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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. 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

  9. 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

  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. 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

  16. 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

  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. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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)

  10. 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.

  11. 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

  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

    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

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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

  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. 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).

  9. 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...

  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. 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)

  12. 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.

  13. 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)

  14. 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)

  15. 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).

  16. 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

  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. 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

  1. 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

  2. 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.)

  3. 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

  4. 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

  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. 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

  8. 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

  9. 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

  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. 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

  19. 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

  20. 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

  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. 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.

  7. 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.

  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. 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.

  14. 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

  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. 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.)

  6. 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.)

  7. 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

  8. 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.)

  9. 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.

  10. 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

  11. 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.

  12. 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)

  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. 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.

  18. 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)

  19. 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 .

  20. 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.

  1. 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.

  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. 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)

  5. 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

  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. 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

  17. 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)

  18. 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)...

  19. 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

  20. 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

  1. 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

  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. 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.)

  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. 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

  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. 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)

  12. 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

  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. 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...

  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. 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

  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

    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

  2. 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

  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. 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.

  6. 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.)

  7. 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

  8. 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.)

  9. 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.)

  10. 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

  11. 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.

  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. 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

  15. 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)

  16. [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

  17. 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

  18. 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

  19. 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.

  20. 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)

  1. 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.)

  2. 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.

  3. 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.

  4. 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.

  5. 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)

  6. 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

  7. 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

  8. 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)

  9. 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

  10. 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.

  11. 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

  12. 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

  13. '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.

  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. 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

  16. [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

  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. 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)

  5. 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

  6. 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

  7. 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.)

  8. 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)

  9. 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

  10. 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

  11. 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)

  12. 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.)

  13. 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)

  14. 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.

  15. 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.

  16. 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.)

  17. 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)

  18. 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.

  19. 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

  20. 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

  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. Primary malignant melanoma of the vagina: a case report

    Jang, Ji Young; Kim, Do Kang; Lee, Eun Hee [College of Medicine, Catholic Univ., Seoul (Korea, Republic of); Kim, Jun Sang [College of Medicine, Chungnam National Univ., Daejeon (Korea, Republic of)

    2003-09-01

    A primary malignant melanoma of the vagina is a very rare gynecological malignant tumor. Its clinical behavior is more aggressive than that of cutaneous and vulvar melanomas. We present a case of a large sized primary melanoma of the lower third of the vagina, with a cervical lesion, in a 58-year-old postmenopausal woman. The patient was treated with conventional external radiation therapy and intracavitary radiotherapy (lCR), without surgical treatment. Although the primary lesion showed a partial response, the patient died of extensive metastases, which were found 4.5 months after the initial diagnosis. We suggest that shortening the treatment period, such as hypofractionated radiation therapy and surgical removal, and various systemic therapies for preventing early distant metastasis, are appropriate treatments for a primary malignant melanoma of the vagina, with a large tumor size.

  6. CT diagnosis of cardiac lipoma

    Objective: To investigate the application of CT in the diagnosis of cardiac lipoma. Methods: Retrospective analysis of 6 patients with cardiac lipoma confirmed by operation and pathology was done. Four patients had singles slice electron beam CT plain and contrast and movie scan. Two patients had 64-slice CT plain and enhanced scan. Results: (1) One patient was isolated intracavitary lipoma in the right artrium, 1 patient was isolated intrapericardial lipoma and 4 patients were intramural lipomas. Of the 4 intramural lipoma, 2 were infiltrative lipomas located in the left ventricle wall or the right ventricle and septum, 2 patients were isolated in the atrio-ventricular septum. (2) CT and three-dimensional reconstruction could depict the location, shape, size, margin and characteristic fat density of lipoma, indicating the diagnosis and classifications. The displacement of coronary artery, pulmonary inflammation and effusions of pericardium and pleural cavity could also be revealed. Conclusion: Cardiac lipoma can be accurately diagnosed and classified by CT. (authors)

  7. Ten-year cures of gynecologic tumors with Cf-252 neutron brachytherapy

    In 1976, Cf-252 was a novel and clinically untested fast-neutron-emitting radioisotope that had been proposed for neutron brachytherapy (NT). About 20 primary tumors had been treated; recurrences had been used to estimate a clinical RBE. Clinical trials at the University of Kentucky treated advanced cervical tumors with intracavitary Cf-252 NT with whole-pelvis photon radiation (50-60 Gy). Local control and up to 10-year survivals were achieved without significant side effects or secondary neoplasms (eg, hematologic malignancies). Treatments were done on an outpatient basis, were much shorter, were better tolerated by medically ill, bleeding, infected, or morbidly obese patients, and produced quicker tumor response with greatly reduced costs. Long-term outcome will be reviewed

  8. Locally advanced cervical cancer: Should intensity-modulated radiotherapy replace brachytherapy?; Complement d'irradiation dans le cancer du col de l'uterus localement evolue: curietherapie uterovaginale ou radiotherapie conformationnelle avec modulation d'intensite?

    Mazeron, R.; Gilmore, J.; Khodari, W.; Dumas, I.; Haie-Meder, C. [Service de radiotherapie, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif cedex (France)

    2011-10-15

    Intensity-modulated conformal radiotherapy (IMRT) is booming as treatment of locally advanced cervical cancer. This technique reduces the doses delivered to organs at risk and, by analogy to the irradiation of prostate cancer, opens the door to the possibility of dose escalation to levels close or similar to those achieved by brachytherapy. To date, several studies comparing IMRT with brachytherapy have been published, often methodologically flawed, concluding sometimes that both techniques are comparable. These results should be taken with extreme caution and should not overshadow the recent advances in brachytherapy with the use of 3D imaging and optimization. Preliminary works also showed that the combination of 3D optimized brachytherapy with IMRT could improve the management of the local disease especially for lesions poorly covered by intracavitary techniques. (authors)

  9. Therapy with radionuclides. Radionuklid-Therapie

    Biersack, H.J.; Hotze, A.L. (Bonn Univ. (Germany). Klinik fuer Nuklearmedizin)

    1992-12-01

    Radioiodine therapy of benign and malignant thyroid diseases is a well-established procedure in Nuclear Medicine. However, the therapeutic use of radioisotopes in other diseases is relatively unknown among our refering physicians. The therapeutic effects of intraarticular (rheumatoid arthritis) and intracavitary (pleural and peritoneal carcinosis) applications yields good results. The radiophosphorus therapy in polycythemia vera rubra has always to be considered as an alternative to chemotherapy. The use of analgetics may be reduced by pain therapy of bone metastasis by injection of bone-seeking beta emitters like Rh-186 HEDP. Other procedures like therapeutic application of meta-iodo-benzylguanidine in neuroblastoma and malignant pheochromocytoma resulted in at least remissions of the disease. Radioimmunotherapy needs further evaluation before it can be recommended as a routine procedure. (orig.).

  10. Regeneration in cervix cancer after 252Cf neutron brachytherapy

    Regeneration of clonogens in human cervical cancer was assessed by the pathological evaluation of the hysterectomy specimen after intracavitary 252Cf neutron brachytherapy implants separated by varying time intervals followed by extrafascial hysterectomy. In this study, patients with bulky/barrel shaped Stage IB cervical cancers received 252Cf implants plus approximately 45 Gy of whole pelvis linear accelerator radiotherapy in approximately 25 fractions in 5 weeks followed by hysterectomy 4-6 weeks after radiotherapy. The specimens were studied grossly and microscopically for residual tumor. It was found that the fraction of positive specimens increased with elapsed time interval between implants. These findings support the hypothesis that there is repopulation of surviving clonogens with increased time interval between the implants. The observation also supports current concerns that rapid depopulation of tumor can lead to rapid repopulation, that is, rapid shrinkage of tumor can alter the physiological environment such that clonogens can rapidly regenerate

  11. 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.)

  12. 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.

  13. Development of brachytherapy technique for nasal tumors in dogs

    Two groups of 4 dogs underwent nasal and ethmoidal turbinectomies followed by irradiation (mean minimal) doses of 5,390 and 6,550 cGy of radiation, respectively from implanted intracavitary sources of iridium 192. Two dogs from each group were euthanatized for histologic evaluation at 3 months after irradiation. The remaining 2 dogs from each group were euthanatized for similar evaluation at 6 months after irradiation. During the course of the study, few clinical complications were encountered. Histologic evaluation of the tissues forming the nasal passages revealed loss of epithelial lining and fibrous tissue replacement of surrounding bone. A direct correlation of pathologic changes could not be associated with the amount of radiation received, but there seemed to be a tendency for greater change in those dogs given higher doses and those kept alive for 6 months

  14. Transesophageal echocardiography. 3. rev. and enl. ed.; Transoesophageale Echokardiografie. Lehrbuch und Altlas zur Untersuchungstechnik und Befundinterpretation

    Lambertz, Heinz [ECHOECUCT-Akademie, Wiesbaden (Germany); Lethen, Harald (eds.) [Internistische Intensivmedizin, Wiesbaden (Germany). Innere Medizin/Kardiologie

    2013-02-01

    The book on transesophageal echocardiography covers the following issues: Development of transesophageal echocardiography, technical advances; indications and contraindication for transesophageal echocardiography; systematic of the medical examination process; cardiac valves and valve prostheses; mitral and aortic valvuloplasty, TAVI and interventional treatment of mitral regurgitation; infectious endocarditis; one-way and effluence disturbances of the left and right ventricle; diseases of the thoracic aorta; undefined right ventricle enlargement; lung embolism, acute infarct complications; TEE during anesthesia and perioperative intensive medicine, cardiac sources of embolism; cardiac tumors, mediastinal lymph nodes; pericardiac diseases; congenital heart diseases in childhood and adulthood; catheter interventions and heart valve reconstruction; surgically corrected congenital cardiac defects; intracavitary versus transesophageal echocardiography; three-dimensional TEE; coronary diagnostics; ischemia and vitality diagnostics.

  15. A comparison of dosimetric parameters and dose distribution around CF -252 and IR-192 LDR Brachytherapy Sources

    Full text: The purpose of this work is the evaluation and comparison of the dose rate distributions around a 252Cf Applicator Tube (AT) and 192Ir LDR sources. The dosimetric parameters were determined for both sources according to the updated AAPM TG-43U1 protocol. The calculations were performed using the Monte Carlo N-particle MCNP code, version 5C. To validate the results of this study, they were compared to experimental and analytical dosimetric data available in the literature for similar source configurations. After validation, the Monte Carlo computer code was applied to investigate the difference between dose rate distributions around the two brachytherapy sources, with the purpose of comparing their efficiency in treatment. The data so obtained also provide further information about spatial dose distributions and are important for detailed treatment planning with 252 Cf or 192Ir LDR sources for interstitial and intracavitary therapy

  16. Combined therapy of radiotherapy and chemotherapy (cisplatin, methotrexate and peplomycin) for esophageal cancer

    Between 1984 and 1990, 46 patients with esophageal cancer (squamous cell carcinoma) were treated with radiotherapy and cisplatin, methotrexate and peplomycin. There were 43 males and 3 females. Ages ranged from 40 to 76 years, with a median of 62 years. There were six stage 2, twenty-three stage 3 and seventeen stage 4 (UICC, 1987). Chemotherapy was done at pre-radiotherapy and at 40 Gy. Radiotherapy was external beam irradiation or external beam irradiation combined with intracavitary irradiation. Initial complete response was achieved in 37.0% of patients. Five year cause-specific survival rate was 15.7% in all patients and 83.3% in patients of stage 2. In patients of stage 2 and stage 3 without esophago-broncho fistula and 60 Gy and more of administrated dose, 5 year cause-specific survival rate was 37.5%. Severe esophagitis and pneumonitis occurred in some patients but no fatal reaction occurred. (author)

  17. Report of the first meeting of the Project Advisory Committee (Technical) 21-24 March 1983, at NEMROCK, Cairo

    The Project Advisory Committee (Technical) (PACT) met on 21-24 March 1983, at NEMROCK, Cairo, Egypt, to discuss the joint IAEA/WHO project on Intracavitary Radiation Therapy for Cancer of the Uterus (Egypt/6/004). At this four day meeting the committee (1) identified a well-defined administrative framework in which earlier diagnosis of uterine cancer may be organized, on a limited but firm basis. (2) Agreed on the clinical and dosimetric principles to be followed in implementing the project. (3) Decided on the types and quantities of equipment which it will need in its first two years. (4) Developed the outline of the syllabus for the first training course, and fixed its date (three weeks from 83-10-29). (5) Reviewed the costs which will be incurred in carrying through the project and found them to be consistent with the funds available

  18. Pharmacokinetics of Hyperthermic Intrathoracic Chemotherapy following Pleurectomy and Decortication

    Paul H. Sugarbaker

    2012-01-01

    Full Text Available In patients with pseudomyxoma peritonei or peritoneal mesothelioma, direct extension of disease through the hemidiaphragm may result in an isolated progression of tumor within the pleural space. We monitored the intrapleural and plasma levels of mitomycin C and doxorubicin by HPLC assay in order to determine the pharmacokinetic behavior of this intracavitary use of chemotherapy. Our results showed a persistent high concentration of intrapleural drug as compared to plasma concentrations. The increased exposure for mitomycin C was 96, and the increased exposure for doxorubicin was 241. When the clearance of chemotherapy from the thoracic cavity was compared to clearance from the abdomen and pelvis, there was a considerably more rapid clearance from the abdomen as compared to the thorax. The pharmacologic study of intrapleural chemotherapy in these patients provides a strong pharmacologic rationale for regional chemotherapy in this group of patients.

  19. Cardiac anatomy and function determined by MR imaging: Review of 350 subjects

    MR imaging yields excellent anatomic and functional information on the cardiovascular system. The authors reviewed the MR imaging findings in 150 patients and 200 healthy subjects. Normal values for ventricular volumes and wall thickness were established. Wall thinning and motion were sensitive and specific indicators of infarction. Coronary arteries and bypass grafts were imaged, and velocity mapping led to flow measurements within them. Valvular regurgitation and intracardiac shunting were measured from ventricular stroke volumes and were found to be accurate. Anatomy in congenital heart disease was well shown, and angiographic and flow measurements were particularly valuable. Abnormalities were defined in patients with cardiomyopathy, aortic aneurysms, intracavitary clot, and cardiac tumors. MR imaging makes available a wide range of information in patients with cardiovascular disease and is an important addition to existing techniques

  20. 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)

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

    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)

  2. 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)

  3. Evaluation of cardiac tumors with magnetic resonance imaging

    Luna, Antonio [Clinica Las Nieves, MR Unit, Jaen (Spain); Ribes, Ramon [Reina Sofia Hospital, MR Unit, Radiology Department, Cordoba (Spain); Caro, Pilar [MR Unit, Dadisa, Cadiz (Spain); Vida, Jose [San Juan De Dios Hospital, MR Unit, Resalta, Cordoba (Spain); Erasmus, Jeremy J. [University of Texas, Department of Radiology, Houston, TX (United States)

    2005-07-01

    Primary cardiac neoplasms are rare, and are more commonly benign than malignant. However, metastases are by far the most common cardiac neoplasms. MRI allows evaluation of myocardial infiltration, pericardial involvement and/or extracardiac extension. MRI overcomes the usual limitations of echocardiography and assesses more accurately changes in cardiac function. Specific tumoral characterization is only possible in cases of myxoma, lipoma, fibroma and hemangioma. Suggestive features of malignancy are right side location, extracardiac extension, inhomogeneity in signal intensity of the tumor and pericardial effusion. The use of intravenous contrast material improves tumor characterization and depiction of tumor borders. MRI also allows differentiation of tumor from other nontumoral masses such as intracavitary tumors or fibromuscular elements of the posterior wall of the right atrium. (orig.)

  4. 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.).

  5. 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)

  6. Percutaneous transhepatic biliary drainage

    The authors have developed their own technique for percutaneous transhepatic biliary drainage (PTD) which they describe. Results of drainages performed since 1977 are presented. As a special application, the authors have also developed a radiation technique, according to the after-loading-method and using PTD. Similar to the intracavitary irradiation of gynecological tumors, a very high dose can be directly applied to the tumour with use of low volume dose and sparing of the neighbouring healthy tissue. The previously inserted drainage catheter is exchanged for a wide bore Teflon-tube and the radiation source Ir-192 is automatically advanced into the tumour stenosis. The isodose distribution is subsequently made under computer assisted guidance. (Auth.)

  7. Comparison of 60Cobalt and 192Iridium sources in high dose rate afterloading brachytherapy

    Purpose: 60Co sources with dimensions identical to those of 192Ir have recently been made available in clinical brachytherapy. A longer half time reduces demands on logistics and quality assurance and perhaps costs. Material and Methods: Comparison of the physical properties of 60Co and 192Ir with regard to brachytherapy. Results: Required activities for the same air kerma rate are lower by a factor of 2.8 for 60Co. Differential absorption in tissues of different densities can be neglected. Monte Carlo calculations demonstrate that integral dose due to radial dose fall off is higher for 192Ir in comparison to 60Co within the first 22 cm from the source (normalization at 1 cm). At larger distances this relationship is reversed. Conclusion: Clinical examples for intracavitary and interstitial applications however, show practically identical dose distributions in the treatment volume. (orig.)

  8. Image-guided radiotherapy and -brachytherapy for cervical cancer.

    Dutta, Suresh; Nguyen, Nam Phong; Vock, Jacqueline; Kerr, Christine; Godinez, Juan; Bose, Satya; Jang, Siyoung; Chi, Alexander; Almeida, Fabio; Woods, William; Desai, Anand; David, Rick; Karlsson, Ulf Lennart; Altdorfer, Gabor

    2015-01-01

    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 and magnetic resonance imaging 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. PMID:25853092

  9. Metastatic hepatocellular carcinoma of the external auditory canal

    2007-01-01

    This report describes a rare case of metastatic hepatocellular carcinoma (HCC) presenting a huge mass in the left external auditory canal (EAC). The patient was a 55-year-old man with hepatitis B virus-related HCC.He presented to our department with a three-month history of increasing left otalgia, and hearing loss with recent fresh aural bleeding. Histopathologic examination indicated that the tumor was secondary to HCC. Although external irradiation was not effective, the tumor was treated with surgical debulking and high dose rate 192 Ir remote afterloading system (RALS) for postoperative intracavitary irradiation. A review of the literature revealed only five other cases of HCC metastasis to the temporal bone, all of which mainly metastasteed in the internal acoustic meatus. The present case is the first report of HCC metastasis to the EAC.

  10. Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients

    Flores Vladimir

    2009-02-01

    Full Text Available Abstract Background A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy. Methods In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated. Results A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31 and 22 (3–27 months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups. Conclusion The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.

