni- and multivariate analyses were used based on the external criterion variable of rectal complication which included even minor injuries. By using these methods, it was clearly indicated that these factors such as TDF of rectum, Z-coordinate of weighted geometric center (WGC-Z), the dose of whole pelvic irradiation, history of chemotherapy and Treponema pallidum hemoagglutination test (TPHA) were important for occurrence of rectal complication. According to discriminant score, 71 out of 92 cases (77%) could be correctly discriminated. (orig.)

  17. A real-time applicator position monitoring system for gynecologic intracavitary brachytherapy

    Xia, Junyi, E-mail: junyi-xia@uiowa.edu; Waldron, Timothy; Kim, Yusung [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa 52242 (United States)

    2014-01-15

    Purpose: To develop a real-time applicator position monitoring system (RAPS) for intracavitary brachytherapy using an infrared camera and reflective markers. Methods: 3D image-guided brachytherapy requires high accuracy of applicator localization; however, applicator displacement can happen during patient transfer for imaging and treatment delivery. No continuous applicator position monitoring system is currently available. The RAPS system was developed for real-time applicator position monitoring without additional radiation dose to patients. It includes an infrared camera, reflective markers, an infrared illuminator, and image processing software. After reflective markers are firmly attached to the applicator and the patient body, applicator displacement can be measured by computing the relative change in distance between the markers. The reflective markers are magnetic resonance imaging (MRI) compatible, which is suitable for MRI-guided HDR brachytherapy paradigm. In our prototype, a Microsoft Kinect sensor with a resolution of 640 by 480 pixels is used as an infrared camera. A phantom study was carried out to compare RAPS' measurements with known displacements ranging from −15 to +15 mm. A reproducibility test was also conducted. Results: The RAPS can achieve 4 frames/s using a laptop with Intel{sup ®} Core™2 Duo processor. When the pixel size is 0.95 mm, the difference between RAPS' measurements and known shift values varied from 0 to 0.8 mm with the mean value of 0.1 mm and a standard deviation of 0.44 mm. The system reproducibility was within 0.6 mm after ten reposition trials. Conclusions: This work demonstrates the feasibility of a real-time infrared camera based gynecologic intracavitary brachytherapy applicator monitoring system. Less than 1 mm accuracy is achieved when using an off-the-shelf infrared camera.

  18. Dose distributions around cylindrical 241Am sources for a clinical intracavitary applicator

    Encapsulated, cylindrical sources containing 2, 5, and 8 Ci of 241Am have been designed and fabricated for intracavitary irradiation of uterine cancers. Exposure rates in air and dose rates in water around these sources have been measured using an ionization chamber and a lithium fluoride thermoluminescent dosimetry system. Dose rates in water at a distance of 2.5 cm from the source center along a direction transverse to the source axis were found to be 10.4, 24.3, and 23.3 cGy/h for the 2-, 5-, and 8-Ci sources, respectively, using an ionization chamber. Under the same conditions, the thermoluminescent dosimetry system yielded the values of 10.3, 23.1, and 22.3 cGy/h. It was observed that the ratio of dose-to-water and exposure in air is sensitive to the scattering geometry and source geometry in the case of 241Am photons. This ratio was found to increase substantially as conditions of full scattering were approached. A three-dimensional integration model was employed for the determination of dose distributions around these sources. Results of this dose computation model have been compared against the measured data and were found to be in good agreement with each other. Average deviations of calculated data from measured data were in the range of 0.2 to 0.5 cGy/h and larger deviations were observed in the paraxial region, where the effects of oblique filtration are more severe. Computed dose rate tables were employed as reference source data in a modified version of a commercial treatment planning system in order to develop a facility for clinical dosimetry of 241Am intracavitary applications

  19. A real-time applicator position monitoring system for gynecologic intracavitary brachytherapy

    Purpose: To develop a real-time applicator position monitoring system (RAPS) for intracavitary brachytherapy using an infrared camera and reflective markers. Methods: 3D image-guided brachytherapy requires high accuracy of applicator localization; however, applicator displacement can happen during patient transfer for imaging and treatment delivery. No continuous applicator position monitoring system is currently available. The RAPS system was developed for real-time applicator position monitoring without additional radiation dose to patients. It includes an infrared camera, reflective markers, an infrared illuminator, and image processing software. After reflective markers are firmly attached to the applicator and the patient body, applicator displacement can be measured by computing the relative change in distance between the markers. The reflective markers are magnetic resonance imaging (MRI) compatible, which is suitable for MRI-guided HDR brachytherapy paradigm. In our prototype, a Microsoft Kinect sensor with a resolution of 640 by 480 pixels is used as an infrared camera. A phantom study was carried out to compare RAPS' measurements with known displacements ranging from −15 to +15 mm. A reproducibility test was also conducted. Results: The RAPS can achieve 4 frames/s using a laptop with Intel® Core™2 Duo processor. When the pixel size is 0.95 mm, the difference between RAPS' measurements and known shift values varied from 0 to 0.8 mm with the mean value of 0.1 mm and a standard deviation of 0.44 mm. The system reproducibility was within 0.6 mm after ten reposition trials. Conclusions: This work demonstrates the feasibility of a real-time infrared camera based gynecologic intracavitary brachytherapy applicator monitoring system. Less than 1 mm accuracy is achieved when using an off-the-shelf infrared camera

  20. Accurate localization of intracavitary brachytherapy applicators from 3D CT imaging studies

    Purpose: To present an accurate method to identify the positions and orientations of intracavitary (ICT) brachytherapy applicators imaged in 3D CT scans, in support of Monte Carlo photon-transport simulations, enabling accurate dose modeling in the presence of applicator shielding and interapplicator attenuation. Materials and methods: The method consists of finding the transformation that maximizes the coincidence between the known 3D shapes of each applicator component (colpostats and tandem) with the volume defined by contours of the corresponding surface on each CT slice. We use this technique to localize Fletcher-Suit CT-compatible applicators for three cervix cancer patients using post-implant CT examinations (3 mm slice thickness and separation). Dose distributions in 1-to-1 registration with the underlying CT anatomy are derived from 3D Monte Carlo photon-transport simulations incorporating each applicator's internal geometry (source encapsulation, high-density shields, and applicator body) oriented in relation to the dose matrix according to the measured localization transformations. The precision and accuracy of our localization method are assessed using CT scans, in which the positions and orientations of dense rods and spheres (in a precision-machined phantom) were measured at various orientations relative to the gantry. Results: Using this method, we register 3D Monte Carlo dose calculations directly onto post insertion patient CT studies. Using CT studies of a precisely machined phantom, the absolute accuracy of the method was found to be ±0.2 mm in plane, and ±0.3 mm in the axial direction while its precision was ±0.2 mm in plane, and ±0.2 mm axially. Conclusion: We have developed a novel, and accurate technique to localize intracavitary brachytherapy applicators in 3D CT imaging studies, which supports 3D dose planning involving detailed 3D Monte Carlo dose calculations, modeling source positions, shielding and interapplicator shielding

  1. Malignant obstructive jaundice: treatment with external-beam and intracavitary radiotherapy

    Eleven patients with obstructive jaundice from unresectable cholangiocarcinoma, metastatic porta hepatis adenopathy, or direct compression from a pancreatic malignancy were treated at the Stanford University Medical Center from 1978-1983 with an external drainage procedure followed by high-dose external-beam radiotherapy and by an intracavitary boost to the site of obstruction with Iridium192 (Ir192). A median dose of 5000 cGy was delivered with 4-6 Mv photons to the tumor bed and regional lymphatics in 9 patients, 1 patient received 2100 cGy to the liver in accelerated fractions because of extensive intrahepatic disease, and 1 patient received 7000 equivalent cGy to his pancreatic tumor bed and regional lymphatics with neon heavy particles. An Ir192 wire source later delivered a 3100-10,647 cGy boost to the site of biliary obstruction in each patient, for a mean combined dose of 10,202 cGy to a point 5 mm from the line source. Few acute complications were noted, but 3/11 patients (27%) subsequently developed upper gastrointestinal bleeding from duodenitis or frank duodenal ulceration 4 weeks, 4 months, and 7.5 months following treatment. Eight patients died - 5 with local recurrence +/- distant metastasis, 2 with sepsis, and 1 with widespread systemic metastasis. Autopsies revealed no evidence of biliary tree obstruction in 3/3 patients. Evolution of radiation treatment technqiues for biliary obstruction in the literature is reviewed. High-dose external-beam therapy followed by high-dose Ir192 intracavitary boost is well tolerated and provides significant palliation

  2. Malignant obstructive jaundice: treatment with external-beam and intracavitary radiotherapy

    Johnson, D.W.; Safai, C.; Goffinet, D.R.

    1985-02-01

    Eleven patients with obstructive jaundice from unresectable cholangiocarcinoma, metastatic porta hepatis adenopathy, or direct compression from a pancreatic malignancy were treated at the Stanford University Medical Center from 1978-1983 with an external drainage procedure followed by high-dose external-beam radiotherapy and by an intracavitary boost to the site of obstruction with Iridium/sup 192/ (Ir/sup 192/). A median dose of 5000 cGy was delivered with 4-6 Mv photons to the tumor bed and regional lymphatics in 9 patients, 1 patient received 2100 cGy to the liver in accelerated fractions because of extensive intrahepatic disease, and 1 patient received 7000 equivalent cGy to his pancreatic tumor bed and regional lymphatics with neon heavy particles. An Ir/sup 192/ wire source later delivered a 3100-10,647 cGy boost to the site of biliary obstruction in each patient, for a mean combined dose of 10,202 cGy to a point 5 mm from the line source. Few acute complications were noted, but 3/11 patients (27%) subsequently developed upper gastrointestinal bleeding from duodenitis or frank duodenal ulceration 4 weeks, 4 months, and 7.5 months following treatment. Eight patients died - 5 with local recurrence +/- distant metastasis, 2 with sepsis, and 1 with widespread systemic metastasis. Autopsies revealed no evidence of biliary tree obstruction in 3/3 patients. Evolution of radiation treatment technqiues for biliary obstruction in the literature is reviewed. High-dose external-beam therapy followed by high-dose Ir/sup 192/ intracavitary boost is well tolerated and provides significant palliation.

  3. Treatment Outcome of Medium-Dose-Rate Intracavitary Brachytherapy for Carcinoma of the Uterine Cervix: Comparison With Low-Dose-Rate Intracavitary Brachytherapy

    Kaneyasu, Yuko, E-mail: kaneyasu@hiroshima-u.ac.jp [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Kita, Midori [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Department of Clinical Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo (Japan); Okawa, Tomohiko [Evaluation and Promotion Center, Utsunomiya Memorial Hospital, Tochigi (Japan); Maebayashi, Katsuya [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Kohno, Mari [Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women' s Medical University Hospital, Tokyo (Japan); Sonoda, Tatsuo; Hirabayashi, Hisae [Department of Radiology, Tokyo Women' s Medical University Hospital, Tokyo (Japan); Nagata, Yasushi [Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

    2012-09-01

    Purpose: To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer. Methods and Materials: We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women's Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general, the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA. Results: The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences. Conclusion: These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.

  4. Treatment Outcome of Medium-Dose-Rate Intracavitary Brachytherapy for Carcinoma of the Uterine Cervix: Comparison With Low-Dose-Rate Intracavitary Brachytherapy

    Purpose: To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer. Methods and Materials: We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women’s Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general, the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA. Results: The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences. Conclusion: These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.

  5. Perioperative and postoperative complications of intracavitary radiation for FIGO stage I-III carcinoma of the cervix

    Purpose: To evaluate perioperative and postoperative complications of low-dose-rate (LDR) intracavitary radiation therapy in patients with FIGO Stage I-III carcinoma of the uterine cervix. Methods and Materials: We retrospectively reviewed the medical and radiotherapy records of all patients treated with radiation between 1960 and 1992 at The University of Texas M. D. Anderson Cancer Center for FIGO I-III carcinomas of the cervix. Patients who had had initial hysterectomy or whose treatment did not include intracavitary irradiation were excluded. The final study included 4043 patients who had undergone 7662 intracavitary procedures. Results: Eleven (0.3%) patients had documented or suspected cases of thromboembolism resulting in 4 deaths. Of these 11 patients, 8 had clinical or radiographic evidence of tumor involving pelvic nodes or fixed pelvic wall. The risk of postoperative thromboembolism did not decrease significantly with the routine use of mini-dose heparin prophylaxis (p = 0.3). Other life-threatening perioperative complications included myocardial infarction (1 death in 5 patients), cerebrovascular accident (2 patients), congestive heart failure or atrial fibrillation (3 patients), and halothane liver toxicity (2 deaths in 2 patients). Intraoperative complications included uterine perforation (2.8%) and vaginal laceration (0.3%), which occurred more frequently in patients ≥ 60 years old (p < 0.01). Fourteen percent of patients had a temperature ≥ 101 deg. F during at least one hospital stay. The only correlation between minor intraoperative complications and disease-specific survival was found in patients who had Stage III disease and uterine perforation; survival was significantly (p = 0.01) decreased in these patients. Conclusions: Fatal or life-threatening complications of intracavitary treatment were very rare. Deep venous thrombosis (DVT) and pulmonary embolism (PE) did not occur in otherwise healthy patients with early disease and were rare even

  6. Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children

    Maarouf, Mohammad; El Majdoub, Faycal [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); University of Witten/Herdecke, Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Cologne-Merheim Medical Center (CMMC), Cologne (Germany); Fuetsch, Manuel [University Hospital of Munich, Department of Neurosurgery, Munich (Germany); Hoevels, Mauritius [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); Lehrke, Ralph [St. Barbara-Klinik Hamm-Heessen, Department of Stereotaxy and Functional Neurosurgery, Hamm (Germany); Berthold, Frank [University Hospital of Cologne, Department Pediatric Oncology, Cologne (Germany); Voges, Juergen [University Hospital of Magdeburg, Department of Stereotaxy and Functional Neurosurgery, Magdeburg (Germany); Sturm, Volker [University Hospital of Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne (Germany); University Hospital of Wurzburg, Department of Neurosurgery, Wuerzburg (Germany)

    2016-03-15

    Although microsurgery remains the first-line treatment, gross total resection of cystic craniopharyngeomas (CP) is associated with significant morbidity and mortality and the addition of external irradiation to subtotal resection proves to achieve similar tumor control. However, concern regarding long-term morbidity associated with external irradiation in children still remains. With this retrospective analysis, the authors emphasize intracavitary brachytherapy using phosphorus-32 (P-32) as a treatment option for children with cystic CP. Between 1992 and 2009, 17 children (median age 15.4 years; range 7-18 years) with cystic CP underwent intracavitary brachytherapy using P-32. Eleven patients were treated for recurrent tumor cysts; 6 patients were treated primarily. MR imaging revealed solitary cysts in 7 patients; 10 patients had mixed solid-cystic lesions (median tumor volume 11.1 ml; range 0.5-78.9 ml). The median follow-up time was 61.9 months (range 16.9-196.6 months). Local cyst control could be achieved in 14 patients (82 %). Three patients showed progression of the treated cystic formation (in-field progression) after a median time of 8.3 months (range 5.3-10.3 months), which led to subsequent interventions. The development of new, defined cysts and progression of solid tumor parts (out-of-field progression) occurred in 5 patients and led to additional interventions in 4 cases. There was neither surgery-related permanent morbidity nor mortality in this study. The overall progression-free survival was 75, 63, and 52 % after 1, 3, and 5 years, respectively. Intracavitary brachytherapy using P-32 represents a safe and effective treatment option for children harboring cystic CP, even as primary treatment. However, P-32 does not clearly affect growth of solid tumor parts or the development of new cystic formations. (orig.) [German] Obwohl die Mikrochirurgie die Methode der Wahl darstellt, ist die komplette Resektion zystischer Kraniopharyngeome haeufig mit einer

  7. Relationship between total iso-effect dose and number of fractions for the treatment of uterine cervical carcinoma by high dose-rate intracavitary irradiation. Chapter 18

    Results are compared in Japan for patients with cervical carcinoma treated by either 1) manual afterloading with low intensity 60Co or 137Cs or 2) remote afterloading with high intensity 60Co sources (Ralstron). No significant difference between them was found for the 5-year survival rates. The relationship between the total tumour dose at point A and the results of high and low dose-rate intracavitary treatment of the patients classified by the number of fractions was also investigated. From this, the optimal dose ranges for each of the fractionation schemes of both high and low dose-rate intracavitary irradiation were determined. (U.K.)

  8. 3D-image-guided high-dose-rate intracavitary brachytherapy for salvage treatment of locally persistent nasopharyngeal carcinoma

    Ren, Yu-Feng; Cao, Xin-Ping; Xu, Jia; Ye, Wei-Jun; Gao, Yuan-Hong; Teh, Bin S.; Wen, Bi-Xiu

    2013-01-01

    Background To evaluate the therapeutic benefit of 3D-image-guided high-dose-rate intracavitary brachytherapy (3D-image-guided HDR-BT) used as a salvage treatment of intensity modulated radiation therapy (IMRT) in patients with locally persistent nasopharyngeal carcinoma (NPC). Methods Thirty-two patients with locally persistent NPC after full dose of IMRT were evaluated retrospectively. 3D-image-guided HDR-BT treatment plan was performed on a 3D treatment planning system (PLATO BPS 14.2). The...

  9. Mid-dose rate intracavitary therapy for uterine cervix cancer with a Selectron; An early experience of Osaka University

    Teshima, Teruki; Inoue, Takehiro; Sasaki, Shigeru; Ohtani, Masatoshi; Kozuka, Takahiro; Inoue, Toshihiko; Ikeda, Hiroshi; Yamazaki, Hideya (Osaka Univ. (Japan). Faculty of Medicine); Murayama, Shigeyuki

    1993-05-01

    From May 1991 through September 1992, a total of 17 previously untreated patients with invasive uterine cervix cancer and with intact uterus were treated with mid-dose rate intracavitary therapy administered with a Selectron. Early primary tumor responses for all patients were complete. No acute or subacute radiation injury was observed except one patient with aplastic anemia who developed rectal ulcer. Two patients of Stage IIIb died from tumor because of local, paraaortic lymph node and distant metastases. Our early experience concluded that Selectron MDR can be used for cervix cancer patients as safely and effectively as our previously used high-dose rate machine. (author).

  10. Intracavitary dosimetry: a comparison of MGHR prescription to doses at points A and B in cervical cancer

    This study, involving 77 patients with carcinoma of the cervix, compares the doses at points A and B with the milligram-hour (mg-h) prescription for the intracavitary use of the Fletcher-Suit after loading applicators. The doses at points A and B were computer calculated. A linear least-square regression analysis was used to compare the two sets of data. Correlation coefficients between doses at points A and B and the mg-h prescription are 0.84 (p < 0.001) and 0.88 (p < 0.001) respectively. The slope of the point A line is 0.78 and the slope of the point B line is 0.24. Therefore, for purposes of a nominal comparison, the dose at point A is approximately 3/4 the mg-h prescription; the dose at point B is approximately 1/4 the mg-h prescription. The limitations and significance of the comparison of the two approaches to intracavitary dosimetry is discussed

  11. Significance of ovoid separation, with different applications of high dose rate intracavitary radio therapy in carcinoma of the uterine cervix: a study from rural centre of Maharashtra, India

    To analyze the difference in the dose distribution with ovoid separation in different applications by the different radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR) intracavitary radio therapy (ICRT)

  12. Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

    Brandao, Samia de Freitas, E-mail: samiabrandao@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear; Campos, Tarcisio Passos Ribeiro de [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil)

    2013-06-15

    Objective: comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and methods: simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results: intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h{sup -1}.p{sup -1}.s, respectively, on the healthy tissue, on the balloon periphery and on the /{sub 1} and /{sub 2} tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h{sup -1}.p{sup -1}.s, respectively on the healthy tissue, on the target tumor and on the /{sub 1} and /{sub 2} infiltration zones. Conclusion: Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones. (author)

  13. Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

    Samia de Freitas Brandao

    2013-07-01

    Full Text Available Objective Comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and Methods Simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results Intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h-1.p-1.s, respectively, on the healthy tissue, on the balloon periphery and on the I 1 and I 2 tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h-1.p-1.s, respectively on the healthy tissue, on the target tumor and on the I 1 and I 2 infiltration zones. Conclusion Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones.

  14. Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors

    Objective: comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and methods: simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results: intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h-1.p-1.s, respectively, on the healthy tissue, on the balloon periphery and on the /1 and /2 tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h-1.p-1.s, respectively on the healthy tissue, on the target tumor and on the /1 and /2 infiltration zones. Conclusion: Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones. (author)

  15. Development of an 241Am applicator for intracavitary irradiation of gynecologic cancers.

    Nath, R; Peschel, R E; Park, C H; Fischer, J J

    1988-05-01

    Sealed sources of 241Am that emit primarily 60 keV photons produce relative dose distributions in water comparable to those from 137Cs or 226Ra sources and can produce dose rates of up to 100 cGy/hr at 1 cm in water. Also, 241Am gamma rays can be effectively shielded by thin layers of high atomic number materials (HVL is 1/8th mm of lead) placed on the applicator or inside some body cavities (for example, hypaque in bladder, barium sulphate in rectum). These properties of 241Am sources open a new approach to optimizing intracavitary irradiation of various cancers by allowing a reduction in dose and volume of irradiated critical organs or by increasing tumor doses. The relative ease with which highly effective shielding is achievable with 241Am sources would allow the design and fabrication of partially shielded applicators which can produce asymmetric dose distributions to allow unidirectional irradiation of localized lesions. Design and dosimetry characteristics of a gynecological applicator containing 241Am sources are presented. The applicator consists of a 2, 3, or 4 segment vaginal plaque (loaded with 2 and 5 Ci 241Am sources) and a tandem made up of a single 8 Ci 241Am source. Dose rates at 2 cm from the plaques are 42.0, 47.4, 58.3 and 56.7 cGy/hr for 5-5, 5-4-5, 5-5-5, and 5-4-4-5 Ci plaques, respectively. The 5-4-5 Ci plaque in combination with the 8 Ci tandem produces dose rates of 60.0 and 22.8 cGy/hr to points A and B, respectively. Surface dose rates on the plaque applicators are 143, 124, 142 and 132 cGy/hr for 5-5, 5-4-5, 5-5-5 and 5-4-4-5 Ci applicators, respectively. The shielding effect of a 0.5 mm thick lead foil on one side of the 5-4-5 Ci applicator is found to be a factor of 16.8; for example, the dose rate at 2 cm from the unshielded side is 42.0 cGy/hr compared to a dose rate of 2.5 cGy/hr at 2 cm from the shielded side. Initial clinical experience with this applicator in the treatment of recurrent gynecological lesions is also presented

  16. Intracavitary cobalt-60 irradiation in the prophylactic treatment of bladder cancer

    Harada, Tadashi; Kigure, Teruaki; Miyagata, Shigeru (Akita Univ. (Japan). School of Medicine) (and others)

    1992-05-01

    This paper describes the technique and preliminary clinical results of transurethral intracavitary whole bladder mucosal irradiation (IWI) for the prophylaxis of bladder cancer. In this procedure, first, the balloon catheter (22 Fr.) is inserted into the bladder, and next the balloon is inflated with 100 ml of air. Then a Co-60 pellet with about 110 GBq of activity is driven into the center of the bladder. With this method, we can irradiate the whole bladder mucosa almost equally. From April 1985, 36 patients with recurrent tumor and 26 patients with primary and multiple tumors of the bladder have been treated with IWI after transurethral resection or microwave coagulation of the tumors. Tumor stage and grade were as follows: Tis (7), T{sub a}, T{sub 1} (41), T{sub 2} (14), G1 (16), G2 (30) and G3 (16). The tumors were transitional cell carcinoma in all patients. IWI was performed once a week, usually 3 to 5 times, depending on the patients. The total dose to the bladder mucosa ranged from 20 to 58.5 Gy with an average dose of 37.6 Gy. Recurrence rates before and after IWI were calculated using the following formula: recurrence rates (RR)=(total number of recurrences/total months of follow up)x100. RR in the 36 patients with recurrent tumor was 14.0 before IWI and 1.8 after IWI (mean follow up 37.6 mos.). RR in the 26 patients with multiple tumors was 1.4 after IWI (mean follow up 34.8 mos.). RR in patients with G1, G2 and G3 tumors were 1.2, 1.7 and 2.2. The most common side effect was temporary urinary frequency observed in 36 patients (52.9%). Three patients had contracted bladder, and two had hydronephrosis. However, proctitis or incontinence was not evident. Although the preliminary clinical results suggest that our new technique is an effective prophylactic treatment for bladder cancer, further investigation is needed to determine its efficacy. (author).

  17. High-dose rate intracavitary irradiation using linear source arrangement for squamous cell carcinoma of the uterine cervix

    Purpose: To evaluate the results of fractionated high-dose-rate (HDR) intracavitary irradiation using a linear source arrangement (LSA) without vaginal ovoids for patients with squamous cell carcinoma of the uterine cervix. Methods and Materials: From 1980 to 1990, 236 patients with squamous cell carcinoma received external beam therapy (EBT) followed by fractionated HDR intracavitary irradiation using LSA (HDR-LSA). The initial FIGO stage was I, II, and III for 19, 71, and 146 patients respectively. Forty Gy in 20 fractions (40 Gy/20 Fr) were delivered to the whole pelvis and additional 10 Gy/5 Fr to the center shielding field with parallel opposed ports. The HDR-LSA dose was 30 Gy/6 Fr or 35 Gy/7 Fr at Manchester's point A giving two fractions per week. During the intracavitary irradiation, patients were treated in the out-patient clinic. A vaginal plastic applicator was inserted with lubricating gel without spinal or general anesthesia and gauze packing. Results: Pelvic failure rate was 10.5% for stage I, 12.7% for stage II, and 35.6% for stage III. Cause-specific 5-year survival rates were 69.1% for stage I, 77.1 % for stage II, and 50.1 % for stage III, respectively. The low survival for stage I disease was suggested to be due to selection bias. In multivariant analyses, stage (stage I+II vs. III, p=0.0003), pre-treatment serum hemoglobin level (p=0.0021), pre-treatment serum total protein level (p=0.0028), and total treatment time (p=0.0035) were significantly associated with cause-specific survival. The rate of late severe complications was 2.1% for rectum, 1.2% for small intestine, and 1.3 % for bladder. Conclusions: The LSA-HDR method following EBT is a safe and effective technique for the majority of patients. Reproducibility of dose distribution and the easiness of the insertion for the patients are suitable for multi-fractionated schedule required in HDR treatment. The benefit of the LSA, compared to the arrangement using a tandem and ovoids, should be

  18. Modelling radiation doses to critical organs of patients undergoing intracavitary brachytherapy treatment at Kumfo Anokye Teaching Hospital

    The main aim of radiotherapy is to destroy cancerous tissues with ionizing radiation while the other normal parts of the body are saved or spared. Intracavitary brachytherapy is a procedure in which radioactive sources are placed in the body cavities close to or inside the target volume to deliver radiation at short distances. In this mode of treatment, high radiation dose can be delivered to the tumour volume with rapid dose fall-off into the surrounding normal tissues. In brachytherapy, the dosimetry in biological tissues is a complex process. Dosimetric parameters such as the dose to critical organs and the total dose to the reference points as in the case of Manchester system are critical for patients undergoing intracavitary brachytherapy treatment. In this study, the Finite Element Method (FEM) has been utilized to solve Boltzmann Transport Equation (BTE) to determine the distribution of angular photon fluxes at various positions in the cervix of cancer patients and the dose distribution calculated for the organs of interest. The time-dependent linear BTE was used to describe the passage of ionizing radiation taking into account tissue heterogeneities and other scattering phenomena before depositing the absorbed dose in a patient. The simulation was carried out to determine doses to the critical organs, namely the rectum and bladder. Results from the study indicate doses to the rectum and the bladder to be in the range of 10.13-85.67cGy and 21.32-78.81cGy respectively for stage I to stage IV cancer patients. Comparison of the results from the model with data from published articles and dose prescriptions from the treatment planning system of the Radiotherapy Center of the Komfo Anokye Teaching Hospital in Ghana for different cancer stages indicate good agreement with standard error of ±20% to ±34%. (au)

  19. Different effects of bladder distention on point A-based and 3D-conformal intracavitary brachytherapy planning for cervical cancer

    Ju, Sang Gyu; Huh, Seung Jae; Shin, Jung Suk; Park, Won; Nam, Heerim; Bae, Sunhyun; Oh, Dongryul; Hong, Chae-Seon; Kim, Jin Sung; Han, Youngyih; Choi, Doo Ho

    2012-01-01

    This study sought to evaluate the differential effects of bladder distention on point A-based (AICBT) and three-dimensional conformal intracavitary brachytherapy (3D-ICBT) planning for cervical cancer. Two sets of CT scans were obtained for ten patients to evaluate the effect of bladder distention. After the first CT scan, with an empty bladder, a second set of CT scans was obtained with the bladder filled. The clinical target volume (CTV), bladder, rectum, and small bowel were delineated on ...