  11. Treatment of stage I and II ovarian cancer

    74 cases of primary ovarian cancer treated here previously were classified into three groups, no residual (corresponding to Stage Ia, Ib), cell residual (Ic-IIc) and mass residual (III,IV), and prognoses were compared. The 5 year survival rates were 83.3%, 29.4% and 12.6% respectively. In Stage I and II cases, almost all of the tumor mass would be removed by operation. Therefore the target of postoperative treatment should be the residual cancer as cell units spread widely throughout the abdominal cavity. For this purpose, IPCP. has been performed on 35 cases of Stage I and II since 1977. The 3 year survival rate for this series is as good as 88.6%, and the sites of recurrence were localized in the small pelvic cavity adjacent to the Douglas pouch in 5 out of 6 relapsed cases. This fact suggests that IPCP is capable of controlling the cancer cells in the upper abdominal cavity, but still insufficient to control them in the pelvic cavity where deeper invasion is suspected. In order to improve the local control ability, utilization of the uterus as the applicator for prophylactic intracavitary irradiation came to be considered. The spread of cancer to the uterus was found in 5 out of 38 cases in Stage I and II(13.2%), but silent invasion was found in only one case. These results suggests that the utilization of the uterus as the applicator for prophylactic intracavitary irradiation would be feasible if no macroscopical cancer extention to the uterus exists and the uterus is suitable for application. Several combinations with Tandem and Ovoid have been tested and an adequate method has been proposed. (author)

  12. Photodynamic therapy of supratentorial gliomas

    Muller, Paul J.; Wilson, Brian C.

    1997-05-01

    We are reporting the results form intraoperative intracavitary PDT treatment in 56 patients with recurrent supratentorial gliomas who had failed previous surgery and radiotherapy. These patients received 2mg/kg Photofin iv. 12-36 hours prior to surgical resection of their tumor or tumor cyst drainage. The median survival times in weeks for glioblastoma (GBM), malignant astrocytoma (MA), malignant mixed astrocytoma-oligodendroglioma and ependymoma were 30, 40, >56 and >174 weeks, respectively. Eight patients with recurrent GBM who received >60 J/cm2 had a median survival of 58 weeks and 24 patients who received recurrent glioblastoma who undergo surgical treatment alone is only 20 weeks. We are also reporting the results of PDT treatment in 20 patients with newly diagnosed MA or GBM treated with intracavitary Photofin-PDT at the time of their initial craniotomy. The median survival of the whole cohort was 44 weeks with a 1 and 2 year survival of 40 percent and 15 percent, respectively. The median survival of patients with GBM was 37 weeks with a 1 and 2 year actuarial survival of 35 percent and 0 percent, respectively. The median survival of patients with MA as 48 weeks with a 1 and 2 year actuarial survival of 44 percent and 33 percent, respectively. Six patients with a Karnofsky score of >70 who received a light dose of >1260J had a median survival of 92 weeks with a 1 and 2 year survival of 83 percent and 33 percent, respectively. The mortality rate in our total series of 93 PDT treatments or brain tumor is 3 percent. The combined serious mortality-morbidity rate is 8 percent.

  13. Radical radiotherapy for endometrial cancer and clinical evaluation of radiation dose for reference points

    Fifteen patients with endometrial cancer (Stage I [5], Stage II [4], Stage III [4], Stage IVa [2]) were treated by radiation therapy alone at Tokyo Women's Medical College during the 23-year period from 1969 to 1991. All patients were considered medically inoperable due to advanced age, hypertension, cardiovascular disease, diabetes mellitus, etc. Patient ages ranged from 46 to 82 years with a mean of 63 years (62.5±12.0). An external beam with a 10 MeV linear accelerator and low dose-rate intracavitary radiotherapy using a TAO applicator were administered to the patients with a total dose of 87.2±19.5 Gy at point A for cervical cancer. The complete response rate was 66.7% by clinical examination after treatment. Intrapelvic recurrence was seen in 1 patient and distant metastasis in 3. The 5-year cumulative survival rate for all patients was 59.3% and 100% for Stage I and II, respectively. Rectal complications were found in 4 cases, bladder in 2. In order to standardize the dose value for radiotherapy for endometrial cancer, we established three reference points (point I: fundus of the uterus, point II: bilateral uterotubal ostium, point III: bilateral mid portion of the lateral wall of the uterine body). These points were determined by measuring myometrial thickness of the uterine body by CT image at the time of treatment planning in each case. We make practical application of these points in radiation treatment and have found them to be useful for standardization and dose specification of intracavitary radiotherapy for endometrial cancer. (author)

  14. Accelerated partial-breast irradiation with interstitial implants. The clinical relevance of the calculation of skin doses

    Purpose: To describe relative skin dose estimations and their impact on cosmetic outcome in interstitial multicatheter accelerated partial-breast irradiation (APBI). Patients and Methods: Between April 2001 and January 2005, 105 consecutive patients with early breast cancer were recruited in Erlangen, Germany, for this substudy of the German-Austrian APBI phase II trial. 51% (54/105) received pulsed-dose-rate (PDR), and 49% (51/105) high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy every hour. Total treatment time was 3-4 days. With a wire cross on the skin surface during the brachytherapy-planning procedure the minimal, mean and maximal relative skin doses (SDmin%, SDmax%, SDmean%) were recorded. Endpoint of this evaluation was the cosmetic outcome in relation to the relative skin doses. Results: Median follow-up time was 38 months (range, 19-65 months). Cosmetic results for all patients were excellent in 57% (60/105), good in 36% (38/105), and fair in 7% (7/105). The SDmin% (27.0% vs. 31.7%; p = 0.032), SDmean% (34.2% vs. 38.1%; p 0.008), and SDmax% (38.2% vs. 46.4%; p 0.003) were significantly lower for patients with excellent cosmetic outcome compared to patients with a suboptimal outcome. SDmean% (37.6% vs. 34.2%; p = 0.026) and SDmax% (45.4% vs. 38.2%; p = 0.008) were significantly higher for patients with good cosmetic outcome compared with the patients with excellent results. Conclusion: The appraisal of skin doses has been shown to be relevant to the achievement of excellent cosmetic outcome. Further investigations are necessary, especially on the basis of CT-based brachytherapy planning, to further improve the treatment results of multicatheter APBI. (orig.)

  15. Accelerated Partial Breast Irradiation With Interstitial Implants: Risk Factors Associated With Increased Local Recurrence

    Purpose: To analyze patient, disease, and treatment-related factors regarding their impact on local control after interstitial multicatheter accelerated partial breast irradiation (APBI). Methods and Materials: Between November 2000 and April 2005, 274 patients with early breast cancer were recruited for the German-Austrian APBI Phase II trial ( (ClinicalTrials.gov) identifier: NCT00392184). In all, 64% (175/274) of the patients received pulsed-dose-rate (PDR) brachytherapy and 36% (99/274) received high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3 to 4 days. Results: The median follow-up time was 64 months (range, 9-110). The actuarial 5-year local recurrence free survival rate (5-year LRFS) was 97.7%. Comparing patients with an age <50 years (49/274) vs. ≥50 years (225/274), the 5-year LRFS resulted in 92.5% and 98.9% (exact p = 0.030; 99% confidence interval, 0.029-0.032), respectively. Antihormonal treatment (AHT) was not applied in 9% (24/274) of the study population. The 5-year LRFS was 99% and 84.9% (exact p = 0.0087; 99% confidence interval, 0.0079-0.0094) in favor of the patients who received AHT. Lobular histology (45/274) was not associated with worse local control compared with all other histologies (229/274). The 5-year LRFS rates were 97.6% and 97.8%, respectively. Conclusions: Local control at 5 years is excellent and comparable to therapeutic successes reported from corresponding whole-breast irradiation trials. Our data indicate that patients <50 years of age ought to be excluded from APBI protocols, and that patients with hormone-sensitive breast cancer should definitely receive adjuvant AHT when interstitial multicatheter APBI is performed. Lobular histology need not be an exclusion criterion for future APBI trials.

  16. Long-term results of pulsed irradiation of skin metastases from breast cancer. Effectiveness and sequelae

    A flexible, reusable skin mold (weight 110 g) was developed for use with a pulsed dose rate (PDR) afterloader. An array of 18 parallel catheters (2 mm diameter) at equal distances of 10 or 12 mm was constructed by fixation of the catheters in a plastic wire mesh. The array is sewn between 2 foam rubber slabs of 5 mm thickness to provide a defined constant distance to the skin. Irradiations are possible up to a maximum field size of 20x23,5 cm using a nominal 37 GBq Ir-192 source. Pulses of 1 Gy reference dose at the skin surface are applied at a rate of 1 pulse every 1.2 hours (0.8 Gy per hour). The dose distribution is geometrically optimized to provide a homogeneous skin dose (100%±10%). The 80% dose level lies at 5 mm below the skin surface. Between April 1994 and December 1997, 52 patients suffering from cutaneous metastases at the thoracic wall were treated with 54 fields and total doses of 38 to 50 Gy (median 42 Gy) applying 2 PDR courses with a pause of 4 to 5 weeks. Results: Forty-six patients (48 fields) were eligible for evaluation in June 1998. The median follow-up was 16 months (range 7.1 to 46.2 months). Local control was achieved in 40 out of 48 fields (83%) or 41 of 46 patients (89%), respectively. Moist desquamation occurred in 52% of the patients. Late reactions were judged after a minimum follow-up of 6 months. Thirty-two fields had been previosuly irradiated with external beam therapy to doses of 40 to 60 Gy. Regardless of whether the skin was preirradiated or not all patients surviving long enough developed telangiectasia within 2 years after PDR irradiation. In preirradiated patients (n=32) skin contractures and/or skin necrosis occurred in 12% each. In newly irradiated patients (n=14) no contractures or skin necrosis were observed. (orig.)

  17. Locally recurrent soft tissue sarcoma(STS) of the extremity following combined therapy. A superior outcome for salvage therapy using re-irradiation

    Local relapse of extremity STS after combined conservative surgery and irradiation is uncommon, and poses a therapeutic challenge for both local control and retention of limb function. This study reports the outcome of 25 such patients seen in a multidisciplinary sarcoma unit. Treatment history prior to the combined therapy included 18 with an intralesional excision, of whom 8 had also experienced one or more local relapses. Limb function was prospectively scored before and after retreatment with the MSTS scoring system. Two were not treated. Initial retreatment for 18 was with surgery alone: amputation for 7, local excision and local re-excision for 11 (14 attempts). Ten received combined conservative surgery and re-irradiation as either initial (5) or subsequent (5) salvage therapy. Re-irradiation was by Pulsed Dose Rate or Iridium implant alone (6), implant with external beam therapy (1), or external beam therapy alone (3). Median retreatment dose was 49.5 Gy (range 35-65 Gy), and median cumulative soft tissue dose was 100 Gy (range 95-120 Gy). Median followup from retreatment is 21 months (8-43 months). Median time to local relapse from the initial irradiation course is 23 mo (6-156 mo). At last followup 15 were alive and disease free; 5 alive with local (2) or systemic (3) disease; 5 dead of disease. Overall local control for surgery, including amputation was(11(18)) (61%) and for local excision 29% ((4(14)) attempts), and 22% retain good or excellent function. Combined retreatment resulted in 100% local control, and 70% retain good or excellent limb function. Six (60%) experienced significant wound healing complications which were possibly exacerbated by multiple prior resections. Three recovered fully, but 3 with bone or peripheral nerve injury have major residual complications. This outcome demonstrates that combined retreatment offers superior local control to local re-excision alone (100% vs 23%), with a functional outcome far superior to amputation, and

  18. Protocol-based image-guided salvage brachytherapy. Early results in patients with local failure of prostate cancer after radiation therapy

    Lahmer, G.; Lotter, M.; Kreppner, S.; Fietkau, R.; Strnad, V. [University Hospital Erlangen (Germany). Dept. of Radiation Oncology

    2013-08-15

    Purpose: To assess the overall clinical outcome of protocol-based image-guided salvage pulsed-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy failure particularly regarding feasibility and side effects. Patients and methods: Eighteen consecutive patients with locally recurrent prostate cancer (median age, 69 years) were treated during 2005-2011 with interstitial PDR brachytherapy (PDR-BT) as salvage brachytherapy after radiotherapy failure. The treatment schedule was PDR-BT two times with 30 Gy (pulse dose 0.6 Gy/h, 24 h per day) corresponding to a total dose of 60 Gy. Dose volume adaptation was performed with the aim of optimal coverage of the whole prostate (V{sub 100} > 95 %) simultaneously respecting the protocol-based dose volume constraints for the urethra (D{sub 0.1} {sub cc} < 130 %) and the rectum (D{sub 2} {sub cc} < 50-60 %) taking into account the previous radiation therapy. Local relapse after radiotherapy (external beam irradiation, brachytherapy with J-125 seeds or combination) was confirmed mostly via choline-PET and increased PSA levels. The primary endpoint was treatment-related late toxicities - particularly proctitis, anal incontinence, cystitis, urinary incontinence, urinary frequency/urgency, and urinary retention according to the Common Toxicity Criteria. The secondary endpoint was PSA-recurrence-free survival. Results: We registered urinary toxicities only. Grade 2 and grade 3 toxicities were observed in up to 11.1 % (2/18) and 16.7 % (3/18) of patients, respectively. The most frequent late-event grade 3 toxicity was urinary retention in 17 % (3/18) of patients. No late gastrointestinal side effects occurred. The biochemical PSA-recurrence-free survival probability at 3 years was 57.1 %. The overall survival at 3 years was 88.9 %; 22 % (4/18) of patients developed metastases. The median follow-up time for all patients after salvage BT was 21 months (range, 8-77 months). Conclusion: Salvage PDR

  19. Penile brachytherapy: Results for 49 patients

    Purpose: To report results for 49 men with squamous cell carcinoma (SCC) of the penis treated with primary penile interstitial brachytherapy at one of two institutions: the Ottawa Regional Cancer Center, Ottawa, and the Princess Margaret Hospital, Toronto, Ontario, Canada. Methods and Materials: From September 1989 to September 2003, 49 men (mean age, 58 years; range, 22-93 years) had brachytherapy for penile SCC. Fifty-one percent of tumors were T1, 33% T2, and 8% T3; 4% were in situ and 4% Tx. Grade was well differentiated in 31%, moderate in 45%, and poor in 2%; grade was unspecified for 20%. One tumor was verrucous. All tumors in Toronto had pulsed dose rate (PDR) brachytherapy (n = 23), whereas those in Ottawa had either Iridium wire (n 22) or seeds (n = 4). Four patients had a single plane implant with a plastic tube technique, and all others had a volume implant with predrilled acrylic templates and two or three parallel planes of needles (median, six needles). Mean needle spacing was 13.5 mm (range, 10-18 mm), mean dose rate was 65 cGy/h (range, 33-160 cGy/h), and mean duration was 98.8 h (range, 36-188 h). Dose rates for PDR brachytherapy were 50-61.2 cGy/h, with no correction in total dose, which was 60 Gy in all cases. Results: Median follow-up was 33.4 months (range, 4-140 months). At 5 years, actuarial overall survival was 78.3% and cause-specific survival 90.0%. Four men died of penile cancer, and 6 died of other causes with no evidence of recurrence. The cumulative incidence rate for never having experienced any type of failure at 5 years was 64.4% and for local failure was 85.3%. All 5 patients with local failure were successfully salvaged by surgery; 2 other men required penectomy for necrosis. The soft tissue necrosis rate was 16% and the urethral stenosis rate 12%. Of 8 men with regional failure, 5 were salvaged by lymph node dissection with or without external radiation. All 4 men with distant failure died of disease. Of 49 men, 42 had an intact

  20. Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial

    Purpose: to evaluate perioperative morbidity, toxicity, and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole irradiation modality after breast-conserving surgery. Patients and methods: from November 1, 2000 to January 31, 2004, 176 women with early-stage breast cancer became partakers in a protocol of tumor bed irradiation alone using pulsed-dose-rate (PDR) or high-dose-rate (HDR) interstitial multicatheter implants. Patients became eligible, if their tumor was an infiltrating carcinoma ≤ 3 cm in diameter, the surgical margins were clear by at least 2 mm, the axilla was surgically staged node-negative, the tumor was estrogen and/or progesterone receptor-positive, well or moderately differentiated (G1/2), the tumor did not contain an extensive intraductal component (EIC) and the patient's age was > 35 years. Implants were positioned using a template guide, delivering either 49.8 Gy in 83 consecutive hours (PDR) or 32.0 Gy in two daily fractions over 4 days (HDR). Perioperative morbidity, toxicity, and cosmetic outcome were assessed. Interim findings of the first 69 patients, who were treated in this multicenter trial, after a median follow-up of 24 months (range, 15-39 months) are presented. Results: one of the 69 patients (1.4%) developed a bacterial infection of the implant. No other perioperative complications, for example bleeding or hematoma, were observed. Acute toxicity was low: 2.9% of the patients (2/69) experienced mild radiodermatitis. Late toxicity: hypersensation/mild pain 7.2% (5/69), intermittent but tolerable pain 1.4% (1/69), mild dyspigmentation 10.1% (7/69), mild fibrosis 11.6% (8/69), moderate fibrosis 1.4% (1/69), mild telangiectasia (2) 11.6% (8/69), and moderate teleangiectasia (1-4 cm2) 1.4% (1/69). Good to excellent cosmetic results were observed in 92.4% of the patients evaluated. All patients (n = 176) remained disease-free to the date of evaluation. Conclusion: this analysis indicates

  1. PDR brachytherapy with flexible implants for interstitial boost after breast-conserving surgery and external beam radiation therapy

    Background and purpose: For radiobiological reasons the new concept of pulsed dose rate (PDR) brachytherapy seems to be suitable to replace traditional CLDR brachytherapy with line sources. PDR brachytherapy using a stepping source seems to be particularly suitable for the interstitial boost of breast carcinoma after breast-conserving surgery and external beam irradiation since in these cases the exact adjustment of the active lengths is essential in order to prevent unwanted skin dose and consequential unfavorable cosmetic results. The purpose of this study was to assess the feasibility and morbidity of a PDR boost with flexible breast implants. Materials and methods: Sixty-five high risk patients were treated with an interstitial PDR boost. The criteria for an interstitial boost were positive margin or close margin, extensive intraductal component (EIC), intralymphatic extension, lobular carcinoma, T2 tumors and high nuclear grade (GIII). Dose calculation and specification were performed following the rules of the Paris system. The dose per pulse was 1 Gy. The pulse pauses were kept constant at 1 h. A geometrically optimized dose distribution was used for all patients. The treatment schedule was 50 Gy external beam to the whole breast and 20 Gy boost. PDR irradiations were carried out with a nominal 37 GBq 192-Ir source. Results: The median follow-up was 30 months (minimum 12 months, maximum 54 months). Sixty percent of the patients judged their cosmetic result as excellent, 27% judged it as good, 11% judged it as fair and 2% judged it as poor. Eighty-six percent of the patients had no radiogenous skin changes in the boost area. In 11% of patients minimal punctiform telangiectasia appeared at single puncture sites. In 3% ((2(65))) of patients planar telangiectasia appeared on the medial side of the implant. The rate of isolated local recurrences was 1.5%. In most cases geometrical volume optimization (GVO) yields improved dose distributions with respect to

  2. Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial

    Ott, O.J.; Lotter, M.; Sauer, R.; Strnad, V. [Dept. of Radiation Oncology, Univ. Hospital Erlangen, Erlangen (Germany); Poetter, R.; Resch, A. [Dept. of Radiotherapy and Radiobiology, Univ. Hospital AKH Wien, Vienna (Austria); Hammer, J. [Dept. of Radiation Oncology, Barmherzige Schwestern Hospital Linz, Linz (Austria); Hildebrandt, G. [Dept. of Radiation Oncology, Univ. Hospital Leipzig, Leipzig (Germany); Poehls, U.; Beckmann, M.W. [Dept. of Gynecology, Univ. Hospital Erlangen, Erlangen (Germany)

    2004-10-01

    Purpose: to evaluate perioperative morbidity, toxicity, and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole irradiation modality after breast-conserving surgery. Patients and methods: from November 1, 2000 to January 31, 2004, 176 women with early-stage breast cancer became partakers in a protocol of tumor bed irradiation alone using pulsed-dose-rate (PDR) or high-dose-rate (HDR) interstitial multicatheter implants. Patients became eligible, if their tumor was an infiltrating carcinoma {<=} 3 cm in diameter, the surgical margins were clear by at least 2 mm, the axilla was surgically staged node-negative, the tumor was estrogen and/or progesterone receptor-positive, well or moderately differentiated (G1/2), the tumor did not contain an extensive intraductal component (EIC) and the patient's age was > 35 years. Implants were positioned using a template guide, delivering either 49.8 Gy in 83 consecutive hours (PDR) or 32.0 Gy in two daily fractions over 4 days (HDR). Perioperative morbidity, toxicity, and cosmetic outcome were assessed. Interim findings of the first 69 patients, who were treated in this multicenter trial, after a median follow-up of 24 months (range, 15-39 months) are presented. Results: one of the 69 patients (1.4%) developed a bacterial infection of the implant. No other perioperative complications, for example bleeding or hematoma, were observed. Acute toxicity was low: 2.9% of the patients (2/69) experienced mild radiodermatitis. Late toxicity: hypersensation/mild pain 7.2% (5/69), intermittent but tolerable pain 1.4% (1/69), mild dyspigmentation 10.1% (7/69), mild fibrosis 11.6% (8/69), moderate fibrosis 1.4% (1/69), mild telangiectasia (< 1 cm{sup 2}) 11.6% (8/69), and moderate teleangiectasia (1-4 cm{sup 2}) 1.4% (1/69). Good to excellent cosmetic results were observed in 92.4% of the patients evaluated. All patients (n = 176) remained disease-free to the date of evaluation. Conclusion

  3. Patterns of care for brachytherapy in Europe (PC BE) in Spain and Poland: Comparative results

    Background: Cancer incidence and its mortality depend on a number of factors, including age, socio-economic status and geographic situation, and its incidence is growing around the world. Cancer incidence in Europe is now about 4000 patients per million per year and due to the ageing population a yearly increase of 1 - 1.5 % in cancer cases is estimated in the next two decades. Most of the cancer treatments will include external beam radiotherapy or brachytherapy. Brachytherapy has increased its use as a radical or palliative treatment and become more sophisticated with the spread of pulsed dose rate and high dose rate afterloading machines, and the use of new planning systems has additionally improved quality of treatment. Aim: The aim of the present study was to compare two countries (Poland and Spain) and to report the differences in the use of brachytherapy in these countries. For this reason, several characteristics related to brachytherapy were compared. Materials/Methods: The data used were collected using a web site questionnaire for the year 2002 where every centre that participated in the survey could introduce, change or update the information requested. Hospitals included in the study were those that provided data on brachytherapy, because our objective was to compare the brachytherapy facilities between Poland and Spain. Results: Data were available for 22 centres in Poland and 39 centres in Spain that provided brachytherapy in 2002. Spain having more centres that applied brachytherapy (1.0 centre per 1,000,000 inhabitants in Spain vs. 0.6 centre per 1,000,000 inhabitants in Poland), the average number of brachytherapy patients per centre is lower in Spain than in Poland, 137 and 382 respectively. The 5 main tumour sites treated with brachytherapy in Poland were: gynaecological (73.7 %), bronchus (13.0 %), breast (2.8 %), prostate (2.4 %) and head and neck (1.6 %). In Spain they were: gynaecological (59.7 %), breast (15.4 %), prostate (12.8 %), head

  4. Accelerated partial-breast irradiation with interstitial implants. Analysis of factors affecting cosmetic outcome

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

    2009-03-15

    Purpose: To analyze patient-, disease-, and treatment-related factors for their impact on cosmetic outcome (CO) after interstitial multicatheter accelerated partial-breast irradiation (APBI). Patients and Methods: Between April 2001 and January 2005, 171 patients with early breast cancer were recruited in Erlangen for this subanalysis of the German-Austrian APBI phase II-trial. 58% (99/171) of the patients received pulsed-dose-rate (PDR), and 42% (72/171) high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3-4 days. Endpoint of this evaluation was the CO, graded as excellent, good, fair, or poor. Patients were divided in two groups with an excellent (n = 102) or nonexcellent (n = 69) cosmetic result. Various factors were analyzed for their impact on excellent CO. Results: The median follow-up time was 52 months (range: 21-91 months). Cosmetic results were rated as excellent in 59.6% (102/171), good in 29.8% (51/171), fair in 9.9% (17/171), and poor in 0.6% (1/171). The initial cosmetic status was significantly worse for the nonexcellent CO group (p = 0.000). The percentage of patients who received PDR brachytherapy APBI was higher in the nonexcellent CO group (68.1% vs. 51%; p = 0.026). Acute toxicity was higher in the nonexcellent CO group (24.6% vs. 12.7%; p = 0.045). Furthermore, the presence of any late toxicity was found to be associated with a worse cosmetic result (65.2% vs. 18.6%; p = 0.000). In detail, the appearance of skin hyperpigmentation (p = 0.034), breast tissue fibrosis (p = 0.000), and telangiectasia (p = 0.000) had a negative impact on CO. Conclusion: The initial, surgery-associated cosmetic status, brachytherapy modality, and the presence of acute and late toxicities were found to have an impact on overall CO. Our data have proven

  5. Image and laparoscopic guided interstitial brachytherapy for locally advanced primary or recurrent gynaecological cancer using the adaptive GEC ESTRO target concept

    Purpose: To retrospectively assess treatment outcome of image and laparoscopic guided interstitial pulsed dose rate brachytherapy (PDR-BT) for locally advanced gynaecological cancer using the adaptive GEC ESTRO target concept. Materials and methods: Between June 2005 and December 2010, 28 consecutive patients were treated for locally advanced primary vaginal (nine), recurrent endometrial (12) or recurrent cervical cancer (seven) with combined external beam radiotherapy (EBRT) and interstitial PDR-BT. Treatment was initiated with whole pelvic EBRT to a median dose of 45 Gy followed by PDR-BT using the Martinez Universal Perineal Interstitial Template (MUPIT). All implants were virtually preplanned using MRI of the pelvis with a dummy MUPIT in situ. The GEC ESTRO high risk clinical target volume (HR CTV), intermediate risk clinical target volume (IR CTV) and the organs at risk (OAR) were contoured and a preplan for implantation was generated (BrachyVision, Varian). The subsequent implantation was performed under laparoscopic visualisation. Final contouring and treatment planning were done using a post-implant CT. Planning aim of PDR-BT was to deliver 30 Gy in 50 hourly pulses to HR CTV. Manual dose optimisation was performed with the aim of reaching a D90 > 80 Gy in the HR CTV calculated as the total biologically equivalent to 2 Gy fractions of EBRT and BT (EQD2). Dose to the OAR were evaluated using dose volume constraints for D2cc of 90 Gy for bladder and 70 Gy for rectum and sigmoid. Results: For HR CTV the median volume was 26 cm3 (7-91 cm3). Coverage of the HR CTV was 97% (90-100%) and D90 was 82 Gy (77-88 Gy). The D2cc for bladder, rectum, and sigmoid were 65 Gy (47-81 Gy), 61 Gy (50-77 Gy), and 52 Gy (44-68 Gy), respectively. Median follow up was 18 months (6-61 months). The actuarial 2 years local control rate was 92% (SE 5), while disease-free survival and overall survival were 59% (SE 11) and 74%, respectively (SE 10). No complications to the laparoscopic

  6. Accelerated partial-breast irradiation with interstitial implants. Analysis of factors affecting cosmetic outcome

    Purpose: To analyze patient-, disease-, and treatment-related factors for their impact on cosmetic outcome (CO) after interstitial multicatheter accelerated partial-breast irradiation (APBI). Patients and Methods: Between April 2001 and January 2005, 171 patients with early breast cancer were recruited in Erlangen for this subanalysis of the German-Austrian APBI phase II-trial. 58% (99/171) of the patients received pulsed-dose-rate (PDR), and 42% (72/171) high-dose-rate (HDR) brachytherapy. Prescribed reference dose for HDR brachytherapy was 32 Gy in eight fractions of 4 Gy, twice daily. Prescribed reference dose in PDR brachytherapy was 49.8 Gy in 83 consecutive fractions of 0.6 Gy each hour. Total treatment time was 3-4 days. Endpoint of this evaluation was the CO, graded as excellent, good, fair, or poor. Patients were divided in two groups with an excellent (n = 102) or nonexcellent (n = 69) cosmetic result. Various factors were analyzed for their impact on excellent CO. Results: The median follow-up time was 52 months (range: 21-91 months). Cosmetic results were rated as excellent in 59.6% (102/171), good in 29.8% (51/171), fair in 9.9% (17/171), and poor in 0.6% (1/171). The initial cosmetic status was significantly worse for the nonexcellent CO group (p = 0.000). The percentage of patients who received PDR brachytherapy APBI was higher in the nonexcellent CO group (68.1% vs. 51%; p = 0.026). Acute toxicity was higher in the nonexcellent CO group (24.6% vs. 12.7%; p = 0.045). Furthermore, the presence of any late toxicity was found to be associated with a worse cosmetic result (65.2% vs. 18.6%; p = 0.000). In detail, the appearance of skin hyperpigmentation (p 0.034), breast tissue fibrosis (p = 0.000), and telangiectasia (p = 0.000) had a negative impact on CO. Conclusion: The initial, surgery-associated cosmetic status, brachytherapy modality, and the presence of acute and late toxicities were found to have an impact on overall CO. Our data have proven that

  7. Optimization of a breast implant in Brachytherapy PDR. Validation with Monte Carlo simulation and measurements with TLDs and GafChromic films

    Background and purpose: The calculation of the dose distribution of Brachytherapy breast implant has been carried out in accordance with the Paris System (PS) in the majority of the radiotherapy departments in Europe. PDR (Pulsed Dose Rate) has lead to an improvement of the treatment procedure, optimization tools, however, allow an improvement of the treatment technique. The goal of this study was to perform a dosimetric verification of an optimized seven needles implant and to try to decrease the active length while preserving the same treatment volume. This corresponds to a ratio 'treated length/active length' (L t/L a) that tends towards 1. Material and Methods: A dosimetry phantom was made of polystyrene, capable of receiving the implant, TLDs (LiF100 1mm3 micro cubes) and films (GafChromic MD55-2). Dose distributions for one source position and for the implant in conformity with the PS were calculated, utilizing version 14.2 of the Plato TPS (Nucletron); the remote afterloading system was a microSelectron-PDR (Nucletron). MCNP (Monte Carlo N-Particles transport) modeling was used for various configurations to evaluate the influence of the composition of the medium, of the presence of the needles and the lack of scatter. Results: The benefit of the optimization was shown by the determination of a L t/L a factor of 1.05 instead of 0.7 for the standard PS. The dose distributions calculated by Plato are in agreement with TLD and film measurements for the optimization and the PS (<5%). The TPS results were confirmed by MC calculation as well as by measurements. MC calculations also showed that only the lack of scatter had a significant influence on the dose received by the skin (20%) Conclusions: The optimization brings a significant benefit in protecting the skin and in homogeneity of the dose distribution in the treated volume. Through MC simulation, this work made it possible to update a parameter significantly influencing dose distribution calculations: the

  8. 康复训练在早期膝骨关节炎患者中应用价值的对比研究%Efficacy of rehabilitation training in patients on senile knee osteoarthritis

    罗灏; 刘君

    2014-01-01

    Objective To evaluate the clinical efficacy of rehabilitation training in treating senile knee osteoarthritis.Methods A hun-dred and twenty patients with knee osteoarthritis were randomized into rehabilitation group and control group with 60 cases each for int-racavitary administration of sodium hyaluronate,ozone,triamcinolone acetonide and gentamicin plus rehabilitation training or only intra-cavitary administration.The therapeutic effects were evaluated using visual analogue scale (VAS),Lysholm knee score scale and sur-face electromyogram.Results The pain was obviously relieved in both groups(P<0.05)and better therapeutic effects were achieved in the combination group.Lysholm scores in rehabilitation group were significantly higher than those of control group (P<0.05);after treatment,85 .0% of patients in rehabilitation group acquired good knee joint function.There were statistically significant differences in the improvements of median frequency and mean power frequency on the surface electromyogram of quadriceps femoris between the two groups (P<0.05).Conclusions Intracavitary administration combined with rehabilitation training has effectively marked therapeutic effects in treating senile knee osteoarthritis and can relieve quadriceps femoris fatigue in these patients.%目的:观察康复训练在早期膝骨关节炎患者中的疗效。方法将120例膝关节骨性关节炎患者随机分为康复组和对照组,每组60例,康复组采用膝关节腔内注射臭氧+玻璃酸钠+曲安奈德+庆大霉素联合膝关节康复训练,对照组采用腔内注射方法,对两组患者治疗前后进行VAS疼痛评估、Lysholm膝关节功能评分和表面肌电检测。结果两组治疗后疼痛程度均明显减轻,但两组比较差异有统计学意义(P<0.05)。康复组Lysholm评分显著高于对照组(P<0.05);康复组功能恢复优良率为85.0%,明显优于对照组(P<0.05)。两组患者治疗后股

  9. Radiotherapy and CT for the nasopharyngeal squamous cell carcinoma, 2

    One hundred and one patients with nasopharyngeal squamous cell carcinoma (NPC) were treated with irradiation. The UICC TNM staging system (1978) was applied : 6 patients were T1NO, 10 T2NO, 5 T3NO, 13 T4NO, 11 T1N+, 18 T2N+, 19 T3N+ and 19 T4N+. Since 1978, computed tomography (CT) was available, and 34 patients were examined with CT at first presentation. The technique of radiotherapy was markedly changed around 1978. The field to the primary site and neck were enlarged. Two-year relapse-free survival was significantly better for the post-CT era than pre-CT era. This was mainly due to improved local-recurrence-free survival and cervical-relapse-free survival. Improvement of local-recurrence-free survival, however, was appreciated in only T3 + T4 patients, there were no differences in T1 + T2 patients. This failure to increase local-recurrence-free survival in the T1 + T2 patients may relate to the fact that a large number of these patients showed T3 or T4 tumors on CT. In 34 patients with CT examination, 14 patients were upstaged based on CT findings alone. Since many clinical T1 or T2 tumors determined without CT information were upstaged to T3 or T4 after performing CT, we studied treatment results of them according to CT staging. Nine of 16 clinical T1 + T2 tumors upstaged to T3 or T4 after performing CT, 3 of which had local recurrence. Seven patients remained as T1 + T2 after performing CT, only one of which experienced local recurrence. It is suggested that mere enlarging of radiation fields or increasing radiation doses could not be curative for a certain group of patients. In order to further increase local control rates, we have started to use intracavitary irradiation with an after-loading technique as a boost. No acute or chronic complications due to intracavitary irradiation have developed. Preliminary results were encouraging. (author)

  10. Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

    Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna (Austria); Nout, Remi A. [Department of Clinical Oncology, Leiden University Medical Center (Netherlands); Tanderup, Kari; Lindegaard, Jacob C. [Department of Oncology, Aarhus University Hospital (Denmark); Westerveld, Henrike [Department of Radiotherapy, Academic Medical Centre, University of Amsterdam (Netherlands); Haie-Meder, Christine [Department of Radiotherapy, Gustave-Roussy, Villejuif (France); Petrič, Primož [Department of Radiotherapy, Institute of Oncology Ljubljana (Slovenia); Department of Radiotherapy, National Center for Cancer Care and Research, Doha (Qatar); Mahantshetty, Umesh [Department of Radiation Oncology, Tata Memorial Hospital, Mumbai (India); Dörr, Wolfgang; Pötter, Richard [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna (Austria)

    2014-05-01

    Background and Purpose: Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study ( (www.embracestudy.dk)) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials: In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results: At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion: Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity

  11. Current status of high dose rate brachytherapy in cervical cancer in Korea and optimal treatment schedule

    Huh, Seung Jae [College of Medicine, Sungkyunkwan Univ., Seoul (Korea, Republic of)

    1998-12-01

    Brachytherapy is an essential part of radiotherapy for uterine cervical cancer. The low dose rate (LDR) regimen has been the major technique of intracavitary therapy for cervical cancer. However, there has been an expansion in the last 20 years of high dose rate (HDR) machines using Ir-192 sources. Since 1979, HDR brachytherapy has been used for the treatment of uterine cervical cancer in Korea. The number of institutions employing HDR has been increasing, while the number of low dose rate system has been constant. In 1995, there was a total 27 HDR brachytherapy units installed and 1258 cases of patients with cervical cancer were treated with HDR. Most common regimens of HDR brachytherapy are total dose of 30-39 Gy at point A with 10-13 fractions in three fractions per week, 24-32 Gy with 6-8 fractions in two fractions per week, and 30-35 Gy with 6-7 fractions in two fractions per week. The average fractionation regimen of HDR brachytherapy is about 8 fractions of 4. 1 Gy each to point A. In Korea, treatment results for HDR brachytherapy are comparable with the LDR series and appears to be a safe and effective alternative to LDR therapy for the treatment of cervical carcinoma. Studies from the major centers report the five-year survival rate of cervical cancer as, 78-86% for Stage I, 68-85% for stage II, and 38-56% for Stage III. World-wide questionnaire study and Japanese questionnaire survey of multiple institutions showed no survival difference in any stages and dose-rate effect ratio (HDR/LDR) was calculated to be 0.54 to 0.58. However, the optimum treatment doses and fractionation schemes appropriate to generate clinical results comparable to conventional LDR schemes have yet to be standardized. In conclusion, HDR intracavitary radiotherapy is increasingly practiced in Korea and an effective treatment modality for cervical cancer. To determine the optimum radiotherapy dose and fractionation schedule, a nation-wide prospective study is necessary in Korea. In

  12. Evaluation of the avidin/biotin-liposome system injected in pleural space and peritoneum for drug delivery to mediastinal lymph nodes

    Medina-Velazquez, Luis Alberto

    The avidin/biotin-liposome system is a new modality recently developed for targeting lymph nodes through the lymphatic system after local injection in a cavity as the route of delivery. In this dissertation we show that the avidin/biotin-liposome system has potential advantages over the injection of only liposomes for targeting lymph nodes. A goal of this dissertation was to evaluate the potential of pleural space as a route of transport for the targeting of mediastinal nodes. Another objective was to study the role of the injected dose of the avidin/biotin-liposome system for targeting mediastinal nodes. Dose, volume, site and sequence of injection of the agents were studied as factors that play an important role in the lymphatic targeting and in the organ distribution of liposomes after intracavitary injection of the avidin/biotin-liposome system. The hypothesis tested in this dissertation was that intracavitary injection of the avidin/biotin-liposome system in pleural space and/or peritoneum results in high levels of mediastinal node targeting with a significant reduction of unfavorable organ distribution when compared with the injection of only liposomes. The specific aims of this dissertation were: (1) to determine the pharmacokinetics, mediastinal node targeting, and biodistribution of avidin and biotin-liposomes injected individually in pleural and peritoneal space, (2) to determine the effect of injected dose and volume on the targeting of mediastinal nodes after intrapleural injection of the avidin/biotin-liposome system, and (3) to evaluate the dose effect of the avidin/biotin-liposome system on the targeting of mediastinal nodes and the lymphatics that drain the peritoneum and pleural space by injecting one agent in peritoneum and the corresponding agent in pleural space, and vice versa. To perform these studies, scintigraphic images were acquired with a gamma camera to non-invasively follow the pharmacokinetics and organ uptake of the avidin

  13. Customized individual applicators for endocavitary brachytherapy in patients with cancers of the nasal cavity, sinonasal region and nasopharynx.