  20. Routine clinical estimation of rectal, rectosigmoidal, and bladder doses from intracavitary brachytherapy in the treatment of carcinoma of the cervix

    An evaluation of rectal, rectosigmoidal, and bladder doses from intracavitary brachytherapy in carcinoma of the cervix has been initiated on a routine basis in an effort to obtain the optimum radiotherapeutic dose. Contrast radiography on a radiotherapy simulator is used to image the rectum and bladder, and dose rates are determined at predesignated reference points with the aid of computer calculated dose distributions. Forty-three patients have been reviewed in order to ascertain the correlation between radiation injury and dose at reference points in the rectum and bladder. In a related study involving 77 patients, the doses at points A and B and the prescription in mghr were analyzed in relation to radiation injury. There was no apparent association between the incidence of radiation injury in either the mghr prescription or the doses at points A or B. Computer calculations were supplemented with in vivo and in vitro thermoluminescent dosimeter (TLD) measurements. We conclude that routine contrast radiography of the rectum and the bladder with dose calculations at selected reference points provides important information for optimizing radiotherapy in carcinoma of the cervix without a significant increase in treatment planning effort or patient discomfort

  1. 3D-image-guided high-dose-rate intracavitary brachytherapy for salvage treatment of locally persistent nasopharyngeal carcinoma

    To evaluate the therapeutic benefit of 3D-image-guided high-dose-rate intracavitary brachytherapy (3D-image-guided HDR-BT) used as a salvage treatment of intensity modulated radiation therapy (IMRT) in patients with locally persistent nasopharyngeal carcinoma (NPC). Thirty-two patients with locally persistent NPC after full dose of IMRT were evaluated retrospectively. 3D-image-guided HDR-BT treatment plan was performed on a 3D treatment planning system (PLATO BPS 14.2). The median dose of 16 Gy was delivered to the 100% isodose line of the Gross Tumor Volume. The whole procedure was well tolerated under local anesthesia. The actuarial 5-y local control rate for 3D-image-guided HDR-BT was 93.8%, patients with early-T stage at initial diagnosis had 100% local control rate. The 5-y actuarial progression-free survival and distant metastasis-free survival rate were 78.1%, 87.5%. One patient developed and died of lung metastases. The 5-y actuarial overall survival rate was 96.9%. Our results showed that 3D-image-guided HDR-BT would provide excellent local control as a salvage therapeutic modality to IMRT for patients with locally persistent disease at initial diagnosis of early-T stage NPC

  2. Effect of Bladder Distension on Dose Distribution of Intracavitary Brachytherapy for Cervical Cancer: Three-Dimensional Computed Tomography Plan Evaluation

    Purpose: To quantify the effect of bladder volume on the dose distribution during intracavitary brachytherapy for cervical cancer. Methods and Patients: The study was performed on 10 women with cervical cancer who underwent brachytherapy treatment. After insertion of the brachytherapy applicator, the patients were transferred to the computed tomography unit. Two sets of computed tomography slices were taken, including the pelvis, one with an empty bladder and one after the bladder was filled with saline. The target and critical organs were delineated by the radiation oncologist and checked by the expert radiologist. The radiotherapy plan was run on the Plato planning system, version 14.1, to determine the dose distributions, dose-volume histograms, and maximal dose points. The doses and organ volumes were compared with the Wilcoxon signed ranks test on a personal computer using the Statistical Package for Social Sciences, version 11.0, statistical program. Results: No significant difference regarding the dose distribution and target volumes between an empty or full bladder was observed. Bladder fullness significantly affected the dose to the small intestine, rectum, and bladder. The median of maximal doses to the small intestine was significantly greater with an empty bladder (493 vs. 284 cGy). Although dosimetry revealed lower doses for larger volumes of bladder, the median maximal dose to the bladder was significantly greater with a full bladder (993 vs. 925 cGy). The rectal doses were also affected by bladder distension. The median maximal dose was significantly lower in the distended bladder (481vs. 628 cGy). Conclusions: Bladder fullness changed the dose distributions to the bladder, rectum, and small intestine. The clinical importance of these changes is not known and an increase in the use of three-dimensional brachytherapy planning will highlight the answer to this question

  3. Continuous or split-course combined external and intracavitary radiotherapy of locally advanced carcinoma of the uterine cervix

    From 1974 to 1984, 442 consecutive patients with carcinoma of the uterine cervix (FIGO IIB: 139, IIIA: 10, IIIB: 221, IVA: 72) were referred for combined intracavitary (IRT) and external radiotherapy (ERT). To improve local control and reduce late rectosigmoid morbidity the treatment strategy was changed from continuous (CRT) to split-course radiotherapy (SCRT) in 1978. Stage by stage the 5-year actuarial estimates of survival, local control, and late morbidity did not differ in relation to strategy. In the patients with tumours larger than 8 cm, the SCRT involved an increased dose in point B, a reduced dose in point A from the IRT, a lower total dose in point A, and a 34 day's prolongation of the total treatment time (TTT). The resulting 5-year actuarial local control rates were significantly lower compared with those after CRT. No difference of late severe morbidity was found except in IVA patients. In the patients with tumours between 4 and 8 cm, the SCRT involved a reduced dose in point A from the IRT, an increased total dose in point A and B, and a 50 day's prolongation of the TTT. In patients with stage IIB, the 5-year actuarial central local control rate was lower (p=0.06), and the 5-year estimate of late severe morbidity significantly higher after SCRT compared with CRT. It is concluded that the increase of the dose in point B in the SCRT was insufficient to prevent the deleterious effect on local tumour control of either the lower dose from IRT in point A, or the prolonged TTT. The increase of the total dose in the SCRT may explain why the late morbidity was not reduced, and may suggest that the TTT is of no significant importance for the risk of late normal tissue damage. (orig.)

  4. A comparison of organs at risk doses in GYN intracavitary brachytherapy for different tandem lengths and bladder volumes.

    Siavashpour, Zahra; Aghamiri, Mahmoud Reza; Jaberi, Ramin; ZareAkha, Naser; Dehghan Manshadi, Hamid Reza; Kirisits, Christian; Sedaghat, Mahbod

    2016-01-01

    The purpose of this study was to investigate the concurrent effects of tandem length and bladder volume on dose to pelvic organs at risk (OARs) in HDR intracavitary brachytherapy treatment of cervical cancer. Twenty patients with locally advanced cervical cancer were selected for brachytherapy using Rotterdam applicators. The patients were CT scanned twice with empty and full bladder. Two treatment plans were prepared on each of the image sets. Patients were categorized into two groups; those treated with a tandem length of 4 cm or smaller (T ≤ 4 cm) and those with tandem length larger than 4 cm (T > 4 cm). Only one tandem tip angle of 30° was studied. Dose-volume histograms (DVHs) of OARs were calculated and compared. Bladder dose was significantly affected by both bladder volume and tandem physical length for T ≤ 4 cm. This was reflected on the values obtained for D2cm³, D1cm³, and D0.1cm³ for both empty and full bladder cases. When T > 4 cm, no correlation could be established between variations in bladder dose and blad-der volume. Rectum dose was generally lower when the bladder was empty and T > 4 cm. Dose to sigmoid was increased when T > 4 cm; this increase was larger when the bladder was full. Our results suggest that, for tandems longer than 4 cm, keeping the bladder empty may reduce the dose to rectum and sigmoid. This is contrary to cases where a shorter than 4 cm tandem is used in which a full bladder (about 50-120 cm³) tends to result in a lower dose to rectum and sigmoid. Attention should be given to doses to sigmoid with long tandem lengths, as a larger tandem generally results in a larger dose to sigmoid. PMID:27167253

  5. CT based three dimensional dose-volume evaluations for high-dose rate intracavitary brachytherapy for cervical cancer

    2014-01-01

    Background In this study, high risk clinical target volumes (HR-CTVs) according to GEC-ESTRO guideline were contoured retrospectively based on CT images taken at the time of high-dose rate intracavitary brachytherapy (HDR-ICBT) and correlation between clinical outcome and dose of HR-CTV were analyzed. Methods Our study population consists of 51 patients with cervical cancer (Stages IB-IVA) treated with 50 Gy external beam radiotherapy (EBRT) using central shield combined with 2–5 times of 6 Gy HDR-ICBT with or without weekly cisplatin. Dose calculation was based on Manchester system and prescribed dose of 6 Gy were delivered for point A. CT images taken at the time of each HDR-ICBT were reviewed and HR-CTVs were contoured. Doses were converted to the equivalent dose in 2 Gy (EQD2) by applying the linear quadratic model (α/β = 10 Gy). Results Three-year overall survival, Progression-free survival, and local control rate was 82.4%, 85.3% and 91.7%, respectively. Median cumulative dose of HR-CTV D90 was 65.0 Gy (52.7-101.7 Gy). Median length from tandem to the most lateral edge of HR-CTV at the first ICBT was 29.2 mm (range, 18.0-51.9 mm). On univariate analysis, both LCR and PFS was significantly favorable in those patients D90 for HR-CTV was 60 Gy or greater (p = 0.001 and 0.03, respectively). PFS was significantly favorable in those patients maximum length from tandem to edge of HR-CTV at first ICBT was shorter than 3.5 cm (p = 0.042). Conclusion Volume-dose showed a relationship to the clinical outcome in CT based brachytherapy for cervical carcinoma. PMID:24938757

  6. Verification of the dose from an Iridium-192 (192Ir) sealed source absorbed by an implantable cardioverter defibrillator (ICD) during uterine intracavitary brachytherapy

    The purpose of this study was to verify the dose absorbed by an implantable cardioverter defibrillator (ICD) from an 192Ir sealed source during uterine intracavitary brachytherapy, and to confirm its immunity to radiation effects. First, prior to treatment, the doses around the ICD position of an anthromorphic phantom were evaluated. Next, we also measured the dose at the ICD position using a fluorescent glass dosimeter and silicon diode dosimeter during the treatment of intracavitary brachytherapy of a patient implanted with an ICD. The results of the phantom study showed the dose percentage at the ICD location, 2 cm deep, to be 0.074% of the prescribed dose. The results of a treatment study similarly showed the dose, measured using a fluorescent glass dosimeter in the ICD position, to be 0.071% of the prescribed dose. During the application of the total prescribed dose, 30 Gy/5 fraction, the dose at the surface of the ICD position was estimated to be 21.2 mGy, well below the 1 Gy maximum recommended in the JASTRO guidelines. We regard dose verification and monitoring during treatment to be both necessary and useful in the treatment of individual cases. (author)

  7. Impact of Heterogeneity-Based Dose Calculation Using a Deterministic Grid-Based Boltzmann Equation Solver for Intracavitary Brachytherapy

    Purpose: To investigate the dosimetric impact of the heterogeneity dose calculation Acuros (Transpire Inc., Gig Harbor, WA), a grid-based Boltzmann equation solver (GBBS), for brachytherapy in a cohort of cervical cancer patients. Methods and Materials: The impact of heterogeneities was retrospectively assessed in treatment plans for 26 patients who had previously received 192Ir intracavitary brachytherapy for cervical cancer with computed tomography (CT)/magnetic resonance-compatible tandems and unshielded colpostats. The GBBS models sources, patient boundaries, applicators, and tissue heterogeneities. Multiple GBBS calculations were performed with and without solid model applicator, with and without overriding the patient contour to 1 g/cm3 muscle, and with and without overriding contrast materials to muscle or 2.25 g/cm3 bone. Impact of source and boundary modeling, applicator, tissue heterogeneities, and sensitivity of CT-to-material mapping of contrast were derived from the multiple calculations. American Association of Physicists in Medicine Task Group 43 (TG-43) guidelines and the GBBS were compared for the following clinical dosimetric parameters: Manchester points A and B, International Commission on Radiation Units and Measurements (ICRU) report 38 rectal and bladder points, three and nine o’clock, and D2cm3 to the bladder, rectum, and sigmoid. Results: Points A and B, D2 cm3 bladder, ICRU bladder, and three and nine o’clock were within 5% of TG-43 for all GBBS calculations. The source and boundary and applicator account for most of the differences between the GBBS and TG-43 guidelines. The D2cm3 rectum (n = 3), D2cm3 sigmoid (n = 1), and ICRU rectum (n = 6) had differences of >5% from TG-43 for the worst case incorrect mapping of contrast to bone. Clinical dosimetric parameters were within 5% of TG-43 when rectal and balloon contrast were mapped to bone and radiopaque packing was not overridden. Conclusions: The GBBS has minimal impact on clinical

  8. Image-based dose planning of intracavitary brachytherapy: registration of serial-imaging studies using deformable anatomic templates

    Purpose: To demonstrate that high-dimensional voxel-to-voxel transformations, derived from continuum mechanics models of the underlying pelvic tissues, can be used to register computed tomography (CT) serial examinations into a single anatomic frame of reference for cumulative dose calculations. Methods and Materials: Three patients with locally advanced cervix cancer were treated with CT-compatible intracavitary (ICT) applicators. Each patient underwent five volumetric CT examinations: before initiating treatment, and immediately before and after the first and second ICT insertions, respectively. Each serial examination was rigidly registered to the patient's first ICT examination by aligning the bony anatomy. Detailed nonrigid alignment for organs (or targets) of interest was subsequently achieved by deforming the CT exams as a viscous-fluid, described by the Navier-Stokes equation, until the coincidence with the corresponding targets on CT image was maximized. In cases where ICT insertion induced very large and topologically complex rearrangements of pelvic organs, e.g., extreme uterine canal reorientation following tandem insertion, a viscous-fluid-landmark transformation was used to produce an initial registration. Results: For all three patients, reasonable registrations for organs (or targets) of interest were achieved. Fluid-landmark initialization was required in 4 of the 11 registrations. Relative to the best rigid bony landmark alignment, the viscous-fluid registration resulted in average soft-tissue displacements from 2.8 to 28.1 mm, and improved organ coincidence from the range of 5.2% to 72.2% to the range of 90.6% to 100%. Compared to the viscous-fluid transformation, global registration of bony anatomy mismatched 5% or more of the contoured organ volumes by 15-25 mm. Conclusion: Pelvic soft-tissue structures undergo large deformations and displacements during the external-beam and multiple-ICT course of radiation therapy for locally advanced cervix

  9. MRI-Guided High–Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience

    Purpose: Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Methods and Materials: Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high–dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Européen de Curiethérapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD2) with planned HRCTV doses of 75 to 85 Gy. Results: From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6%) with a median tumor size of 5 cm, squamous histology (82.8%), and no radiographic nodal involvement (53.1%). Most patients (67.2%) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6%, 81.8%, and 87.6%, respectively. Predictors of local failure included adenocarcinoma histology (P<.01) and clinical response at 3 months (P<.01). Among the adenocarcinoma subset, receiving HRCTV D90 EQD2 ≥84 Gy was associated with improved local control (2-year local control rate 100% vs 54.5%, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9%. Conclusions: This study constitutes one of the largest reported series of MRI-guided brachytherapy in North

  10. MRI-Guided High–Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience

    Gill, Beant S.; Kim, Hayeon; Houser, Christopher J. [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Kelley, Joseph L.; Sukumvanich, Paniti; Edwards, Robert P.; Comerci, John T.; Olawaiye, Alexander B.; Huang, Marilyn; Courtney-Brooks, Madeleine [Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Beriwal, Sushil, E-mail: beriwals@upmc.edu [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)

    2015-03-01

    Purpose: Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Methods and Materials: Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high–dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Européen de Curiethérapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD{sub 2}) with planned HRCTV doses of 75 to 85 Gy. Results: From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6%) with a median tumor size of 5 cm, squamous histology (82.8%), and no radiographic nodal involvement (53.1%). Most patients (67.2%) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6%, 81.8%, and 87.6%, respectively. Predictors of local failure included adenocarcinoma histology (P<.01) and clinical response at 3 months (P<.01). Among the adenocarcinoma subset, receiving HRCTV D{sub 90} EQD{sub 2} ≥84 Gy was associated with improved local control (2-year local control rate 100% vs 54.5%, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9%. Conclusions: This study constitutes one of the largest reported series of MRI

  11. Biological effect of pulsed dose rate brachytherapy with stepping sources if short half-times of repair are present in tissues

    Purpose: To explore the possible increase of radiation effect in tissues irradiated by pulsed brachytherapy (PDR) for local tissue dose rates between those 'averaged over the whole pulse' and the instantaneous high dose rates close to the dwell positions. Increased effect is more likely for tissues with short half-times of repair of the order of a few minutes, similar to pulse durations. Methods and Materials: Calculations were done assuming the linear quadratic formula for radiation damage, in which only the dose-squared term is subject to exponential repair. The situation with two components of T(1(2)) is addressed. A constant overall time of 140 h and a constant total dose of 70 Gy were assumed throughout, the continuous low dose rate of 0.5 Gy/h (CLDR) providing the unitary standard effects for each PDR condition. Effects of dose rates ranging from 4 Gy/h to 120 Gy/h (HDR at 2 Gy/min) were studied, covering the gap in an earlier publication. Four schedules were examined: doses per pulse of 0.5, 1, 1.5, and 2 Gy given at repetition frequencies of 1, 2, 3, and 4 h, respectively, each with a range of assumed half-times of repair of 4 min to 1.5 h. Results are presented for late-responding tissues, the differences from CLDR being two or three times greater than for early-responding tissues and most tumors. Results: Curves are presented relating the ratio of increased biological effect (proportional to log cell kill) calculated for PDR relative to CLDR. Ratios as high as 1.5 can be found for large doses per pulse (2 Gy) if the half-time of repair in tissues is as short as a few minutes. The major influences on effect are dose per pulse, half-time of repair in tissue, and--when T(1(2)) is short--the instantaneous dose rate. Maximum ratios of PDR/CLDR occur when the dose rate is such that pulse duration is approximately equal to T(1(2)). As dose rate in the pulse is increased, a plateau of effect is reached, for most T(1(2))s, above 10 to 20 Gy/h, which is therefore radiobiologically equivalent to the highest HDR. A stepping source of 1 curie carries a sphere of 'HDR' of radius 20 mm with it in its track through tissue. High ratios of PDR/LDR effect can be avoided by keeping dose per pulse below 1 Gy. Conclusions: Therefore, about 75% of the total dose is delivered at HDR in a PDR implant of moderate volume, reducing to 40% as the source decays from 1 to 0.3 curies. Even so, restricting the dose per pulse to 0.5 or 0.6 Gy should avoid ratios of increased effect larger than about 10%. It appears likely that PDR delivered by stepping source might behave more like HDR than LDR, especially for tissues with a substantial component of repair of very short T(1(2))

  12. Observation of hyperfractional integrated intracavitary brachytherapy on efficacy and complications in patients with middle and advanced squamous cell carcinoma of the cervix

    Objective: To observe and compare the efficacy and complications of hyperfractional integrated intracavitary brachtherapy in middle-advanced squamous-cell carcinoma with the traditional brachytherapy. Methods: In the observed group, 328 patients with cervical cancer received hyperfractional integrated intracavitary after loading therapy between Jan 2004 and Jan 2005 were selected. The dose of point A was 2.5 Gy-3.0 Gy/fraction, 2 fractions per week, and the total dose of reference point A was 49.8 Gy in stage IIb, 52.6 Gy in stage IIIb. In the control group, 331 cases treated with traditional afterloading brachytherapy between Jan 2002 and Dec 2003 were selected. The dose of point A was 5.0∼7.0 Gy/fraction, 1 fraction per week, and the total dose of point A was 50.1 Gy in stage IIb, 53.5 Gy in stage IIIb, In vitro irradiation began at the same time with the intracavitary brachytherapy. The whole pelvic was irradiated with 15 MV X-rays. Results: In the observed group, the recent control rate of stage IIb was 97.2% (104/107), 94.1% (208/221) for stage IIIb. The 3- year survival rate was 80.5% (264/328), and the 5-year survival rate was 68.6% (225/328). The complication rate was 5.2% (17/328) for cystitis, 14.6% (48/328) for proctitis. Out of 331 cases in control group, the recent control rate of stage IIb was 95.4% (103/108), 92.8% (207/223) for stage IIIb. The 3-year survival rate was 75.2% (249/332), the 5-year survival rate was 62.5% (207/331). The complication rate was 13.3% (44/331) for cystitis, and 32.3% (107/331) for proctitis. Conclusions: Compared with combination of traditional brachytherapy and external radiotherapy, combination of hyperfractional integrated brachtherapy therapy and external radiotherapy has no significant improvement for recent control rate and long-term survival rate, but could reduce the complication rates of cystitis and proctitis. (authors)

  13. Design and construction of a holder to the safety handling of Cs-137 to be used in cervix cancer treatments using intracavitary brachytherapy by afterloading

    In venezuelan public hospitals where cervix cancer treatments are performed by means of Cs-137 manual afterloading systems, the handling of the sources is done with two type of holders, metallic and plastic, the plastic holders are pieces of induced serious radio-sanitary problem such as loser of the Cs-137 source and radioactive contamination in the treatment area, this has caused the interruption of the treatments in many hospitals. This interruption had a high social cost because of the thousands women waiting for intracavitary therapy. To start again with the treatments, the metallic holders were required but there were not enough funds in the budget, because of this problem in a short time IVIS'S health physics drew and made a low price source holder. (authors). 2 figs., 2 tabs

  14. Phantom evaluation of stacked-type dual-frequency 1-3 composite transducers: A feasibility study on intracavitary acoustic angiography.

    Kim, Jinwook; Li, Sibo; Kasoji, Sandeep; Dayton, Paul A; Jiang, Xiaoning

    2015-12-01

    In this paper, we present phantom evaluation results of a stacked-type dual-frequency 1-3 piezoelectric composite transducer as a feasibility study for intracavitary acoustic angiography. Our previous design (6.5/30 MHz PMN-PT single crystal transducer) for intravascular contrast ultrasound imaging exhibited a contrast-to-tissue ratio (CTR) of 12 dB with a penetration depth of 2.5 mm. For improved penetration depth (>3 mm) and comparable contrast-to-tissue ratio (>12 dB), we evaluated a lower frequency 2/14 MHz PZT 1-3 composite transducer. Superharmonic imaging performance of this transducer and a detailed characterization of key parameters for acoustic angiography are presented. The 2/14 MHz arrangement demonstrated a -6 dB fractional bandwidth of 56.5% for the transmitter and 41.8% for the receiver, and produced sufficient peak-negative pressures (>1.5 MPa) at 2 MHz to induce a strong nonlinear harmonic response from microbubble contrast agents. In an in-vitro contrast ultrasound study using a tissue mimicking phantom and 200 μm cellulose microvessels, higher harmonic microbubble responses, from the 5th through the 7th harmonics, were detected with a signal-to-noise ratio of 16 dB. The microvessels were resolved in a two-dimensional image with a -6dB axial resolution of 615 μm (5.5 times the wavelength of 14 MHz waves) and a contrast-to-tissue ratio of 16 dB. This feasibility study, including detailed explanation of phantom evaluation and characterization procedures for key parameters, will be useful for the development of future dual-frequency array transducers for intracavitary acoustic angiography. PMID:26112426

  15. Trans-abdominal ultrasound (US) and magnetic resonance imaging (MRI) correlation for conformal intracavitary brachytherapy in carcinoma of the uterine cervix

    Purpose: Trans-abdominal ultrasonography (US) is capable of determining size, shape, thickness, and diameter of uterus, cervix and disease at cervix or parametria. To assess the potential value of US for image-guided cervical cancer brachytherapy, we compared US-findings relevant for brachytherapy to the corresponding findings obtained from MR imaging. Materials and methods: Twenty patients with biopsy proven cervical cancer undergoing definitive radiotherapy with/without concomitant Cisplatin chemotherapy and suitable for brachytherapy were invited to participate in this study. US and MR were performed in a similar reproducible patient positioning after intracavitary application. US mid-sagittal and axial image at the level of external cervical os was acquired. Reference points D1 to D9 and distances were identified with respect to central tandem and flange, to delineate cervix, central disease, and external surface of the uterus. Results: Thirty-two applications using CT/MR compatible applicators were evaluable. The D1 and D3 reference distances which represent anterior surface had a strong correlation with R = 0.92 and 0.94 (p < 0.01). The D2 and D4 reference distances in contrast, which represent the posterior surface had a moderate (D2) and a strong (D4) correlation with R = 0.63 and 0.82 (p < 0.01). Of all, D2 reference distance showed the least correlation of MR and US. The D5 reference distance representing the fundal thickness from tandem tip had a correlation of 0.98. The reference distances for D6, D7, D8, and D9 had a correlation of 0.94, 0.82, 0.96, and 0.93, respectively. Conclusions: Our study evaluating the use of US, suggests a reasonably strong correlation with MR in delineating uterus, cervix, and central disease for 3D conformal intracavitary brachytherapy planning.

  16. Assessment of cumulative external beam and intracavitary brachytherapy organ doses in gynecologic cancers using deformable dose summation

    Purpose: Due to inter-fraction variation in applicator position, organ displacement and deformation, doses to targets and normal tissues may not be accurately represented by adding the doses from external beam radiation therapy (EBRT) and intracavitary brachytherapy (ICBT) using rigid image registration. Deformable image registration permits organ and applicators to be spatially matched in 3D, enabling more accurate tracking of the accumulated volumetric dose to the target as well as organs at risk (OAR). This study assesses the dosimetric impact of using deformable image registration to determine the cumulative EBRT and ICBT doses to the rectum and bladder. Methods and materials: Data from 20 patients with stage IB1-IVA cervical cancer were analyzed. Nine of the patients were treated with ICBT and EBRT which included a nodal or parametrium boost while eleven were treated with ICBT and EBRT with no boost. Dose summation was performed in two stages. For the first stage, only the ICBT fractional doses were added using both “parameter adding” and deformable registration techniques. In the second stage, the ICBT and EBRT doses were combined using “parameter adding” in two ways. Partial “parameter adding” considers the cumulative ICBT dose from deformable registration as one parameter while full “parameter adding” uses fractional ICBT parameters. The cumulative minimum doses to 2cc (D2cc) of the rectum and bladder were compared between deformable registration and “parameter adding” techniques. Results: Dose summation of ICBT fractions only using deformable registration yielded D2cc values that were (10.1 ± 9.5)% lower for the rectum and (7.2 ± 6.3)% lower for the bladder compared to “parameter adding”. When ICBT and EBRT doses were summed deformably, the group without EBRT boost had D2cc that were (0.0 ± 4.6)% and (−1.2 ± 2.9)% lower for the rectum and bladder respectively compared to partial “parameter adding”. With EBRT boost, the

  17. Risk of late rectal complications following definitive external radiotherapy and high dose rate intracavitary irradiation for FIGO stage IIB carcinoma of the uterine cervix

    Purpose: To correlate several dosimetric parameters with late rectal complications in patients treated with a combination of external radiotherapy and high dose rate(HDR) intracavitary irradiation(ICR) for FIGO stage IIB carcinoma of the cervix, retrospectively. Materials and Methods: Between 1990 and 1992, 88 patients with stage IIB cervical carcinoma underwent treatment with definitive radiotherapy alone and had a minimum of 2 years of follow up at the Department of Radiation Oncology in Yonsei Cancer Center. The median patient age was 57 years. Radiotherapy consisted of 44-54 Gy(median 49 Gy) external beam followed by a high dose rate intracavitary irradiation 5 Gy per fraction given twice a week, to a total dose of 30 Gy on point A. Parametrial boosting was administered to several patients with lateral parametrial diseases. The median dose to point A was 79.2 Gy. Late rectal complications were scored according to the Kottmeier's grading system. Rectal complications were analyzed as a function of various dosimetric factors (external whole pelvis doses, ICR rectal doses;r and dr, total rectal doses;R and DR, TDF, BED and ICR reference volumes). The maximum rectal doses to the anterior rectal mucosa by contrast media(r, R) and reference rectal point doses by ICRU 38(dr, DR) were calculated. The ICR reference volumes were calculated by the HDR planning system. The TDF (time dose fractionation factor) and BED(biologically effective dose) were also calculated. Complication probabilities were then plotted as a function of the above factors. Regression analysis and the Student's T-test were performed in order to fit data to determine an analytical relationship between complication probability and mean doses with grade 2 or 3 major rectal complications and those without them. Results: There were a total of 27(30.7%) rectal(12 grade 1, 12 grade 2, 3 grade 3) complications. We found a significant correlation between the external whole pelvis doses(midline shielding start

  18. Comparison between CT-based volumetric calculations and ICRU reference-point estimates of radiation doses delivered to bladder and rectum during intracavitary radiotherapy for cervical cancer

    Purpose: To compare CT-based volumetric calculations and International Commission on Radiation Units and Measurements (ICRU) reference-point estimates of radiation doses to the bladder and rectum in patients with carcinoma of the uterine cervix treated with definitive low-dose-rate intracavitary radiotherapy (ICRT). Methods and Materials: Between November 2001 and March 2003, 60 patients were prospectively enrolled in a pilot study of ICRT with CT-based dosimetry. Most patients underwent two ICRT insertions. After insertion of an afterloading ICRT applicator, intraoperative orthogonal films were obtained to ensure proper positioning of the system and to facilitate subsequent planning. Treatments were prescribed using standard two-dimensional dosimetry and planning. Patients also underwent helical CT of the pelvis for three-dimensional reconstruction of the radiation dose distributions. The systems were loaded with 137Cs sources using the Selectron remote afterloading system according to institutional practice for low-dose-rate brachytherapy. Three-dimensional dose distributions were generated using the Varian BrachyVision treatment planning system. The rectum was contoured from the bottom of the ischial tuberosities to the sigmoid flexure. The entire bladder was contoured. The minimal doses delivered to the 2 cm3 of bladder and rectum receiving the highest dose (DBV2 and DRV2, respectively) were determined from dose-volume histograms, and these estimates were compared with two-dimensionally derived estimates of the doses to the corresponding ICRU reference points. Results: A total of 118 unique intracavitary insertions were performed, and 93 were evaluated and the subject of this analysis. For the rectum, the estimated doses to the ICRU reference point did not differ significantly from the DRV2 (p = 0.561); the mean (± standard deviation) difference was 21 cGy (± 344 cGy). The median volume of the rectum that received at least the ICRU reference-point dose was 2

  19. The correlation between DVH at CT-image based 192Ir intracavitary brachytherapy and effects or complications for patients with locally advanced cervical cancer

    Objective: To investigate the correlation between dose volume histogram (DVH) of tumor targets and organs at risk (OAR) at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods: Ten patients with FIGO stage IIIB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimensional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy, CT images were acquired with applicators in place. Gross tumor volume (GTV), clinical target volume (CTV) and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30-42 Gy in 5-7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose (BED) and biologically equivalent dose in 2 Gy fractions (BED2) for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3 (D2cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results: The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV (D90) were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV (D90) were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose (V90) for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose

  20. Intracavitary in vivo dosimetry based on multichannel fiber-coupled optically stimulated luminescence (OSL) of Al2O3:C for Curietherapy

    The brachytherapy is an old technique using sealed radioactive sources of low or average energy. This technique is still therapeutically and economically relevant today and always evolving (e.g. High Dose Rate (HDR) brachytherapy). This treatment enables to deliver a high dose of irradiation in a limited tumoral volume and enables to minimize the risk of radiation-induced cancer as preserving the Organs at Risks (OAR). However, this technique generates high dose gradients, which makes in vivo dosimetry difficult to implement. Hence, the deviations observed between doses delivered and prescribed are often up to the maximal deviation tolerated by the nuclear safety regulations (± 5%) in conformational radiotherapy. Those regulations have been made mandatory in France since 2011. This thesis has been done within the framework of the ANR-TECSAN INTRADOSE project and is based on the past technological benefits demonstrated during the MAESTRO European project and the ANR-TECSAN CODOFER project, in particular a RL/OSL multichannel instrumentation (Radioluminescence - Optically Stimulated Luminescence) made and validated in preclinical evaluation during the MAESTRO project. The purpose of the INTRADOSE project is to demonstrate the feasibility of the intracavitary In Vivo Dosimetry (IVD) by dosimetric catheter using optical fibers and alumina crystals Al2O3:C with the aim of improving the safety of patients treated by HDR brachytherapy. This new probe enables to measure a dose distribution (several points) close to the OAR, it offers a little diameter (≤ 3 mm) designed for an intracavitary use (e.g. to insert in the urethra), it is transparent, radiation stable and reusable after dose reading and sterilization. During this study, we have first developed this new dosimetric sensor based on the OSL using the properties of the alumina crystal. Several tests have been done in order to evaluate the feasibility and the compatibility with a medical application. Then

  1. Revascularização da artéria coronária direita intra-atrial Revascularization of intracavitary right coronary artery

    Artur Lourenção Júnior

    1990-12-01

    Full Text Available A artéria coronária direita, em seu trajeto no sulco atrioventricular direito, pode, em raras ocasiões, penetrar na cavidade atrial direita. Esta variação anatômica poderá modificar a tática cirúrgica em operações de revascularização miocárdica. No presente trabalho, relatamos o caso em que a ponte de veia safena para a artéria coronária direita foi realizada em posição intra-atrial direita.The right coronary artery, during your course in the right atrioventricular sulcus, can sometimes penetrate the right atrial cavity. This anatomical variety can modify the surgical tactics in aortocoronary by-pass surgery. In this paper we present a patient in whom the by-pass with saphenous vein graft to the right coronary artery was made in right intracavitary position.