    Kadah, Basel Al; Niewald, Marcus; Papaspyrou, George; Dzierma, Yvonne; Schneider, Mathias; Schick, Bernhard

    2016-06-01

    Brachytherapy has become an established therapeutic regimen for primary, persistent, recurrent and metastatic tumour disease in the head and neck region. This study presents the authors' preliminary experience with intracavitary brachytherapy by means of an individual silicone applicator in the treatment of patients with nasal, sinonasal, orbital and nasopharyngeal cancer. Between January 2001 and January 2013, twenty patients with cancer of the nasal cavity, the paranasal sinuses and nasopharynx underwent surgery and intracavitary brachytherapy with the aid of an individually manufactured silicone applicator in the Department of Otolaryngology, Head and Neck Surgery and in the Department of Radiotherapy and Radiooncology at the Saarland University Medical Center of Homburg, Germany. The tumour was localized in the nasal cavity/paranasal sinuses (15) affecting the orbit twice and the nasopharynx (5). There were 14 patients with squamous cell carcinoma, 2 patients with mixed tumours and one patient with adenocarcinoma, adenoid cystic carcinoma, mucosal melanoma or plasmocytoma. The majority of the patients presented with advanced disease (T3 or T4 tumours). In 18/20 patients, brachytherapy was performed as a boost technique, in the remaining two solely because of a previous radiation series. All surgical interventions were performed endonasally. Three to six weeks after surgery, a cast of the nasal cavity was created under general anaesthesia. Subsequently, an individual brachytherapy silicon applicator with two to four plastic tubes was manufactured. The radiation therapy was applied using the Ir-192 high-dose-rate-afterloading method (total dose 10-20 Gy) in two to five sessions, additionally in 18/20 patients a percutaneous radiotherapy with a total dose of 30-60 Gy was applied. After a mean duration of follow-up of 2 years, 7/20 patients experienced a local progression, 5/19 a regional recurrence in the neck nodes and 4/19 distant metastases. The 2-year

  14. Bladder–Rectum Spacer Balloon in High-Dose-Rate Brachytherapy in Cervix Carcinoma

    Purpose: To compare bladder and rectum doses with the use of a bladder–rectum spacer balloon (BRSB) versus standard gauze packing in the same patient receiving 2 high-dose-rate intracavitary brachytherapy fractions. Methods and Materials: This was a randomized study to compare the reduction in bladder and rectum doses with the use of a BRSB compared with standard gauze packing in patients with carcinoma of the cervix being treated with high-dose-rate intracavitary brachytherapy. The patients were randomized between 2 arms. In arm A, vaginal packing was done with standard gauze packing in the first application, and BRSB was used in the second application. Arm B was the reverse of arm A. The International Commission for Radiation Units and Measurement (ICRU) point doses and doses to 0.1-cm3, 1-cm3, 2-cm3, 5-cm3, and 10-cm3 volumes of bladder and rectum were compared. The patients were also subjectively assessed for the ease of application and the time taken for application. Statistical analysis was done using the paired t test. Results: A total of 43 patients were enrolled; however, 3 patients had to be excluded because the BRSB could not be inserted owing to unfavorable local anatomy. Thus 40 patients (80 plans) were evaluated. The application was difficult in 3 patients with BRSB, and in 2 patients with BRSB the application time was prolonged. There was no significant difference in bladder doses to 0.1 cm3, 1 cm3, 2 cm3, 5 cm3, and 10 cm3 and ICRU bladder point. Statistically significant dose reductions to 0.1-cm3, 1-cm3, and 2-cm3 volumes for rectum were observed with the BRSB. No significant differences in 5-cm3 and 10-cm3 volumes and ICRU rectum point were observed. Conclusion: A statistically significant dose reduction was observed for small high-dose volumes in rectum with the BRSB. The doses to bladder were comparable for BRSB and gauze packing. Transparent balloons of variable sizes are recommended for patients with a less spacious vaginal cavity

  15. Bladder–Rectum Spacer Balloon in High-Dose-Rate Brachytherapy in Cervix Carcinoma

    Rai, Bhavana [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India); Patel, Firuza D., E-mail: firuzapatel@gmail.com [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India); Chakraborty, Santam; Sharma, Suresh C.; Kapoor, Rakesh [Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India); Aprem, Abi Santhosh [Corporate R and D Division, HLL Lifecare Limited, Karamana, Trivandrum (India)

    2013-04-01

    Purpose: To compare bladder and rectum doses with the use of a bladder–rectum spacer balloon (BRSB) versus standard gauze packing in the same patient receiving 2 high-dose-rate intracavitary brachytherapy fractions. Methods and Materials: This was a randomized study to compare the reduction in bladder and rectum doses with the use of a BRSB compared with standard gauze packing in patients with carcinoma of the cervix being treated with high-dose-rate intracavitary brachytherapy. The patients were randomized between 2 arms. In arm A, vaginal packing was done with standard gauze packing in the first application, and BRSB was used in the second application. Arm B was the reverse of arm A. The International Commission for Radiation Units and Measurement (ICRU) point doses and doses to 0.1-cm{sup 3}, 1-cm{sup 3}, 2-cm{sup 3}, 5-cm{sup 3}, and 10-cm{sup 3} volumes of bladder and rectum were compared. The patients were also subjectively assessed for the ease of application and the time taken for application. Statistical analysis was done using the paired t test. Results: A total of 43 patients were enrolled; however, 3 patients had to be excluded because the BRSB could not be inserted owing to unfavorable local anatomy. Thus 40 patients (80 plans) were evaluated. The application was difficult in 3 patients with BRSB, and in 2 patients with BRSB the application time was prolonged. There was no significant difference in bladder doses to 0.1 cm{sup 3}, 1 cm{sup 3}, 2 cm{sup 3}, 5 cm{sup 3}, and 10 cm{sup 3} and ICRU bladder point. Statistically significant dose reductions to 0.1-cm{sup 3}, 1-cm{sup 3}, and 2-cm{sup 3} volumes for rectum were observed with the BRSB. No significant differences in 5-cm{sup 3} and 10-cm{sup 3} volumes and ICRU rectum point were observed. Conclusion: A statistically significant dose reduction was observed for small high-dose volumes in rectum with the BRSB. The doses to bladder were comparable for BRSB and gauze packing. Transparent balloons of

  16. Pulsed low dose rate brachytherapy for pelvic malignancies

    Purpose: The pulsed low dose rate remote afterloading unit was designed to combine the radiation safety and isodose optimization advantages of high dose rate technology with the radiobiologic advantages of continuous low dose rate brachytherapy. This is the first report of a prospective clinical trial evaluating the relative incidence of acute toxicity and local control in patients with pelvic malignancies who underwent interstitial or intracavitary brachytherapy with the pulsed low dose rate remote afterloader. Methods and Materials: From 5/11/92-6/21/95, 65 patients underwent 77 brachytherapy procedures as part of their treatment regimen for pelvic malignancies. Using the pulsed low dose rate Selectron, equipped with a single cable-driven 0.3-1.0 Ci Ir192 source, target volume doses of 0.40-0.85 Gy per pulse were prescribed to deliver the clinically determined dose. Forty-five intracavitary and 32 interstitial procedures were performed. Fifty-four patients had primary and 11 recurrent disease. Patients were followed closely to assess incidence of Grade 3-5 acute and delayed toxicity, local control, and survival. Results: With a median follow-up of 16.1 months (range 1-29), 33 patients are NED, 10 alive with disease, 13 dead with disease, 4 dead of intercurrent disease, and 5 lost to follow-up. Local control was maintained until last follow-up or death in 48 cases, local failure occurred in 11, unknown in 5. Grade 3-5 acute toxicities (requiring medical or surgical intervention) occurred in 5 out of 77 procedures (6.5%), delayed complications in 10 patients (15% actuarial incidence at 2 years). In the 52 procedures performed for 42 patients with cervix cancer, the acute toxicity incidence was 5.8%, with a 14% 2-year actuarial incidence of delayed complications. Of 32 interstitial templates performed on 30 patients for pelvic malignancies, there were three incidences of acute toxicity and five delayed toxicities. Conclusion: Using the parameters described for this

  17. Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

    Background and Purpose: Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study ( (www.embracestudy.dk)) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials: In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results: At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion: Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity

  18. Development of computerized dose planning system and applicator for high dose rate remote afterloading irradiation

    Choi, T. J. [Keimyung Univ., Taegu (Korea); Kim, S. W. [Fatima Hospital, Taegu (Korea); Kim, O. B.; Lee, H. J.; Won, C. H. [Keimyung Univ., Taegu (Korea); Yoon, S. M. [Dong-a Univ., Pusan (Korea)

    2000-04-01

    To design and fabricate of the high dose rate source and applicators which are tandem, ovoids and colpostat for OB/Gyn brachytherapy includes the computerized dose planning system. Designed the high dose rate Ir-192 source with nuclide atomic power irradiation and investigated the dose characteristics of fabricated brachysource. We performed the effect of self-absorption and determining the gamma constant and output factor and determined the apparent activity of designed source. he automated computer planning system provided the 2D distribution and 3D includes analysis programs. Created the high dose rate source Ir-192, 10 Ci(370GBq). The effective attenuation factor from the self-absorption and source wall was examined to 0.55 of the activity of bare source and this factor is useful for determination of the apparent activity and gamma constant 4.69 Rcm{sup 2}/mCi-hr. Fabricated the colpostat was investigated the dose distributions of frontal, axial and sagittal plane in intra-cavitary radiation therapy for cervical cancer. The reduce dose at bladder and rectum area was found about 20 % of original dose. The computerized brachytherapy planning system provides the 2-dimensional isodose and 3-D include the dose-volume histogram(DVH) with graphic-user-interface mode. emoted afterloading device was built for experiment of created Ir-192 source with film dosimetry within {+-}1 mm discrepancy. 34 refs., 25 figs., 11 tabs. (Author)

  19. Current situation of high-dose-rate brachytherapy for cervical cancer in Brazil

    Silva, Rogerio Matias Vidal da; Souza, Divanizia do Nascimento, E-mail: rmv.fisica@gmail.com [Universidade Federal de Sergipe (UFS), Sao Cristovao, SE (Brazil); Pinezi, Juliana Castro Dourado [Pontificia Universidade Catolica de Goias (PUC-Goias), Goiania, GO (Brazil); Macedo, Luiz Eduardo Andrade [Hospital Chama, Arapiraca, AL (Brazil)

    2014-05-15

    To assess the current situation of high-dose-rate (HDR) brachytherapy for cancer of the cervix in Brazil, regarding apparatuses, planning methods, prescription, fractionation schedule and evaluation of dose in organs at risk. Materials and methods: in the period between March/2012 and May/2013, a multiple choice questionnaire was developed and sent to 89 Brazilian hospitals which perform HDR brachytherapy. Results: sixty-one services answered the questionnaire. All regions of the country experienced a sharp increase in the number of HDR brachytherapy services in the period from 2001 to 2013. As regards planning, although a three-dimensional planning software was available in 91% of the centers, conventional radiography was mentioned by 92% of the respondents as their routine imaging method for such a purpose. Approximately 35% of respondents said that brachytherapy sessions are performed after teletherapy. The scheme of four 7 Gy intracavitary insertions was mentioned as the most frequently practiced. Conclusion: the authors observed that professionals have difficulty accessing adjuvant three-dimensional planning tools such as computed tomography and magnetic resonance imaging. (author)

  20. Clinical and experimental investigation on small intestinal injury following radiation therapy for carcinoma of uterine cervix

    Radiation injury of the small bowel was observed in 6 of 460 patients with carcinoma of uterine cervix who were treated by radiation between April 1966 and December 1973 at Tokyo Women's Medical College, Department of Radiology. Three of these 6 patients were treated conservatively and the other 3 others underwent surgery but died subsequently. Clinically and surgically these 6 patients showed marked adhesions of intestinal loops, which may be accounted for by the radiation injury of the small bowel. Clinical experience has shown that it is necessary to use a small radiation field to decrease small bowel injury from radiation. An experiment using abdominal radiation in mice confirmed that LD sub(50/30) is larger with a center split, maintaining equal integral doses. In adult dogs, severe small bowel obstruction was observed with over 4000 rad irradiation. Small bowel injury was milder in case with center split, intracavitary irradiation, and small radiation field. It was concluded that center split is one of the methods of preventing radiation injury of the small bowel. (Evans, J.)

  1. Results of radiation therapy for uterine cervical cancer using high dose rate remote after loading system

    In Japan, radiotherapy with high dose rate remote after loading system (HDR-RALS) for intracavitary brachytherapy is the standard treatment for more than 30 years. This report showed the usefulness of HDR-RALS for uterine cervical cancer. From 1980 through 1999, 442 patients with uterine cervical cancers (stage I: 66, stage II: 161, stage III: 165, stage IV: 50) were treated. Radiotherapy was performed both external teletherapy and HDR-RALS. Overall survival rate at 5 years was 60.2%. The 5-year actuarial incidence of all complications was 16.4%. The 5-year actuarial incidence of all complications in cases treated with the sum doses of whole pelvic irradiation (without central shield) and RALS up to 49 Gy, 50 to 59 Gy or larger doses were 7.5%, 11.0% and 25.2%, respectively. Radiation therapy using HDR-RALS was very effective. While the dose of whole pelvic irradiation was increased, the actuarial incidence of all complications was increased. (author)

  2. Dosimetric evaluation of a combination of brachytherapy applicators for uterine cervix cancer with involvement of the distal vagina; Avaliacao dosimetrica de uma combinacao de aplicadores para braquiterapia de tumores do colo uterino com acometimento da porcao distal da vagina

    Guimaraes, Roger Guilherme Rodrigues [Real e Benemerita Sociedade Portuguesa de Beneficencia, Sao Paulo, SP (Brazil). Servico de Radioterapia Estereotactica; Carvalho, Heloisa de Andrade; Stuart, Silvia Radwanski; Rubo, Rodrigo Augusto [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Servico de Radioterapia], e-mail: handrade@hcnet.usp.br; Seraide, Rodrigo Migotto [Centro de Oncologia Campinas, SP (Brazil)

    2009-07-15

    Objective: To evaluate an alternative brachytherapy technique for uterine cervix cancer involving the distal vagina, without increasing the risk of toxicity. Materials And Methods: Theoretical study comparing three different high-dose rate intracavitary brachytherapy applicators: intrauterine tandem and vaginal cylinder (TC); tandem/ring applicator combined with vaginal cylinder (TR+C); and a virtual applicator combining both the tandem/ring and vaginal cylinder in a single device (TRC). Prescribed doses were 7 Gy at point A, and 5 Gy on the surface or at a 5 mm depth of the vaginal mucosa. Doses delivered to the rectum, bladder and sigmoid colon were kept below the tolerance limits. Volumes covered by the isodoses, respectively, 50% (V50), 100% (V100), 150% (V150) and 200% (V200) were compared. Results: Both the combined TR+C and TRC presented a better dose distribution as compared with the TC applicator. The TR+C dose distribution was similar to the TRC dose, with V150 and V200 being about 50% higher for TR+C (within the cylinder). Conclusion: Combined TR+C in a two-time single application may represent an alternative therapy technique for patients affected by uterine cervix cancer involving the distal vagina. (author)

  3. Simultaneous compensation for after- irradiation in the treatment of cervix cancer

    The combined radiation therapy which consists of the intracavitary radium application and external compensatory irradiation has been established in Yonsei Cancer Center. 149 cases received radium application among the total 355 patients of cervix cancer, which had been treated by irradiation from Oct. 1969 to Dec.1972 are examined for the tumor dose on each point by Ernst radium application method. Point A; 5625 rads, Point B; 1864 rads, Co; 8375 rads. These data suggest that the metastatic lymph nodes absorbed insufficient dose from the radium treatment only and proportional irregularity of dose distribution on each point. The pattern of radium arrangement was classified in 8 types as the frequency of use in the selected cases and the above facts were established by the experimental study. And then, for delivery of cancer lethal dose in the primary site and involved pelvic lymphatics simultaneously, the total cancercidal dose was estimated as; Point A; 8,000-9,000 rads, Point B; 5,500-6,000 rads, Co: 12,000-15,000 rads. The compensating devices in accordance with 8 types of radium arrangement are made, to correct the irregularity of estimated tumor dose on each point when external compensatory Co-60 irradiation is done, after-radium irradiation. Details are given of how the treatment is planned and applied. The result as so far obtained are gratifying

  4. Complete evaluation of anatomy and morphology of the infertile patient in a single visit; the modern infertility pelvic ultrasound examination.

    Groszmann, Yvette S; Benacerraf, Beryl R

    2016-06-01

    The comprehensive "one-stop shop" ultrasound evaluation of an infertile woman, performed around cycle days 5 to 9, will reveal abundant information about the anatomy and morphology of the pelvic organs and thereby avoid costly radiation and iodinated contrast exposure. We propose a two-dimensional and three-dimensional ultrasound to examine the appearance and shape of the endometrium, endometrial cavity, myometrium, and junctional zone, to assess for müllerian duct anomalies fibroids, adenomyosis, and polyps. We then evaluate the adnexa with grayscale ultrasound and Doppler, looking for ovarian masses or cysts, and signs of tubal disease. The cul-de-sac is imaged to look for masses, endometriosis, and free fluid. We then push gently on the uterus and ovaries to assess mobility. Lack of free movement of the organs would suggest adhesions or endometriosis. The sonohysterogram then allows for more detailed evaluation of the endometrial cavity, endometrial lining, and any intracavitary lesions. Tubal patency is then assessed during the sonohysterogram in real time by introducing air and saline or contrast and imaging the tubes (HyCoSy). With this single comprehensive ultrasound examination, patients can obtain a reliable, time-efficient, minimally invasive infertility evaluation in their own clinician's office at significantly less cost and without radiation. PMID:27054310

  5. Measuring the absorbed dose in critical organs during low rate dose brachytherapy with {sup 137} Cs using thermoluminescent dosemeters; Medicion de la dosis absorbida en organos criticos durante braquiterapia de baja tasa de dosis con {sup 137} Cs usando dosimetros termoluminiscentes

    Torres, A. [UAEM, Fac. de Medicina, 50180 Toluca, Estado de Mexico (Mexico); Gonzalez, P.R. [ININ, A.P. 18-1027, 11801 Mexico D.F. (Mexico); Furetta, C.; Azorin, J. [UAM-I, 09340 Mexico D.F. (Mexico); Andres, U.; Mendez, G. [Centro Estatal de Cancerologia de Tabasco, A. Gregorio Mendez No. 2838, Col. Atasta, 86100 Villahermosa, Tabasco (Mexico)

    2003-07-01

    Intracavitary Brachytherapy is one of the most used methods for the treatment of the cervical-uterine cancer. This treatment consists in the insertion of low rate dose {sup 137}Cs sources into the patient. The most used system for the treatment dose planning is that of Manchester. This planning is based on sources, which are considered fixed during the treatment. However, the experience has shown that, during the treatment, the sources could be displaced from its initial position, changing the dose from that previously prescribed. For this reason, it is necessary to make measurements of the absorbed dose to the surrounding organs (mainly bladder and rectum). This paper presents the results of measuring the absorbed dose using home-made LiF: Mg, Cu, P + Ptfe thermoluminescent dosimeters (TLD). Measurements were carried out in-vivo during 20 minutes at the beginning and at the end of the treatments. Results showed that the absorbed dose to the critical organs vary significantly due to the movement of the patient during the treatment. (Author)

  6. The role of radiation therapy in the treatment of malignant melanoma in the nasal cavity and nasopharynx-case report

    Purpose: Primary mucosal malignant melanoma of the nasal cavity, paranasal sinuses, and nasopharynx (hereinafter referred to collectively as the sinonasal tract, i.e., sinonasal tract mucosal malignant melanomas [SNMMs]) is rare, accounting for between 0.3% and 2% of all malignant melanomas and about 4% of head and neck melanomas. Surgery is the treatment of choice for sinonasal mucosal malignant melanomas, especially complete resection of the tumor with sufficient free margins. Radiotherapy has controversial role in the treatment. Melanoma cells are traditionally considered as radioresistant because they have a high capacity for repair of sublethal damages, in particular when we used a conventional fractionation. Therefore, hypo fractionation considered as a reasonable treatment regimen for this disease. Case: In this paper, we have reported the patient with intranasal cavity malignant melanoma. Functional endoscopic sinus surgery was performed to excise the nasal cavity tumor. However, using positron emission tomography/computed tomography scan with fluorodeoxyglucose was diagnosed residual nasopharyngeal tumor. Then, intracavitary brachytherapy for nasopharynx was further administered. Solitary metastatic cervical nodal involvement which was completely removed has been occurred 6 months after the end of brachytherapy. Even with the regional disease progression, we used external radiation therapy, as a modality of treatment. Conclusion: We decided to show this case report because of its rarity and the possible use of radiotherapy. (author)

  7. Technique, complications, and clinical value of endomyocardial biopsy in patients with heterotopic heart transplants.

    Cooper, D K; Fraser, R C; Rose, A G; Ayzenberg, O; Oldfield, G S; Hassoulas, J; Novitzky, D; Uys, C J; Barnard, C N

    1982-01-01

    A review of 157 consecutive biopsies of donor endomyocardium in patients with heterotopic heart transplants is reported. The technique of percutaneous transvenous endomyocardial biopsy after this operation is described; manipulation of the catheter and bioptome into the junction of the donor superior vena cava and right atrium can be difficult when this anastomotic junction is small, as a result either of operative surgical technique or of subsequent contraction. The complication rate was 4%, but one patient may have died from infection resulting from biopsy when the bioptome had to be introduced at the groin. The histopathological changes seen in the biopsy specimens have been graded according to a scoring system to give the clinician a guide to the severity of rejection. Histopathological assessment was of clinical value in 96% of cases, but was inaccurate on two occasions, once because an opinion was given on what was in retrospect an inadequate sample. In patients undergoing persistent low-grade acute or chronic rejection there was difficulty in detecting or appreciating the true extent of myocardial fibrosis; this led to inadequate immunosuppressive treatment in two patients. Attention is drawn to the fact that ischaemic fibrosis resulting from the vascular changes of chronic rejection may spare the endomyocardium, which is kept viable by intracavitary blood, and that this may lead to a misleading histopathological report. Images PMID:6760446

  8. CT and the heart: Present state of the art and its future

    Overview of non-invasive cardiac computed tomography (CCT) presently technologically feasible - with an outlook on the future. CCT seems to be an addition to the cardiodiagnostic imaging spectrum of cardiac isotope scanning and cardiosonography already firmly established; and it will probably soon have to establish its rank. The indications for CCT already proven and those avaited in the future will be systematically analyzed in this presentation. Conventional present-day CCT with long scanning times of 3-5 seconds has already provided satisfactory clinical information, considering the fact that there is slow motion of the damaged area in myocardial desease as experimentally shown by an over 20 min long arrest of contrast-material (given i.v.) in the infarcted areas. EKG-gated scanning and reconstruction techniques under development will provide better spatial and chronological resolution. However, much development is yet to be done, it is to be expected that CCT will eventually render data about the function of a specific area of the ventricular wall. Decreased scanning times and scanning intervals will provide dynamic studies of cardiac function and alow time/concentration examinations. These latter studies will be especially valuable to demonstrate the intracavitary cardiac flow in detail. (orig.)

  9. Carcinoma of the cervix

    Purpose: To discuss a variety of technical and clinical issues concerning the management of carcinoma of the uterine cervix. Radiation therapy plays a central role in the management of patients with invasive carcinoma of the uterine cervix. Although survival rates are high for patients with small volume disease, clinicians continue to search for approaches that might improve treatment results for patients who have bulky central disease, evidence of regional dissemination or other factors associated with a high rate of disease recurrence. New technical approaches have contributed to controversy about the best means of optimizing therapeutic ratio. This course will review current approaches to the management of cervical cancer. Technical aspects of intracavitary and external beam treatment will be emphasized. Problems with brachytherapy dose specification will be discussed as will technical factors that may influence the incidence of treatment-related complications. Current understanding of the natural history of disease and of clinical factors that influence the rate of disease recurrence will be reviewed, including the importance of tumor volume, lymph node involvement, and histologic type on natural history and prognosis. The possible role of controversial methods of clinical evaluation such as lymphangiography and surgical staging will be discussed. Some of the more controversial aspects of treatment including the indications of radiation therapy vs. surgical therapy for stage IB disease, the role of extended field therapy, postoperative therapy, adjuvant hysterectomy, and neoadjuvant or concurrent chemotherapy will be discussed. Conclusions from the recent NCI consensus conference on cervical cancer will be reviewed

  10. Carcinoma of the cervix

    Purpose: To discuss a variety of technical and clinical issues concerning the management of carcinoma of the uterine cervix. Radiation therapy plays a central role in the management of patients with invasive carcinoma of the uterine cervix. Although survival rates are high for patients with small volume disease, clinicians continue to search for approaches that might improve treatment results for patients who have bulky central disease, evidence of regional dissemination or other factors associated with a high rate of disease recurrence. New technical approaches have contributed to controversy about the best means of optimizing therapeutic ratio. This course will review current approaches to the management of cervical cancer. Technical aspects of intracavitary and external beam treatment will be emphasized. Problems with brachytherapy dose specification will be discussed as will technical factors that may influence the incidence of treatment-related complications. Current understanding of the natural history of disease and of clinical factors that influence the rate of disease recurrence will be reviewed, including the importance of tumor volume, lymph node involvement, and histologic type on natural history and prognosis. The possible role of controversial methods of clinical evaluation such as lymphangiography and surgical staging will be discussed. Some of the more controversial aspects of treatment such as the indications for radiation therapy vs. surgical therapy for stage IB disease, the role of extended field therapy, postoperative therapy, adjuvant hysterectomy and neoadjuvant or concurrent chemotherapy will be reviewed

  11. Hyperthermia treatment at moderate depth laboratory and clinical experience using three methods

    The authors developed 3 ways to heat tumors deeper than 5cm. 1.) Interstitial 915MHz or 300MHz antennae inserted in plastic carriers with air-cooling for uniform heat field, before and after 192 Ir proved most effective (6/9 CR), well tolerated. 2.) Intracavitary 915MHz or 300MHz antenna in aircooled, waterproof jacket, inserted in pharynx, esophagus or rectum, combined with radiation teletherapy was less effective (9/23 CR), often poorly tolerated. 3.) A system of 2 or 3 standard design 300MHz horn waveguides excited in phase has been evaluated, placed about phantoms and living subjects. Both depth and homogeneity of heating profiles were greatly enhanced by positive interference of waveforms. Heat fields in vitro were determined in tissue equivalent phantoms by thermocouples and 3 dimensional photography of liquid crystal sheets. In pigs temperatures in therapeutic range were obtained up to 9cm depth. About 900 patient treatments have been given using 2 applicators opposed for tumors in pelvis, abdomen, thorax and extremities, with minimal toxicity equal to that of a single applicator. Treatments have been uniformly well tolerated with surprisingly little discomfort. Patients perspire profusely. Core temperature has increased at most 20C, when 2 fields were treated consecutively. Significant palliation and tumor control was achieved in 90% of 42 completed, with 5/42 CR, 25/42 PR. Details of invitro and invivo experiments are presented

  12. Immediate versus delayed hysterectomy for endometrial carcinoma: surgical morbidity and hospital stay

    A retrospective review presented is of the intraoperative complications, postoperative morbidity, and length of hospitalization in 138 patients with stage I endometrial carcinoma treated at Yale-New Haven Hospital from January 1, 1977 to December 31, 1981. One group (stage IA, grade 1) was treated with surgery alone; two groups were treated with preoperative intracavitary radium, followed with either an immediate or a delayed hysterectomy. The three groups were comparable in age, weight, and major preoperative medical problems. The mean estimated blood loss during surgery and transfusion requirements during hospitalization were similar for all three groups. The duration of the surgery in the immediate group was longer than the other two groups. The occurrence of febrile morbidity and major postoperative complications in the three groups was similar, except for bacteriuria, which was significantly more common in the immediate group. The length of the postoperative hospitalization was the same for each group; however, the delayed group as compared with the immediate group had a total hospitalization of two days longer. Hence, in the current study, immediate hysterectomy did not significantly increase the surgical or postoperative morbidity rate, compared with delayed hysterectomy. The single hospital stay in the former treatment group represented cost containment

  13. Carcinoma of the cervical stump: comparison of radiation therapy factors, survival and patterns of failure with carcinoma of the intact uterus

    Eighty-nine patients with previously untreated invasive carcinoma of the cervical stump were seen at Yale-New Haven Hospital from 1953 through 1977. This represented 9.4% of the carcinomas of the cervix seen during this time period. Eighty-five of the 89 patients (95.5%) had ''true'' cancers of the cervical stump diagnosed 2 years or more after subtotal hysterectomy, while 4 of the 89 patients (4.5%) had ''coincident'' cancers diagnosed within 2 years of the subtotal hysterectomy. All cervical cancers were staged by the F.I.G.O. classification. Patient characteristics, methods of management, failure sites and survival of patients with carcinoma of the cervical stump were compared to those patients with carcinoma in the intact uterus. Patients with cervical stump cancers were treated in a similar manner to those with carcinomas of the intact uterus, using a combination of external beam irradiation and intracavitary radium. The stump cancer patients had a similar stage distribution to the patients with cancers of the intact uterus but, on the average, they were older and received less irradiation. The patterns of failure were similar on a stage for stage basis, but the survival and disease-free survival for stump cancer patients were superior to those of the patients with carcinoma of the intact uterus

  14. Transoesophageal detection of heart graft rejection by electrical impedance: Using finite element method simulations

    Giovinazzo, G.; Ribas, N.; Cinca, J.; Rosell-Ferrer, J.

    2010-04-01

    Previous studies have shown that it is possible to evaluate heart graft rejection level using a bioimpedance technique by means of an intracavitary catheter. However, this technique does not present relevant advantages compared to the gold standard for the detection of a heart rejection, which is the biopsy of the endomyocardial tissue. We propose to use a less invasive technique that consists in the use of a transoesophageal catheter and two standard ECG electrodes on the thorax. The aim of this work is to evaluate different parameters affecting the impedance measurement, including: sensitivity to electrical conductivity and permittivity of different organs in the thorax, lung edema and pleural water. From these results, we deduce the best estimator for cardiac rejection detection, and we obtain the tools to identify possible cases of false positive of heart rejection due to other factors. To achieve these objectives we have created a thoracic model and we have simulated, with a FEM program, different situations at the frequencies of 13, 30, 100, 300 and 1000 kHz. Our simulation demonstrates that the phase, at 100 and 300 kHz, has the higher sensitivity to changes in the electrical parameters of the heart muscle.

  15. Leakage of caesium braquitherapy sources

    In several Venezuelan public hospitals where cervix uteri tumours are treated by intracavitary radiotherapy, that use manual after loading Fletcher method, with Caesium 137 sources, the use of improper source holders, locally manufactured from pieces of drainage plastic tubing, which deteriorated and created a corrosive environment all around the sources, omission of manufacturer's recommendations regarding corrosion information, source storage, inspection and testing, violation of International Atomic Energy Agency Radiation Protection Procedures, and lack of proper regulatory control, resulted integrity damage to about sixty special form sources (ISO2919 C 63322), leakage of Cs-137 from a supposed insoluble refractory active content (caesium silicoaluminate), and contamination of applicators, floors and bedding. When the situation was detected by means removal contamination tests, after routine inspections, the sources were removed from the hospitals, decontaminated by means of immersion in 3% EDTA solution in ultrasonic bath, subjected to leaking assessment tests, and the ones that passed were placed in low cost stainless steel source holders, designed and built by the instituto Venezolano de Investigaciones Cientificas (IVIC) returned to the hospitals. The leaking sources were removed from use and considered radioactive waste. In order to avoid the occurrence of similar situations, all the importers of such sources are now required to send them to IVIC for testing and placement in proper source holders, before they are shipped to the hospitals. (author)

  16. Long-term survival following two recurrences and re-irradiation courses for a nasopharyngeal carcinoma: a case report

    Haddad P

    2010-10-01

    Full Text Available "nBackground: Local recurrence in Nasopharyngeal Carcinoma (NPC presents is a major challenge. Patients experience substantial morbidity as well as poor survival if no further treatment is offered. Residual or recurrent nasopharyngeal carcinoma is usually managed by chemotherapy, stereotactic radiosurgery, external beam radiation therapy (EBRT, interstitial, and intracavitary brachytherapy or salvage surgery. This case presents the treatment of two consecutive localized recurrences of NPC."n "nCase presentation: The patient was a 59-year-old man who underwent a course of radical external-beam radiotherapy for a primary NPC in 1999, then another course of external radiation in 2004 for his first recurrence, and finally a course of brachytherapy for the second recurrence in 2005. The patient is well now in 2010, with no signs of disease five years after the third radiotherapy."n "nConclusion: Our experience of re-irradiation for this twice recurrent nasopharyngeal carcinoma has been promising with encouraging tumor control and acceptable treatment-related toxicity profile. This case indicates the efficacy of definitive re-irradiation for regional recurrence and the necessity for long-term observation for the salvageable early-stage local failure.

  17. Current situation of high-dose-rate brachytherapy for cervical cancer in Brazil

    To assess the current situation of high-dose-rate (HDR) brachytherapy for cancer of the cervix in Brazil, regarding apparatuses, planning methods, prescription, fractionation schedule and evaluation of dose in organs at risk. Materials and methods: in the period between March/2012 and May/2013, a multiple choice questionnaire was developed and sent to 89 Brazilian hospitals which perform HDR brachytherapy. Results: sixty-one services answered the questionnaire. All regions of the country experienced a sharp increase in the number of HDR brachytherapy services in the period from 2001 to 2013. As regards planning, although a three-dimensional planning software was available in 91% of the centers, conventional radiography was mentioned by 92% of the respondents as their routine imaging method for such a purpose. Approximately 35% of respondents said that brachytherapy sessions are performed after teletherapy. The scheme of four 7 Gy intracavitary insertions was mentioned as the most frequently practiced. Conclusion: the authors observed that professionals have difficulty accessing adjuvant three-dimensional planning tools such as computed tomography and magnetic resonance imaging. (author)

  18. The monetary value of the man.rem and optimization in radiation therapy (brachytherapy)

    The personnel exposed by sources used for intracavitary radiation therapy in Denmark receive more than 40% of the collective dose recorded by personal dosemeters in Denmark. As the application of after-loading technique has become generally accepted by the medical profession in Denmark as a replacement to a considerable degree for manual radium therapy, the most promising suggestion for reduction of radiation doses is the introduction of after-loading facilities in all radiation therapy centres. Such facilities are now being planned in Denmark but their realization will entail great expense and therefore the financial aspects of these plans will be very important. At present the advantage of after-loading cannot be simply demonstrated to the politicians holding the purse strings, i.e. in terms of improved therapeutical gain, e.g. increased survival, although the incidence of complications has been shown to be lower, but the reduction in personnel radiation doses by the change to after-loading will be evident and be an important part of the cost-benefit analysis. By detailed investigation of all expenditures and savings, cost-benefit analysis has been carried out in order to isolate the relationship between expense and the collective dose reduction. If after-loading facilities are established in Denmark today with the intention of reducing the risk for employees and without any expectation of improvements in treatment, the monetary value of the man.rem implied is 10,000 kr. or 2000 US dollars. (author)

  19. High-dose-rate brachytherapy for soft tissue sarcoma in children: a single institution experience

    To report our experience treating soft tissue sarcoma (STS) with high dose rate brachytherapy alone (HBRT) or in combination with external beam radiotherapy (EBRT) in pediatric patients. Eighteen patients, median age 11 years (range 2 – 16 years) with grade 2–3 STS were treated with HBRT using Ir-192 in a interstitial (n = 14) or intracavitary implant (n = 4). Eight patients were treated with HBRT alone; the remaining 10 were treated with a combination of HBRT and EBRT. After a median follow-up of 79.5 months (range 12 – 159), 14 patients were alive and without evidence of disease (5-year overall survival rate 84.5%). There were no local or regional failures in the group treated with HBRT alone. One patient developed distant metastases at 14 months and expired after 17 months. In the combined HBRT and EBRT group, there was 1 local failure (22 months), and 3 patients developed pulmonary metastatic disease 18, 38 and 48 months after diagnosis and no these patients were alive at the time of this report. The overall local control to HBRT alone and HBRT plus EBRT were 100 and 90%, respectively. The acute affects most common were local erythema and wound dehiscence in 6 (33%) and 4 (22%) patients. Late effects were observed in 3 patients (16.5%). Excellent local control with tolerable side effects have been observed in a small group of paediatric patients with STS treated by HBRT alone or in combination with EBRT

  20. A phantom study on bladder and rectum dose measurements in brachytherapy of cervix cancer using FBX aqueous chemical dosimeter.