  2. Different effects of bladder distention on point A-based and 3D-conformal intracavitary brachytherapy planning for cervical cancer

    This study sought to evaluate the differential effects of bladder distention on point A-based (AICBT) and three-dimensional conformal intracavitary brachytherapy (3D-ICBT) planning for cervical cancer. Two sets of CT scans were obtained for ten patients to evaluate the effect of bladder distention. After the first CT scan, with an empty bladder, a second set of CT scans was obtained with the bladder filled. The clinical target volume (CTV), bladder, rectum, and small bowel were delineated on each image set. The AICBT and 3D-ICBT plans were generated, and we compared the different planning techniques with respect to the dose characteristics of CTV and organs at risk. As a result of bladder distention, the mean dose (D50) was decreased significantly and geometrical variations were observed in the bladder and small bowel, with acceptable minor changes in the CTV and rectum. The average D2cm3 and D1cm3 showed a significant change in the bladder and small bowel with AICBT; however, no change was detected with the 3D-ICBT planning. No significant dose change in the CTV or rectum was observed with either the AICBT or the 3D-ICBT plan. The effect of bladder distention on dosimetrical change in 3D-ICBT planning appears to be minimal, in comparison with AICBT planning. (author)

  3. 卡孕栓、双氯芬酸钠栓在宫颈癌后装放疗术中镇痛效果的临床分析%Clinical analysis on the analgesic effect of Methyl Carboprost and Diclofenac Sodium for intracavitary brachytherapy

    2007-01-01

    Objective: To observe the effects of Methyl Carboprost and Diclofenac Sodium on opening orifice of uterus and pain controlling in patients with uterine cervix cancer (UCC) when receiving intracavitary brachytherapy. Methods: Sixty patients with UCC of stage ⅡA-ⅢB were divided into three groups randomly before receiving the intracavitary brachytherapy:the patients in group A received Methyl Carboprost in the hind fornix of the vagina, group B received Didofenac Sodium in the anus, while group C was the control group. Results: The painlessness rates in groups A, B and C were 89.9%, 91.3%and 36.4%, respectively. The incidences of patients with relaxed uterus cervix in groups A, B and C were 91.7%, 85.9% and 48.9%, respectively. Conclusion: Methyl Carboprost and Diclofenac Sodium are useful in relaxing uterus cervix and pain controlling in patients with UCC when receiving intracavitary brachytherapy.

  4. 三维适形放疗配合腔内后装治疗宫颈癌的临床研究%Clinical study of three dimensional conformal radiotherapy combined with intracavitary brachytherapy in the treatment of cervical cancer

    Yeqin Zhou; Daiyuan Ma; Tao Ren; Xianfu Li; Jing Hu; Bangxian Tan

    2011-01-01

    Objective: The aim of our study was to evaluate the outcome and complications of cervical cancer patients undergoing conventional intracavitary brachytherapy (ICBT) treated with 3D-conformal radiotherapy (3DCRT). Methods: Sixty cervical cancer patients were divided randomly into the conformal group and the conventional group. Thirty patients treated with 3D-conformal radiotherapy in the 3DCRT group, when the whole pelvic received DT 40 Gy, a planning CT scan of each patient was obtained and the second 3DCRT therapy plan was taken. Then, continued to irradiate to 50 Gy. At last, 3DCRT was boosted at local involved volumes to the total close of 60 Gy. When 3DCRT was combined with intracavitary brachytherapy, the dose of brachytherapy to point A was 30 Gy/5 fractions. In the conventional group, after a total tumor dose of 40 Gy was delivered by the whole pelvic irradiation, the four-field technique was used to irradiate the total pelvic and regional nodes (median close of 10 Gy), and the involved volumes were boosted to 60 Gy and the dose of brachytherapy to point A was 30 Gy-36 Gy/5-6 fractions. Moreover, both groups were combined with intracavitary brachytherapy respectively. Results: The 1, 2, 3-year survival rates for the 3DCRT group and the conventional group were 96.7%, 93.3%, 90.0% and 86.6%, 76.7%,70% respectively (P = 0.04, P = 0.02 and P = 0.02). There was a statistically significant difference between the two groups.Compared to the two groups each other in toxic effects, except for the Ⅰ-Ⅱ grade rectal and bladder reaction and pelvic fibrosis which was lower in the 3DCRT group (P = 0. 007, P = 0. 006 and P = 0. 015), the side effects were similar and well tolerated in two groups. Conclusion: The all-course 3DCRT combined with intracavitary brachytherapy can be considered as an effective and feasible approach to cervical cancer and may significantly improve the survival rate and reduce the late toxicity. This new rote for 3DCRT merits need further

  5. High-dose-rate-intracavitary brachytherapy applications and the difference in the bladder and rectum doses: A study from rural centre of Maharashatra, India

    Jain Vandana

    2007-01-01

    Full Text Available Aim : To report the difference in the bladder and rectum doses with different applications by the radiotherapists in the same patient of the carcinoma of the uterine cervix treated by multiple fractions of high-dose-rate (HDR intracavitary brachytherapy (ICBT. Materials and Methods : Between January 2003 to December 2004, a total of 60 cases of the carcinoma uterine cervix were selected randomly for the retrospective analyses. All 60 cases were grouped in six groups according to the treating radiotherapist who did the HDR-ICBT application. Three radiotherapists were considered for this study, named A, B and C. Ten cases for each radiotherapist in whom all three applications were done by the same radiotherapist. And 10 cases for each radiotherapist with shared applications in the same patient (A+B, A+C and B+C. The bladder and rectal doses were calculated in reference to point "A" dose and were limited to 80% of prescribed point "A" dose, as per ICRU-38 recommendations. Received dose grouped in three groups- less then 80% (< 80%, 80-100% and above 100% (>100%. A total of 180 applications for 60 patients were calculated for the above analyses. Results : There is a lot of difference in the bladder and rectal doses with the application by the different radiotherapists, even in the same patient with multiple fractions of HDR-ICBT. Applications by ′A′ radiotherapist were within the limits in the self as well as in the shared groups more number of times, by ′B′ radiotherapist was more times exceeding the limit and by ′C′ radiotherapist doses were in between the A and B. Discussion and Conclusion : For the rectal and bladder doses most important factors are patient′s age, disease stage, duration between EBRT and HDR-ICRT and patient anatomy, but these differences can be minimized to some extent by careful application, proper packing and proper fixation.

  6. A Prospective Cohort Study to Compare Treatment Results Between 2 Fractionation Schedules of High-Dose-Rate Intracavitary Brachytherapy (HDR-ICBT) in Patients With Cervical Cancer

    Huang, Eng-Yen [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Taiwan (China); Sun, Li-Min [Department of Radiation Oncology, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan (China); Lin, Hao [Department of Gynecologic Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Lan, Jen-Hong [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Chanchien, Chan-Chao [Department of Gynecologic Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Huang, Yu-Jie; Wang, Chang-Yu [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Wang, Chong-Jong, E-mail: cjw1010@adm.cgmh.org.tw [Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China)

    2013-01-01

    Purpose: To compare the treatment results of 2 fractionation schedules for high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. Methods and Materials: From June 2001 through January 2008, 267 patients with stage IB-IVA cervical cancer were enrolled in the study. All patients underwent 4-field pelvic irradiation and HDR-ICBT. The median central and parametrial doses were 39.6 Gy and 45 Gy, respectively. Patient underwent either 6 Gy Multiplication-Sign 4 (HDR-4) (n=144) or 4.5 Gy Multiplication-Sign 6 (HDR-6) (n=123) to point A of ICBT using {sup 192}Ir isotope twice weekly. The rates of overall survival, locoregional failure, distant metastasis, proctitis, cystitis, and enterocolitis were compared between HDR-4 and HDR-6. Results: There were no significant differences in the demographic data between HDR-4 and HDR-6 except for total treatment time. The 5-year proctitis rates were 23.0% and 21.5% in HDR-4 and HDR-6 (P=.399), respectively. The corresponding rates of grade 2-4 proctitis were 18.7% and 9.6% (P=.060). The corresponding rates of grades 3-4 proctitis were 5.2% and 1.3% (P=.231). Subgroup analysis revealed that HDR-4 significantly increased grade 2-4 proctitis in patients aged {>=}62 years old (P=.012) but not in patients aged <62 years (P=.976). The rates of overall survival, locoregional failure, distant metastasis, cystitis, and enterocolitis were not significantly different between HDR-4 and HDR-6 schedules. Conclusion: The small fraction size of HDR-ICBT is associated with grade 2 proctitis without compromise of prognosis in elderly patients. This schedule is suggested for patients who tolerate an additional 2 applications of HDR-ICBT.

  7. Factors for Predicting Rectal Dose of High-Dose-Rate Intracavitary Brachytherapy After Pelvic Irradiation in Patients With Cervical Cancer: A Retrospective Study With Radiography-Based Dosimetry

    Purpose: To evaluate the predictive factors for rectal dose of the first fraction of high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. Methods and Materials: From March 1993 through February 2008, 946 patients undergoing pelvic irradiation and HDR-ICBT were analyzed. Examination under anesthesia (EUA) at the first implantation of the applicator was usually performed in the early period. Rectal point was determined radiographically according to the 38th Report of the International Commission of Radiation Units and Measurements (ICRU). The ICRU rectal dose (PRD) as a percentage of point A dose was calculated; multiple linear regression models were used to predict PRD. Results: Factors influencing successful rectal dose calculation were EUA (p < 0.001) and absence of diabetes (p = 0.047). Age (p < 0.001), body weight (p = 0.002), diabetes (p = 0.020), and EUA (p < 0.001) were independent factors for the PRD. The predictive equation derived from the regression model was PRD (%) = 57.002 + 0.443 x age (years) - 0.257 x body weight (kg) + 6.028 x diabetes (no: 0; yes: 1) - 8.325 x EUA (no: 0; yes: 1) Conclusion: Rectal dose at the first fraction of HDR-ICBT is positively influenced by age and diabetes, and negatively correlated with EUA and body weight. A small fraction size at point A may be considered in patients with a potentially high rectal dose to reduce the biologically effective dose if the ICRU rectal dose has not been immediately obtained in the first fraction of HDR-ICBT.

  8. External beam and HDR intracavitary irradiation: an effective tool in the primary treatment of cervical cancer - excellent 10 year results and low side effects

    Introduction: The purpose of this paper is to present our 15 years experience in the primary treatment of cervical cancer with a combination of external beam irradiation and high dose rate brachytherapy. Survival data will be presented and the safe use of intrauterine HDR applications will be demonstrated. Material and Methods: From August 1980 to December 1990, 303 patients with cancer of the uterine cervix underwent primary irradiation in a combination of external beam and HDR intracavitary treatment at the Department of Radiation Oncology at the Sisters of Mercy Hospital in Linz, Austria. All patients were classified according to the FIGO rules: Stage I 54 patients, stage II 171, stage III 75 and stage IV 3 patients. 8 patients were lost to follow up. The mean follow up time of survivors is 110 months. Results and Discussion: A complete remission could be achieved in 282 patients, which is 93%; persistent tumour was found in 21 patients at the first follow up check 3 to 5 months after completion of irradiation. The actuarial overall survival probability for all patients at 5 and 10 years is 62 % and 42 % respectively, the disease specific survival probability is 68 % and 64 %. The local control rate at 5 and 10 years is 73 % and 72 % respectively. According to stage, disease specific survival lies at 90 % for stage I, 69 % for stage II, and 48 % for stage III and IV at 5 years, and at 10 years 87 %, 66 % and 41 % respectively. The actuarial local control probability for stages I, II, and III/IV is 90 %, 74 %, and 60 % respectively at 5 yr, and 88 %, 74 %, and 56 % at 10 yr. (Kaplan-Meier calculations). From all 303 patients 34 suffered from 40 severe and moderate side effects (glossary of Chassagne and Sismondi). The rate for grade II complications is 10 % and for grade III 3 %. Conclusion: Intrauterine HDR brachycurietherapy in addition to external beam irradiation for primary treatment of invasive carcinoma of the uterine cervix provides the same treatment

  9. Localizing intracavitary brachytherapy applicators from cone-beam CT x-ray projections via a novel iterative forward projection matching algorithm

    Pokhrel, Damodar; Murphy, Martin J.; Todor, Dorin A.; Weiss, Elisabeth; Williamson, Jeffrey F. [Department of Radiation Oncology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia 23298 (United States)

    2011-02-15

    Purpose: To present a novel method for reconstructing the 3D pose (position and orientation) of radio-opaque applicators of known but arbitrary shape from a small set of 2D x-ray projections in support of intraoperative brachytherapy planning. Methods: The generalized iterative forward projection matching (gIFPM) algorithm finds the six degree-of-freedom pose of an arbitrary rigid object by minimizing the sum-of-squared-intensity differences (SSQD) between the computed and experimentally acquired autosegmented projection of the objects. Starting with an initial estimate of the object's pose, gIFPM iteratively refines the pose parameters (3D position and three Euler angles) until the SSQD converges. The object, here specialized to a Fletcher-Weeks intracavitary brachytherapy (ICB) applicator, is represented by a fine mesh of discrete points derived from complex combinatorial geometric models of the actual applicators. Three pairs of computed and measured projection images with known imaging geometry are used. Projection images of an intrauterine tandem and colpostats were acquired from an ACUITY cone-beam CT digital simulator. An image postprocessing step was performed to create blurred binary applicators only images. To quantify gIFPM accuracy, the reconstructed 3D pose of the applicator model was forward projected and overlaid with the measured images and empirically calculated the nearest-neighbor applicator positional difference for each image pair. Results: In the numerical simulations, the tandem and colpostats positions (x,y,z) and orientations ({alpha},{beta},{gamma}) were estimated with accuracies of 0.6 mm and 2 deg., respectively. For experimentally acquired images of actual applicators, the residual 2D registration error was less than 1.8 mm for each image pair, corresponding to about 1 mm positioning accuracy at isocenter, with a total computation time of less than 1.5 min on a 1 GHz processor. Conclusions: This work describes a novel, accurate

  10. Intracavitary brachytherapy significantly enhances local control of early T-stage nasopharyngeal carcinoma: the existence of a dose-tumor-control relationship above conventional tumoricidal dose

    Purpose: To study the efficacy of intracavitary brachytherapy (ICT) in early T-stage nasopharyngeal carcinoma (NPC). Methods and Materials: All T1 and T2 (nasal infiltration) NPC treated with a curative intent from 1984 to 1996 were analyzed (n = 509). One hundred sixty-three patients were given ICT after radical external radiotherapy (ERT) (Group A). They were compared with 346 patients treated by ERT alone (Group B). The ERT delivered the tumoricidal dose (uncorrected BED-10 ≥75 Gy) to the primary tumor and did not differ between the two groups in technique or dosage. The ICT delivered a dose of 18-24 Gy in 3 fractions over 15 days to a point 1 cm perpendicular to the midpoint of the plane of the sources. ICT was used to treat local persistence diagnosed at 4-6 weeks after ERT (n = 101) or as an adjuvant for the complete responders to ERT (n = 62). Results: The two groups did not differ in patients' age or sex, rate of distant metastasis, rate of regional failure, overall survival, or the follow-up duration. However, Group A had significantly more T2 lesions and Group B had significantly more advanced N-stages. Local failure was significantly less (crude rates 6.75% vs. 13.0%; 5-year actuarial rates 5.40% vs. 10.3%) and the disease-specific mortality was significantly lower (crude rates 14.1 % vs. 21.7%; 5-year actuarial rates 11.9% vs. 16.4%) in Group A compared to Group B. Multivariate analysis showed that the ICT was the only significant prognostic factor predictive for fewer local failures (Cox regression p = 0.0328, risk ratio = 0.49, 95% confidence interval (95% CI) = 0.256-0.957). However, when ICT was excluded from the Cox regression model, the total physical dose or the total BED-10 uncorrected for tumor repopulation during the period of radiotherapy became significant in predicting ultimate local failure rate. The two groups were comparable in the incidence rates of each individual chronic radiation complication and the actuarial cumulative rate of

  11. Occupational monitoring intracavitary radium therapy

    The working exposure conditions in two big hospital in Rio de Janeiro, Brazil, that use 226Ra tubes in preloaded applicators were evaluated. The effective dose equivalents were obtained and the results of the investigation lead to the conclusion that it can be reduced to lower and reasonably achievable Le vels with good professional training, correct working conditions and afterloading techniques. (M.C.K.)

  12. Innovation in gynaecological brachytherapy: new technologies, pulse dose-rate brachytherapy, image, definition of new volumes of interest and their impact on dosimetry: application in a clinical research programme 'S.T.I.C.'

    Brachytherapy plays a fundamental role in the therapeutic approach of patients with stage I-IV cervical carcinoma. Technical modalities have evolved during the last decades: stepping source technology, imaging modalities development, specially IMN, treatment planning system integrating 3D images. Images from CT-Scan and MRI have contributed to a better knowledge of tumoral extension and critical organs. CT and/or MRI compatible applicators allow a sectional image based approach with a better definition of tumour volume compared to traditional approaches. The introduction of 3D image based approach for GTV and CTV requires new definitions and a common language. In 2000, a working group within GEC-ESTRO was created to support 3D image based 3D treatment planning approach in cervix cancer BT. The task was to determine a common terminology enabling various groups to use a common language. Recommendations were described and proposed based on clinical experience and dosimetric concepts of different institutions. Two CTVs were described en relation to the risk for recurrence: high-risk CTV and intermediate risk CTV. In order to better define the role of such definitions and their potential impact on the complication incidence in patients with cervical cancer, a special French programme was developed. The aim of this programme is to study the incidence of the severe 2-year complication rate in two comparable patient populations: one population is treated using PDR brachytherapy with CT-Scan or MRI with the applicators in place allowing a 3D dosimetry with optimization, the second population is treated using standard X-rays radiographs, without any delineation of the target nor optimisation. Each population arm includes 425 patients. A medico-economic assessment is performed, allowing a real cost of the most sophisticated approach compared to a historical dosimetric system. (author)

  13. Transforming Growth Factor β-1 (TGF-β1) Is a Serum Biomarker of Radiation Induced Fibrosis in Patients Treated With Intracavitary Accelerated Partial Breast Irradiation: Preliminary Results of a Prospective Study

    Purpose: To examine a relationship between serum transforming growth factor β -1 (TGF-β1) values and radiation-induced fibrosis (RIF). Methods and Materials: We conducted a prospective analysis of the development of RIF in 39 women with American Joint Committee on Cancer stage 0-I breast cancer treated with lumpectomy and accelerated partial breast irradiation via intracavitary brachytherapy (IBAPBI). An enzyme-linked immunoassay (Quantikine, R and D, Minneapolis, MN) was used to measure serum TGF-β1 before surgery, before IBAPBI, and during IBAPBI. Blood samples for TGF-β1 were also collected from 15 healthy, nontreated women (controls). The previously validated tissue compliance meter (TCM) was used to objectively assess RIF. Results: The median time to follow-up for 39 patients was 44 months (range, 5-59 months). RIF was graded by the TCM scale as 0, 1, 2, and 3 in 5 of 20 patients (25%), 6 of 20 patients (30%), 5 of 20 patients (25%), and 4 of 20 patients (20%), respectively. The mean serum TGF-β1 values were significantly higher in patients before surgery than in disease-free controls, as follows: all cancer patients (30,201 ± 5889 pg/mL, P=.02); patients with any type of RIF (32,273 ± 5016 pg/mL, PROC of 0.867 (95% confidence interval 0.700-1.000). The TGF-β1 threshold cutoff was determined to be 31,000 pg/mL, with associated sensitivity and specificity of 77.8% and 90.0%, respectively. Conclusions: TGF-β1 levels correlate with the development of moderate to severe RIF. The pre-IBAPBI mean TGF-β1 levels can serve as an early biomarker for the development of moderate to severe RIF after IBAPBI

  14. Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

    Purpose: To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. Methods and Materials: Eligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size 10 (α/β = 10) at point A. The primary endpoint was the 2-year pelvic disease progression-free (PDPF) rate. All patients received a radiotherapy quality assurance review. Results: Between September 2004 and July 2007, 60 eligible patients were enrolled. Thirty-six patients were assessed with FIGO stage Ib1; 12 patients with stage IIa; and 12 patients with stage IIb. Median tumor diameter was 28 mm (range, 6–39 mm). Median overall treatment time was 43 days. Median follow-up was 49 months (range, 7–72 months). Seven patients developed recurrences: 3 patients had pelvic recurrences (2 central, 1 nodal), and 4 patients had distant metastases. The 2-year PDPF was 96% (95% confidence interval [CI], 92%–100%). The 2-year disease-free and overall survival rates were 90% (95% CI, 82%–98%) and 95% (95% CI, 89%–100%), respectively. The 2-year late complication rates (according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer of Grade ≥1) were 18% (95% CI, 8%–28%) for large intestine/rectum, 4% (95% CI, 0%–8%) for small intestine, and 0% for bladder. No Grade ≥3 cases were observed for genitourinary/gastrointestinal late complications. Conclusions: These results suggest that definitive radiotherapy using HDR-ICBT with a low cumulative dose schedule (BED, 62 Gy10 at point A) can provide excellent local control without severe toxicity in nonbulky (<4-cm) early-stage cervical cancer.

  15. Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

    Toita, Takafumi, E-mail: b983255@med.u-ryukyu.ac.jp [Department of Radiology, Graduate School of Medical Science, University of Ryukyus, Okinawa (Japan); Kato, Shingo [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan); Kataoka, Masaaki [Department of Radiology, National Shikoku Cancer Center, Ehime (Japan); Shikama, Naoto [Department of Radiation Oncology, Saku Central Hospital, Saku (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan); Tokumaru, Sunao [Department of Radiology, Saga University, Saga (Japan); Yamauchi, Chikako [Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan); Suzuki, Osamu [Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan); Sakurai, Hideyuki [Proton Medical Research Center and Tsukuba University, Tsukuba (Japan); Numasaki, Hodaka; Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital, Tokyo (Japan); Kagami, Yoshikazu [Radiation Oncology Division, National Cancer Center Hospital, Tokyo (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

    2012-01-01

    Purpose: To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. Methods and Materials: Eligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size <40 mm in diameter (assessed by T2-weighted magnetic resonance imaging), and no pelvic/para-aortic lymphadenopathy. The treatment protocol consisted of whole-pelvis external beam radiotherapy (EBRT) of 20 Gy/10 fractions, pelvic EBRT with midline block of 30 Gy/15 fractions, and HDR-ICBT of 24 Gy/4 fractions (at point A). The cumulative biologically effective dose (BED) was 62 Gy{sub 10} ({alpha}/{beta} = 10) at point A. The primary endpoint was the 2-year pelvic disease progression-free (PDPF) rate. All patients received a radiotherapy quality assurance review. Results: Between September 2004 and July 2007, 60 eligible patients were enrolled. Thirty-six patients were assessed with FIGO stage Ib1; 12 patients with stage IIa; and 12 patients with stage IIb. Median tumor diameter was 28 mm (range, 6-39 mm). Median overall treatment time was 43 days. Median follow-up was 49 months (range, 7-72 months). Seven patients developed recurrences: 3 patients had pelvic recurrences (2 central, 1 nodal), and 4 patients had distant metastases. The 2-year PDPF was 96% (95% confidence interval [CI], 92%-100%). The 2-year disease-free and overall survival rates were 90% (95% CI, 82%-98%) and 95% (95% CI, 89%-100%), respectively. The 2-year late complication rates (according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer of Grade {>=}1) were 18% (95% CI, 8%-28%) for large intestine/rectum, 4% (95% CI, 0%-8%) for small intestine, and 0% for bladder. No Grade {>=}3 cases were

  16. Transforming Growth Factor β-1 (TGF-β1) Is a Serum Biomarker of Radiation Induced Fibrosis in Patients Treated With Intracavitary Accelerated Partial Breast Irradiation: Preliminary Results of a Prospective Study

    Boothe, Dustin L. [Weill Cornell Medical College of Cornell University, New York, New York (United States); Coplowitz, Shana [Department of Radiation Oncology, Stich Radiation Center, Weill Cornell Medical College of Cornell University, New York, New York (United States); Greenwood, Eleni [Weill Cornell Medical College of Cornell University, New York, New York (United States); Barney, Christian L. [Department of Radiation Oncology, Ohio State University, Columbus, Ohio (United States); Christos, Paul J. [Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College of Cornell University, New York, New York (United States); Parashar, Bhupesh; Nori, Dattatreyudu; Chao, K. S. Clifford [Department of Radiation Oncology, Stich Radiation Center, Weill Cornell Medical College of Cornell University, New York, New York (United States); Wernicke, A. Gabriella, E-mail: gaw9008@med.cornell.edu [Department of Radiation Oncology, Stich Radiation Center, Weill Cornell Medical College of Cornell University, New York, New York (United States)

    2013-12-01

    Purpose: To examine a relationship between serum transforming growth factor β -1 (TGF-β1) values and radiation-induced fibrosis (RIF). Methods and Materials: We conducted a prospective analysis of the development of RIF in 39 women with American Joint Committee on Cancer stage 0-I breast cancer treated with lumpectomy and accelerated partial breast irradiation via intracavitary brachytherapy (IBAPBI). An enzyme-linked immunoassay (Quantikine, R and D, Minneapolis, MN) was used to measure serum TGF-β1 before surgery, before IBAPBI, and during IBAPBI. Blood samples for TGF-β1 were also collected from 15 healthy, nontreated women (controls). The previously validated tissue compliance meter (TCM) was used to objectively assess RIF. Results: The median time to follow-up for 39 patients was 44 months (range, 5-59 months). RIF was graded by the TCM scale as 0, 1, 2, and 3 in 5 of 20 patients (25%), 6 of 20 patients (30%), 5 of 20 patients (25%), and 4 of 20 patients (20%), respectively. The mean serum TGF-β1 values were significantly higher in patients before surgery than in disease-free controls, as follows: all cancer patients (30,201 ± 5889 pg/mL, P=.02); patients with any type of RIF (32,273 ± 5016 pg/mL, P<.0001); and women with moderate to severe RIF (34,462 ± 4713 pg/mL, P<0.0001). Patients with moderate to severe RIF had significantly elevated TGF-β1 levels when compared with those with none to mild RIF before surgery (P=.0014) during IBAPBI (P≤0001), and the elevation persisted at 6 months (P≤.001), 12 months (P≤.001), 18 months (P≤.001), and 24 months (P=.12). A receiver operating characteristic (ROC) curve of TGF-β1 values predicting moderate to severe RIF was generated with an area under the curve (AUC){sub ROC} of 0.867 (95% confidence interval 0.700-1.000). The TGF-β1 threshold cutoff was determined to be 31,000 pg/mL, with associated sensitivity and specificity of 77.8% and 90.0%, respectively. Conclusions: TGF-β1 levels correlate with