    Bansal, Anil K; Semwal, Manoj K; Arora, Deepak; Sharma, D N; Julka, P K; Rath, G K

    2013-06-01

    The ferrous sulphate-benzoic acid-xylenol orange (FBX) chemical dosimeter, due to its aqueous form can measure average volume doses and hence may overcome the limitations of point dosimetry. The present study was undertaken to validate the use of FBX dosimeter for rectum and bladder dose measurement during intracavitary brachytherapy (ICBT) and transperineal interstitial brachytherapy (TIB). We filled cylindrical polypropylene tubes (PT) and Foley balloons (FB) with FBX solution and used them as substitutes for rectum and bladder dose measurements respectively. A water phantom was fabricated with provision to place the Fletcher-type ICBT and MUPIT template applicators, and FBX filled PT and FB within the phantom. The phantom was then CT scanned for treatment planning and subsequent irradiation. Our results show that the average difference between DVH derived dose value and FBX measured dose is 3.5% (PT) and 13.7% (FB) for ICBT, and 9% (PT) and 9.9% (FB) for TIB. We believe that the FBX system should be able to provide accuracy and precision sufficient for routine quality assurance purposes. The advantage of the FBX system is its water equivalent composition, average volume dose measuring capability, and energy and temperature independent response as compared to TLD or semiconductor dosimeters. However, detailed studies will be needed with regards to its safety before actual in-vivo dose measurements are possible with the FBX dosimeter. PMID:22687710

  1. Practical aspects of personal exposure monitoring in hospitals and research laboratories

    The practical aspects of personal exposure monitoring in hospitals and research laboratories are closely linked to the type of radiation source and methods used for diagnosis or therapy. Various sources emit X-rays, γ-photons, high energy electrons or beta particles. In external radiation therapy, sources are either sealed or electrically generated; in brachytherapy, they are sealed to be used in interstitial and intracavitary irradiation. A radiodiagnostic department applies X-rays in a variety of ways. In nuclear medicine and in research laboratories unsealed sources are to be used for intravenous injection and radioactive labelling. The personnal is thus exposed, to the risk of external exposure or both external and internal exposure. Additional survey procedures are needed in the following instances: 1) radiodiagnosis especially in the disciplines where X-rays are necessary for the follow-up of the intervention (orthopedics, vascular and interventional radiology); 2) brachytherapy where the handling of sources requires the monitoring of radiation exposure to the hands; 3) nuclear medicine where employees handling unsealed sources require additional survey of the hands as well. However, the highest risk is that of internal exposure following contamination. For this situation the legislation calls for a periodic radiotoxicological and/or whole-body counting. In practice, such monitoring carried out every 6 months is not always adapted to the circumstances

  2. Computerized radiation treatment planning

    Following a general introduction, a chain consisting of three computer programs which has been developed for treatment planning of external beam radiotherapy without manual intervention is described. New score functions used for determination of optimal incidence directions are presented and the calculation of the position of the isocentre for each optimum combination of incidence directions is explained. A description of how a set of applicators, covering fields with dimensions of 4 to 20 cm, for the 6 to 20 MeV electron beams of a MEL SL75-20 linear accelerator was developed, is given. A computer program for three dimensional electron beam treatment planning is presented. A microprocessor based treatment planning system for the Selectron remote controlled afterloading system for intracavitary radiotherapy is described. The main differences in treatment planning procedures for external beam therapy with neutrons instead of photons is discussed. A microprocessor based densitometer for plotting isodensity lines in film dosimetry is described. A computer program for dose planning of brachytherapy is presented. Finally a general discussion about the different aspects of computerized treatment planning as presented in this thesis is given. (Auth.)

  3. Measuring the absorbed dose in critical organs during low rate dose brachytherapy with 137 Cs using thermoluminescent dosemeters

    Intracavitary Brachytherapy is one of the most used methods for the treatment of the cervical-uterine cancer. This treatment consists in the insertion of low rate dose 137Cs sources into the patient. The most used system for the treatment dose planning is that of Manchester. This planning is based on sources, which are considered fixed during the treatment. However, the experience has shown that, during the treatment, the sources could be displaced from its initial position, changing the dose from that previously prescribed. For this reason, it is necessary to make measurements of the absorbed dose to the surrounding organs (mainly bladder and rectum). This paper presents the results of measuring the absorbed dose using home-made LiF: Mg, Cu, P + Ptfe thermoluminescent dosimeters (TLD). Measurements were carried out in-vivo during 20 minutes at the beginning and at the end of the treatments. Results showed that the absorbed dose to the critical organs vary significantly due to the movement of the patient during the treatment. (Author)

  4. Primary fibro sarcoma of the heart.

    Kabashi, Serbeze; Hoxha, Naim; Gashi, Shkelzen; Ahmegjekaj, Ilir; Bejta, Ilir; Sadiku, Muharrem; Ymeri, Halit; Kabashi, Antigona; Bicaj, Xhavit; Mucaj, Sefedin

    2013-01-01

    Primary malignant heart tumors represent rare entities where fibro sarcoma represents about 3% of all. Introducing the patient: A 15 years old patient with cardiac insufficiency (heart failure) symptoms, such as weakness, cyanosis, palpitations and breathing difficulties; enlargement of upper mediastinum and pleural effusion. Through echocardiography a pericardial effusion and intracavitary thrombus in atrium was diagnosed. With computed tomography is diagnosed a tumoral mass in right atrium which is also spread in the right ventricle of the heart. Tumor is completely removed; pat histology result showed primary fibro sarcoma of the heart. At that time no metastasis was found. Conclusion. Primary malignant heart tumors may manifest like cardiac insufficiency or like systemic diseases. Fibrosarcomas are rare and have bad prognosis. On average patients can live around six months after initial symptoms appeared and diagnosis of the tumor was done. In the case of cardiac insufficiency with differential diagnosis we should also think of heart tumors, which could certainly be proved for or eliminated by echocardiography. PMID:24167396

  5. November 2015 Arizona thoracic society notes

    Robbins RA

    2015-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2015 Arizona Thoracic Society meeting was held on Wednesday, November 18, 2015 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities. There were 3 case presentations: 1. Dr. Gerald Schwartzberg presented a case of a 56-year-old man with a history of diabetes, alcoholism and tobacco abuse who has a history of Mycobacterium avium-intracellulare (MAI with a residual thin-walled cavity in his right upper lobe (RUL. After quitting drinking and smoking and years of being asymptomatic, he presented with hemoptysis. Chest x-ray showed increasing density in the RUL. CT scan showed an intracavitary density in his previous cavity presumably a fungus ball. Sputum cultures are pending. Discussion followed on management of fungus balls. Bronchoscopy was recommended to view the bronchial anatomy to exclude other diagnosis as well ...

  6. Hyperthermo-chemo-radiotherapy for the treatment of the patients with esophageal cancer invading the neighboring organs

    Ninety two cases of a3 esophageal cancer invading the neighboring organs diagnosed by histopathology post operation were described. They underwent no treatment before operation; radiotherapy or chemo-radiotherapy before operation; or hyperthermo-chemo-radiotherapy (HCR) before operation. For chemotherapy, bleomycin or CDDP was used. Radiation dose was 30 Gy in total at 1.5-2.0 Gy x 5/wk. For hyperthermotherapy, radiofrequency wave was generated by the intracavitary hyperthermia system, Endoradiotherm 100A (Olympus Kohgaku Ltd.) and the treatment was carried out at 42-45 degC for 30 min x 2/wk x 6. The HCR case exhibited significantly (p<0.05) higher survival rates of 3 years of 21.2% and 5 years of 12.7% than other two cases where no one survived after 3 years. In particular, some of patients of grade 3 who were judged to have markedly responded to the HCR survived for a long period. HCR might be thus useful for a3 esophageal cancer. (K.H.)

  7. Radiotherapy for 71 patients with tonsillar carcinoma

    Objective: To evaluate the therapeutic outcome and determine the prognosticators of tonsillar carcinoma treated by different approaches. Methods: A retrospective study was done on 71 tonsillar carcinoma patients treated from August 1971 to October 1995 by three different ways of radiotherapy. All were pathologically proved. Fifteen patients received external bean therapy plus intracavitary brachytherapy (EBRT + BRT), 39 patients were treated by EBRT only (EBRT) and the other 17 patients underwent FBRT plus chemotherapy (EBTR + CHEMO). Results: The local control rates of EBRT + BRT, EBRT and EBRT + chemo were 82.1%, 68.4% and 64.2%. There was significant difference between EBRT + BRT and the other two groups (x2=4.65, P=0.030; x2=5.65, P=0.018). The 3-, 5- and 10- year survival rates of EBRT + BRT, EBRT and EBRT + CHEMO were 76.3%, 53.2%, 31.2%; 74.0%, 45.2%, 33.5% and 75.2%, 47.1%, 25.3%. All these survival rates showed no statistical significance. (P > 0.05). Conclusion: Brachytherapy, when used to increase the dose effect, may enhance the local effect without any change in the overall survival

  8. Prospects for quantitative computed tomography imaging in the presence of foreign metal bodies using statistical image reconstruction

    X-ray computed tomography (CT) images of patients bearing metal intracavitary applicators or other metal foreign objects exhibit severe artifacts including streaks and aliasing. We have systematically evaluated via computer simulations the impact of scattered radiation, the polyenergetic spectrum, and measurement noise on the performance of three reconstruction algorithms: conventional filtered backprojection (FBP), deterministic iterative deblurring, and a new iterative algorithm, alternating minimization (AM), based on a CT detector model that includes noise, scatter, and polyenergetic spectra. Contrary to the dominant view of the literature, FBP streaking artifacts are due mostly to mismatches between FBP's simplified model of CT detector response and the physical process of signal acquisition. Artifacts on AM images are significantly mitigated as this algorithm substantially reduces detector-model mismatches. However, metal artifacts are reduced to acceptable levels only when prior knowledge of the metal object in the patient, including its pose, shape, and attenuation map, are used to constrain AM's iterations. AM image reconstruction, in combination with object-constrained CT to estimate the pose of metal objects in the patient, is a promising approach for effectively mitigating metal artifacts and making quantitative estimation of tissue attenuation coefficients a clinical possibility

  9. Radiotherapeutic management of carcinomas of the vagina and vulva

    Purpose: To review important basic information regarding vaginal and vulvar carcinomas, including etiology, epidemiology, anatomy, pathology, spread patterns, presentation and work-up and staging. In addition, treatment concepts strategies, and radiotherapeutic techniques will be reviewed and discussed. Discussion: Vaginal carcinoma is rare, making up only 1-2% of gynecologic malignancies. However, the predominant role of radiotherapy (RT) is its management results in a significant number of patients referred to radiation oncology. Treatment and outcomes vary substantially according to stage. Important issues for consideration include the respective roles of external beam RT, brachytherapy, and surgery, intracavitary vs. interstitial brachytherapy, dose rate considerations, combined modality therapy, and management of non-squamous cell histologies. Vulvar carcinoma is similarly uncommon, comprising only 3-5% of gynecologic malignancies. Radiotherapy has a number of established roles in the management of this disease including adjuvant therapy, as part of combined modality treatment for advanced disease, salvage therapy, palliative treatment, and less often, as primary management. These issues will be discussed along with technical factors important in radiotherapeutic management. Finally, relevant literature will be reviewed with an emphasis of completed Gynecologic Oncology Group Trials

  10. Nasopharyngeal carcinoma--a review of radiotherapy techniques.

    Tsao, S Y

    1993-07-01

    With modern megavoltage external X-ray treatment for nasopharyngeal carcinoma, results have improved but late sequelae, which are more often associated with the treatment of advanced tumours or multiple courses of external treatment, have also surfaced. Life-threatening complications include temporal lobe necrosis and hypothalamic-pituitary dysfunction. As CT scanning is superior to conventional radiography in tumour mapping, a new dedicated working staging system, catering for cross-sectional imaging parameters, is proposed for a prospective, multi-centre exercise to finalise on a badly needed common system. With it, case selection for more conservative (to minimise complications) or intensified treatments is facilitated. Intracavitary radiation has now been developed well enough for the nasopharynx. For earlier cases, based on the new staging system, this method has the potential to complement a "sub-radical" external treatment dose designed to minimise complications. A multi-centre trial is indicated. To reach cancericidal doses for the more advanced tumours coming very close to vital structures, extra machine time, though precious, is fully justified so that smaller treatment fractions delivered with facial shells for accurate reproduction of precise machine geometry and field geography can be implemented. Otherwise, subsequent management of possible serious treatment complications may cost more than the treatment itself. Various possible complications of radiotherapy and avoidance and management are outlined. PMID:8257075

  11. Management of stab wounds to the anterior abdominal wall

    João Baptista Rezende-Neto

    2014-01-01

    Full Text Available The meeting of the Publication "Evidence Based Telemedicine - Trauma and Emergency Surgery" (TBE-CiTE, through literature review, selected three recent articles on the treatment of victims stab wounds to the abdominal wall. The first study looked at the role of computed tomography (CT in the treatment of patients with stab wounds to the abdominal wall. The second examined the use of laparoscopy over serial physical examinations to evaluate patients in need of laparotomy. The third did a review of surgical exploration of the abdominal wound, use of diagnostic peritoneal lavage and CT for the early identification of significant lesions and the best time for intervention. There was consensus to laparotomy in the presence of hemodynamic instability or signs of peritonitis, or evisceration. The wound should be explored under local anesthesia and if there is no injury to the aponeurosis the patient can be discharged. In the presence of penetration into the abdominal cavity, serial abdominal examinations are safe without CT. Laparoscopy is well indicated when there is doubt about any intracavitary lesion, in centers experienced in this method.

  12. Radiotherapy for carcinoma of the esophagus in patients aged eighty or older

    Between 1980 and 1988, 206 patients with esophageal cancer were treated initially with radiotherapy. The patients were classified into three groups according to age. Ninety-four patients aged 43-69 years comprised Group A, 83 patients aged 70-79 years comprised Group B, and 29 patients aged 80-86 years comprised Group C. There were no statistically significant differences in background factors between Groups A, B, and C, except for the sex ratio. The male:female ratio was 7.5:1 in Group A, 3.9:1 in Group B, and 1.9:1 in Group C, with the difference between Groups A and C being statistically significant (p less than 0.05). High-dose-rate intracavitary irradiation (HDRII) with or without external irradiation (EI) was performed in 64%, 69%, and 83% of the patients from Groups A, B, and C, respectively. Patients in Groups A, B, and C achieved CR in 23%, 24%, and 34% of cases following radiotherapy. Two- and 5-year survival rates were 16.7% and 6.7% in Group A, 17.2% and 6.0% in Group B, and 27.1% and 20.3% in Group C. No significant differences were found in the patterns of failure and in the radiation-induced injuries between the three groups. Our data suggested that radiotherapy was the treatment of first choice for patients 80 years old and older

  13. Radiation therapy sequelae in the gastro-intestinal tract

    60 patients (50 female, 60 male) aged 16 to 81 years are reported who were treated as in-patients due to irradiation sequelae in the gastro-intestinal tract. In combined intracavitary and percutaneous irradiation, average radium dose was 5,086 mg eh (1,920 to 7,480 mgeh) and average percutaneous dose was 45.5 gy (29.9 to 60 gy). In exclusively percutaneous irradiation, average dose was 60.5 gy (45 to 100.5 gy in two series). 22 out of 46 patients exhibited acute irradiation reactions in the gastro-intestinal fract which required to discontinue radio therapy in 8 cases. Several concurrent irradiation sequelae could be shown in most patients. Clinical symptoms emerged immediately after an irradiation series, but also up to 10 years later. Median latency period for small-intestine lesions was some 13 months and some 9 months (0 to 17 1/2 years) for large-intestine lesions. (orig./MG)

  14. Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement: an intraoperative dilemma.

    Essandoh, Michael; Portillo, Juan; Zuleta-Alarcon, Alix; Castellon-Larios, Karina; Otey, Andrew; Sai-Sudhakar, Chittoor B

    2015-03-01

    High transaortic valvular gradients, after combined aortic valve and mitral valve replacement, require prompt intraoperative diagnosis and appropriate management. The presence of high transaortic valvular gradients after cardiopulmonary bypass, in this setting, can be secondary to the following conditions: prosthesis dysfunction, left ventricular outflow tract obstruction, supravalvular obstruction, prosthesis-patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients, pressure recovery phenomenon, and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Transesophageal echocardiography is an extremely useful tool for timely diagnosis and treatment of this complication. We describe a case of a critically ill patient with endocarditis and acute lung injury, who presented for combined aortic valve and mitral valve replacement. Transesophageal echocardiographic assessment, post-cardiopulmonary bypass, revealed high transaortic valvular gradients due to encroachment of the mitral prosthesis strut on the left ventricular outflow tract, which was compounded by a small, hypertrophied, and hyperkinetic left ventricle. Discontinuation of inotropic support, administration of fluids, phenylephrine, and esmolol led to resolution of the high gradients and prevented further surgery. PMID:25549635

  15. Conservative management of anal and rectal cancer

    The role of irradiation in the management of anal and rectal cancer has changed during the past ten years. In small epidermoid carcinomas of the anal canal (T1 T2) irradiation is in most departments considered the primary treatment, giving a 5-year survival rate of between 60 and 80% with good sphincter preservation. Even in larger tumors, irradiation can still offer some chance of cure without colostomy. Surgery remains the basic treatment of rectal cancer but irradiation is used in association with surgery in many cases. Radiotherapy is of value in the conservative management of cancer of the rectum in three situations: In small polypoid cancers contact X-ray therapy can give local control in about 90%. In cancers of the middle rectum, preoperative external irradiation may increase the chances of restorative surgery and reduce the risk of local relapse. In inoperable patients, external radiotherapy and/or intracavitary irradiation may cure some patients with infiltrating tumors (T2 T3) without colostomy. (orig.)

  16. An integrated ultrasound-computer dosimetry system for radiation therapy

    A highly interactive on-line computer-based radiation therapy planning system has been developed to allow first-hand participation by the physician for maximum input of clinical judgement in treatment planning. The system utilizes an ultrasound scanning device for acquisition of the patient's contour and anatomical information for simultaneous evaluation by the therapist and processing by the computer. The man-machine interaction and graphic data entry are achieved through a sonic graph pen digitizer mounted on the screen of a multi-colour video monitor. A second graph pen digitizer on a radiograph view box is used for digitization and entry to the computer of other graphic data sources. Radiation treatment parameters are graphically entered directly on the echogram of the patient's cross-sectional anatomy. The radiation dose distribution for a proposed plan is then computed and displayed superimposed in a contrasting colour on the echogram for further scrutiny by the therapist and possible modification. When an acceptable plan is produced, the radiation fields are accurately marked on the patient body in reference to the radiation ports displayed. The system is used for external beam planning with simple, multiple, and irregular fields and intracavitary and interstitial implant dosimetry. Since in this system the radiation delivery is planned based on the cross-sectional anatomy, it is well suited for planning of heavy particle beam therapy which utilizes the stopping characteristics of the accelerated particles in the absorbing medium. (author)

  17. Assessing Response Using Tc99m-MIBI Early after Interstitial Chemotherapy with Carmustine-Loaded Polymers in Glioblastoma Multiforme: Preliminary Results

    D. Cecchin

    2014-01-01

    Full Text Available Introduction. Early signs of response after applying wafers of carmustine-loaded polymers (gliadel are difficult to assess with imaging because of time-related imaging changes. Tc99m-sestamibi (MIBI brain single-photon emission tomography (SPET has reportedly been used to reveal areas of cellularity distinguishing recurrent neoplasm from radionecrosis. Our aim was to explore the role of MIBI SPET in assessing response soon after gliadel application in glioblastoma multiforme (GBM. Methods. We retrospectively reviewed the charts on 28 consecutive patients with a radiological diagnosis of GBM who underwent MIBI SPET/CT before surgery (with intracavitary gliadel placement in 17 patients, soon after surgery, and at 4 months. The area of uptake was selected using a volume of interest that was then mirrored contralaterally to obtain a semiquantitative ratio. Results. After adjusting for ratio at the baseline, the effect of treatment (gliadel versus non-gliadel was not statistically significant. Soon after surgery, however, 100% of patients treated with gliadel had a decreased ratio, as opposed to 62.5% of patients in the non-gliadel group P=0.0316. The difference between ratios of patients with radical versus partial resection reached statistical significance by a small margin P=0.0528. Conclusions. These data seem to suggest that the MIBI ratio could be a valuable tool for monitoring the effect of gliadel early after surgery.

  18. Prognostic significance of pretherapeutic and therapeutic factors in patients with advanced cancer of the uterine cervix treated with radical radiotherapy alone

    The prognostic importance of various pretherapeutic and therapeutic factors was analysed in a group of 413 cervical cancer patients with stage IIB (183 pts) and IIIB (230 pts) treated with radical radiotherapy, which consisted of external irradiation and intracavitary brachytherapy. Univariate analysis of pretherapeutic factors revealed the prognostic significance of patient age, history of abortion, stage, haemoglobin and hematocrit levels. Five-year overall survival rate in stage IIB patients was 51% in stage IIIB 40% and the respective rates for local control at each stage were 61%, and 46%. Univariate analysis of therapeutic factors showed that survival and local control rates increased with the dose, but a significant difference was found only in the case of a paracentral (point A) dose. In a multivariate analysis only patient age, abortions, and clinical stage appeared to have a significant and independent impact on survival. Linear regression analysis results indicated that prolongation of treatment time between 33 and 108 days caused a loss of local control of 0.36% per day. (orig.)

  19. Prognostic significance of pretherapeutic and therapeutic factors in patients with advanced cancer of the uterine cervix treated with radical radiotherapy alone

    Karolewski, K.; Korzeniowski, S.; Urbanski, K.; Kojs, Z. [Centre of Oncology, Maia Sklodowska-Curie Memorial Inst., Krakow (Poland); Sokolowski, A. [Dept. of Statistics, Cracow Univ. of Economics (Poland)

    1999-11-01

    The prognostic importance of various pretherapeutic and therapeutic factors was analysed in a group of 413 cervical cancer patients with stage IIB (183 pts) and IIIB (230 pts) treated with radical radiotherapy, which consisted of external irradiation and intracavitary brachytherapy. Univariate analysis of pretherapeutic factors revealed the prognostic significance of patient age, history of abortion, stage, haemoglobin and hematocrit levels. Five-year overall survival rate in stage IIB patients was 51% in stage IIIB 40% and the respective rates for local control at each stage were 61%, and 46%. Univariate analysis of therapeutic factors showed that survival and local control rates increased with the dose, but a significant difference was found only in the case of a paracentral (point A) dose. In a multivariate analysis only patient age, abortions, and clinical stage appeared to have a significant and independent impact on survival. Linear regression analysis results indicated that prolongation of treatment time between 33 and 108 days caused a loss of local control of 0.36% per day. (orig.)

  20. CT and the heart: present state of the art and its future. A review

    Felix, R.; Lackner, K.; Thurn, P.

    1980-02-01

    Overview of non-invasive cardiac computed tomography (CCT) presently technologically feasible - with an outlook on the future. CCT seems to be an addition to the cardiodiagnostic imaging spectrum of cardiac isotope scanning and cardiosonography already firmly established; and it will probably soon have to establish its rank. The indications for CCT already proven and those awaited in the future will be systematically analyzed in this presentation. Conventional present-day CCT with long scanning times of 3-5 seconds has already provided satisfactory clinical information, considering the fact that there is slow motion of the damaged area in myocardial desease as experimentally shown by an over 20 min long arrest of contrast-material (given i.v.) in the infarcted areas. EKG-gated scanning and reconstruction techniques under development will provide better spatial and chronological resolution. However, much development is yet to be done, it is to be expected that CCT will eventually render data about the function of a specific area of the ventricular wall. Decreased scanning times and scanning intervals will provide dynamic studies of cardiac function and alow time/concentration examinations. These latter studies will be especially valuable to demonstrate the intracavitary cardiac flow in detail.

  1. Sci—Thur AM: YIS - 11: Estimation of Bladder-Wall Cumulative Dose in Multi-Fraction Image-Based Gynaecological Brachytherapy Using Deformable Point Set Registration

    Zakariaee, R [Physics Department, University of British Columbia, Vancouver, BC (Canada); Brown, C J; Hamarneh, G [School of Computing Science, Simon Fraser University, Burnaby, BC (Canada); Parsons, C A; Spadinger, I [British Columbia Cancer Agency, Vancouver, BC (Canada)

    2014-08-15

    Dosimetric parameters based on dose-volume histograms (DVH) of contoured structures are routinely used to evaluate dose delivered to target structures and organs at risk. However, the DVH provides no information on the spatial distribution of the dose in situations of repeated fractions with changes in organ shape or size. The aim of this research was to develop methods to more accurately determine geometrically localized, cumulative dose to the bladder wall in intracavitary brachytherapy for cervical cancer. The CT scans and treatment plans of 20 cervical cancer patients were used. Each patient was treated with five high-dose-rate (HDR) brachytherapy fractions of 600cGy prescribed dose. The bladder inner and outer surfaces were delineated using MIM Maestro software (MIM Software Inc.) and were imported into MATLAB (MathWorks) as 3-dimensional point clouds constituting the “bladder wall”. A point-set registration toolbox for MATLAB, Coherent Point Drift (CPD), was used to non-rigidly transform the bladder-wall points from four of the fractions to the coordinate system of the remaining (reference) fraction, which was chosen to be the emptiest bladder for each patient. The doses were accumulated on the reference fraction and new cumulative dosimetric parameters were calculated. The LENT-SOMA toxicity scores of these patients were studied against the cumulative dose parameters. Based on this study, there was no significant correlation between the toxicity scores and the determined cumulative dose parameters.

  2. Tumor regression dynamics with external radiotherapy in cancer cervix and its implications

    BACKGROUND: To study the external radiotherapy (EXTRT) regression patterns in cancer of the cervix. AIMS: Evaluate EXTRT tumor regression doses (TRD) for 50% (TRD50). 80% response (TRD80), normalized dose response gradient (γ50) and slope (slope 50) with clinical outcome. SETTINGS AND DESIGN: Patients, treated solely with radiotherapy and enrolled for other prospective studies having weekly tumor regressions recorded were considered. MATERIAL AND METHODS: Seventy-seven patients received 50Gy of EXTRT at 2 Gy/fraction followed by 18Gy of high-dose rate intracavitary brachytherapy at 6 Gy/fraction. Loco-regional regressions were assessed clinically at weekly intervals during EXTRT to generate EXTRT dose-response curves. STATISTICAL ANALYSIS USED: Student's t test, logistic regression, Kaplan Meier and Cox's proportional hazard model. Scatter plots were fitted using cubic fit. RESULTS: Age (P=0.052) and absence or presence of gross residual tumor (AGRT and PGRT respectively) following EXTRT (P50. (P80 (P50 (P=0.001). Response status to EXTRT was a prognosticator for loco-regional disease free survival (LDFS) (AGRT vs. PGRT; P=0.046). On multivariate analysis, both TRD50 and TRD80 emerged as significant predictors for tumor status at end of EXTRT while TRD80 was the sole determinant of LDFS. CONCLUSION: Extent of tumor regression to EXTRT is an important predictor for treatment outcome in cancer cervix as evident from TRD50 and TRD80 values of EXTRT tumor regression curves. (author)

  3. Direct reconstruction of the Vienna applicator on MR images

    Purpose: To introduce and test a direct reconstruction concept for intracavitary tandem ring applicators in MR image-based brachytherapy treatment planning. Materials and methods: Optical measurements of transparent ring-phantoms provided the geometric relation between source path and the Vienna ring applicator as visible on MRI. For the manual direct reconstruction method (PLATO), the geometry plotted on a transparency was placed on the screen and rotated to fit with visible ring holes. With the software-integrated reconstruction method (OncentraGYN), the applicator geometry was directly used when placing the visible parts of the applicator in the 3D dataset. Clinical feasibility was tested in 10 clinical insertions. Reconstruction and dose calculation were performed independently on two treatment planning systems (PLATO and OncentraGYN) using MRI alone. DVH parameters for targets and organs at risk were analysed and compared to the clinically used radiograph/MRI registration-based method. Results: The direct reconstruction concept for both methods was feasible and reduced treatment planning time. Evaluated DVH parameters for plans using direct reconstruction methods differed from clinically used plans (traditional reconstruction) in mean differences ≤0.2 Gy for plans with 7 Gy prescribed dose. Conclusion: If the relation between applicator shape visible on MRI and the source path is defined once, the reconstruction process can be performed by directly placing the applicator in the MRI dataset.

  4. Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids

    Pietro Gambadauro

    2012-01-01

    Full Text Available Uterine fibroids are common in women of reproductive age and various conservative treatments are available. In order to achieve a successful conservative treatment of fibroids, functional integrity of the uterus is as important as tumor removal or symptoms relief. In this context, intrauterine adhesions must be recognized as a possible complication of conservative management of uterine fibroids, but diagnostic pitfalls might justify an underestimation of their incidence. Hysteroscopic myomectomy can cause adhesions as a result of surgical trauma to the endometrium. The average reported incidence is around 10% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids. Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of intracavitary adhesions. Prevention strategies including bipolar resection, barrier gel or postoperative estradiol, might be useful, but stronger evidence is needed. In view of current knowledge, we would recommend a prevention strategy based on a combination of surgical trauma minimization and identification of high-risk cases. Early hysteroscopic diagnosis and lysis possibly represents the best means of secondary prevention and treatment of postoperative intrauterine adhesions.

  5. Clinical picture and treatment of complications of lower part of large intestine resulting from radiotherapy for intra-pelvic cancer

    The authors described clinical pictures and those treatments of 40 patients with complications of the lower part of the large intestine resulting from radiotherapy for cancer of the uterus, ovarium or the penis. As the radiotherapy, 60Co-telecobalt (6,000-16,000R) and 60Co-needle (1,000-8,568 mch) intracavitary irradiation were used alone or in combination. Findings in the complications of the lower part of the large intestine were classified into Grade I (13 cases), II (14), III (14), and IV (4) according to Sherman. The prodromal symptoms of the complications appeared in 2-6 months following the irradiation in more than a half of the patients, and it appeared within a year in most of the patients. Most of the patients complained about melena, anemia, proctagra, tenesmus and diarrhea. In the cases of Grade III, the symptoms of ileus such as constipation, abdominal distention, and abdominal pain appeared. Internal treatment was given principally, and preternal anus was made when frequent blood transfusion was required. Fourteen cases of those in Grade I and II recovered within 1-3 years. The cases which received proctostomy, including those who had bleeding, stricture and fistulation, had favorable prognosis. This result suggested that the radiotherapy for intra-pelvic cancer should be controlled to prevent further development of the complications in the rectum beyond Grade I. (Serizawa, K.)

  6. Chronic necrotizing pulmonary aspergillosis in pneumoconiosis - Clinical and radiologic findings in 10 patients

    Kato, T.; Usami, I.; Morita, H.; Goto, M.; Hosoda, M.; Nakamura, A.; Shima, S. [Nagoya City University, Nagoya (Japan). School of Medicine, Dept. of Internal Medicine

    2002-01-01

    The authors studied 10 male patients with pneumoconiosis who were seen at Asahi Rosai Hospital and received a clinical diagnosis of chronic necrotizing pulmonary aspergillosis (CNPA) during a 15-year period, and detailed the long-term clinical and radiologic courses of four cases. Their occupational histories included pottery making and coal mining. Chest radiographic findings by the International Labor Organization profusion grading system were greater than category 2. All patients were symptomatic, with a productive cough, haemoptysis, and dyspnea. Serum findings were positive for the aspergillosis antibody in seven patients. The radiologic findings consisted of parenchymal infiltrates and cavities mostly containing mycetoma, which generally involved the upper lobes. The disease progressed slowly; in one patient, broad destruction of the lung was observed after > 10 years without antifungal administration. Most of the patients experienced clinical and radiologic improvement after receiving antifungal therapy, by oral, inhaled, or intracavitary administration. It was concluded that chronic persistent or progressive upper-lobe infiltrates and cavities in patients with pneumoconiosis should raise the possibility of CNPA. Early diagnosis and initiation of effective therapy are recommended to achieve a better outcome.

  7. Carcinoma of the cervix: results of a hyperbaric oxygen trial associated with the use of the Cathetron

    Since 1971, 82 patients with advanced carcinoma of the cervix has been included in a randomised clinical trial in association with the Working Party on Radiotherapy and Hyperbaric Oxygen of the Medical Research Council. External irradiation was given in 10 fractions by an unconventional schedule, either in air or HBO, and combined with three large fractions of intracavitary irradiation using the Cathetron. The results are acceptable overall, with 69% local control, 15% with tumour developing outside the treated volume and 40% survival at five years, but no improvement has been shown with HBO. Symptoms suggestive of some degree of late damage to the small bowel were present in 13% of patients, with higher but not statistically significant, incidence in the HBO group. It is postulated that the schedule of radiotherapy used has allowed reoxygenation during treatment and that no further gain due to the use of HBO may be achieved. After a review of the results from other centres and taking into account the difficulties of treatment in HBO it is concluded that for advanced carcinomas of the cervix the addition of HBO to radiotherapy is not clinically worthwhile. (author)

  8. Surgical treatment of lung cancer. On the clinical guideline for the management of lung cancer

    Surgical treatments of lung cancer are discussed mainly on the evidence-based medicine (EBM)-based Clinical Guideline for the Management of Lung Cancer (revised 2005). Described items are application of surgical treatment, techniques, evidence bases for certain techniques, lymph node excision, video-assisted thoracoscopic surgery (VATS), postoperative therapy of non-small cell lung cancer (NSCC), preoperative adjuvant therapy of NSCC, and present state and future of surgical treatment. Comments are mentioned in this order as follows. The operation can be only applicable on physiological and oncological (clinical stage) considerations. For respectable cancer, lobectomy is essentially recommendable. Recommended techniques like bronchoplasty are orderly described with their evidence. Evidence is said to be insufficient to excise lymph nodes and to perform VATS. Postoperative radiotherapy (RT) of early stage NSCC is not a standard, but chemotherapy (CMT) is recommended because evidences have been accumulated until the revision of the guideline. Evidence is said not yet enough to recommend preoperative RT, CMT or RT+CMT as a standard. Studies of diagnosis and treatment of lung cancer are now under remarkable progress as exemplified by 3D therapeutic plan by CT-simulation, heavy ion therapy, stereotactic RT and intra-cavitary RT, and surgery will be still one of multiple modalities. (R.T.)