  17. Aspectos técnicos da cateterização do seio coronariano baseada no componente atrial do eletrograma intracavitário e anatomia radiológica durante o procedimento de implante de marcapasso biventricular Technical aspects of coronary sinus catheterization based on the atrial component of the intracavitary electrogram and radiological anatomy during the implantation procedure of a biventricular pacemaker

    Fernando Sérgio Oliva de Souza

    2006-04-01

    Full Text Available OBJETIVO: Apresentar uma proposição técnica baseada na experiência de 130 implantes utilizando técnica simplificada para cateterização do seio coronariano, baseada no componente atrial do eletrograma intracavi-tário e anatomia radiológica. MÉTODOS: De outubro de 2001 a outubro de 2004 foram realiza-dos 130 implantes de marcapasso biventricular, utilizando-se anatomia radiológica e observação de eletrograma intracavitário, com prioridade ao componente atrial. RESULTADOS: O implante do sistema, utilizando-se a estimulação do ventrículo esquerdo via seio coronariano, não foi possível em 8 pacientes. Em 12 pacientes foram observadas dificuldades na canulação do óstio coronário e em 15 pacientes observaram-se dificuldades de progressão do eletrodo através do seio coronariano. O tempo médio de utilização de radioscopia foi de 18,69 min. CONCLUSÃO: A técnica de implante, utilizando a morfologia do componente atrial do eletrograma intracavitário e anatomia radiológica, demonstrou ser pouco trabalhosa, segura e eficaz para canulação do óstio do seio coronariano, necessitando de reduzido tempo de radioscopia.OBJECTIVE: To present a technical proposal based on the experience of 130 implantations using a simplified technique for coronary sinus catheterization, based on the atrial component of the intracavitary electrogram and radiological anatomy. METHODS: From October, 2001 to October, 2004, 130 biventricular pacemaker implantations were performed, using radiological anatomy and observation of the intracavitary electrogram, focusing on the atrial component. RESULTS: The implantation of the system using left ventricular pacing via coronary sinus was not possible in 8 patients. Difficulties on the cannulation of the coronary ostium were felt in 12 patients and difficulties of lead advancement through the coronary sinus were felt in 15 patients. The mean time of radioscopy utilization was 18.69 min. CONCLUSION: The

  18. Coexistência de colonização fúngica intracavitária (bola fúngica e tuberculose ativa Coexistence of intracavitary fungal colonization (fungus ball and active tuberculosis

    Gisela Unis

    2005-04-01

    Full Text Available INTRODUÇÃO: Embora a tuberculose pulmonar seja o principal fator predisponente para o surgimento de colonização fúngica em cavidade saneada, a coexistência das duas doenças é rara. A simultaneidade de colonização fúngica e micobacteriose ativa na mesma cavidade (bacilos álcool-ácido resistentes entre as massas de hifas é excepcional. OBJETIVO: Descrever achados clínicos, diagnósticos, radiológicos, condições associadas e evolução em pacientes com tuberculose e colonização fúngica intracavitária pulmonar. MÉTODO: Foram avaliadas, retrospectivamente, fichas clínicas de 625 pacientes, entre os anos de 1974 e 2002, com bola fúngica diagnosticada por imunodifusão e/ou estudo micológico. O critério de inclusão foi baciloscopia positiva no escarro ou em histopatologia. RESULTADOS: Foram selecionados catorze pacientes. Todos apresentaram hemoptise, seguida de tosse com expectoração, dispnéia, emagrecimento, febre, astenia e dor torácica. Em dois casos, um colonizado por Aspergillus niger e outro por Scedosporium apiospermum (Teleomorfo, Pseudallescheria boydii, houve concomitância lesional da tuberculose ativa e bola fúngica. Nos demais, a micobactéria foi encontrada em parênquima circunjacente ou em pulmão contralateral. CONCLUSÃO: Este estudo corrobora o antagonismo entre A. fumigatus e Mycobacterium tuberculosis. A possibilidade de concomitância de colonização fúngica e micobacteriose é demonstrada em outros agentes fúngicos, particularmente S. apiospermum (P. boydii e A. niger.BACKGROUND: Although pulmonary tuberculosis is the principal predisposing factor for intracavitary fungal colonization, the coexistence of the two diseases is rare. Simultaneity of fungal colonization and active mycobacteriosis in the same cavity (acid-fast bacilli found among hyphal masses is highly unusual. OBJECTIVE: To describe clinical findings, diagnostic procedures, radiographic aspects, accompanying conditions and

  19. Occupational monitoring in intracavitary radium therapy

    In Brazil, the highest incidence of cancer in females is in the uterine cervix, in which Bracytherapy treatment plays a very important role. The majority of our Clinics use 226Ra or 137Cs tubes to perform this therapy. As many of these Clinics do not use the afterloading technique, we investigated the occupational exposure for the staffs belonging to two big Hospitals in Rio de Janeiro, where the working conditions are very different. For this, besides the normal film badge, placed in the upper part of the trunk, each person has been provided with seven additional thermoluminescent dosimeters (chips - 7LiF) placed at: left ring finger, right ring finger, forehead (between the eyes), over the thyroid, in the midle of the back and the front of the trunk, and over the gonadal region. In Hospital A, where the staff is composed of 1 medical doctor and 1 nurse, they treat about 13 patients per month. In Hospital B, the staff was composed of 12 medical doctors, 2 technicians and 7 murses, and about 20 patients are treated monthly. The occupational exposures have been investigated separately for each step of the 226Ra routine. From these results we could easily identify that: the nurses working in the infermary do not use the lateral lead protection of beds to clean the patients; in Hospital B, where there are perfect conditions for storage and manipulation of the radioactive sources, the technician in charge of these tasks, together with the transport of the applicator, except in his hands, suffers no exposure at all. Besides that, we could also see that in Hospital A, where the nurse plays also the role of that technician, and the local protection conditions are not correct, the estimated annual exposures are still below the annual limits according to ICRP N0. 26/1977. This analysis has been completed with measures of occupational exposures in Clinics using the after loading technique. (author)

  20. Perioperative morbidity of intracavitary gynecologic brachytherapy

    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs

  1. Perioperative morbidity of intracavitary gynecologic brachytherapy

    Lanciano, R.; Corn, B.; Martin, E.; Schulthesis, T.; Hogan, W.M.; Rosenblum, N. [Fox Chase Cancer Center, Philadelphia, PA (United States)

    1994-07-30

    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs.

  2. Clinical and dosimetric results of three-dimensional image-guided and pulsed dose rate curie-therapy in locally advanced cervical cancers; Resultats cliniques et dosimetriques de la curietherapie de debit de dose pulse guidee par imagerie tridimensionnelle dans les cancers du col de l'uterus localement evolues

    Mazeron, R.; Gilmore, J.; Dumas, I.; Abrous-Anane, S.; Haberer, S.; Verstraet, R.; Champoudry, J.; Martinetti, F.; Morice, P.; Haie-Meller, C. [Institut de cancerologie Gustave-Roussy, Villejuif (France)

    2011-10-15

    The authors report a review of data obtained between 2004 and 2009 on 130 women who had been treated by optimized pulsed-rate curie-therapy for a locally advanced cervical cancer. Results are discussed in terms of cancer stage, treatment (with or without concomitant chemotherapy), planning method (MRI, scanography), delivered doses in the clinical target volumes, surgery, relapse occurrence and localizations, global survival probability, local control, undesirable side effects, occurrence of intestine or urinary toxicity. It appears that the association of a concomitant chemo-radiotherapy and optimized curie-therapy results in a good local-regional control and a low toxicity level. Short communication

  3. Citron - the first indigenous remote afterloading intracavitary brachytherapy unit

    In keeping with its tradition of pioneering cancer patient cure and care, the Cancer Institute embarked on a project funded by DAE in 1994 to develop an economical import substitute. The prototype unit named CITRON promises to be a suitable import substitute satisfying a long standing need in the country

  4. Innovation in gynaecological brachytherapy: new technologies, pulse dose-rate brachytherapy, image, definition of new volumes of interest and their impact on dosimetry: application in a clinical research programme 'S.T.I.C.'; Nouveautes en curietherapie gynecologique: nouvelles technologies, curietherapie pulsee, imagerie, definitions de nouveaux volumes d'interet et leur impact sur la dosimetrie: applications dans le cadre d'un STIC

    Haie-Meder, C. [Institut Gustave-Roussy, Service de Curietherapie, 94 - Villejuif (France); Peiffert, D. [Centre Alexis-Vautrin, Service de Radiotherapie, 54 - Vandoeuvre-Les-Nancy (France)

    2006-11-15

    Brachytherapy plays a fundamental role in the therapeutic approach of patients with stage I-IV cervical carcinoma. Technical modalities have evolved during the last decades: stepping source technology, imaging modalities development, specially IMN, treatment planning system integrating 3D images. Images from CT-Scan and MRI have contributed to a better knowledge of tumoral extension and critical organs. CT and/or MRI compatible applicators allow a sectional image based approach with a better definition of tumour volume compared to traditional approaches. The introduction of 3D image based approach for GTV and CTV requires new definitions and a common language. In 2000, a working group within GEC-ESTRO was created to support 3D image based 3D treatment planning approach in cervix cancer BT. The task was to determine a common terminology enabling various groups to use a common language. Recommendations were described and proposed based on clinical experience and dosimetric concepts of different institutions. Two CTVs were described en relation to the risk for recurrence: high-risk CTV and intermediate risk CTV. In order to better define the role of such definitions and their potential impact on the complication incidence in patients with cervical cancer, a special French programme was developed. The aim of this programme is to study the incidence of the severe 2-year complication rate in two comparable patient populations: one population is treated using PDR brachytherapy with CT-Scan or MRI with the applicators in place allowing a 3D dosimetry with optimization, the second population is treated using standard X-rays radiographs, without any delineation of the target nor optimisation. Each population arm includes 425 patients. A medico-economic assessment is performed, allowing a real cost of the most sophisticated approach compared to a historical dosimetric system. (author)

  5. A method of quality audit for treatment planning system for intracavitary HDR brachytherapy

    High dose rate brachytherapy is a multipurpose modality. Quality audit (QAu) is an independent examination and evaluation of quality assurance activities and results of an institution. Both clinical and physical aspects of patient treatments must be subjected to careful control and planning to achieve a high degree of accuracy in radiation therapy treatments. Comprehensive quality assurance (QA) programmes should be established to cover all steps from dose prescription to dose delivery. These programmes should include detailed internal checks performed by the radiotherapy centres and external audits made by independent bodies. A systematic and independent examination and evaluation to determine whether quality activities and results comply with planned arrangements and whether the arrangements are implemented effectively and are suitable to achieve objectives is called quality audit. One purpose of a quality audit (QAu) is to evaluate the need for improvement or corrective action

  6. External r[iotherapy plus intracavitary brachytherapy for recurrent chordoma of the nasopharynx

    We report a case of recurrent nasopharyngeal chordoma treated by external beam r[iotherapy plus brachytherapy, and discuss this technique in relation to treatment modalities reported in the literature. (orig.)

  7. Biological effective doses in the intracavitary high dose rate brachytherapy of cervical cancer

    Y. Sobita Devi

    2011-12-01

    Full Text Available Purpose: The aim of this study is to evaluate the decrease of biological equivalent dose and its correlation withlocal/loco-regional control of tumour in the treatment of cervical cancer when the strength of the Ir-192 high dose rate(HDR brachytherapy (BT source is reduced to single, double and triple half life in relation to original strength of10 Ci (~ 4.081 cGy x m2 x h–1. Material and methods: A retrospective study was carried out on 52 cervical cancer patients with stage II and IIItreated with fractionated HDR-BT following external beam radiation therapy (EBRT. International Commission onRadiation Units and Measurement (ICRU points were defined according to ICRU Report 38, using two orthogonal radiographimages taken by Simulator (Simulix HQ. Biologically effective dose (BED was calculated at point A for diffe -rent Ir-192 source strength and its possible correlation with local/loco-regional tumour control was discussed. Result: The increase of treatment time per fraction of dose due to the fall of dose rate especially in HDR-BT of cervicalcancer results in reduction in BED of 2.59%, 7.02% and 13.68% with single, double and triple half life reduction ofsource strength, respectively. The probabilities of disease recurrence (local/loco-regional within 26 months are expectedas 0.12, 0.12, 0.16, 0.39 and 0.80 for source strength of 4.081, 2.041, 1.020, 0.510 and 0.347 cGy x m2 x h–1, respectively.The percentages of dose increase required to maintain the same BED with respect to initial BED were estimated as1.71, 5.00, 11.00 and 15.86 for the dose rate of 24.7, 12.4, 6.2 and 4.2 Gy/hr at point A, respectively. Conclusions: This retrospective study of cervical cancer patients treated with HDR-BT at different Ir-192 sourcestrength shows reduction in disease free survival according to the increase in treatment time duration per fraction.The probable result could be associated with the decrease of biological equivalent dose to point A. Clinical end pointof this study is more significant from double half life reduction of original source strength.

  8. Fractionation and protaction in the intracavitary local irradiation of gynecological tumors

    The difficulties of dosage and temporary adaptation of the short time afterloading therapy to an optimal healing result combined with a minimum of side-effects in radiotherapy of gynecological tumors are still not solved yet. Only a therapy scheme which parts from the good results of the long term radium therapy in combination with an adequately dosed and distributed deep therapy has a chance to replace the radium therapy of gynecological tumors in the long run. (orig.)

  9. Intracavitary radiotherapy of cervix carcinoma with flexible applicators after vesicovaginal interposition operation of the uterus

    Advantages of new flexible intracervical applicators treating cervical cancer with high dose rate afterloading brachytherapy are reported: The insertion of the flexible applicator is usually possible without anesthesia and dilatation of the cervix. Therefore the treatment can be performed on an outpatient basis. The risks of perforation and infection are minimal. Dosimetry and documentation of the applicator geometry are possible, if the planning system allows the definition of individual curves of an individual applicator. We now prefer flexible applicators instead of rigid steel applicators treating cervix carcinoma. (orig.)

  10. Determination of the dose around an ovoid for treatments in intracavitary brachytherapy Hdr

    On this work the results of the dosimetric measurements are presented around an ovoid of 2 cm diameter. The measurements were carried out using a water mannequin, an ovoid, a radiation gamma source of 192Ir and thermoluminescent dosemeters. The dosimetry was realized in the direction of the rectum and bladder. To know the effect of the shielding of the devices type Manchester in the dose, the thermoluminescent dosemeters were irradiated to a radiation gamma source of 192Ir contained in the Gamma med Plus equipment. The planning was realized normalizing the calculation to 2.5 cm from the applicator center on the transverse plane (2.5, 0, 0). The results show that the dose distribution for an ovoid without shielding is more uniform in the transversal plane to the source axis. The results were compared with the calculated results by means of the planning system BrachyVision. While the absorbed dose distribution around an ovoid with shielding is completely anisotropic. This anisotropic is due to the shielding. (Author)

  11. Long-term effects of an intracavitary treatment with californium-252 on normal tissue

    About one hundred fifty swine were exposed to either radium-226 or californium-252 sources in the uterine cervix to determine an RBE for both acute and long-term effects. That value for early changes in the tissues at risk in the treatment of cervical cancer was between 6.2 and 6.8. The incidence of complications increased with time after exposure, especially among animals treated with 252Cf. Analysis of rectal injury showed that ulceration occurred frequently within a year postexposure at doses between 1600 and 2400 rad calculated at 2 cm lateral to the source midline. Fat necrosis and smooth muscle atrophy, resulting in a local rectal stricture, were delayed changes observed in some animals. The lower ureter was the site for a greater frequency of complications than the GI tract. Ureteral stricture often occurred at doses of 1200 rad from 252Cf and 7000 rad from 226Ra. Observation of delayed effects in the uterine-cervix in animals held up to 4 years postexposure indicate that the RBE for 252Cf may be increased to a value as high as 18, while repair may have even decreased it to about 5.6 in the rectum. Fifty swine are still being observed for long-term effects after doses above 800 rad from 252Cf and 5000 rad from 226Ra

  12. Impact of delineation uncertainties on dose to organs at risk in CT-guided intracavitary brachytherapy.

    Duane, Frances K

    2014-08-07

    This study quantifies the inter- and intraobserver variations in contouring the organs at risk (OARs) in CT-guided brachytherapy (BT) for the treatment of cervical carcinoma. The dosimetric consequences are reported in accordance with the current Gynecological Groupe Européen de Curiethérapie\\/European Society for Therapeutic Radiology and Oncology guidelines.

  13. Intracavitary radiotherapy of tongue and oral cavity bottom mucouse membrane carcinomas

    The paper describes a Co-60 sources featuring enhanced activity at the ends which are used by the method of sequential two-stage manual introduction. The source is most acceptable for treating oral cavity tumors. A technique of intratissue, package and combined radiation treatment is proposed within the 3-level (stage) scheme which has enabled 3-year survival for all stages of tongue cancer in 61.8% of cases and that of oral cavity bottom mucouse in 72.2% of cases

  14. Dose distribution and risk factors in tele cobalt therapy and intracavitary treatment with sealed sources of Cesium-137

    The purpose of this work is to evaluate dose to organs, outside the treatment volume. The experimental measurements were done using TLD dosemeters, placed in various regions of a Rando Alderson Phantom. The theoretical absorbed doses were calculated using the Monte Carlo method applied to a mathematical phantom. (author)

  15. Long-term effects of an intracavitary treatment with californium-252 on normal tissue. [Swine, /sup 226/Ra

    Sullivan, M.F.; Beamer, J.L.; Mahony, T.D.; Cross, F.T.; Lund, J.E.; Endres, G.W.R.

    1976-01-01

    About one hundred fifty swine were exposed to either radium-226 or californium-252 sources in the uterine cervix to determine an RBE for both acute and long-term effects. That value for early changes in the tissues at risk in the treatment of cervical cancer was between 6.2 and 6.8. The incidence of complications increased with time after exposure, especially among animals treated with /sup 252/Cf. Analysis of rectal injury showed that ulceration occurred frequently within a year postexposure at doses between 1600 and 2400 rad calculated at 2 cm lateral to the source midline. Fat necrosis and smooth muscle atrophy, resulting in a local rectal stricture, were delayed changes observed in some animals. The lower ureter was the site for a greater frequency of complications than the GI tract. Ureteral stricture often occurred at doses of 1200 rad from /sup 252/Cf and 7000 rad from /sup 226/Ra. Observation of delayed effects in the uterine-cervix in animals held up to 4 years postexposure indicate that the RBE for /sup 252/Cf may be increased to a value as high as 18, while repair may have even decreased it to about 5.6 in the rectum. Fifty swine are still being observed for long-term effects after doses above 800 rad from /sup 252/Cf and 5000 rad from /sup 226/Ra.

  16. Evaluation of two intracavitary high-dose-rate brachytherapy devices for irradiating additional and irregularly shaped volumes of breast tissue

    Lu, Sharon M., E-mail: sharonlu@ucsd.edu [Department of Radiation Oncology and Center for Advanced Radiotherapy Technologies (CART), University of California, San Diego, La Jolla, CA (United States); Scanderbeg, Daniel J.; Barna, Patrick; Yashar, William; Yashar, Catheryn [Department of Radiation Oncology and Center for Advanced Radiotherapy Technologies (CART), University of California, San Diego, La Jolla, CA (United States)

    2012-04-01

    The SAVI and Contura breast brachytherapy applicators represent 2 recent advancements in brachytherapy technology that have expanded the number of women eligible for accelerated partial breast irradiation in the treatment of early-stage breast cancer. Early clinical experience with these 2 single-entry, multichannel high-dose-rate brachytherapy devices confirms their ease of use and dosimetric versatility. However, current clinical guidelines for SAVI and Contura brachytherapy may result in a smaller or less optimal volume of treated tissue compared with traditional interstitial brachytherapy. This study evaluates the feasibility of using the SAVI and Contura to irradiate larger and irregularly shaped target volumes, approaching what is treatable with the interstitial technique. To investigate whether additional tissue can be treated, 17 patients treated with the SAVI and 3 with the Contura were selected. For each patient, the planning target volume (PTV) was modified to extend 1.1 cm, 1.3 cm, and 1.5 cm beyond the tumor bed cavity. To evaluate dose conformance to an irregularly shaped target volume, 9 patients treated with the SAVI and 3 with the Contura were selected from the original 20 patients. The following asymmetric PTV margin combinations were assessed for each patient: 1.5/0.3, 1.3/0.3, and 1.1/0.3 cm. For all patients, treatment planning was performed, adopting the National Surgical Adjuvant Breast and Bowel Project guidelines, and dosimetric comparisons were made. The 6-1 and 8-1 SAVI devices can theoretically treat a maximal tissue margin of 1.5 cm and an asymmetric PTV with margins ranging from 0.3 to 1.5 cm. The 10-1 SAVI and Contura can treat a maximal margin of 1.3 cm and 1.1 cm, respectively, and asymmetric PTV with margins ranging from 0.3-1.3 cm. Compared with the Contura, the SAVI demonstrated greater dosimetric flexibility. Risk of developing excessive hot spots increased with the size of the SAVI device. Both the SAVI and Contura appear capable of treating >1.0-cm margins and irregularly shaped PTVs. The 6-1 SAVI device demonstrated the greatest versatility in targeting PTVs approaching what is treatable using the interstitial technique.

  17. Determination of the dose around an ovoid for treatments in intracavitary brachytherapy Hdr; Determinacion de la dosis alrededor de un ovoide para tratamientos en braquiterapia intracavitaria HDR

    Rivera M, T. [IPN, Centro de Investigacion en Ciencia Aplicada y Tecnologia Avanzada, Legaria No. 694, Col. Irrigacion, 11500 Mexico D. F. (Mexico); Velasco V, R. A. E. [Hospital Central Militar, Periferico y Ejercito Nacional s/n, Lomas de Sotelo, 11200 Mexico D. F. (Mexico); Serrano F, A. K. [Hospital Juarez de Mexico, Av. Instituto Politecnico Nacional No. 5190, Col. Magdalena de las Salinas, 03220 Mexico D. F. (Mexico); Azorin N, J., E-mail: trivera@ipn.m [Universidad Autonoma Metropolitana, Unidad Iztapalapa, Av. San Rafael Atlixco No. 186, Col. Vicentina, 09340 Mexico D. F. (Mexico)

    2010-09-15

    On this work the results of the dosimetric measurements are presented around an ovoid of 2 cm diameter. The measurements were carried out using a water mannequin, an ovoid, a radiation gamma source of {sup 192}Ir and thermoluminescent dosemeters. The dosimetry was realized in the direction of the rectum and bladder. To know the effect of the shielding of the devices type Manchester in the dose, the thermoluminescent dosemeters were irradiated to a radiation gamma source of {sup 192}Ir contained in the Gamma med Plus equipment. The planning was realized normalizing the calculation to 2.5 cm from the applicator center on the transverse plane (2.5, 0, 0). The results show that the dose distribution for an ovoid without shielding is more uniform in the transversal plane to the source axis. The results were compared with the calculated results by means of the planning system BrachyVision. While the absorbed dose distribution around an ovoid with shielding is completely anisotropic. This anisotropic is due to the shielding. (Author)

  18. Modeling correlation indices between bladder and Foley′s catheter balloon dose with CT-based planning using limited CT slices in intracavitary brachytherapy for carcinoma of cervix

    Oinam Arun

    2008-01-01

    Full Text Available Purpose: To derive and validate an index to correlate the bladder dose with the catheter balloon dose using limited computed tomography (CT slices. Materials and Methods: Applicator geometry reconstructed from orthogonal radiographs were back-projected on CT images of the same patients for anatomy-based dosimetric evaluation. The correlation indices derived using power function of the catheter balloon dose and the bladder volume dose were validated in 31 patients with cervical cancer. Results: There was significant correlation between International Commission on Radiation Units (ICRU-38 balloon reference dose (Dr and the dose received by 25% bladder volume (D 25 (P < 0.0001. Significant correlation was also found between the reference dose of mid-balloon point (D rm and the dose to D 25 (P < 0.0001. Average percentage difference [100 x (observed index - expected index / expected index] of observed value of I′ 25 (index for the dose to D25 bladder with respect to mid-balloon reference point from that of expected value was 0.52%, when the index was modeled with reference dose alone. Similarly the average percentage difference for I′10cc (index for the dose to 10 cc volume of bladder with respect to mid balloon point was 0.84%. When this index was modeled with absolute bladder volume and reference dose, standard deviation of the percentage difference between observed and expected index for D rm reduced by approximately 2% when compared to D r . Conclusion: For clinical applications, correlation index modeled with reference dose and volume predicts dose to absolute volume of bladder. Correlation index modeled with reference dose gives a good estimate of dose to relative bladder volume. From our study, we found D rm to be a better indicator of bladder dose than D r .

  19. To analyze the impact of intracavitary brachytherapy as boost radiation after external beam radiotherapy in carcinoma of the external auditory canal and middle ear: A retrospective analysis

    Dinesh K Badakh

    2014-01-01

    Conclusion: ICBT as a boost after EBRT has got a positive impact on the OS. In conclusion, our results demonstrate that radical radiation therapy (EBRT and ICBT is the treatment of choice for stage T2, carcinoma of EACMA.

  20. SU-F-19A-04: Dosimetric Evaluation of a Novel CT/MR Compatible Fletcher Applicator for Intracavitary Brachytherapy of the Cervix Uteri

    Gifford, K; Han, T [UT MD Anderson Cancer Center, Houston, TX (United States); Mourtada, F [Christiana Care Hospital, Newark, DE (United States); Eifel, P [The UT MD Anderson Cancer Center, Houston, TX (United States)

    2014-06-15

    Purpose: To validate a Monte Carlo model and evaluate the dosimetric capabilities of a novel commercial CT/MR compatible Fletcher applicator for cervical cancer brachytherapy. Methods: MCNPX 2.7.0 was used to model the Fletcher CT/MR shielded applicator (FA) and 192Ir HDR source. Energy deposition was calculated with a track length estimator modified by an energy-dependent heating function. A high density polystyrene phantom was constructed with three film pockets for validation of the MCNPX model. Three planes of data were calculated with the MCNPX model corresponding to the three film planes in phantom. The planes were located 1 cm from the most anterior, posterior, and medial extents of the FA right ovoid. Unshielded distributions were calculated by modeling the shielded cells as air instead of the tungsten alloy. A third order polynomial fit to the OD to dose curve was used to convert OD of the three film planes to dose. Each film and MCNPX plane dose distribution was normalized to a point 2 cm from the center of the film plane and in a region of low dose gradient. MCNPX and film were overlaid and compared with a distance-to-agreement criterion of (±2%/±2mm). Shielded and unshielded distributions were overlaid and a percent shielded plot was created. Results: 85.2%, 97.1%, and 96.6% of the MCNPX points passed the (±2%/±2mm) criterion respectively for the anterior, lateral, and posterior film comparison planes. A majority of the points in the anterior plane that exceeded the DTA criterion were either along edges of where the film was cut or near the terminal edges of the film. The percent shielded matrices indicated that the maximum % shielding was 50%. Conclusion: These data confirm the validity of the FA Monte Carlo model. The FA ovoid can shield up to 50% of the dose in the anteroposterior direction.

  1. Comparison of DVH parameters and loading patterns of standard loading, manual and inverse optimization for intracavitary brachytherapy on a subset of tandem/ovoid cases

    Purpose: Comparison of inverse planning with the standard clinical plan and with the manually optimized plan based on dose-volume parameters and loading patterns. Materials and methods: Twenty-eight patients who underwent MRI based HDR brachytherapy for cervix cancer were selected for this study. Three plans were calculated for each patient: (1) standard loading, (2) manual optimized, and (3) inverse optimized. Dosimetric outcomes from these plans were compared based on dose-volume parameters. The ratio of Total Reference Air Kerma of ovoid to tandem (TRAKO/T) was used to compare the loading patterns. Results: The volume of HR CTV ranged from 9-68 cc with a mean of 41(±16.2)cc. Mean V100 for standard, manual optimized and inverse plans was found to be not significant (p = 0.35, 0.38, 0.4). Dose to bladder (7.8 ± 1.6 Gy) and sigmoid (5.6 ± 1.4 Gy) was high for standard plans; Manual optimization reduced the dose to bladder (7.1 ± 1.7 Gy p = 0.006) and sigmoid (4.5 ± 1.0 Gy p = 0.005) without compromising the HR CTV coverage. The inverse plan resulted in a significant reduction to bladder dose (6.5 ± 1.4 Gy, p = 0.002). TRAK was found to be 0.49(±0.02), 0.44(±0.04) and 0.40(±0.04)cGy m-2 for the standard loading, manual optimized and inverse plans, respectively. It was observed that TRAKO/T was 0.82(±0.05), 1.7(±1.04) and 1.41(±0.93) for standard loading, manual optimized and inverse plans, respectively, while this ratio was 1 for the traditional loading pattern. Conclusions: Inverse planning offers good sparing of critical structures without compromising the target coverage. The average loading pattern of the whole patient cohort deviates from the standard Fletcher loading pattern.

  2. Clinical outcome and dosimetric parameters of chemo-radiation including MRI guided adaptive brachytherapy with tandem-ovoid applicators for cervical cancer patients: A single institution experience.

    Nomden, C.N.; Leeuw, A.A. de; Roesink, J.M.; Tersteeg, R.J.; Moerland, M.A.; Witteveen, P.O.; Schreuder, H.W.B.; Dorst, E.B. van; Jurgenliemk-Schulz, I.M.