  9. Long-term Follow-up Results of a Multi-institutional Phase 2 Study of Concurrent Chemoradiation Therapy for Locally Advanced Cervical Cancer in East and Southeast Asia

    Purpose: To report the long-term survival and toxicity of a multi-institutional phase 2 study of concurrent chemoradiation therapy (CCRT) for locally advanced cervical cancer in east and southeast Asia. Methods and Materials: Ten institutions from 8 Asian countries participated in the study. Between April 2003 and March 2006, 120 patients (60 with bulky stage IIB and 60 with stage IIIB) were treated with CCRT. Radiation therapy consisted of pelvic external beam radiation therapy and either high-dose-rate or low-dose-rate intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m2) were administered during the course of radiation therapy. Treatment results were evaluated by the rates of local control, overall survival, and late toxicities. Results: Median follow-up was 63.7 months, and the follow-up rate at 5 years was 98%. The 5-year local control and overall survival rates for all patients were 76.8% and 55.1%, respectively. The 5-year rates of major late toxicities of the rectum and bladder were 7.9% and 0%, respectively. Conclusions: The long-term results have suggested that CCRT is safe and effective for patients with locally advanced cervical cancer in east and southeast Asia. However, further efforts are needed to improve overall survival

  10. Long-term Follow-up Results of a Multi-institutional Phase 2 Study of Concurrent Chemoradiation Therapy for Locally Advanced Cervical Cancer in East and Southeast Asia

    Kato, Shingo, E-mail: s_kato@saitama-med.ac.jp [Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama (Japan); National Institute of Radiological Sciences of Japan, Chiba (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Gunma University, Gunma (Japan); Thephamongkhol, Kullathorn; Chansilpa, Yaowalak [Division of Radiation Oncology, Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok (Thailand); Cao, Jianping [School of Radiation Medicine and Public Health, Soochow University, Soochow (China); Xu, Xiaoting [Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Soochow (China); Devi, C. R. Beena; Swee, Tang Tieng [Department of Radiotherapy and Oncology, Hospital Umum Sarawak, Kuching (Malaysia); Calaguas, Miriam J.C. [Department of Radiation Oncology, St. Luke' s Medical Center, Quezon City, the Philippines (Philippines); Reyes, Rey H. de los [Department of Obstetrics and Gynecology, Dr Jose R. Reyes Memorial Medical Center, Manila, the Philippines (Philippines); Cho, Chul-Koo [Department of Radiation Oncology, Korea Cancer Center Hospital, Seoul (Korea, Republic of); Dung, To Anh [Department of Breast and Gynecology Radiotherapy, National Cancer Institute, Hanoi (Viet Nam); Supriana, Nana [Department of Radiation Therapy, Faculty of Medicine, University of Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta (Indonesia); Erawati, Dyah [Division of Radiotherapy, Dr Soetomo General Hospital, Surabaya (Indonesia); Mizuno, Hideyuki [National Institute of Radiological Sciences of Japan, Chiba (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma (Japan); Tsujii, Hirohiko [National Institute of Radiological Sciences of Japan, Chiba (Japan)

    2013-09-01

    Purpose: To report the long-term survival and toxicity of a multi-institutional phase 2 study of concurrent chemoradiation therapy (CCRT) for locally advanced cervical cancer in east and southeast Asia. Methods and Materials: Ten institutions from 8 Asian countries participated in the study. Between April 2003 and March 2006, 120 patients (60 with bulky stage IIB and 60 with stage IIIB) were treated with CCRT. Radiation therapy consisted of pelvic external beam radiation therapy and either high-dose-rate or low-dose-rate intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m{sup 2}) were administered during the course of radiation therapy. Treatment results were evaluated by the rates of local control, overall survival, and late toxicities. Results: Median follow-up was 63.7 months, and the follow-up rate at 5 years was 98%. The 5-year local control and overall survival rates for all patients were 76.8% and 55.1%, respectively. The 5-year rates of major late toxicities of the rectum and bladder were 7.9% and 0%, respectively. Conclusions: The long-term results have suggested that CCRT is safe and effective for patients with locally advanced cervical cancer in east and southeast Asia. However, further efforts are needed to improve overall survival.

  11. Experience with an orthovoltage X-ray therapy machine being used as the only radiotherapy equipment at Mulago Hospital, Kampala, Uganda

    In October 1988 a Radiotherapy Unit became fully operational utilising a deep X-ray therapy machine operating at a maximum kilovoltage of 300 kv at Mulago Hospital. This is the national referral hospital of Uganda and it is the teaching hospital of Makerere University Medical School which is Uganda's only Medical School. A review of the first one hundred and sixty-one cancer patients (161) treated with this machine is presented showing the commonly treated tumours, common problems encountered during the treatment as well as the complications seen and their frequency during this period. A review of the common tumours (histologically proven) as recorded in the Uganda cancer register from 1975-1978 (which were the latest records available in the register at the time of writing of the Paper) is also presented. These figures are used in combination with our experiences to point out the inadequacy of having only orthovoltage facilities in a center like ours. The dire need for Megavoltage radiotherapy facilities as well as facilities for intracavitary treatment are pointed out as being basic in a unit which can effectively treat most of the tumours as seen at Mulago Hospital, Uganda and probably in most centres of the developing world. (author). 1 ref., 8 tabs

  12. The association of rectal equivalent dose in 2 Gy fractions (EQD2) to late rectal toxicity in locally advanced cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University

    Tharavichtikul, Ekkasit; Chitapanarux, Taned; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Wanwilairat, Somsak; Chitapanarux, Imjai [Faculty of Medicine, Chiang Mai University, Chiang Mai (Thailand); Meungwong, Pooriwat [Lampang Cancer Hospital, Lampang (Thailand); Traisathit, Patrinee [Faculty of Science, Chiang Mai University, Chiang Mai (Thailand); Galalae, Razvan [aculty of Medicine, Christian-Albrechts University at Kiel, Kiei (Germany)

    2014-06-15

    To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities. Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale > or = grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269-22.244). The cumulative rectal dose in EQD2 >65 Gy have association with > or = grade 2 LENT-SOMA scale.

  13. Ultrasonography of Uterine Leiomyomas

    Sabrina Q. Rashid

    2016-03-01

    Full Text Available Leiomyomas or myomas of the uterus, also known as a fibroid uterus, are the most common tumors of the uterus. They are benign neoplasms of smooth muscle origin with various degrees of fibrous connective tissue. These tumors can develop in any part of the female genital tract where there is smooth muscle or fibrous tissue, even in the ovary, broad ligament, and vagina. They need to be differentiated from adenomyosis and intracavitary polyps. They mostly remain asymptomatic but sometimes they cause significant morbidity. In such situations, hysterectomy or other surgical intervention is indicated. On ultrasonography, most uterine leiomyomas typically appear as well-defined, solid masses. Their echogenicity is usually similar to that of the myometrium, but sometimes they are hypoechoic. They often show some posterior acoustic shadowing. Variants of leiomyomas occur when they undergo cystic degeneration, hyalinization, or calcification. In such situations, determining a diagnosis is sometimes difficult. Magnetic resonance imaging can be used in this situation for an accurate diagnosis.

  14. External photon beams: Physical aspects

    Radiotherapy procedures fall into two main categories: external beam radiotherapy and brachytherapy. In external beam radiotherapy the radiation source is at a certain distance from the patient and the target within the patient is irradiated with an external radiation beam. In brachytherapy (see Chapter 13) radiation sources are placed directly into the target volume (intracavitary or interstitial brachytherapy) or on to a target (surface mould or intraoperative radiotherapy). Most external beam radiotherapy is carried out with photon beams, some with electron beams and a very small fraction with more exotic particles such as protons, heavier ions or neutrons. This chapter deals with external photon beam radiotherapy. Photon external beams are all characterized by the same physical parameters, but fall into various categories depending on their origin, means of production and energy. There are two origins of photon beams: g rays, which originate from radioactive nuclei, and X rays, which originate in a target bombarded with energetic electrons. The X rays from a target consist of bremsstrahlung photons and characteristic photons. X rays are produced either in an X ray tube (superficial or orthovoltage X rays) or in a linac (megavoltage X rays)

  15. Clinical applications of the imatron fast CT scanner

    Utilizing three imaging modes, Cine CT has proven satisfactory in the assessment of left ventricular mass and function including ejection fractions and abnormalities of wall motion. It is helpful in documenting pericardial constrictions, as well as in assessing intracavitary tumors and thrombi. In the lungs, it is used to document AV fistulae and to evaluate the vascularity of mediastinal masses and to exclude invasion or major thoracic vessels. It can be used, as in the conventional scanner, for needle directed lung and chest well biopsies. It is frequently used in a airway studies to differentiate fixed from physiologic constrictions and to assess tracheomalacia and bronchopulmonary dysplasias. It can be used to plan radiation ports in the treatment of breast carcinoma. In the abdomen, successful applications include its use in the assessment of renal blood flow and the evaluation of cavernous hemangiomas of the liver as well as in screening of possible aortic aneurysms. In orthopedics, Cine CT is used to evaluate patellofermoral tracking in subluxations of the patella and used to evaluate subluxations and dislocations of the radio-ulnar joint. Cine CT by virtue of its speed and satisfactory spatial resolution is a significant imaging modality for evaluating the beating heart. Other applications include the evaluation of aortic aneurysms and dissections, para-aortic mass lesions, airway obstructions and patellar tracking and forearm subluxations

  16. [Radiation safety during work on the ANET-V therapeutic apparatus with 252Cf sources].

    Chekhonadskiĭ, V N; Drygin, V N; Vaĭnberg, M Sh; Komar, V Ia; Elisiutin, G P

    1985-03-01

    The Soviet ANET-W intracavitary neutron therapy apparatus is charged with 252Cf sources, the total mass of the radionuclide being 2100 micrograms. The radiation exposure of the staff has been studied and the results presented. Possible emergency situations have been analysed, methods of their prevention and liquidation worked out. Induced radioactivity in the patient's body has been estimated. Radiation dose levels for the medical staff are 10-15 times lower for the ANET-W apparatus than those for 252Cf sources administered by the manual series system but 10 times higher than those for the AGAT-W gamma-apparatus. The design, blocking system and emergency reset of the sources provide for safe work on the ANET-W apparatus. During liquidation of an emergency situation irradiation of the staff does not exceed 0.3 of the annual maximum tolerance dose. The level of induced activity in the patient's body is insignificant as in 10.5 min it does not exceed background values. PMID:3982256

  17. The calculation of dose from photon exposures using reference human phantoms and Monte Carlo methods. Pt. 5

    There has been some evidence that cervical cancer patients who were treated by radiotherapy, had an increased incidence of second primary cancers noticeable 15 years or more after the radiotherapy. The data suggested that high dose pelvic irradiation was associated with increase in cancers of the bladder, kidneys, rectum, ovaries, corpus uteri, and non-Hodgkin's lymphoma but not leukemia (Kleinerman et al., 1982, Morton 1973). The aim of the present work is to estimate the absorbed dose, due to radiotherapy treatment for cervival cancer, to various organs and tissues in the body. Monte Carlo calculations were performed to calculate the organ absorbed doses resulting from intracavitary sources such as ovoids and applicators filled or loaded with radium, Co-60 and Cs-137. For that purpose a routine which simulates an internal source was constructed and added to the existing Monte Carlo code (GSF-Bericht S-885, Kramer et al.). Calculations were also made for external beam therapy. Various anterior, posterior and lateral fields were applied, resulting from megavoltage, Co-60 and Cs-137 therapy machines. The calculated organ doses are tabulated in three different ways: as organ dose per air Kerma in the reference field, according to the recommendations of the International Commission on Radiation Units and Measurements (ICRU Report No 38, 1985); as organ dose per surface dose and as organ dose per tissue dose at Point B. (orig.)

  18. Late radiotherapeutic morbidity in patients with carcinoma of the uterine cervix: the application of the French-Italian glossary

    Background and purpose. The aim of this study was to perform a retrospective analysis of the complications observed and the importance of delayed symptoms for radiotherapeutic morbidity in patients treated by radiotherapy alone for cervical cancer. Materials and methods. From 1979 to 1991, 145 patients with primary uterine cervical cancer were treated with external radiotherapy and intracavitary applications. During the follow-up, all signs, symptoms and therapy of late treatment complications were recorded. Complications were graded according to the French-Italian glossary. This glossary is used for recording morbidity after treatment of gynaecological cancer. Results. Overall, 119 late complications were recorded. They were most frequently located in the gastro-intestinal system (53%) with a median time to development of 9 months. Urinary complications were recorded in 20%. Very few complications were recorded in vagina/uterus (12%) and pelvic soft tissue (5%). The probability of surviving without tumour recurrence and/or late combined moderate to severe organ morbidity decreased with increasing FIGO stage. Conclusions. For reporting gynaecological morbidity, the French-Italian glossary is useful. Treatment optimization must take into account actuarial estimates of survival and morbidity

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

    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 conductivity and permittivity of different organs in the thorax, changes in magnitude and phase due to a lesion producing a scar, a global ischaemia of the heart, pleural effusion in the lungs, fat thickness increase, displacement of the catheter inside the oesophagus and movement of one electrode on the thorax surface. From these results, we deduce the best estimator for cardiac rejection detection and obtain the tools to identify eventual cases of false positives due to other factors. To achieve these objectives we have created a thoracic model and we have simulated different situations at the frequencies of 13, 30, 100, 300 and 1000 kHz. Our simulation demonstrates that the phase, at 100 and 300 kHz, would be a better estimator than the magnitude to evaluate a heart rejection condition

  20. Remote Afterloading High Dose Rate Brachytherapy AMC EXPERIANCES

    Park, Su Gyong; Chang, Hye Sook; Choi, Eun Kyong; Yi, Byong Yong [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    1992-12-15

    Remote afterloading high dose rate brachytherapy(HDRB) is a new technology and needs new biological principle for time and dose schedule. Here, authors attempt to evaluate the technique and clinical outcome in 116 patients, 590 procedures performed at Asan Medical Center for 3 years. From Sep. 1985 to Aug 1992, 471 procedures of intracavitary radiation in 55 patients of cervical cancer and 26 of nasopharyngeal cancer, 79 intraluminal radiation in 12 of esophageal cancer, 11 of endobronchial cancer and 1 Klatskin tumor and 40 interstitial brachytherapy in 4 of breast cancer, 1 sarcoma and 1 urethral cancer were performed. Median follow-up was 7 months with range 1-31 months. All procedures except interstitial were performed under the local anesthesia and they were all well tolerated and completed the planned therapy except 6 patients. 53/58 patients with cervical cancer and 22/26 patients with nasopharynx cancer achieved CR. Among 15 patients with palliative therapy, 80% achieves palliation. We will describe the details of the technique and results in the text. To evaluate biologic effects of HDRB and optimal time/dose/fractionation schedule, we need longer follow-up. But authors feel that HDRB with proper fractionation schedule may yield superior results compared to the low dose rate brachytherapy considering the advantages of HDRB in safety factor for operator, better control of radiation dose and volume and patients comfort over the low dose brachytherapy.

  1. The role of brachytherapy in cancer control in Africa

    The availability of radiotherapy is an essential for the adequate cure of palliation of cancer in developing as it is in Industrialized Countries. The use of sealed sources in surface, interstitial and intracavitary techniques makes possible the administration of a very high dose in a matter of hours or even minutes, and owing to the inverse square law, this dose falls off rapidly both between the sources in the tumour and in the surrounding normal tissues. A curative treatment may be given in this way to small accessible cancers such as Stage 1 cancer of the cervix or tongue, and complementary treatment by external irradiation from a Cobalt Unit or a Linear accelerator for a more extensive disease such as a Stage 3 carcinoma of the cervix, turns a palliation into a cure in a significant number of patients. The paper discusses the advantages and disadvantages of manual and remote after loading techniques with high and low dose-rate techniques. It also examines the problems raised by requests for an increase in the size of the source at present in use in manual and remote systems. The potential advantages from such an increase are discussed. (author)

  2. Continuous and split-course radiotherapy in locally advanced carcinoma of the uterine cervix. Analyses of local control, distant metastases, crude survival, early and late morbidity and prognostic factors

    From 1974 to 1984, 442 consecutive patients with carcinoma of the uterine cervix were referred for combined intracavitary (IRT) and external radiotherapy (ERT). Dose prescriptions were performed based on the points A and B of the Manchester system. From 1978 the treatment strategy was changed from continuous (CRT) to split course radiotherapy (SCRT) with a higher total dose to point B, a lower dose to point A from the IRT, and a longer total treatment time (TTT). The purpose of the present thesis is: To evaluate local tumour control, distant metastases, survival and complications in the rectosigmoid and bladder in relation to treatment strategy (continuous and split course radiotherapy). To evaluate prognostic factors and importance of treatment strategy for local control, distant metastases, and survival by uni- and multivariate analyses. To develop a classification system (AADK, Aarhus, Denmark) for the recording of early and late radiation complications allowing and estimation of the importance of latency when reporting late radiotherapeutic morbidity and a rescoring of complication grade, and to compare results from AADK with those from the French-Italian glossary recording the maximal damage. To evaluate early and late radiotherapeutic morbidity and the importance of latency by comparing frequencies and actuarial estimates of late complications, to estimate the combined late organ morbidity and the probability of being alive, cured and without serious complications. (EG) (61 refs.)

  3. Sci—Thur AM: YIS - 11: Estimation of Bladder-Wall Cumulative Dose in Multi-Fraction Image-Based Gynaecological Brachytherapy Using Deformable Point Set Registration

    Dosimetric parameters based on dose-volume histograms (DVH) of contoured structures are routinely used to evaluate dose delivered to target structures and organs at risk. However, the DVH provides no information on the spatial distribution of the dose in situations of repeated fractions with changes in organ shape or size. The aim of this research was to develop methods to more accurately determine geometrically localized, cumulative dose to the bladder wall in intracavitary brachytherapy for cervical cancer. The CT scans and treatment plans of 20 cervical cancer patients were used. Each patient was treated with five high-dose-rate (HDR) brachytherapy fractions of 600cGy prescribed dose. The bladder inner and outer surfaces were delineated using MIM Maestro software (MIM Software Inc.) and were imported into MATLAB (MathWorks) as 3-dimensional point clouds constituting the “bladder wall”. A point-set registration toolbox for MATLAB, Coherent Point Drift (CPD), was used to non-rigidly transform the bladder-wall points from four of the fractions to the coordinate system of the remaining (reference) fraction, which was chosen to be the emptiest bladder for each patient. The doses were accumulated on the reference fraction and new cumulative dosimetric parameters were calculated. The LENT-SOMA toxicity scores of these patients were studied against the cumulative dose parameters. Based on this study, there was no significant correlation between the toxicity scores and the determined cumulative dose parameters

  4. Current status and perspectives of brachytherapy for cervical cancer.

    Toita, Takafumi

    2009-02-01

    Standard definitive radiotherapy for cervical cancer consists of whole pelvic external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). In Japan, high-dose-rate ICBT (HDR-ICBT) has been utilized in clinical practice for more than 40 years. Several randomized clinical trials demonstrated that HDR-ICBT achieved comparative outcomes, both for pelvic control and incidences of late complications, to low-dose-rate (LDR) ICBT. In addition, HDR-ICBT has some potential advantages over LDR-ICBT, leading to further improvement in treatment results. Prior to the current computer planning systems, some excellent treatment planning concepts were established. At present, systems modified from these concepts, or novel approaches, such as image-guided brachytherapy (IGBT) are under investigation. One serious problem to be solved in HDR-ICBT for cervical cancer is that of the discrepancy in standard treatment schedules for combination HDR-ICBT and EBRT between the United States and Japan. Prospective studies are ongoing to assess the efficacy and toxicity of the Japanese schedule. PMID:19225920

  5. Preliminary experience on the implementation of computed tomography (CT)-based image guided brachytherapy (