    2013-01-01

    PURPOSE: To evaluate dosimetric parameters and clinical outcome for cervical cancer patients treated with chemo-radiation and MR-image guided adaptive brachytherapy (MR-IGABT) using tandem-ovoid applicators for intracavitary or combined intracavitary/interstitial approaches. METHOD: This retrospecti

  3. Radiation therapy alone in the treatment of cervix cancer stages IIB and IIB. Results from Hospital Mario Gatti, Pontificia Universidade Catolica de Campinas; Radioterapia exclusiva no tratamneto do cancer de colo do utero estadios IIB e IIIB. Resultados do Convenio Hospital Mario Gatti/Pontificia Universidade Catolica de Campinas

    Ferrigno, Robson [Fundacao Antonio Prudente, Sao Paulo, SP (Brazil). Hospital A.C. Camargo; Oliveira Faria, Sergio Luis Campos de [Pontificia Univ. Catolica de Campinas, SP (Brazil). Hospital Mario Gatti

    1995-05-01

    From September 1989 to December 1992, 178 patients with cervix cancer were treated with radiation therapy alone, being 81 stage IIIB patients were randomized according to the number of intracavitary brachytherapy insertion realized after external irradiation. Of these, 34 were treated with two intracavitary insertion (group A) and 47 with one insertion (group B). Among stage IIIB patients, 54 were treated with one intracavitary insertion after external irradiation (group C) and 47 with external irradiation alone as they had no geometrical condition for intracavitary insertion (group D). There were no statistical difference in 50 months disease free survival among patients stage IIB treated with one or two intracavitary insertion, 72,3% and 70.6% respectively (P=0,711). The 50 months disease free survival were better in patients stage IIIB treated with external irradiation followed by one intracavitary insertion, compared with those treated with external irradiation alone, 51,8% and 30,2% respectively (P=0,007). This series suggests that there is no difference in the treatment of stage IIB cervix cancer with one or two intracavitary insertion. Among stage IIIB patients, the worse result of those treated with external irradiation alone was probably due to the unfavorable prognostic factors, as they were excluded for brachytherapy because they showed no geometrical condition for intracavitary insertion and larger tumor volume. (author) 18 refs., 2 figs., 5 tabs.

  4. Current issues result in a paradigm shift in reprocessing medical and surgical instruments.

    Alfa, Michelle J

    2016-05-01

    The objective of this report is to review the available scientific data on reprocessing of medical and surgical instruments and discuss the current issues related to cleaning and disinfection of flexible endoscopes and intracavitary ultrasound probes. PMID:27131134

  5. Nursing intervention in gynecologic brachytherapy under general anesthesia

    We reconsidered our nursing intervention in gynecologic intracavitary brachytherapy as general anesthesia was introduced. We recognized that safety, comfort, privacy protection and relief of anxiety of the patients were important points for nursing with corporation of other medical staffs. (author)

  6. Nursing intervention on complications of patients undergoing per cutem intracavitary myocardium of ventricular septum chemical ablation%对经皮腔内室间隔心肌化学消融术病人并发症的护理干预

    方建梅; 王海双; 叶虹; 王川怡; 黄伟剑

    2008-01-01

    @@ 经皮腔内室间隔心肌化学消融术(percutaneous transluminal septal myocardium ablation,PTSMA)是近几年来通过化学消融减轻肥厚型心肌病(hypertrophicobstructive eardiomyopathy,HOCM)室间隔不对称性肥厚,达到缓解左室流出道梗阻,从而改善病人症状的介入方法.我科自2004年3月-2006年3月对12例HOCM病人实施了PTSMA治疗,现将术后并发症的护理报告如下.

  7. Preparation of a program for the independent verification of the brachytherapy planning systems calculations; Confeccion de un programa para la verificacion independiente de los calculos de los sistemas de planificacion en braquiterapia

    V Carmona, V.; Perez-Calatayud, J.; Lliso, F.; Richart Sancho, J.; Ballester, F.; Pujades-Claumarchirant, M.C.; Munoz, M.

    2010-07-01

    In this work a program is presented that independently checks for each patient the treatment planning system calculations in low dose rate, high dose rate and pulsed dose rate brachytherapy. The treatment planning system output text files are automatically loaded in this program in order to get the source coordinates, the desired calculation point coordinates and the dwell times when it is the case. The source strength and the reference dates are introduced by the user. The program allows implementing the recommendations about independent verification of the clinical brachytherapy dosimetry in a simple and accurate way, in few minutes. (Author).

  8. Preparation of a program for the independent verification of the brachytherapy planning systems calculations

    In this work a program is presented that independently checks for each patient the treatment planning system calculations in low dose rate, high dose rate and pulsed dose rate brachytherapy. The treatment planning system output text files are automatically loaded in this program in order to get the source coordinates, the desired calculation point coordinates and the dwell times when it is the case. The source strength and the reference dates are introduced by the user. The program allows implementing the recommendations about independent verification of the clinical brachytherapy dosimetry in a simple and accurate way, in few minutes. (Author).

  9. 27th Annual national conference on radiation control

    A wide variety of topics related to radiation control are presented in the 21 papers selected for the database. Topics covered include: radioactive soil cleanup standards, low-level radioactive waste, Licensing State Designation program, health physics, radioactive contamination of scrap metal, radioactive contamination of food, U.S. Nuclear Regulatory Commission materials licensing program, high and pulsed dose rate medical therapy, licensing of a commercial mixed waste facility, radioactive sewer discharge regulations, air emission standards for radionuclides, and regulation of naturally occurring radioactive materials in oil and gas fields. Other topics covered, but not selected for the database, are primarily related to medical x-ray programs

  10. Outcome analysis of salvage radiotherapy for occult cervical cancer found after simple hysterectomy

    The objective was to analyze the outcomes of the patients, who received salvage radiotherapy for incidentally discovered cervical cancer following simple hysterectomy, and to identify the influence of intracavitary radiotherapy on treatment outcomes. Data from 117 patients with occult cervical cancer who underwent simple hysterectomy followed by salvage radiotherapy from September 1979 to November 2010 were collected. All the patients received external beam radiotherapy with (n=45) or without (n=72) intracavitary radiotherapy. Local control, disease-free survival, overall survival and treatment-related toxicity were investigated. The median follow-up time was 75 months. The 5- and 10-year local control/disease-free survival/overall survival rates were 93/87/87% and 90/84/83%, respectively. Among 98 patients who had no residual disease and negative resection margin on surgical specimens, 32 (33%) received intracavitary radiotherapy and 66 (67%) did not. There were no differences in patient and tumor characteristics between patients treated with and without intracavitary radiotherapy. The 5-year local control rate for the non-intracavitary radiotherapy group was 93 versus 94% for the intracavitary radiotherapy group (P=0.564); the disease-free survival rate was 88 versus 94% (P=0.894); the overall survival rate was 95 versus 85% (P=0.106), respectively. Among all patients, there were 5% of Grade 3 or higher late toxicities. Patients with occult invasive cervical cancer discovered following simple hysterectomy could be treated safely and effectively with salvage radiotherapy. For patients with no residual disease and negative resection margin, intracavitary radiotherapy could be omitted. (author)

  11. Radiosterilisation of the vagina in therapeutic doses - does it exist

    The endogenous genital flora is a major source of infections of the female genital tract, especially in patients with cervical or endometrial cancer. Until recently the 'radiosterilisation of the vagina', respectively a prophylactic and/or therapeutic effect of irradiation (external highvoltage as well as intracavitary-radium) concerning infections was postulated in the literature. This theory was disproved in a prospective clinical and bacteriological study covering 48 patients with advanced cervical cancer undergoing primary intracavitary radium-irradiation and 38 patients with inoperable endometrical cancer, undergoing primary iridium-192-afterloading. Following intracavitary radium for cervical cancer some typical nosocomial pathogens like Streptococcus faecalis, Enterobacter, Klebsiella, Proteus and Pseudomonas were isolated significantly more frequently than before treatment. Likewise, the mean number of aerobic bacterial species increased significantly after irradiation. Also primary Ir-192 (afterloading) irradiation did not alter the frequency of isolation of the resident flora in endometrial cancer patients. Therefore, 'radiosterilisation' of the vagina as result of radiotherapy does not exist. (orig.)

  12. Reirradiation as therapeutical choice in the local failure of nasopharyngeal carcinoma

    In the local failure of nasopharyngeal carcinoma, on previouysly irradiated patients, reirradiation is a therapeutical choice. Different techniques of external irradiation and brachitherapy that have been used have brought about satisfactory results. We set out our results in 10 cases of salvage treatment using external or intracavitary radiotherapy on their own or combinated. In intracavitary radiotherapy groups (alone or combinated with external beam irradiation) there has been no local failure. In the exclusively external radiotherapy groups local failure has been registrated in 2 of 4 patients. Nowadays after an average control period of 5.5 years, 6 of 10 patients are alive and free of disease. (Author)

  13. Longitudinal change in quantitative meniscus measurements in knee osteoarthritis - data from the Osteoarthritis Initiative

    We aimed to apply 3D MRI-based measurement technology to studying 2-year change in quantitative measurements of meniscus size and position. Forty-seven knees from the Osteoarthritis Initiative with medial radiographic joint space narrowing had baseline and 2-year follow-up MRIs. Quantitative measures were obtained from manual segmentation of the menisci and tibia using coronal DESSwe images. The standardized response mean (SRM = mean/SD change) was used as measure of sensitivity to longitudinal change. Medial tibial plateau coverage decreased from 34.8 % to 29.9 % (SRM -0.82; p < 0.001). Change in medial meniscus extrusion in a central image (SRM 0.18) and in the central five slices (SRM 0.22) did not reach significance, but change in extrusion across the entire meniscus (SRM 0.32; p = 0.03) and in the relative area of meniscus extrusion (SRM 0.56; p < 0.001) did. There was a reduction in medial meniscus volume (10 %; p < 0.001), width (7 %; p < 0.001), and height (2 %; p = 0.08); meniscus substance loss was strongest in the posterior (SRM -0.51; p = 0.001) and weakest in the anterior horn (SRM -0.15; p = 0.31). This pilot study reports, for the first time, longitudinal change in quantitative 3D meniscus measurements in knee osteoarthritis. It provides evidence of improved sensitivity to change of 3D measurements compared with single slice analysis. (orig.)

  14. Longitudinal change in quantitative meniscus measurements in knee osteoarthritis - data from the Osteoarthritis Initiative

    Bloecker, Katja [Paracelsus Medical University Salzburg and Nuremberg (Austria); Salzburg, Institute of Anatomy, Salzburg (Austria); BHS Linz, Department of Orthopaedics, Linz (Austria); Wirth, W.; Eckstein, F. [Paracelsus Medical University Salzburg and Nuremberg (Austria); Salzburg, Institute of Anatomy, Salzburg (Austria); Chondrometrics GmbH, Ainring (Germany); Guermazi, A. [Boston University School of Medicine, Boston, MA (United States); Boston Imaging Core Lab (BICL), Boston, MA (United States); Hitzl, W. [Paracelsus Medical University Salzburg and Nuremberg, Research Office, Salzburg (Austria); Hunter, D.J. [University of Sydney, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, Sydney (Australia)

    2015-10-15

    We aimed to apply 3D MRI-based measurement technology to studying 2-year change in quantitative measurements of meniscus size and position. Forty-seven knees from the Osteoarthritis Initiative with medial radiographic joint space narrowing had baseline and 2-year follow-up MRIs. Quantitative measures were obtained from manual segmentation of the menisci and tibia using coronal DESSwe images. The standardized response mean (SRM = mean/SD change) was used as measure of sensitivity to longitudinal change. Medial tibial plateau coverage decreased from 34.8 % to 29.9 % (SRM -0.82; p < 0.001). Change in medial meniscus extrusion in a central image (SRM 0.18) and in the central five slices (SRM 0.22) did not reach significance, but change in extrusion across the entire meniscus (SRM 0.32; p = 0.03) and in the relative area of meniscus extrusion (SRM 0.56; p < 0.001) did. There was a reduction in medial meniscus volume (10 %; p < 0.001), width (7 %; p < 0.001), and height (2 %; p = 0.08); meniscus substance loss was strongest in the posterior (SRM -0.51; p = 0.001) and weakest in the anterior horn (SRM -0.15; p = 0.31). This pilot study reports, for the first time, longitudinal change in quantitative 3D meniscus measurements in knee osteoarthritis. It provides evidence of improved sensitivity to change of 3D measurements compared with single slice analysis. (orig.)

  15. Review of RBE and OER values for Cf-neutrons

    Californium-252, an isotope emitting neutrons, gamma photons and alpha particles, is being investigated for its practical use in intracavitary and interstitial brachytherapy. A review of published RBE and OER values for californium neutrons as a function of dose rate for a variety of biological endpoints is given. (Auth.)

  16. Stereotaxic myelotomy in the treatment of pain syndromes in oncologic patients

    Consideration is given to results of clinical application of stereotaxic myelotomy to patients with malignant tumors of female genital organs. Patients earlier have undergone courses of combined (remote and intracavitary) radiotherapy. It is shown that stereotaxic myelotomy is one of the methods of pain suppression in patients with malignant tumors in the region of small pelvis

  17. Brachytherapy surface mould: a treatment modality for some typical sites

    Brachytherapy techniques generally used are interstitial implants, intracavitary/intraluminal applications and surface mould therapy. At M.D. Oswal Cancer Hospital surface moulds with remote after-moulding system with 192Ir wires for treatment of some typical sites have been used

  18. Review of radioisotope use in therapeutic radiology in South Africa

    Since the National Conference on Nuclear Energy: application of isotopes and radiation, Pretoria (1963), radiotherapy has advanced steadily as an established medical discipline in South Africa. In compiling this bibliography the author has limited the field to publications in radiotherapy by South Africans. General information an photon teletherapy, interstitial and intracavitary radiotherapy, and particle beams is given in this bibliographic review

  19. 21 CFR 310.503 - Requirements regarding certain radioactive drugs.

    2010-04-01

    ... cyanocobalamin Intestinal absorption studies. Gold 198 Colloidal Liver scans. Do ......do Intracavitary treatment... project, which use had been approved on or before July 25, 1975 in accordance with 10 CFR 35.11 (or... holding the specific license under 10 CFR 35.11 (or equivalent regulation of an Agreement State); (5)...

  20. Designing of central shield in Ca Cx cases

    This paper deals with the designing aspects of central shielding block for external radiotherapy used in treatment of Ca Cx patients who are already treated or are going to be treated with intracavitary radiation (ICR) treatments. The designing aspects are discussed in detail particularly for the region between point A and point B. (author)

  1. Nasopharyngeal impression technique for fabrication of a radiation carrier

    A new technique for intracavitary application of Iridium 192 seeds in carcinoma of the nasopharynx is described. This technique allows for accurate construction of a nasopharyngeal carrier that permits the radiotherapist to deliver an adequate dose of irradiation to the nasopharynx

  2. Adaptive error detection for HDR/PDR brachytherapy: Guidance for decision making during real-time in vivo point dosimetry

    Kertzscher Schwencke, Gustavo Adolfo Vladimir; Andersen, Claus E.; Tanderup, Kari

    2014-01-01

    Purpose:This study presents an adaptive error detection algorithm (AEDA) for real-timein vivo point dosimetry during high dose rate (HDR) or pulsed dose rate (PDR) brachytherapy (BT) where the error identification, in contrast to existing approaches, does not depend on an a priori reconstruction of...... identify all false errors represented by mispositioned dosimeters contrary to an error detection algorithm relying on the original reconstruction. Conclusions:The study demonstrates that the AEDA error identification during HDR/PDR BT relies on a stable dosimeter position rather than on an accurate...... dosimeter reconstruction, and the AEDA’s capacity to distinguish between true and false error scenarios. The study further shows that the AEDA can offer guidance in decision making in the event of potential errors detected with real-time in vivo point dosimetry....

  3. Dosimetric feasibility of stereotactic body radiation therapy as an alternative to brachytherapy for definitive treatment of medically inoperable early stage endometrial cancer

    This study was designed to evaluate the dosimetric feasibility of definitive stereotactic body radiation therapy (SBRT) for the treatment of medically inoperable early stage endometrial cancer. CT simulation scans from 10 medically inoperable early stage endometrial cancer patients previously treated with high dose-rate (HDR) intracavitary brachytherapy were used to generate Helical Tomotherapy (HT) plans using the IMRT mode with clinical target volumes (CTVs) that included the uterus plus cervix. A prescription dose of 34 Gy in 4 fractions was used. The SBRT dosimetry was compared to the 10 prior intracavitary brachytherapy plans normalized to a standard dose. Organs at risk (OARs) evaluated were the bladder, rectum, sigmoid, femoral heads, and other bowel, including both large and small bowel. The simulation CT and daily image guidance for 4 patients treated with this technique were evaluated to assess for interfraction variation in the uterine position and effects on dosimetry. Compared to intracavitary brachytherapy, HT SBRT produced significantly greater overall target coverage to the uterus, boost CTV, and PTV, with exception of the V150% of the uterus. HT SBRT significantly increased dose to the rectum, bowel, and femoral heads compared to intracavitary brachytherapy, though not outside of dose tolerance limits. Review of daily image guidance for patients treated with this technique demonstrated good reproducibility with a mean overlap index of 0.87 (range, 0.74 – 0.99). Definitive SBRT for medically inoperable early stage endometrial cancer appears to be a feasible treatment option. Future studies are warranted to evaluate long-term clinical outcomes with this technique, compared to HDR intracavitary brachytherapy

  4. Comparison of 3D MRI with high sampling efficiency and 2D multiplanar MRI for contouring in cervix cancer brachytherapy

    MRI sequences with short scanning times may improve accessibility of image guided adaptive brachytherapy (IGABT) of cervix cancer. We assessed the value of 3D MRI for contouring by comparing it to 2D multi-planar MRI. In 14 patients, 2D and 3D pelvic MRI were obtained at IGABT. High risk clinical target volume (HR CTV) was delineated by 2 experienced radiation oncologists, using the conventional (2D MRI-based) and test (3D MRI-based) approach. The value of 3D MRI for contouring was evaluated by using the inter-approach and inter-observer analysis of volumetric and topographic contouring uncertainties. To assess the magnitude of deviation from the conventional approach when using the test approach, the inter-approach analysis of contouring uncertainties was carried out for both observers. In addition, to assess reliability of 3D MRI for contouring, the impact of contouring approach on the magnitude of inter-observer delineation uncertainties was analysed. No approach- or observer - specific differences in HR CTV sizes, volume overlap, or distances between contours were identified. When averaged over all delineated slices, the distances between contours in the inter-approach analysis were 2.6 (Standard deviation (SD) 0.4) mm and 2.8 (0.7) mm for observers 1 and 2, respectively. The magnitude of topographic and volumetric inter-observer contouring uncertainties, as obtained on the conventional approach, was maintained on the test approach. This variation was comparable to the inter-approach uncertainties with distances between contours of 3.1 (SD 0.8) and 3.0 (SD 0.7) mm on conventional and test approach, respectively. Variation was most pronounced at caudal HR CTV levels in both approaches and observers. 3D MRI could potentially replace multiplanar 2D MRI in cervix cancer IGABT, shortening the overall MRI scanning time and facilitating the contouring process, thus making this treatment method more widely employed

  5. Studies on occupational exposure to external radiation at Fukuoka University Hospital

    This is a report of the yearly changes of exposure received by workers in radiological occupations at Fukuoka University Hospital from August 1973 to December 1980. The total number of the workers during this period involving diagnostic radiology, radiotherapy and the other related fields included 153 physicians, 27 technicians, 29 nurses and 16 assistants. Out of 225 workers, only two angiographers and two involved in intracavitary radiation therapy received more than 500 mrem of the annual exposure dose. The highest dose was 610 mrem. The exposure doses have gradually decreased each year. The exposure of the workers has remarkably decreased to almost negligible since a remote afterloading system was installed for intracavitary radiation therapy. In no worker was any somatic effect of radiation detected in the periodical physical examinations, even in the number of lymphocytes in the peripheral blood. (author)

  6. A comparative study of external radiotherapy alone versus external radiotherapy + brachytherapy in carcinoma cervix stage III B

    Carcinoma of the cervix is the commonest cancer seen in women at Sardar Patel Medical College, Bikaner (Rajasthan). In the present study external radio-therapy and brachytherapy are used in carcinoma cervix stage III B. After 4000 to 4500 rads to pelvis by external radio-therapy, patient was assessed for intra cavitary application. Total given dose to point A was 7500 rads, to point B was 5000 rads. If patient was not suitable a split course was given where patient was asked to come after 3 weeks for intracavitary application. A comparative study of both methods was done. There was significant improvement in the control of central disease by applying intracavitary source. Radiation reactions were comparable. (author). 4 tables, 10 refs

  7. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer low localization

    The research demonstrates possibility of improvement of direct treatment results after the use of preoperative combined radiotherapy with radio modification for patients with the locally advanced cancer of rectum. Based on the analysis of the results of chemo radiation treatment of 97 patients with tumors of the lower- and medium ampulla localization (T3N0-1M0), in which the radiotherapy was carried out by various modes of exposure. External beam radiotherapy combined with Capecitabine in a daily dose of 850 mg/m2 and a combination of external beam and intracavitary radiotherapy combined with Capecitabine in a daily dose of 850 mg/m2 were compared. The analysis of tolerability showed that preoperative combination of external and intracavitary radiation therapy has shown an acceptable toxicity profile, increase the number of patients transferred in resectable form of disease and the number of sphincter-preserving operations

  8. Application of the ICRU Report 38 reference volume concept to the radiotherapeutic management of recurrent endometrial and cervical carcinoma

    Radiation therapy was given to 25 patients presenting with pelvic recurrence of endometrial (14) and cervical (11) cancer. Of these patients, all but one had undergone hysterectomy following their original diagnosis. Two endometrial patients received post operative intracavitary irradiation. The recurrence-free interval ranged from 5 to 71 months (mean = 21 months). External beam radiation therapy for pelvic recurrence ranged from 3000 to 5000 cGy. Additional central radiation was given to 18 patients with either external beam, intracavitary, interstitial, or transvaginal technique. Dose and dose rates from brachytherapy was documented with maximum values, along with the location of these dose points. Such specification is essential in obtaining a more accurate impression of the total dose delivered to the patient, especially when different techniques are employed to increase the dose to the center of the pelvis

  9. Therapy results of malignant tumors of the paranasal sinuses in patients treated at the Metropolitan Onco-Radiologic Centre of Budapest

    A report is given on the therapy of 301 patients with ethmoidomaxillary tumors treated at the Metropolitan Onco-Radiologic Centre of Budapest between 1946 und 1974. Most of these patients were in an advanced stage when the first diagnosis was established. The five-year survival rate of all stages was 27%, which does not strongly differ from the average falue of 30% mentioned in literature. The five-year survival rate of the patients submitted to a combined surgical and radiologic treatment was 33%, that of the patients treated by irradiations only was 16%. 81 patients received an intracavitary brachycurietherapy after having undergone a non-radical operation. The five-year survival rate of this group was 38%. The intracavitary brachycurietherapy is most favorable and should always be applied in case of this not very radiosensible, often even radioresistant tumor. (orig.)

  10. Design and Thermal Distribution of Intra-hyperthermia Microwave Antennas for Utero-cervical Applicators

    Intracavitary brachytherapy combined hypertermin for utero-cervical cancer seems to be a promising method for salvage treatments in persistent tumors and inoperable or previously irradiated cervical recurrences. In order to heat the vaginal apex and uterus, power full conical antennas which are suitable for afterloading cervical applicator have been designed for use in conjunction with intracavitary radiation therapy. The antennas were constructed with conical conductive material to feed line and the effective length were designed proportional to microwave length, Power deposition profiles of 2450 MHz of conical antennas were studied in both phantom models and muscle tissue and compared to those of commonly used dipole antenna. Improvement of the heating pattern was found in both phantom and muscle tissue. The heating pattern produced by the conical antenna resembles an ellipsoid and then the temperature distribution in depth was extended to 2-3 cm from the effective antenna axis

  11. Radiotherapy in benign uterine bleeding disorders

    Radiotherapy was earlier a method of choice for treatment of benign bleeding disorders (metropathia), especially in woman of high surgical risk. During the period 1912 to 1977 933 women with benign bleeding disorders were treated at Radiumhemmet with intracavitary brachytherapy or external irradiation or a combination of both. The result with regard to cure of the uterine bleedings was good (48%). Hormonal withdrawal symptoms after treatment were noted in 45% of the patients. In the long term follow up an increased risk of cardiovascular death was found in women treated before menopause. Malignant tumours occurred in 107 cases versus 90.2 expected. The estimated ovarian dose of ionizing radiation varied from 3.5 Gy to 6.0 Gy for the three standard techniques. Two women gave birth to a healthy child 4 and 5 years after intracavitary radium treatment. The estimated absorbed dose to the ovaries in these two women were 1 Gy and 4 Gy, respectively

  12. Sacral plexus injury after radiotherapy for carcinoma of cervix

    A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases

  13. Left ventricular pacing vector selection by novel echo-particle imaging velocimetry analysis for optimization of quadripolar cardiac resynchronization device: a case report

    Martiniello, Alfonso/A. Roberto/R.; Pedrizzetti, Gianni/G.; Bianchi, Valter/V.; Tonti, Giovanni/G.; D’Onofrio, Antonio/A.; Caso, Pio/P.

    2016-01-01

    Background The availability of pacing configurations offered by quadripolar left ventricular leads could improve patients’ response to cardiac resynchronization therapy; however, the selection of an optimal setting remains a challenge. Echo-particle imaging velocimetry has shown that regional anomalies of synchrony/synergy of the left ventricle are related to the alteration, reduction, or suppression of the physiological intracavitary pressure gradients. These observations are also supported ...

  14. The feasibility of transoesophageal bioimpedance measurements for the detection of heart graft rejection

    Giovinazzo, Giuseppe; Ribas, Núria; Cinca, J.; Rosell Ferrer, Francisco Javier

    2011-01-01

    Previous studies demonstrate that it is possible to evaluate a heart graft rejection condition using a bioimpedance technique by means of an intracavitary catheter. We propose to use a less invasive technique consisting in the use of a transoesophageal catheter and two standard ECG electrodes on the thorax. The aim of this work is to evaluate, using the finite element method, several parameters affecting the transoesophageal impedance measurement, including sensitivity to electrical conduc...

  15. Tumors of the genitals in girls

    Literature data on the rate and character of neoplasms in girl's genitals are presented as well as morphological classification variants of ovary and germinogenetic neoplasms in particular and role of combined treatment different types. It is shown that in the case of ovary neoplasms the surgery, chemotherapy and (in certain cases) radiotherapy are used. As for rhabdomyosarcoma of vagina and neck of the uterus the treatment consists of chemotherapy and intracavitary radiotherapy

  16. Treatment of cancer of the uterus in developing countries: Proposals for a programme

    Cancer of the uterus is one of the most common forms of cancer in developing countries. It may be successfully treated or favourably influenced by intracavitary treatment. For this therapy there are commercially available systems. Three levels of complexity (according to the equipment of the hospital) are recommended for the application of this procedure in the developing countries and the procedure for its introduction is suggested

  17. Role of physicist in development of palliative care services in a radiotherapy dept

    Radiotherapy Center at Padhar Hospital has been in existence since 1982 and through external cobalt therapy 8888 patients have received treatment while over 1200 patients have received brachytherapy treatment, both intracavitary and interstitial. Situated in tribal district of Betul of Madhya Pradesh, Padhar Hospital caters to, the needs of cancer patients from over 400 km radius in Madhya Pradesh and Maharashtra, as there is no tertiary level hospital in a radius of 200 km

  18. Role of saline infusion sonography in abnormal uterine bleeding

    Megha Sharma

    2013-08-01

    Conclusions: We found Saline Infusion Sonography to be an easy and safe procedure, though being less sensitive, it cannot replace hysteroscopy as a whole. Though hysteroscopy is a gold standard, saline infusion sonography is an easy, safe procedure for diagnosing intracavitary pathologies in low resource setting and despite being less sensitive, it can still reduce the number of hysteroscopies. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 533-538

  19. Cardiac calcified amorphous tumor: A systematic review of the literature

    Quentin de Hemptinne; Didier de Cannière; Jean-Luc Vandenbossche; Philippe Unger

    2015-01-01

    Background: Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracavitary cardiac mass. Several case reports have been published but large series are lacking. Objective: To determine clinical features, current management and outcomes of this rare disease. Design: A systematic review of all articles reporting cases of CAT in order to perform a pooled analysis of its clinical features, management and outcomes. Data sources: An electronic search of all English arti...

  20. The Ultrasound and MRI Findings of Uterine Adenofibroma: A Case Report

    Kim, Hyun Jung; Rha, Sung Eun; Byun, Jae Young; Lee, Ah Won [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2011-09-15

    Adenofibroma is an extremely rare benign m'ullerian mixed tumor composed of epithelium and mesenchymal cells. Most uterine adenofibromas occur in the endometrium, but they rarely protrude into the vagina. To date, only a few such cases with the imaging findings have been reported. Therefore, we report here on the sonographic and magnetic resonance (MR) imaging findings of a case of endometrial adenofibroma protruding into the vaginal cavity in a 28-year-old woman. The uterine adenofibroma appeared as a large intracavitary echogenic mass containing multiple small internal cysts, and it was distending the vaginal cavity on transrectal sonography. T2- weighted MR images showed a large intracavitary mass with heterogeneous high signal intensity protruding into the vaginal cavity. On gadolinium-enhanced T1-weighted MR images, heterogeneous septa-like enhancement was noted in the mass. Although uterine adenofibroma is extremely rare, adenofibroma can be suggested as a possible diagnosis when an intracavitary uterine mass, with multiple internal small cystic components and enhancing septa-like structures, is protruding into the vaginal cavity on imaging

  1. Adaptive error detection for HDR/PDR brachytherapy: Guidance for decision making during real-time in vivo point dosimetry

    Purpose: This study presents an adaptive error detection algorithm (AEDA) for real-timein vivo point dosimetry during high dose rate (HDR) or pulsed dose rate (PDR) brachytherapy (BT) where the error identification, in contrast to existing approaches, does not depend on an a priori reconstruction of the dosimeter position. Instead, the treatment is judged based on dose rate comparisons between measurements and calculations of the most viable dosimeter position provided by the AEDA in a data driven approach. As a result, the AEDA compensates for false error cases related to systematic effects of the dosimeter position reconstruction. Given its nearly exclusive dependence on stable dosimeter positioning, the AEDA allows for a substantially simplified and time efficient real-time in vivo BT dosimetry implementation. Methods: In the event of a measured potential treatment error, the AEDA proposes the most viable dosimeter position out of alternatives to the original reconstruction by means of a data driven matching procedure between dose rate distributions. If measured dose rates do not differ significantly from the most viable alternative, the initial error indication may be attributed to a mispositioned or misreconstructed dosimeter (false error). However, if the error declaration persists, no viable dosimeter position can be found to explain the error, hence the discrepancy is more likely to originate from a misplaced or misreconstructed source applicator or from erroneously connected source guide tubes (true error). Results: The AEDA applied on twoin vivo dosimetry implementations for pulsed dose rate BT demonstrated that the AEDA correctly described effects responsible for initial error indications. The AEDA was able to correctly identify the major part of all permutations of simulated guide tube swap errors and simulated shifts of individual needles from the original reconstruction. Unidentified errors corresponded to scenarios where the dosimeter position was

  2. Adaptive error detection for HDR/PDR brachytherapy: Guidance for decision making during real-time in vivo point dosimetry

    Kertzscher, Gustavo, E-mail: guke@dtu.dk; Andersen, Claus E., E-mail: clan@dtu.dk [Centre for Nuclear Technologies, Technical University of Denmark, DTU Nutech, Frederiksborgvej 399, DK-4000 Roskilde (Denmark); Tanderup, Kari, E-mail: karitand@rm.dk [Department of Oncology, Aarhus University Hospital and Institute of Clinical Medicine, Aarhus University, Norrebrogade 44, DK-8000 Aarhus (Denmark)

    2014-05-15

    Purpose: This study presents an adaptive error detection algorithm (AEDA) for real-timein vivo point dosimetry during high dose rate (HDR) or pulsed dose rate (PDR) brachytherapy (BT) where the error identification, in contrast to existing approaches, does not depend on an a priori reconstruction of the dosimeter position. Instead, the treatment is judged based on dose rate comparisons between measurements and calculations of the most viable dosimeter position provided by the AEDA in a data driven approach. As a result, the AEDA compensates for false error cases related to systematic effects of the dosimeter position reconstruction. Given its nearly exclusive dependence on stable dosimeter positioning, the AEDA allows for a substantially simplified and time efficient real-time in vivo BT dosimetry implementation. Methods: In the event of a measured potential treatment error, the AEDA proposes the most viable dosimeter position out of alternatives to the original reconstruction by means of a data driven matching procedure between dose rate distributions. If measured dose rates do not differ significantly from the most viable alternative, the initial error indication may be attributed to a mispositioned or misreconstructed dosimeter (false error). However, if the error declaration persists, no viable dosimeter position can be found to explain the error, hence the discrepancy is more likely to originate from a misplaced or misreconstructed source applicator or from erroneously connected source guide tubes (true error). Results: The AEDA applied on twoin vivo dosimetry implementations for pulsed dose rate BT demonstrated that the AEDA correctly described effects responsible for initial error indications. The AEDA was able to correctly identify the major part of all permutations of simulated guide tube swap errors and simulated shifts of individual needles from the original reconstruction. Unidentified errors corresponded to scenarios where the dosimeter position was

  3. Efficacy of Radiofrequency Hyperthermia Combined with Chemotherapy 
in Treatment of Malignant Pericardial Effusion Caused by Lung Cancer

    Pengfei LUO

    2011-07-01

    Full Text Available Background and objective Malignant pericardial effusion is one of the serious complications of lung cancer and lack effective treatment methods. The aim of this study is to evaluate the efficacy and safety of radiofrequency hyperthermia combined with chemotherapy for patients with malignant pericardial effusion caused by lung cancer. Methods Fifty-five patients with malignant pericardial effusion caused by lung cancer were divided into hyperthermia combined with chemotherapy group (combined therapy group and chemotherapy group. The combined therapy group was treated with radiofrequency hyperthermia after the pericardiocentesis and intracavitary injection (cisplatin 20 mg and dexamethasone 5 mg, when patients’ general state of health improved, systemic chemotherapy was performed. The chemotherapy group was treated only with intracavitary injection and systemic chemotherapy. Intracavitary chemotherapy was performed for 1-6 times (average 3 times. Hyperthermia was performed twice per week with an average of 6 times following intracavitary and systemic chemotherapy. The temperature of intracavitary was 40.5 oC-41.5 oC for 60 min during the hyperthermia periods. Systemic chemotherapy consists of cisplatin (75 mg/m2 and vinorelbine (50 mg/m2. Results The complete remission rate (CR of malignant pericardial effusion was 54.3% and the response rate (RR was 91.4% in the combined therapy group, while the rates of CR and RR of chemotherapy group were 25.0% and 70.0%, and the differences of CR and RR between the two groups were significant (P<0.05. After treatment, the quality of life improved significantly in both groups, but the combined therapy group had a higher KPS score than in the chemotherapy group (P<0.05. The adverse events associated with the chemotherapy included gastrointestinal toxicity and myelosup-pression, and there were no significant differences between the two groups. The main side effects associated with radiofrequency hyperthermia

  4. A comparison between tandem and ovoids and interstitial gynecologic template brachytherapy dosimetry using a hypothetical computer model

    Purpose: To evaluate the dose distribution within the clinical target volume between two gynecologic brachytherapy systems - the tandem and ovoids and the Syed-Neblett gynecologic template - using a hypothetical computer model. Methods and Materials: Source positions of an intracavitary system (tandem and ovoids) and an interstitial system (GYN template) were digitized into the Nucletron Brachytherapy Planning System. The GYN template is composed of a 13-catheter implant (12 catheters plus a tandem) based on the Syed-Neblett gynecologic template. For the tandem and ovoids, the dwell times of all sources were evenly weighted to produce a pear-shaped isodose distribution. For the GYN template, the dwell times were determined using volume optimization. The prescribed dose was then normalized to point A in the intracavitary system and to a selected isodose line in the interstitial system. The treated volume in the two systems was kept approximately the same, and a cumulative dose-volume histogram of the treated volume was then generated with the Nucletron Brachytherapy Planning System to use for comparison. To evaluate the dose to a hypothetical target, in this case the cervix, a 2-cm-long, 3-cm-diameter cylinder centered along the tandem was digitized as the clinical target volume. The location of this hypothetical cervix was based on the optimal application of the brachytherapy system. A visual comparison of clinical target coverage by the treated volume on three different orthogonal planes through the treated volume was performed. The percentage dose-volume histograms of the target were generated for comparison. Multiple midline points were also placed at 5-mm intervals away from the tandem in the plane of the cervix to simulate the location of potential bladder and rectal dose points. Doses to these normal structures were calculated for comparison. Results: Although both systems covered the hypothetical cervix adequately, the interstitial system had a better

  5. Partial breast irradiation for early breast cancer: 3-year results of the German-Austrian phase II-trial

    Purpose: to evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. Materials and methods: from 11/2000 to 11/2004, 240 women with early stage breast cancer participated in a protocol of tumor bed irradiation alone using pulsed dose rate (PDR) or high dose rate (HDR) interstitial multi-catheter implants (partial breast irradiation). Perioperative morbidity, acute and late toxicity as well as cosmetic outcome were assessed. Of the first 51 patients treated in this multicenter trial, we present interim findings after a median follow-up of 36 months. Results: perioperative Morbidity: Bacterial infection of the implant: 2% (1/51). Acute toxicity: radiodermatitis grade 1: 4% (2/51). Late toxicity: breast pain grade 1: 8% (4/51), grade 2: 2% (1/51); dyspigmentation grade 1: 8% (4/51); fibrosis grade 1: 4% (2/51), grade 2: 8% (4/51); telangiectasia grade 1: 10% (5/51), grade 2: 4% (2/51). Cosmetic results: Excellent and good in 94% (48/51) of the patients. Conclusion: this analysis indicates that accelerated partial breast irradiation with 192-iridium interstitial multicatheter PDR-/HDR-implants (partial breast irradiation) is feasible with low perioperative morbidity, low acute and mild late toxicity at a median follow-up of 36 months. The cosmetic result is not significantly affected. (orig.)

  6. Local control and survival in patients with soft tissue sarcomas treated with limb sparing surgery in combination with interstitial brachytherapy and external radiation

    Purpose: The purpose of this study was to evaluate local control, survival and complication rate after treatment of soft tissue sarcoma (STS) with limb-sparing surgery combined with pulsed-dose rate (PDR) interstitial brachytherapy (BRT) and external beam radiotherapy (EBRT). Patients and methods: A retrospective review of 39 adult patients (female/male = 25/14, mean age 51(range 21-78) years) with STS who underwent primary limb-sparing surgery combined with PDR BRT (20 Gy) and additional post-operative EBRT (50 Gy) during the years 1995-2004. Results: Five patients developed local recurrence after a mean follow-up of 3.4 (1.5-5.9) years. The probability of local recurrence free 5 years survival was 83%. At the time of follow-up 10 patients had died (mean follow-up 2.3 (0.8-7.1) years) and 29 patients were still alive (mean follow-up 5.9 (2.1-11.2) years). The overall 5-year survival rate was 76%. Nineteen (49%) patients suffered from some degree of decreased force or function of the affected extremity, 16 (41%) suffered from oedema, 12 (31%) had persistent pain, 8 (21%) suffered from wound complications, and in 4 (10%) of these patients plastic surgery were required. Conclusion: Limb sparing surgery, combined with PDR BRT and EBRT can result in good local control in patients with soft tissue sarcomas. BRT is an effective modality with good cosmetic results and acceptable toxicity

  7. Feasibility and early results of interstitial intensity-modulated HDR/PDR brachytherapy (IMBT) with/without complementary external-beam radiotherapy and extended surgery in recurrent pelvic colorectal cancer

    Background: A new multimodality treatment concept consisting of extended resection and postoperative fractionated intensity-modulated interstitial brachytherapy (IMBT) was introduced for pelvic recurrence of colorectal carcinoma. Patients and Methods: 46 patients received extended resection and single plastic tubes were sutured directly onto the tumor bed. IMBT was started within 2 weeks postoperatively with a median dose of 24.5 Gy (5-35 Gy). Patients were treated either with high-dose-rate brachytherapy (HDR; n=23) or with pulsed-dose-rate brachytherapy (PDR; n=23). 25 patients received complementary 45-Gy external-beam irradiation (EBRT) to the pelvic region after explanting the plastic tubes. Results: Median follow-up was 20.6 months (7-107 months) and mean patient survival 25.7±25.8 months (median 17, range 1-107 months). After 5 years overall survival, disease-free survival and local control rate were 23%, 20% and 33%, significantly influenced by the resectional state. There was a trend in favor of PDR compared to HDR, which reached statistical significance in patients who had not received additional EBRT. Conclusion: The combination of extended surgery and postoperative interstitial IMBT is feasible and offers effective interdisciplinary treatment of recurrent colorectal cancer. In this small and inhomogeneous cohort of patients PDR seems to be more effective than HDR, particularly when application of complementary EBRT is not possible. None of the patients who required resection of distant metastasis survived >2 years in this study. (orig.)

  8. Partial breast irradiation for early breast cancer: 3-year results of the German-Austrian phase II-trial; Teilbrustbestrahlung beim Mammakarzinom mit guenstigen prognostischen Faktoren: 3-Jahres-Ergebnisse der deutschoesterreichischen Phase II-Studie

    Ott, O.J.; Lotter, M.; Sauer, R.; Strnad, V. [Strahlenklinik, Universitaetsklinikum Erlangen (Germany); Poetter, R. [Universitaetsklinik fuer Strahlentherapie und Strahlenbiologie, AKH Wien (Austria); Hildebrandt, G. [Strahlenklinik, Universitaetsklinikum Leipzig (Germany); Hammer, J. [Abt. fuer Strahlentherapie, KH Barmherzige Schwestern Linz (Austria); Beckmann, M.W. [Frauenklinik, Universitaetsklinikum Erlangen (Germany)

    2005-07-01

    Purpose: to evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. Materials and methods: from 11/2000 to 11/2004, 240 women with early stage breast cancer participated in a protocol of tumor bed irradiation alone using pulsed dose rate (PDR) or high dose rate (HDR) interstitial multi-catheter implants (partial breast irradiation). Perioperative morbidity, acute and late toxicity as well as cosmetic outcome were assessed. Of the first 51 patients treated in this multicenter trial, we present interim findings after a median follow-up of 36 months. Results: perioperative Morbidity: Bacterial infection of the implant: 2% (1/51). Acute toxicity: radiodermatitis grade 1: 4% (2/51). Late toxicity: breast pain grade 1: 8% (4/51), grade 2: 2% (1/51); dyspigmentation grade 1: 8% (4/51); fibrosis grade 1: 4% (2/51), grade 2: 8% (4/51); telangiectasia grade 1: 10% (5/51), grade 2: 4% (2/51). Cosmetic results: Excellent and good in 94% (48/51) of the patients. Conclusion: this analysis indicates that accelerated partial breast irradiation with 192-iridium interstitial multicatheter PDR-/HDR-implants (partial breast irradiation) is feasible with low perioperative morbidity, low acute and mild late toxicity at a median follow-up of 36 months. The cosmetic result is not significantly affected. (orig.)

  9. Australasian brachytherapy audit: results of 'end-to-end' dosimetry pilot study

    We present the results of a pilot study to test the feasibility of a brachytherapy dosimetry audit. The feasibility study was conducted at seven sites from four Australian states in both public and private centres. A purpose-built cylindrical water phantom was imaged using the local imaging protocol and a treatment plan was generated to deliver 1Gy to the central (1 of 3) thermoluminescent dosimeter (TLD) from six dwell positions. All centres completed the audit, consisting of three consecutive irradiations, within a 2-h time period, with the exception of one centre that uses a pulsed dose rate brachytherapy unit. All TLD results were within 4.5% of the predicted value, with the exception of one subset where the dwell position step size was incorrectly applied. While the limited data collected in the study demonstrated considerable heterogeneity in clinical practice, the study proved a brachytherapy dosimetry audit to be feasible. Future studies should include verification of source strength using a Standard Dosimetry Laboratory calibrated chamber, a phantom that more closely mimics the clinical situation, a more comprehensive review of safety and quality assurance (QA) procedures including source dwell time and position accuracy, and a review of patient treatment QA procedures such as applicator position verification.

  10. Interstitial prostate brachytherapy. LDR-PDR-HDR

    The first comprehensive overview of interstitial brachytherapy for the management of local or locally advanced prostate cancer. Written by an interdisciplinary team who have been responsible for the successful GEC-ESTRO/EAU Teaching Course. Discusses in detail patient selection, the results of different methods, the role of imaging, and medical physics issues. Prostate brachytherapy has been the subject of heated debate among surgeons and the proponents of the various brachytherapy methods. This very first interdisciplinary book on the subject provides a comprehensive overview of innovations in low dose rate (LDR), high dose rate (HDR), and pulsed dose rate (PDR) interstitial brachytherapy for the management of local or locally advanced prostate cancer. In addition to detailed chapters on patient selection and the use of imaging in diagnostics, treatment guidance, and implantation control, background chapters are included on related medical physics issues such as treatment planning and quality assurance. The results obtained with the different treatment options and the difficult task of salvage treatment are fully discussed. All chapters have been written by internationally recognized experts in their fields who for more than a decade have formed the teaching staff responsible for the successful GEC-ESTRO/EAU Prostate Brachytherapy Teaching Course. This book will be invaluable in informing residents and others of the scientific background and potential of modern prostate brachytherapy. It will also prove a useful source of up-to-date information for those who specialize in prostate brachytherapy or intend to start an interstitial brachytherapy service.

  11. Determination of the accuracy of implant reconstruction and dose delivery in brachytherapy in The Netherlands and Belgium

    Purpose: To gain insight into the accuracy of brachytherapy treatments, the accuracy of implant reconstruction and dose delivery was investigated in 33 radiotherapy institutions in The Netherlands and Belgium. Materials and methods: The accuracy of the implant reconstruction method was determined using a cubic phantom containing 25 spheres at well-known positions. Reconstruction measurements were obtained on 41 brachytherapy localizers, 33 of which were simulators. The reconstructed distances between the spheres were compared with the true distances. The accuracy of the dose delivery was determined for high dose rate (HDR), pulsed dose rate (PDR) and low dose rate (LDR) afterloading systems using a polymethyl methacrylate cylindrical phantom containing a NE 2571 ionization chamber in its centre. The institutions were asked to deliver a prescribed dose at the centre of the phantom. The measured dose was compared with the prescribed dose. Results: The average reconstruction accuracy was -0.07 mm (±0.4 mm, 1 SD) for 41 localizers. The average deviation of the measured dose from the prescribed dose was +0.9% (±1.3%, 1 SD) for 21 HDR afterloading systems, +1.0% (±2.3%, 1 SD) for 12 PDR afterloaders, and +1.8% (±2.5%, 1 SD) for 15 LDR afterloaders. Conclusions: This comparison showed a good accuracy of brachytherapy implant reconstruction and dose delivery in The Netherlands and Belgium

  12. Tratamento cirúrgico da artéria coronária direita intra-atrial

    José Carlos R. IGLÉZIAS

    1997-07-01

    Full Text Available A localização intracavitária da artéria coronária é rara. Segundo Ochsner & Mills (1, ela ocorreu com a artéria coronária direita em 0,9% e com o ramo interventricular em 0,2%. A localização da lesão e as condições patológicas relacionadas ao comprimento e diâmetro da coronária podem auxiliar na exposição da coronária intracavitária para uma revascularização apropriada. Freqüentemente os cirurgiões não estão habituados com a posição intracavitária e, durante a dissecção, podem abrir uma câmara cardíaca onde o vaso penetra. Os problemas que podem advir dai são a entrada de ar para a cavidade, a dificuldade na exposição do vaso, o sangramento e a obstrução da artéria durante o fechamento da miotomia. São relatados os casos de 3 pacientes que necessitaram de revascularização cirúrgica do miocárdio e que apresentavam a artéria coronária direita intracavitária. A localização e o comprimento da porção intracavitária da artéria auxiliam no manejo intra-operatório. A técnica utilizada para o fechamento da cavidade variou entre a anastomose na posição intracavitária com o fechamento da miotomia ao redor do enxerto (Figura 1, a liberação da artéria coronária para uma posição superficial (Figura 2, seguida da anastomose e fechamento da cavidade com sutura simples, feita subepicárdica.An intracavitary location of a coronary artery is rare in our surgical experience with revascularization. This variant has occured in the right coronary artery (0.01% and in left anterior descending coronary artery (0.2%. The location of the lesion and the pathological condition, length and size of the coronary may dictate exposure of an intracavitary coronary artery for proper revascularization; more commonly surgeons are anaware of the intracavitary position and during intramyocardial dissection of an artery will open a cardiac chamber where the vessel traverses the cavity. Problems that arise are introducion

  13. Brachytherapy as sole treatment modality in initial cervix carcinoma

    The aim of this study was to evaluate brachytherapy as the only treatment modality in inoperable early cervix carcinoma patients (carcinoma in situ, IA and IBocc). In a retrospective analysis 36 patients were treated with intracavitary irradiation between 1984 and 1988 in the Radiotherapy Department of the National Institute of Neoplasmic Diseases. Distribution by stage was; carcinoma in situ: one patient (2,47%), IA: six patients (16,6%), IBooc: twenty-nine patients (80,7%). Histology revealed epidermoid carcinoma in all cases. Mean age 55 years (range: 32-78). Treatment consisted in: two intracavitary applications of Radium, for 120 hours each, with a month interval, in 30 patients (carcinoma in situ: one, IA: four, IBocc: twenty-five patients), two applications of 72 hours each, with 15 days interval in four patients (IA: one, IBocc: 3) and one single intracavitary radium application in two patients (IA and IBocc). Local control was complete in all carcinoma in situ and IA patients. Only 1 of 29 patients with IBocc stage failed to respond, in spite of having received two applications, this shows that local response is independent of the number of insertions. Incidence of complications was low, and resolved with medical treatment. One patient had rectal adenocarcinoma 3 years after treatment -it was considered as radio induced neoplasm, since time of appearance was more than two years and localization was within irradiated area. Two patients died form intercurrent diseases, one (IBocc) from persistent diseases. Two patients were lost to follow-up. Three years survival was: 100% for carcinoma in situ and IA 86,2% for IBocc. Five years survival was 80% for IA and IBocc. Brachytherapy as unique modality of treatment is highly effective in initial cervix carcinoma stages. (author). 41 refs., 14 tabs., 2 figs., 1 ill

  14. Present status of radiotherapy in Venezuela

    The purpose of the work was to discover the conditions obtaining in the practice of radiotherapy in Venezuela; 15 public radiotherapy centres were visited, evaluated and information obtained on physical environment, treatment units, intracavitary radiotherapy groups, medical and para-medical personnel, recording of clinical data and number of patients. In the groups it was observed that: only one of 17 voltage stabilizing units was operating; the four linear accelerators can only be operated irregularly and there are 17 60Co units operating, but the majority of those are antiquated and worn out. One centre has a simulator and another has a computer. In intracavitary radiotherapy, approximately 50% of the centres do not carry out utero-vaginal implants in proper conditions. There are sufficient radiotherapists, but their working conditions cannot be compared with those in developed countries. There is a lack of auxiliary personnel, radiation physicists and dosimetrists. There is no training for radiotherapy technicians and there are not enough of them. In 50% of the centres, no treatment plans are made; one-third do not have any devices for immobilization. Four hospitals do not use radiotherapy histories or treatment graphics, and in four institutions no tumour record is used. The conclusion is that oncological radiotherapy is not adequate in most of the centres and it is recommended that: the damaged equipment should be repaired; the 60Co units with inadequate source-axis distances should be replaced; new sources should be acquired for the equipment with source-axis distances of 80 cm; maintenance should be constant; simulators should be provided; damaged intracavitary radiotherapy equipment and sources should be replaced; the numbers and training of technical personnel should be increased; physicists and dosimetrists should be trained; a national radiation physics centre should be set up, and the recording of clinical information should be improved. (author)

  15. Results of salvage radiotherapy after inadequate surgery in invasive cervical carcinoma patients: A retrospective analysis

    Purpose: To evaluate the results of salvage radiotherapy (RT) after inadequate surgery in patients with invasive carcinoma of the cervix. Methods and Materials: Between 1996 and 2001, 105 invasive cervical carcinoma patients were treated at our center with external beam RT with or without intracavitary RT after having undergone total/subtotal hysterectomy at outside institutions. Results: The median follow-up was 34 months. The gap between surgery and RT was 23-198 days (median, 80). Clinically visible residual disease was present in 81 patients (77.1%). Total hysterectomy had been done in 82 patients (78%) and subtotal hysterectomy in 23 patients (22%). The 5-year overall survival, disease-free survival, and pelvic control rates of all patients were 55.2%, 53.3%, and 72.4%, respectively. On univariate analysis, older age, total hysterectomy, hemoglobin level >10 g% before RT, nonsquamous histologic type, use of intracavitary RT, a shorter gap between surgery and RT, and the absence of, or a small volume of, residual disease favorably affected the outcome. The 5-year actuarial rate of late toxicity (Radiation Therapy Oncology Group Criteria) was 19% in the rectum, 4.8% in the bladder, 24.8% in the skin, and 14.3% in the small intestine. Conclusions: Inadequate and inappropriate surgery in invasive cervical cancer with resulting gross residual disease is common in India. Factors such as the use of intracavitary RT, the correction of anemia, and a shorter gap between surgery and RT will enable postoperative RT to achieve acceptable results with minimal morbidity

  16. Irradiation levels of various occupational groups and optimization of radiation monitoring

    The information on the density of distribution of individual dose of the medical personnel performing X-ray and radioisotope diagnostics and intracavitary and distance therapy is analyzed and used to establish the probability of exceeding radiation levels of various occupational groups higher than 1/3 MPD. The necessity of personnel monitoring with generators of short-lived isotopes during X-ray and radioisotope diagnostics is proved. Analytical dependences which permit to calculate the necessary sampling volume for the certain errors of determination of the mean dose and measuring individual doses, are presented

  17. Dose and volume specification for reporting interstitial therapy

    The ICRU has previously published reports dealing with Dose Specification for Reporting External Beam Therapy with Photons and Electrons (ICRU Report 29, ICRU, 1978), Dose Specification for Reporting External Beam Therapy (ICRU Report 50, ICRU, 1993) and Dose and Volume Specification for Reporting Intracavitary Therapy in Gynecology (ICRU Report 38, ICRU, 1985). The present report addresses the problem of absorbed dose specification for report interstitial therapy. Although specific to interstitial therapy, many of the concepts developed in this report are also applicable to certain other kinds of brachytherapy applications. In particular, special cases of intraluminal brachytherapy and plesio-brachytherapy via surface molds employing x or gamma emitters are addressed in this report

  18. MRI as an adjunct to echocardiography for the diagnostic imaging of cardiac masses

    Nine patients underwent magnetic resonance imaging (MRI) as part of the diagnostic evaluation for cardiac masses; eight of them had been preliminary studied by 2D-echocardiography (US). MRI did not add to the US diagnostic information in patients affected by intracavitary masses. It represented the definitive diagnostic modality in two patients with intramural pathology: one with ventricular rhabdomyoma, the second with an echinococcyal cyst located within the left atrial wall. The complementary role of MRI to US in cardiac masses is discussed. (orig.)

  19. Verification of the calculation program for brachytherapy planning system of high dose rate (PLATO); Programa de verificacion del calculo para un sistema de planificacion de braquiterapia de alta tasa de dosis (PLATO)

    Almansa, J.; Alaman, C.; Perez-Alija, J.; Herrero, C.; Real, R. del; Ososrio, J. L.

    2011-07-01

    In our treatments are performed brachytherapy high dose rate since 2007. The procedures performed include gynecological intracavitary treatment and interstitial. The treatments are performed with a source of Ir-192 activity between 5 and 10 Ci such that small variations in treatment times can cause damage to the patient. In addition the Royal Decree 1566/1998 on Quality Criteria in radiotherapy establishes the need to verify the monitor units or treatment time in radiotherapy and brachytherapy. All this justifies the existence of a redundant system for brachytherapy dose calculation that can reveal any abnormality is present.

  20. Magnetic Resonance Imaging (MRI) Markers for MRI-Guided High-Dose-Rate Brachytherapy: Novel Marker-Flange for Cervical Cancer and Marker Catheters for Prostate Cancer

    Schindel, Joshua; Muruganandham, Manickam [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States); Pigge, F. Christopher [Department of Chemistry, University of Iowa, Iowa City, Iowa (United States); Anderson, James [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States); Kim, Yusung, E-mail: yusung-kim@uiowa.edu [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States)

    2013-06-01

    Purpose: To present a novel marker-flange, addressing source-reconstruction uncertainties due to the artifacts of a titanium intracavitary applicator used for magnetic resonance imaging (MRI)-guided high-dose-rate (HDR) brachytherapy (BT); and to evaluate 7 different MRI marker agents used for interstitial prostate BT and intracavitary gynecologic HDR BT when treatment plans are guided by MRI. Methods and Materials: Seven MRI marker agents were analyzed: saline solution, Conray-60, copper sulfate (CuSO{sub 4}) (1.5 g/L), liquid vitamin E, fish oil, 1% agarose gel (1 g agarose powder per 100 mL distilled water), and a cobalt–chloride complex contrast (C4) (CoCl{sub 2}/glycine = 4:1). A plastic, ring-shaped marker-flange was designed and tested on both titanium and plastic applicators. Three separate phantoms were designed to test the marker-flange, interstitial catheters for prostate BT, and intracavitary catheters for gynecologic HDR BT. T1- and T2-weighted MRI were analyzed for all markers in each phantom and quantified as percentages compared with a 3% agarose gel background. The geometric accuracy of the MR signal for the marker-flange was measured using an MRI-CT fusion. Results: The CuSO{sub 4} and C4 markers on T1-weighted MRI and saline on T2-weighted MRI showed the highest signals. The marker-flange showed hyper-signals of >500% with CuSO{sub 4} and C4 on T1-weighted MRI and of >400% with saline on T2-weighted MRI on titanium applicators. On T1-weighted MRI, the MRI signal inaccuracies of marker-flanges were measured <2 mm, regardless of marker agents, and that of CuSO{sub 4} was 0.42 ± 0.14 mm. Conclusion: The use of interstitial/intracavitary markers for MRI-guided prostate/gynecologic BT was observed to be feasible, providing accurate source pathway reconstruction. The novel marker-flange can produce extremely intense, accurate signals, demonstrating its feasibility for gynecologic HDR BT.

  1. Indication, methods and results of selective arteriography of the A. iliaca interna in case of erectile dysfunction

    Baehren, W.; Gall, H.; Scherb, W.; Thon, W.

    1988-01-01

    Erectile dysfunction very frequently can be traced back to the real cause by means of angiography. Selective angiography is the method of choice in cases where other causes of circulatory disturbance have already been excluded, and non-invasive tests are expected to yield information of relevance to therapy. The qualitatively best angiographic results are obtained by examination under peridural anesthesia and by intracavitary injection of vaso-active substances. Selective arteriography is indicated in cases of primary or post-traumatic erectile dysfunction. It is a prerequisite of surgery for revascularisation of the pudendal-penile vascular bed.

  2. Indication, methods and results of selective arteriography of the A. iliaca interna in case of erectile dysfunction

    Erectile dysfunction very frequently can be traced back to the real cause by means of angiography. Selective angiography is the method of choice in cases where other causes of circulatory disturbance have already been excluded, and non-invasive tests are expected to yield information of relevance to therapy. The qualitatively best angiographic results are obtained by examination under peridural anesthesia and by intracavitary injection of vaso-active substances. Selective arteriography is indicated in cases of primary or post-traumatic erectile dysfunction. It is a prerequisite of surgery for revascularisation of the pudendal-penile vascular bed. (orig./MG)

  3. Cost effective method of manual afterloading 192Ir brachytherapy

    Full text: In radiotherapy, brachytherapy mode of treatment has equal importance like the external beam radiotherapy. In our hospital we have manual afterloading 137Cs kit supplied by BRIT for intracavitary treatment of carcinoma cervix and vaginal cases. In July 1999, we also started afterloading 192Ir brachytherapy. For a hospital like ours, where funds are minimal, it is impossible to procure remote afterloading brachytherapy unit, which is very costly. So we have developed the cost-effective 192Ir manual brachytherapy and so far we have done 60 cases which include intraluminal and interstitial cases

  4. Magnetic Resonance Imaging (MRI) Markers for MRI-Guided High-Dose-Rate Brachytherapy: Novel Marker-Flange for Cervical Cancer and Marker Catheters for Prostate Cancer

    Purpose: To present a novel marker-flange, addressing source-reconstruction uncertainties due to the artifacts of a titanium intracavitary applicator used for magnetic resonance imaging (MRI)-guided high-dose-rate (HDR) brachytherapy (BT); and to evaluate 7 different MRI marker agents used for interstitial prostate BT and intracavitary gynecologic HDR BT when treatment plans are guided by MRI. Methods and Materials: Seven MRI marker agents were analyzed: saline solution, Conray-60, copper sulfate (CuSO4) (1.5 g/L), liquid vitamin E, fish oil, 1% agarose gel (1 g agarose powder per 100 mL distilled water), and a cobalt–chloride complex contrast (C4) (CoCl2/glycine = 4:1). A plastic, ring-shaped marker-flange was designed and tested on both titanium and plastic applicators. Three separate phantoms were designed to test the marker-flange, interstitial catheters for prostate BT, and intracavitary catheters for gynecologic HDR BT. T1- and T2-weighted MRI were analyzed for all markers in each phantom and quantified as percentages compared with a 3% agarose gel background. The geometric accuracy of the MR signal for the marker-flange was measured using an MRI-CT fusion. Results: The CuSO4 and C4 markers on T1-weighted MRI and saline on T2-weighted MRI showed the highest signals. The marker-flange showed hyper-signals of >500% with CuSO4 and C4 on T1-weighted MRI and of >400% with saline on T2-weighted MRI on titanium applicators. On T1-weighted MRI, the MRI signal inaccuracies of marker-flanges were measured 4 was 0.42 ± 0.14 mm. Conclusion: The use of interstitial/intracavitary markers for MRI-guided prostate/gynecologic BT was observed to be feasible, providing accurate source pathway reconstruction. The novel marker-flange can produce extremely intense, accurate signals, demonstrating its feasibility for gynecologic HDR BT

  5. [New challenges to the treatment of cervical intraepithelial neoplasia].

    Sun, J H

    2016-07-01

    Due to the progress of intracavitary afterloading technology and dosage of brachytherapy, a similar dose distribution as that of cervical conization can be achieved and can be applied to the treatment of cervical intraepithelial neoplasia (CIN), it is called "afterloading conization" . Being adjusted the radioactive source movement and weight, low exposure doses to the ovary, endometrium and vagina can be assured. So a high quality of life after treatment could be maintained and overcomes the shortcomings of cervical conization and hysterectomy, such as anesthesia, bleeding, over or insufficient treatment, early ovarian ageing and operative complications. PMID:27531273

  6. Dosimetric characterization of interstitial radiotherapy sources: application to iridium 192

    192Ir interstitial radiotherapy sources have been characterized in terms of normal kerma-rate in air ksub(n), with an air-filled graphite cavity chamber of known volume, thus leading to primary standards. The distribution of absorbed dose in water has been studied, at different depths in a phantom, with an intracavitary chamber and with lithium fluoride thermoluminescent dosemeters. These two experimental investigations, complemented with the establishment of a rigorous formalism, made it possible to determine the transmission function phi(d) in water, which is used in calculation codes for interstitial therapy. The values thus obtained are then compared to these previously published

  7. Slim 198gold-grain implanter loaded with standard royal marsden 14-grain magazines

    We designed a slim gold-grain implanter with adaptable lengths to implant areas accessible only through long, narrow, examining instruments, such as a suspension laryngoscope. The implanter is loaded with the same 14-grain magazine designed for and supplied with the Royal Marsden gun. The simplicity of the loading mechanism with a minimum of moving parts makes the instrument practically trouble free. Although it is designed to be used along narrow examining instruments, it can also be used in any situation in which a permanent implant is required, for instance, prostatic cancer and pelvic recurrences in cancer of the uterine cervix previously treated by external and intracavitary irradiation

  8. Radiotherapy of corpus carcinoma. Retrospective study

    Banaschak, A.; Wever, T.; Schicke, B.

    1985-01-01

    96 women with primary carcinoma corporis uteri and 79 women after surgery were treated between 1965-1970 with different radiotherapeutic methods, in some cases in combination with cytostatics and gestagens. In the group of primary radiation best results were obtained with combination of intracavitary brachytherapy and external radiation (55% 5-years-survival), and in the postoperative group with external radiation alone (67% 5-years-survival). Late complications with 17% fibrosis in the parametrial tissue and 12% persistant diarrhea in the postoperative group needs strict individualization in therapy and requires exact knowledge on extention and biological behavior of the tumor.

  9. Radiotherapy of corpus carcinoma

    96 women with primary carcinoma corporis uteri and 79 women after surgery were treated between 1965 - 1970 with different radiotherapeutic methods, in some cases in combination with cytostatics and gestagens. In the group of primary radiation best results were obtained with combination of intracavitary brachytherapy and external radiation (55% 5-years-survival), and in the postoperative group with external radiation alone (67% 5-years-survival). Late complications with 17% fibrosis in the parametrial tissue and 12% persistant diarrhea in the postoperative group needs strict individualization in therapy and requires exact knowledge on extention and biological behavior of the tumor. (author)

  10. The American Brachytherapy Society recommendations for low-dose-rate brachytherapy for carcinoma of the cervix

    Purpose: This report presents guidelines for using low-dose-rate (LDR) brachytherapy in the management of patients with cervical cancer. Methods: Members of the American Brachytherapy Society (ABS) with expertise in LDR brachytherapy for cervical cancer performed a literature review, supplemented by their clinical experience, to formulate guidelines for LDR brachytherapy of cervical cancer. Results: The ABS strongly recommends that radiation treatment for cervical carcinoma (with or without chemotherapy) should include brachytherapy as a component. Precise applicator placement is essential for improved local control and reduced morbidity. The outcome of brachytherapy depends, in part, on the skill of the brachytherapist. Doses given by external beam radiotherapy and brachytherapy depend upon the initial volume of disease, the ability to displace the bladder and rectum, the degree of tumor regression during pelvic irradiation, and institutional practice. The ABS recognizes that intracavitary brachytherapy is the standard technique for brachytherapy for cervical carcinoma. Interstitial brachytherapy should be considered for patients with disease that cannot be optimally encompassed by intracavitary brachytherapy. The ABS recommends completion of treatment within 8 weeks, when possible. Prolonging total treatment duration can adversely affect local control and survival. Recommendations are made for definitive and postoperative therapy after hysterectomy. Although recognizing that many efficacious LDR dose schedules exist, the ABS presents suggested dose and fractionation schemes for combining external beam radiotherapy with LDR brachytherapy for each stage of disease. The dose prescription point (point A) is defined for intracavitary insertions. Dose rates of 0.50 to 0.65 Gy/h are suggested for intracavitary brachytherapy. Dose rates of 0.50 to 0.70 Gy/h to the periphery of the implant are suggested for interstitial implant. Use of differential source activity or

  11. Maxillary sinus atelectasis report of two cases

    Sadeghi M

    2002-08-01

    Full Text Available Maxillary sinus atelectasis is a rare and relatively unknown disease. Most patients present with non-sinonasel complaints. Negative intracavitary pressure due to ostial obstruction is suggested as the most probable etiology. Two patients with sinus atelectasis are presented in this paper: Case 1 presented with enophthalmus and maxillary sinus opacity and atelectasis in imaging. Endoscopic uncinectomy and midle antrostomy was done for this patient. Case 2 presented with mid-facial deformity and depression. Caldwel-Luc procedure with inferior meatal antrostomy was done. In 1 year follow up, they were asymptomatic and with no deterioration of facial deformity.

  12. 'In vivo' Dose Measurements in High-Dose-Rate Brachytherapy Treatments for Cervical Cancer: A Project Proposal

    The aim of this thesis project is to compare doses calculated from the treatment planning system using computed tomography images, with those measured 'in vivo' by using thermoluminescent dosimeters placed at different regions of the rectum and bladder of a patient during high-dose-rate intracavitary brachytherapy treatment of uterine cervical carcinoma. The experimental dosimeters characterisation and calibration have concluded and the protocol to carry out the 'in vivo' measurements has been established. In this work, the calibration curves of two types of thermoluminescent dosimeters (rods and chips) are presented, and the proposed protocol to measure the 'in vivo' dose is fully described.

  13. Method of making isodose curve using thermoluminescence dosemeter

    Line source of 60Co in the form of needles and tubes are extensively used in radiotherapy in moulds, implants, and intracavitary techniques for the treatment of malignant lesions. It is important to have isodose distributions in tissue for those source for purposes of treatment planning. The isodose distributions have been obtained experimentally by using tinny lithium-fluoride (Lsub(i)F) thermoluminescent dosemeters (TLD) and they are compared to the theoretical results. The distinct advantages of Lsub(i)F (TLD) in such measurements are briefly discussed. (author)

  14. Dose and volume specification for reporting interstitial therapy

    NONE

    1997-12-30

    The ICRU has previously published reports dealing with Dose Specification for Reporting External Beam Therapy with Photons and Electrons (ICRU Report 29, ICRU, 1978), Dose Specification for Reporting External Beam Therapy (ICRU Report 50, ICRU, 1993) and Dose and Volume Specification for Reporting Intracavitary Therapy in Gynecology (ICRU Report 38, ICRU, 1985). The present report addresses the problem of absorbed dose specification for report interstitial therapy. Although specific to interstitial therapy, many of the concepts developed in this report are also applicable to certain other kinds of brachytherapy applications. In particular, special cases of intraluminal brachytherapy and plesio-brachytherapy via surface molds employing x or gamma emitters are addressed in this report.

  15. Bladder and rectal complications following radiotherapy for cervix cancer

    One-hundred and thirty-two patients with cervix carcinoma who were treated with whole pelvis irradiation and two intracavitary applications had bladder and rectal dosimetry during brachytherapy with contrast agents placed into the bladder and rectum prior to orthogonal simulator radiographs. Doses were computer calculated at points A and B, F (bladder), R1 (rectum), and R2 (rectosigmoid). Late occurring bladder and rectal complications were graded on a severity scale of 1 to 3, and 14% had grade 2 or 3 injuries (9% developed fistulas). Statistical evaluation of the data showed that severe bladder and rectal injuries occur more commonly in stage IIIA and IIIB disease and in those receiving high external beam doses (5000 rad +). Analysis of variance tests revealed a significant correlation of brachytherapy dose to points R1 and R2 with severe rectal injuries but there was not a correlation of dose to F with bladder injuries. Nor was there correlation of injuries with dose to point A or the milligram-hour dose. We conclude that our technique for rectal dosimetry is adequate but that an improved technique of bladder dosimetry is needed. Also, when combining whole pelvis irradiation with two intracavitary applications (4000 rad to point A), the whole pelvis dose should probably not exceed 4000-4500 rad

  16. Extended-field radiation therapy for carcinoma of the cervix

    The survival of cervical carcinoma patients with paraaortic/high common iliac nodal metastases was evaluated by retrospective chart review during a 13-year interval. Thirty-three patients with cervical carcinoma and surgically documented nodal metastases received primary, extended-field radiation therapy. Overall 2-year and 5-year actuarial survival rates after diagnosis were 37% and 31%, respectively. Survival was analyzed in terms of the variables patient age, clinical stage, tumor histologic type, the presence of enlarged paraaortic/high common iliac lymph nodes, the extent of nodal involvement (microscopic versus macroscopic), the presence of intraperitoneal disease, and whether intracavitary brachytherapy was administered. The use of intracavitary radiation therapy was associated with improved local control and survival (P = 0.017). None of the other variables were statistically related to patient survival. Twenty-two of the patients died of cervical cancer and five are surviving without evidence of cancer. Four patients died of intercurrent disease. Two patients developed bowel-related radiation complications; both patients received chemotherapy concurrent with the radiation therapy. One of the two patients died of radiation enteritis. The use of extended-field radiation therapy does benefit a small group of patients and may result in extended patient survival

  17. Multiple-site perineal applicator (MUPIT) for treatment of prostatic, anorectal, and gynecologic malignancies

    Recently, transperineal interstitial-intracavitary applicators have been used to treat locally limited and advanced perineal and gynecologic malignancies. The authors have developed a single afterloading applicator, referred to as the ''MUPIT'' (Martinez Universal Perineal Interstitial Template), which with its prototypes has been utilized to treat 78 patients with malignancies of the cervix, vagina, female urethra, perineum, prostate, and anorectal region. The device basically consists of two acrylic cylinders, an acrylic template with a predrilled array of holes that serve as guides for trocars, and a cover plate. Some of the guide holes on the template are angled outward to permit a wide lateral coverage without danger of striking the ischium. The cylinders have an axial hole large enough to pass a central tandem or a suction tube for the drainage of secretions. Thus, the device allows for the interstitial placement of 192Ir ribbons as well as the intracavitary placement of either 137Cs tubes or 192Ir ribbons. In use, the cylinders are placed in the vagina and rectum and then fastened to the template, so that a fixed geometric relationship among the tumor volume, normal structures, and source placement is preserved throughout the course of the implantation. Appropriate computer programs also have been developed on a minicomputer for the corresponding dose-rate computations

  18. Radiotherapy for the vulvar cancer

    Fifteen patients who had primary vulvar cancer treated with radiotherapy as an initial treatment at Hyogo Medical Center for Adults and Hyogo Cancer Center from January 1971 to December 1990 are presented. Two patients were stage 0, one stage I, three stage II and nine stage III. Nine patients received electron irradiation with or without interstitial irradiation and intracavitary vaginal irradiation. Five patients received megavoltage X-ray irradiation using AP/PA parallel opposed fields including the pelvic nodes and perineum followed by boost irradiation of electrons, interstitial irradiation and intracavitary vaginal irradiation. The total dose delivered to the primary tumor ranged from 50 to 100 Gy (73 Gy on average). The actuarial 5-year survival rate of the patients was 43.6%. Complete regression (CR) was achieved in 60% of the patients. However, CR was not achieved in any of five patients with palpable inguinal nodes. In contrast, all the patients who had tumors of less than 2 cm in diameter achieved CR. Five of nine CR cases relapsed. First sites of failure were vagina, groin and vulvar region. Recurrence occurred more than four years after treatment in three cases. Necrosis occurred in five of nine CR cases. (author)

  19. Radiotherapy for the vulvar cancer

    Hirota, Saeko; Soejima, Toshinori; Motohara, Tomofumi (Hyogo Medical Center for Adults, Akashi (Japan)) (and others)

    1993-03-01

    Fifteen patients who had primary vulvar cancer treated with radiotherapy as an initial treatment at Hyogo Medical Center for Adults and Hyogo Cancer Center from January 1971 to December 1990 are presented. Two patients were stage 0, one stage I, three stage II and nine stage III. Nine patients received electron irradiation with or without interstitial irradiation and intracavitary vaginal irradiation. Five patients received megavoltage X-ray irradiation using AP/PA parallel opposed fields including the pelvic nodes and perineum followed by boost irradiation of electrons, interstitial irradiation and intracavitary vaginal irradiation. The total dose delivered to the primary tumor ranged from 50 to 100 Gy (73 Gy on average). The actuarial 5-year survival rate of the patients was 43.6%. Complete regression (CR) was achieved in 60% of the patients. However, CR was not achieved in any of five patients with palpable inguinal nodes. In contrast, all the patients who had tumors of less than 2 cm in diameter achieved CR. Five of nine CR cases relapsed. First sites of failure were vagina, groin and vulvar region. Recurrence occurred more than four years after treatment in three cases. Necrosis occurred in five of nine CR cases. (author).

  20. Multiple-site perineal applicator (MUPIT) for treatment of prostatic, anorectal, and gynecologic malignancies

    Martinez, A.; Cox, R.S.; Edmundson, G.K.

    1984-02-01

    Recently, transperineal interstitial-intracavitary applicators have been used to treat locally limited and advanced perineal and gynecologic malignancies. The authors have developed a single afterloading applicator, referred to as the ''MUPIT'' (Martinez Universal Perineal Interstitial Template), which with its prototypes has been utilized to treat 78 patients with malignancies of the cervix, vagina, female urethra, perineum, prostate, and anorectal region. The device basically consists of two acrylic cylinders, an acrylic template with a predrilled array of holes that serve as guides for trocars, and a cover plate. Some of the guide holes on the template are angled outward to permit a wide lateral coverage without danger of striking the ischium. The cylinders have an axial hole large enough to pass a central tandem or a suction tube for the drainage of secretions. Thus, the device allows for the interstitial placement of /sup 192/Ir ribbons as well as the intracavitary placement of either /sup 137/Cs tubes or /sup 192/Ir ribbons. In use, the cylinders are placed in the vagina and rectum and then fastened to the template, so that a fixed geometric relationship among the tumor volume, normal structures, and source placement is preserved throughout the course of the implantation. Appropriate computer programs also have been developed on a minicomputer for the corresponding dose-rate computations.

  1. Evaluation of late morbidity in patients with carcinoma of the uterine cervix following a dose rate change

    Background: A retrospective analysis of late complications for patients with cervical cancer treated with two different brachytherapy schedules in one institute, using the French-Italian glossary. Materials and methods: From 1979 until 1986, a total of 77 patients were treated with external radiation followed by two intracavitary applications with the Gynatron Cs-137 afterloading (dose rate 0. 54 Gy/h). After 1986, 66 patients received intracavitary applications with Selectron-LDR (dose rate 1.07 Gy/h). Because of the expected increase in complications with increasing dose rate, the dose per application was reduced from 25 Gy to 20 Gy. Results: 49/77 late gastrointestinal and urinary complications were scored in the Gynatron group and 46/68 in the Selectron group. Actuarial estimates at 5 years showed 42% and 54.1% late gastrointestinal complications and 16.9% and 24.1% for late urinary complications in the patients treated with, respectively, the Gynatron and Selectron. Conclusions: Despite the dose reduction, there remains a clear dose rate influence on the late morbidity. Correction for this influence is essential

  2. Potential brachytherapy nuclides of future

    In the past there were relatively few radionuclides available for brachytherapy. But the situation is rapidly changing with the development of many new sources with properties that may be advantageous in certain clinical situations. In the choice of an acceptable, rather than an ideal radionuclide, it is important to consider the physical dose distribution, radiobiological effectiveness, ease of radiation protection, logistics and cost. Taking into account these factors, a number of radionuclides have been tried and more are being considered for specific type of applications. Presently, 137Cs is the most commonly used radionuclide for intracavitary therapy and 192Ir for interstitial therapy. 125I has more or less replaced 198Au for permanent implants. Clinical studies are being carried out to assess the feasibility of replacing 137Cs with 241Am for intracavitary applications and 125I with 103Pd and/or 169Yb for interstitial permanent implants. Other radionuclides being considered are 75Fe and 145Sm. Neutron induced brachytherapy is a new technique being tried to ensure complete radiation safety. (author). 1 tab

  3. Results of radiation therapy for carcinoma of the uterine cervix

    Fifty-nine consecutive patients who were treated with radiation therapy for carcinoma of the uterine cervix between April 1982 and December 1986 were reviewed. Twelve patients were treated with low dose-rate intracavitary irradiation using radium-226, and 46 were treated with high dose-rate irradiation using a remote afterloading system combined with external irradiation, and the other one was treated with external irradiation alone. The 5-year-survival rates for stage Ib, IIa, IIb, IIIb, and IVa were 77.8, 85.7, 87.5, 45.5 and 40.0%, respectively. The 5-year-survival rates for the low and high dose-rates irradiation were 66.7 and 73.9%, respectively. The most common complication of radiation therapy was rectal bleeding, which required conservative treatment (grade 2) in 11 (18.6%). The morbidities for the low and high dose-rates irradiation were similar. The causes of death in 17 patients were local recurrence in 14, metastases in 2 and other specified in one. These findings suggest that high dose-rate intracavitary irradiation is as effective as low dose-rate irradiation for carcinoma of the uterine cervix, and that further efforts for controlling the local tumors with stage IIIb disease without an increased rate of side-effects is required. (author)

  4. The dose time relationship in the radiotherapy of carcinoma of the cervix: application of CRE formalism

    A retrospective analysis of 291 patients with cancer of the uterine cervix treated with a combination of external and intracavitary radiotherapy was carried out. Patients were either treated with 45 Gy in 20 fractions by five fractions per week to with 42 Gy in 14 fractions by three fractions per week or with 42 Gy in 14 fractions by three fraction per week schedule by external radiotherapy. For brachytherapy the total dose was 24 to 32 Gy at a dose rate of 1.4 to 2.2 Gy per hour. Complication were correlated with total CRE values for point A (CREsub(TA)) and for rectum CREsub(TR). Correlations of CREsub(TA) with overall complication rate (p value 0.1) as well as rectal complication rate (p value >0.1). In order to limit Grade II and III rectal and bladder complications to acceptable level, in combined external and intracavitary treatments, CREsub(TA) value of less than 2500 reu is suggested. (author). 49 refs., 4 tabs., 4 figs., 1 appendix

  5. [Report on 114 primary vaginal carcinomas].

    Sun, J H; Zhang, W H; Li, A L; Wu, A R

    1987-11-01

    114 patients with primary carcinoma of the vagina were treated in our hospital from 1958 to 1978. It accounted for 0.83% of all gynecological malignant tumors in the same period. The youngest was 26 years of age, the oldest 75. Patients 40-59 years comprised 61.4%. 33% of patients had wedding age under 17. 63.4% had more than 4 pregnancies and 58.4% gave more than 4 births. 89.69% was diagnosed as squamous cell carcinoma, 7.2% as adenocarcinoma, 2.06% as undifferentiated carcinoma and 1 as embryonic carcinoma. The tumor occurred frequently in the upper third and posterior wall of the vagina (60% and 68%). In this series, there were 21 stage I, 29 stage II, 61 stage III and 3 stage IV lesions. 110 patients were treated by radiotherapy in different schemes. Intracavitary radium or caesium plus 60Co external irradiation by four fields gave better result with a 5 year survival rate of 66.1%. Only 2 out of 12 patients were cured by 60Co rotation alone but if supplemented by intracavitary radium or caesium, the cure rate was increased. The 5 year survival rate was 71.4% for stage I, 62.1% for stage II, 42.6% for stage III and O for stage IV. After the radiotherapy, rectovaginal fistula developed in 1 patient, vesicovaginal fistula in 1. 14% was complicated with rectal bleeding and 8.18% with hematuria. PMID:3452544

  6. Percutaneous placement of peritoneal port-catheter in oncologic patients

    The aim of this paper is to describe the technique of percutaneous ultrasound (US)-guided placement of a peritoneal port-catheter in an interventional radiological setting. Nineteen patients with peritoneal carcinomatosis were selected for intraperitoneal port-catheter placement in order to perform intracavitary receptor-immuno- or radio-immunotherapy with Ytrium-90. All the procedures were performed percutaneously under US and fluoro guidance; the insertion site for catheters was chosen according to abdominal conditions and US findings: all devices were implanted at the lower abdominal quadrants. All patients were followed up with CT and US according to the therapy protocol. The procedure was successfully completed in 15/19 patients, in 4 being contraindicated by peritoneal adhesions. No procedure-related complications and device occlusions during therapy were observed; one catheter displaced 7 months later the placement. In our experience, this procedure was feasible, reliable and easy to perform, allowing the correct administration of the planned intracavitary therapy. Peritoneal adhesions are the main limitation of peritoneal port placement. (orig.)

  7. Radiation therapy for carcinoma of the uterine cervix. Comparison of two brachytherapy schedules

    We compared the survival rates and late effects for two groups of cervical cancer patients treated with almost the same external radiotherapy but different remote afterloading systems (RALS) for high-dose-rate intracavitary radiation therapy regimens. A total of 218 patients with carcinoma of the uterine cervix were treated. For 98 patients, intracavitary brachytherapy was delivered with 6-7.5 Gy/fraction to Point A (Group A), and for 120, 5 Gy/fraction with a modified source step size (Group B). The 3-year cause-specific survival rates by stage and treatment schedule were Group A: 91% and Group B: 96% in Stage I, 89% and 92% in Stage II, 64% and 75% in Stage III, 44% and 69% in Stage IV. The survival curves did not reveal any statistically significant differences at any stage. The 3-year cumulative local failure rates were 14% in Group A and 7% in Group B (P = 0.1202), while the actuarial rates of developing rectal complication (Grade 2 or more) at 3 years were 25% in Group A and 4% in Group B (P < 0.0001). This retrospective analysis suggests that a low dose per fraction with modified source step size is advantageous because of yielding almost the same local control but with fewer rectal complications. (author)

  8. Influence of dose rate on normal tissue tolerance

    Dose rate is one of the most important factors that determine the biological effects of a given dose of radiation. In general, the effects of radiation decrease with a decrease in dose rate. Dose rates that have been used in radiation therapy range from a few cGy/day for permanently implanted interstitial sources for a few Gy/min for external beam radiation therapy and high-dose-rate intracavitary brachytherapy. Processes such as repair of sublethal and potential lethal damage, cell cycle progression and redistribution, repopulation, and reoxygenation that are important for biological effects of fractionated external beam radiation therapy are also important for low-dose-rate intracavitary brachytherapy and brachytherapy and temporarily implanted interstitial sources. Repair of sublethal damage during continuous low-dose-rate irradiation (CLDRI) is probably the most important factor underlying the dose-rate effects observed in animal and human cell lines in vitro and tumor and normal tissues in vivo (1,2). The extent to which these processes determine the effect of dose rate varies with the intrinsic radiosensitivity, repair capacity, and proliferative kinetics of the stromal cells comprising the tissue. In this paper the influence of clinically relevant dose rate on normal tissue tolerance is discussed. To quantify the dose-rate effect, the dose-rate factor (DRF), which is a ratio of the isoeffect dose for a given dose rate and the isoeffect dose of the reference dose rate, has been estimated for each normal tissue whenever possible

  9. Lymphocyte radiosensitivity is a significant prognostic factor for morbidity in carcinoma of the cervix

    Purpose: To study the relationship between pretreatment peripheral blood lymphocyte radiosensitivity and morbidity following radiation therapy. Methods and Materials: A prospective study was carried out in which patients with carcinoma of the cervix underwent radiation therapy. Intrinsic radiosensitivity was measured on pretreatment peripheral blood lymphocytes, using a limiting dilution clonogenic assay. Late morbidity was assessed using the Franco-Italian glossary. Results were correlated in an actuarial analysis. Results: There were no correlations between the measured lymphocyte radiosensitivity (SF2) and colony-forming efficiency, patient age, tumor grade, or disease stage. For 83 patients, lymphocyte SF2 was a significant prognostic factor for the probability of developing both any (p=0.002) and Grade 3 (p=0.026) morbidity. In 174 patients, stage showed borderline significance as a prognostic factor for morbidity (p=0.056). However, the type of treatment (intracavitary alone, intracavitary plus parametrial irradiation, single insertion plus whole-pelvis irradiation) was significantly associated with the probability of developing late complications (p=0.013). There was a weak significant inverse correlation between lymphocyte SF2 and grade of morbidity (r=-0.34, p=0.002). Conclusion: These data highlight the importance of normal cell radiosensitivity as a factor determining radiation therapy response. They also show that peripheral blood lymphocyte SF2 is a highly significant prognostic factor for the probability of developing late radiation morbidity, and that carcinoma of the cervix is a good model for testing radiobiologic principles in the clinic

  10. A dynamic study of intravenously administered 13NH3 in man with positron computed tomography

    A whole body, multislice positron computed tomograph (POSITOLOGICA-II) was used to study the time course of concentration of 13N following intravenous administration of 13NH3 in the human heart, lungs and liver. Serial 30 seconds or 1 minute Positron-CT scans 6 to 7 minutes were performed immediately after intravenous administration of 13NH3 and time activity curves of the blood pool in the right and left ventricles, myocardium, lungs and liver were derived from these scans. The first scan gave cardiac blood pool images and these intracavitary 13N activity disappeared rapidly thereafter. On the other hand the myocardial 13N activity remained nearly constant throughout the period of observation and high quality cross-sectional images of the left ventricular myocardium were obtained. The patients with myocardial infarction revealed diminished accumulaton of 13N at the sites corresponding to the infaction. In the lung, there was a moderate uptake of 13N and this was washed out more slowly than in the intracavitary blood pool. The liver revealed a late uptake of 13N. These observations may represent transference of metabolized 13NH3. As the results, the present study clealy demonstrated the usefulness of 13NH3 as an imaging agent not only to the heart but also to the lungs and liver. (author)

  11. Current status of radiation therapy. Evidence-based medicine (EBM) of radiation therapy. Current management of patients with esophageal cancer

    The best management for small mucosal esophageal cancer is generally endoscopic mucosal resection. However, for submucosal cancer and extensive mucosal caner, either radical surgery or radiation seems to be an equally efficacious option. Radiation therapy concurrent with chemotherapy is more effective than radiation therapy alone for patients with unresectable esophageal cancer. The key drugs are cisplatin and 5-fluorouracil. However, for patients with poor performance status or for aged patients, radiation therapy alone is still a choice of treatment. Surgery has generally been indicated for patients with resectable esophageal cancer. However, outcomes of concurrent chemoradiation therapy may be comparable with those of surgery. Therefore, a prospective randomized study should be performed to determine the best management for patients with resectable esophageal cancer. The usefulness of intra-cavitary irradiation for esophageal cancer has not been clarified. A prospective randomized trial with a large number of patients is necessary to determine the effectiveness of intra-cavitary irradiation. The best management for patients with loco-regionally recurrent esophageal cancer after surgery has not been determined. Intensive therapy should be considered if the site of recurrence is limited and the time interval from surgery to recurrence is long. Chemotherapy is essential in the management of patients with small cell esophageal cancer. However, the best local therapy has not been determined. (author)

  12. High dose rate brachytherapy for oral cancer

    Brachytherapy results in better dose distribution compared with other treatments because of steep dose reduction in the surrounding normal tissues. Excellent local control rates and acceptable side effects have been demonstrated with brachytherapy as a sole treatment modality, a postoperative method, and a method of reirradiation. Low-dose-rate (LDR) brachytherapy has been employed worldwide for its superior outcome. With the advent of technology, high-dose-rate (HDR) brachytherapy has enabled health care providers to avoid radiation exposure. This therapy has been used for treating many types of cancer such as gynecological cancer, breast cancer, and prostate cancer. However, LDR and pulsed-dose-rate interstitial brachytherapies have been mainstays for head and neck cancer. HDR brachytherapy has not become widely used in the radiotherapy community for treating head and neck cancer because of lack of experience and biological concerns. On the other hand, because HDR brachytherapy is less time-consuming, treatment can occasionally be administered on an outpatient basis. For the convenience and safety of patients and medical staff, HDR brachytherapy should be explored. To enhance the role of this therapy in treatment of head and neck lesions, we have reviewed its outcomes with oral cancer, including Phase I/II to Phase III studies, evaluating this technique in terms of safety and efficacy. In particular, our studies have shown that superficial tumors can be treated using a non-invasive mold technique on an outpatient basis without adverse reactions. The next generation of image-guided brachytherapy using HDR has been discussed. In conclusion, although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner, HDR brachytherapy remains an important option for treatment of oral cancer. (author)

  13. Accelerated Partial Breast Irradiation: 5-Year Results of the German-Austrian Multicenter Phase II Trial Using Interstitial Multicatheter Brachytherapy Alone After Breast-Conserving Surgery

    Purpose: To evaluate the impact of accelerated partial breast irradiation on local control, side effects, and cosmesis using multicatheter interstitial brachytherapy as the sole method for the adjuvant local treatment of patients with low-risk breast cancer. Methods and Materials: 274 patients with low-risk breast cancer were treated on protocol. Patients were eligible for the study if the tumor size was 35 years, hormone receptors were positive, and histologic grades were 1 or 2. Of the 274 patients, 175 (64%) received pulse-dose-rate brachytherapy (Dref = 50 Gy). and 99 (36%) received high-dose-rate brachytherapy (Dref = 32.0 Gy). Results: Median follow-up was 63 months (range, 9-103). Only 8 of 274 (2.9%) patients developed an ipsilateral in-breast tumor recurrence at the time of analysis. The 5-year actuarial local recurrence-free survival probability was 98%. The 5- year overall and disease-free survival probabilities of all patients were 97% and 96%, respectively. Contralateral in-breast malignancies were detected in 2 of 274 (0.7%) patients, and distant metastases occurred in 6 of 274 (2.2%). Late side effects ≥Grade 3 (i.e., breast tissue fibrosis and telangiectasia) occurred in 1 patient (0.4%, 95%CI:0.0-2.0%) and 6 patients (2.2%, 95%CI:0.8-4.7%), respectively. Cosmetic results were good to excellent in 245 of 274 patients (90%). Conclusions: The long-term results of this prospective Phase II trial confirm that the efficacy of accelerated partial breast irradiation using multicatheter brachytherapy is comparable with that of whole breast irradiation and that late side effects are negligible.

  14. Partial breast irradiation for locally recurrent breast cancer within a second breast conserving treatment: Alternative to mastectomy? Results from a prospective trial

    Purpose: To assess the outcome of multi-catheter pulse dose rate (PDR) brachytherapy of re-irradiation for local ipsilateral breast tumour recurrence (IBTR) in regard to local control, survival, morbidity and quality of life (QoL). Patients and methods: Between 1999 and 2006, 39 patients were included with histologically confirmed IBTR, Karnofsky index ⩾80% and refusal of mastectomy. Exclusion criteria were multicentric invasive growth pattern, unclear surgical margins, distant metastasis and a postoperative breast not suitable for interstitial brachytherapy. Primary endpoint was local tumour control. Morbidity, cosmetic outcome and QoL were assessed in 24/39 patients. Results: The five year actuarial local control rate was 93% after a mean follow up of 57 (±30) months with two second local relapses. Overall survival and disease free survival, both at 5 years, were 87% and 77%, respectively. Late side effects Grade 1–2 were observed in 20/24 patients after a mean follow-up of 30 (±18) months. Late side effects ⩾Grade 3 occurred in 4/24 patients. Cosmetic outcome was excellent to fair in 76% of women. Overall QoL was comparable to a healthy control group. Mean scores of scales and items of QLQ-BR23 were comparable to primary breast conserving therapy. Conclusions: Accelerated PDR-brachytherapy following breast conserving surgery (BCS) for local IBTR results in local tumour control comparable to mastectomy. Morbidity is moderate; the cosmetic outcome is good and hardly any impairment on QoL is observed.

  15. Feasibility of combined operation and perioperative intensity-modulated brachytherapy of advanced/recurrent malignancies involving the skull base

    Strege, R.J.; Eichmann, T.; Mehdorn, H.M. [University Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Neurosurgery; Kovacs, G.; Niehoff, P. [University Hospital Schleswig-Holstein, Kiel (Germany). Interdisciplinary Brachytherapy Center; Maune, S. [University Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Otolaryngology; Holland, D. [University Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Ophthalmology

    2005-02-01

    Purpose: To assess the technical feasibility and toxicity of combined operation and perioperative intensity-modulated fractionated interstitial brachytherapy (IMBT) in advanced-stage malignancies involving the skull base with the goal of preserving the patients' senses of sight. Patients and Methods: This series consisted of 18 consecutive cases: ten patients with paranasal sinus carcinomas, five with sarcomas, two with primitive neuroectodermal tumors (PNETs), and one with parotid gland carcinoma. After, in most cases, subtotal surgical resection (R1-R2: carried out so that the patients' senses of sight were preserved), two to twelve (mean five) afterloading plastic tubes were placed into the tumor bed. IMBT was performed with an iridium-192 stepping source in pulsed-dose-rate/high-dose-rate (PDR/HDR) afterloading technique. The total IMBT dose, ranging from 10 to 30 Gy, was administered in a fractionated manner (3-5 Gy/day, 5 days/week). Results: Perioperative fractionated IMBT was performed in 15 out of 18 patients and was well tolerated. Complications that partially prevented or delayed IMBT in some cases included cerebrospinal fluid leakage (twice), meningitis (twice), frontal brain syndrome (twice), afterloading tube displacement (twice), seizure (once), and general morbidity (once). No surgery- or radiation-induced injuries to the cranial nerves or eyes occurred. Median survival times were 33 months after diagnosis and 16 months after combined operation and IMBT. Conclusion: Perioperative fractionated IMBT after extensive but vision-preserving tumor resection seems to be a safe and well-tolerated treatment of advanced/recurrent malignancies involving the skull base. These preliminary state suggest that combined operation and perioperative fractionated IMBT is a palliative therapeutic option in the management of fatal malignancies involving the base of the skull, a strategy which leaves the patients' visual acuity intact. (orig.)

  16. The role of interstitial brachytherapy in the treatment of vaginal and vulvar malignancies

    Seeger, A.R.; Windschall, A.; Lotter, M.; Sauer, R.; Strnad, V. [Dept. of Radiation Oncology, Univ. of Erlangen-Nuremberg, Erlangen (Germany); Mehlhorn, G.; Beckmann, M.W. [Dept. of Gynecology, Univ. of Erlangen-Nuremberg, Erlangen (Germany)

    2006-03-15

    Background: irradiation has established itself as a treatment for vulvar and vaginal malignancies. Due to the sensitive nature of the vulvar and vaginal tissues, interstitial brachytherapy (iBT) provides an effective, gentle and individualized therapy. Patients and Methods: patients with vulvar (nine of 22) and vaginal (13 of 22) malignancies were treated using interstitial pulsed-dose-rate brachytherapy (PDR-iBT). Twelve out of 22 patients were additionally treated using external-beam therapy to the pelvis and regional lymph nodes. The median total dose of PDR-iBT administered to patients with vulvar carcinoma was 55.0 Gy. The median total PDR dose administered to patients with vaginal malignancies amounted to 20.25 Gy. Results: the median follow-up time for patients with vulvar cancer was 19 months and for patients with vaginal malignancies 27 months. Acute mucositis or skin reactions during iBT were observed in 15 of 22 patients. Two of 22 patients showed delayed side effects. After 6 months, 77.8% of the patients with vulvar cancer (seven out of nine) and 100% of the patients with vaginal malignancies (13 out of 13) achieved complete local remission. One patient out of nine with vulvar carcinoma developed local recurrence, four out of nine regional recurrence, and two out of nine developed regional recurrence and had local tumor following therapy. In patients with malignancies of the vagina, no cases of local recurrence were observed, but distant metastases were found in five out of 13 patients. At the time of analysis, eleven out of 22 patients with vulvar or vaginal carcinoma were still alive. Conclusion: IBT achieved good local control without serious delayed side effects in both localizations. However, survival is limited by regional or distant metastases. (orig.)

  17. Bladder Function Preservation With Brachytherapy, External Beam Radiation Therapy, and Limited Surger in Bladder Cancer Patients: Long-Term Results

    Purpose: To report long-term results of a bladder preservation strategy for muscle-invasive bladder cancer (MIBC) using external beam radiation therapy and brachytherapy/interstitial radiation therapy (IRT). Methods and Materials: Between May 1989 and October 2011, 192 selected patients with MIBC were treated with a combined regimen of preoperative external beam radiation therapy and subsequent surgical exploration with or without partial cystectomy and insertion of source carrier tubes for afterloading IRT using low dose rate and pulsed dose rate. Data for oncologic and functional outcomes were prospectively collected. The primary endpoints were local recurrence-free survival (LRFS), bladder function preservation survival, and salvage cystectomy-free survival. The endpoints were constructed according to the Kaplan-Meier method. Results: The mean follow-up period was 105.5 months. The LRFS rate was 80% and 73% at 5 and 10 years, respectively. Salvage cystectomy-free survival at 5 and 10 years was 93% and 85%. The 5- and 10-year overall survival rates were 65% and 46%, whereas cancer-specific survival at 5 and 10 years was 75% and 67%. The distant metastases-free survival rate was 76% and 69% at 5 and 10 years. Multivariate analysis revealed no independent predictors of LRFS. Radiation Therapy Oncology Group grade ≥3 late bladder and rectum toxicity were recorded in 11 patients (5.7%) and 2 patients (1%), respectively. Conclusions: A multimodality bladder-sparing regimen using IRT offers excellent long-term oncologic outcome in selected patients with MIBC. The late toxicity rate is low, and the majority of patients preserve their functional bladder

  18. Interstitial high-dose rate brachytherapy as boost for anal canal cancer

    To assess clinical outcomes of patients treated with a high-dose rate brachytherapy boost for anal canal cancer (ACC). From August 2005 to February 2013, 28 patients presenting an ACC treated by split-course external beam radiotherapy (EBRT) and HDR brachytherapy with or without chemotherapy in a French regional cancer center in Nice were retrospectively analyzed. Median age was 60.6 years [34 – 83], 25 patients presented a squamous cell carcinoma and 3 an adenocarcinoma; 21 received chemotherapy. Median dose of EBRT was 45 Gy [43.2 – 52]. Median dose of HDR brachytherapy was 12 Gy [10 - 15] with a median duration of 2 days. Median overall treatment time was 63 days and median delay between EBRT and brachytherapy was 20 days. Two-year local relapse free, metastatic free, disease free and overall survivals were 83%, 81.9%, 71.8% and 87.7% respectively. Acute toxicities were frequent but not severe with mostly grade 1 toxicities: 37% of genito-urinary, 40.7% of gastro-intestinal and 3.7% of cutaneous toxicities. Late toxicities were mainly G1 (43.1%) and G2 (22%). Two-year colostomy-free survival was 75.1%, one patient had a definitive sphincter amputation. High-dose rate brachytherapy for anal canal carcinoma as boost represents a feasible technique compared to low or pulsed-dose rate brachytherapy. This technique remains an excellent approach to precisely boost the tumor in reducing the overall treatment time

  19. Pulsed Irradiation Studies in Mice, Rats and Dogs

    Radiation lethality as a function of radiation dose rate has been extensively explored over the range of less than one rad to a few hundreds of rad/min, but comparatively little is known of the biological consequences at exposure intensities of the order of 105-106 rad/min. In the present experiments radiations produced by a TRIGA reactor have been used to study the comparative acute-mortality responses (LD50/30) of mice and dogs irradiated either at moderate dose rates (40 or 100 rad/min for mice and 23 rad/min for dogs) or by a single high dose-rate radiation pulse (∼ 106 rad/min for mice and ∼2.0 X 105 rad/min for dogs). In the mouse experiments, the LD50/30 of animals exposed at the moderate dose rates of 40 rad of n/min or 100 rad for gamma-radiation/min was not significantly different from the LD50/30 of animals exposed to the same radiation given as a pulsed exposure. Likewise, in acute mortality studies conducted with unilaterally neutron-irradiated dogs, no significant differences in LDso/sowere found between groups irradiated at 23 rad/min or exposed to pulsed dose rates in excess of 1.5 x 105 rad/min. Other studies have been conducted to determine if recovery from radiation injury in mice, as estimated by the split-dose irradiation technique, is influenced by the rate at which the initial sublethal injury is produced. Recovery has been compared at 5 and 14 days post-irradiation in groups of animals exposed at either 40 or 9 x 104 rad/min and no dose-rate dependency of recovery has been detected. (author)

  20. Aktuelle Entwicklungen in der Strahlentherapie des Prostatakarzinoms: HDR-Brachytherapie

    Knocke-Abulesz TH

    2004-01-01

    Full Text Available In der primären Therapie des Prostatakarzinoms ist die Seed-Implantation neben der radikalen Prostatektomie und der konformalen 3D-geplanten Teletherapie in den letzten Jahren insbesondere bei den lokal begrenzten Tumoren die dritte etablierte Behandlungstechnik geworden. In den USA werden bereits fast ein Drittel der Patienten mit dieser Technik behandelt. Im Gegensatz hierzu wurde in der Strahlentherapie in den letzten beiden Jahrzehnten die Langzeit-Implantation von Nukliden bei den meisten Tumoren zugunsten der fraktionierten Afterloading-Bestrahlung in "high dose rate" (HDR- Technik ersetzt – wobei partiell für HNO- und gynäkologische Tumoren die HDR-Technik als "pulse-dose-rate" (PDR- Verfahren modifiziert wird, um die biologischen Vorteile der LDR- und die technologischen Vorteile der HDR-Anwendung zu vereinen. Vorteile der Methode im Vergleich zur Seed-Implantation sind: – Niedrigere Kosten, allgemeine Verfügbarkeit, – Idealer Strahlenschutz, – Zuverlässige Dosisverteilung, – Keine Migration von Seeds, – Durchführbar auch nach TURP, – Durchführbar bei manifesten Lokalrezidiven. Allerdings liegen bisher nur vereinzelte klinische Ergebnisse beim Prostatakarzinom vor, die zeigen, daß eine lokale Dosiserhöhung in Kombination mit der Teletherapie eine Verbesserung der lokalen Kontrolle bei kapselüberschreitenden Tumoren ermöglicht. Inwieweit der Einsatz der Technik bei Lokalrezidiven zu langandauernden Remissionen führen kann, ist Gegenstand von laufenden Untersuchungen. Der Ersatz der Seed-Implantation durch eine 2-tägige fraktionierte Brachytherapie mit vier Bestrahlungen ist derzeit Gegenstand einer prospektiven Studie, deren erste Langzeitergebnisse in diesem Jahr erwartet werden.

  1. WE-F-BRD-01: HDR Brachytherapy II: Integrating Imaging with HDR

    In recent years, with the advent of high/pulsed dose rate afterloading technology, advanced treatment planning systems, CT/MRI compatible applicators, and advanced imaging platforms, image-guided adaptive brachytherapy treatments (IGABT) have started to play an ever increasing role in modern radiation therapy. The most accurate way to approach IGABT treatment is to provide the infrastructure that combines in a single setting an appropriate imaging device, a treatment planning system, and a treatment unit. The Brachytherapy Suite is not a new concept, yet the modern suites are incorporating state-of-the-art imaging (MRI, CBCT equipped simulators, CT, and /or US) that require correct integration with each other and with the treatment planning and delivery systems. Arguably, an MRI-equipped Brachytherapy Suite is the ideal setup for real-time adaptive brachytherapy treatments. The main impediment to MRI-IGABT adoption is access to MRI scanners. Very few radiation oncology departments currently house MRI scanners, and even fewer in a dedicated Brachytherapy Suite. CBCT equipped simulators are increasingly offered by manufacturers as part of a Brachytherapy Suite installation. If optimized, images acquired can be used for treatment planning, or can be registered with other imaging modalities. This infrastructure is relevant for all forms of brachytherapy, especially those utilizing multi-fractionated courses of treatment such as prostate and cervix. Moreover, for prostate brachytherapy, US imaging systems can be part of the suite to allow for real-time HDR/LDR treatments. Learning Objectives: Understand the adaptive workflow of MR-based IGBT for cervical cancer. Familiarize with commissioning aspects of a CBCT equipped simulator with emphasis on brachytherapy applications Learn about the current status and future developments in US-based prostate brachytherapy

  2. WE-F-BRD-01: HDR Brachytherapy II: Integrating Imaging with HDR

    Craciunescu, O [Duke University Medical Center, Durham, NC (United States); Todor, D [Virginia Commonwealth University, Richmond, VA (United States); Leeuw, A de

    2014-06-15

    In recent years, with the advent of high/pulsed dose rate afterloading technology, advanced treatment planning systems, CT/MRI compatible applicators, and advanced imaging platforms, image-guided adaptive brachytherapy treatments (IGABT) have started to play an ever increasing role in modern radiation therapy. The most accurate way to approach IGABT treatment is to provide the infrastructure that combines in a single setting an appropriate imaging device, a treatment planning system, and a treatment unit. The Brachytherapy Suite is not a new concept, yet the modern suites are incorporating state-of-the-art imaging (MRI, CBCT equipped simulators, CT, and /or US) that require correct integration with each other and with the treatment planning and delivery systems. Arguably, an MRI-equipped Brachytherapy Suite is the ideal setup for real-time adaptive brachytherapy treatments. The main impediment to MRI-IGABT adoption is access to MRI scanners. Very few radiation oncology departments currently house MRI scanners, and even fewer in a dedicated Brachytherapy Suite. CBCT equipped simulators are increasingly offered by manufacturers as part of a Brachytherapy Suite installation. If optimized, images acquired can be used for treatment planning, or can be registered with other imaging modalities. This infrastructure is relevant for all forms of brachytherapy, especially those utilizing multi-fractionated courses of treatment such as prostate and cervix. Moreover, for prostate brachytherapy, US imaging systems can be part of the suite to allow for real-time HDR/LDR treatments. Learning Objectives: Understand the adaptive workflow of MR-based IGBT for cervical cancer. Familiarize with commissioning aspects of a CBCT equipped simulator with emphasis on brachytherapy applications Learn about the current status and future developments in US-based prostate brachytherapy.

  3. Clinical experience with the MammoSite[reg] radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial

    Background and purpose: In a prospective multi-center phase II trial, we investigated the MammoSite[reg] Radiation Therapy System, a new device for delivering intracavitary brachytherapy following breast conserving surgery. The MammoSite[reg] is a dual lumen, closed ended catheter with a small, spherical inflatable balloon and a port for connecting a remote afterloader to the central lumen. We analyzed the surgical procedure and placement of the MammoSite[reg], treatment planning and radiation delivery complications and cosmesis, as well the comfort for the patients. Patients and methods: Between 2002 and 2004 a total of 32 patients (pts) were implanted using the MammoSite[reg]. The reference isodose was defined 1 cm from the balloon surface. We analyzed the post-implant anatomic position of the applicator and the geometric form of the balloon via ultrasound, CT and X-ray, related side effects, cosmetic outcome and patient quality of life. Results: Twenty-three out of 32 patients (72%) were eligible for MammoSite[reg] intracavitary brachytherapy. Twenty-eight percentage had to be excluded because of different reasons. Eleven patients were treated with primary brachytherapy with a total dose of 34 Gy (2x3.4 Gy) and 12 had a boost with a mean dose of 13.3 Gy (range: 7.5-15 Gy; 2x2.5 Gy) combined with EBRT and doses ranged between 46 and 50 Gy. In three cases a balloon rupture occurred. We observed two abscesses within 3 months of implantation and serious seroma development in 10 patients (39%). Skin related side effects were erythema in 21 patients (91%), hyperpigmentation in 13 patients (56%) and teleangiectasia in six patients (26%) after mean follow-up 20 months. Conclusions: The MammoSite[reg] Radiation Therapy System is a feasible treatment modality for intracavitary brachytherapy of breast cancer after breast conserving surgery. The advantage of the system is only one applicator is necessary for the delivery of a fractionated radiotherapy. In addition, patient

  4. Postoperative radiation for cervical cancer with pathologic risk factors

    Purpose: To examine the efficacy of postoperative radiation therapy for early-stage cervical cancer with pathologic risk factors. Methods and Materials: We reviewed the charts of 83 patients who received postoperative radiation therapy at our facility from March 1980 to November 1993 for early stage cervix cancer with positive surgical margins, positive pelvic or periaortic lymph nodes, lymphovascular space invasion, deep invasion, or for disease discovered incidentally at simple hysterectomy. Twenty-eight patients received low dose rate (LDR) intracavitary radiation with or without external beam pelvic irradiation and 55 patients received external beam pelvic irradiation with high dose rate (HDR) intracavitary implants. Of these 83 patients, 66 were evaluable--20 LDR and 46 HDR patients. All patients received 45-50 Gy external beam irradiation and 20 Gy LDR equivalent intracavitary irradiation prescribed to 0.5 cm below the mucosa. Ninety percent of the LDR group and 92% of the HDR group completed treatment within < 56 days. Treatment-related toxicities were scored according to the GOG toxicity scale. Mean and median follow-up times were 101 months and 111 months (3-172 months) for the LDR group and 42 and 40 months (3-98 months) for the HDR group. Results: The 5-year disease-free survival was 89% for the LDR group and 72% for the HDR group. Local control was observed in 90% (18 out of 20) of the LDR patients and 89% (41 out of 46) of the HDR patients for an overall local control rate of 89.5%. Two of 20 LDR patients (10%) experienced recurrence (two pelvic with distant metastasis). Nine of 46 HDR patients (22%) had recurrence of disease (three pelvic, four distant metastasis, and two pelvic with distant metastasis). In the HDR group, 6 out of 16 (38%) with positive lymph nodes died of disease whereas, 27 out of 30 (90%) of the patients with negative lymph nodes remain free of disease. Three of 20 (15%) LDR patients and 4 out of 46 (9%) HDR patients experienced

  5. Percutaneous diagnosis and treatment in disease conditions of the bile ducts and the gallbladder. Possibilities and relative value. Perkutane Diagnostik und Therapie an Gallenwegen und Gallenblase. Moeglichkeiten und Stellenwert

    Hauenstein, K.H.; Wimmer, B. (Freiburg Univ. (Germany, F.R.). Abt. Roentgendiagnostik); Salm, R.; Farthmann, E.H. (Freiburg Univ. (Germany, F.R.). Abt. Allgemeinchirurgie mit Poliklinik)

    1991-03-01

    Percutaneous transhepatic access to the bile duct has opened up new possibilities not only for diagnosis by means of cholangiography and cholangioscopy with endoscopically guided biopsy by small-bore equipment, but also for the treatment of benign and malignant obstructive jaundice. In malignant disease recanalization of the obstruction is possible by means of laser, intracavitary irritation, internal bile drainage in Klatskin tumors, large-diameter endoprostheses (e.g., a Y-shaped prosthesis) or metal stents. In benign disease, balloon dilatation of inflammatory stenoses, stone extractions from the bile duct or gallbladder by means of Dormia baskets, ultrasound or pezo electric shockwave-contact lithotripsy and chemical litholysis are possible very often percutaneous access is a real alternative to surgical intervention. (orig.).

  6. Measurement of pre-assembled source trains using HDR-1000 plus well-chamber

    Manual afterloading kit for intracavitary irradiation often makes use of spring-loaded multiple source assembly. The pre-assembled source trains pose problem for verification of source strength, quoted by the supplier. Measurements have been carried out to estimate the correction required for measurement of spring loaded source trains, supplied by BRIT, using HDR-1000 Plus well-type ionisation chamber. The correction factor required for measurement of medium tandem loading worked out to be about 1.015 and that for long tandem about 1.026. It has also been observed that marginal differences in the length and relative activity of individual sources do not make significant difference in the estimated correction factor. (author)

  7. Acute pelvic inflammatory disease: pictorial essay focused on computed tomography and magnetic resonance imaging findings

    Febronio, Eduardo Miguel; Rosas, George de Queiroz; D' Ippolito, Giuseppe, E-mail: giuseppe_dr@uol.com.br [Department of Imaging Diagnosis, Escola Paulista de Medicina - Universidade Federal de Sao Paulo (EPMUnifesp), Sao Paulo, SP (Brazil)

    2012-11-15

    The present study was aimed at describing key computed tomography and magnetic resonance imaging findings in patients with acute abdominal pain derived from pelvic inflammatory disease. Two radiologists consensually selected and analyzed computed tomography and magnetic resonance imaging studies performed between January 2010 and December 2011 in patients with proven pelvic inflammatory disease leading to presentation of acute abdomen. Main findings included presence of intracavitary fluid collections, anomalous enhancement of the pelvic excavation and densification of adnexal fat planes. Pelvic inflammatory disease is one of the leading causes of abdominal pain in women of childbearing age and it has been increasingly been diagnosed by means of computed tomography and magnetic resonance imaging supplementing the role of ultrasonography. It is crucial that radiologists become familiar with the main sectional imaging findings in the diagnosis of this common cause of acute abdomen (author)

  8. Occupational exposure in medicine - a review of radiation doses to hospital staff in north-west England

    monitoring results relating principally to exposure during 1981 have been collated and examined. The analysis indicates that the doses received by staff are for the most part very low and provide little reason for concern. The only area of work in which worthwhile and cost-effective dose reductions could probably be achieved is that involving the use of pre-loaded applicators in gynaecological intra-cavitary therapy. Some relatively high staff exposures result from the use of this technique, and very significant reductions in these doses are confidently expected from a programme which has now commenced for the increasing use of remotely-controlled after-loading equipment housed in shielded treatment rooms. (author)

  9. CT features of lymphobronchial tuberculosis in children, including complications and associated abnormalities

    Lymphobronchial tuberculosis (TB) is tuberculous lymphadenopathy involving the airways, which is particularly common in children. To describe CT findings of lymphobronchial TB in children, the parenchymal complications and associated abnormalities. CT scans of children with lymphobronchial TB were reviewed retrospectively. Lymphadenopathy, bronchial narrowing, parenchymal complications and associations were documented. Infants comprised 51% of patients. The commonest site of lymphadenopathy was the subcarinal mediastinum (97% of patients). Bronchial compression was seen in all children (259 bronchi, of these 28% the bronchus intermedius) with severe or complete stenosis in 23% of affected bronchi. Parenchymal complications were present in 94% of patients, including consolidation (88%), breakdown (42%), air trapping (38%), expansile pneumonia (28%), collapse (17%) and bronchiectasis (9%), all predominantly on the right side (63%). Associated abnormalities included ovoid lesions, miliary nodules, pleural disease and intracavitary bodies. Airway compression was more severe in infants and most commonly involved the bronchus intermedius. Numerous parenchymal complications were documented, all showing right-side predominance. (orig.)

  10. IMAGE-GUIDED RADIOTHERAPY AND -BRACHYTHERAPY FOR CERVICAL CANCER

    Suresh eDutta

    2015-03-01

    Full Text Available Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT, and 2-dimensional intracavitary brachytherapy.Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron emission tomography (PET and magnetic resonance imaging (MRI has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT, allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer.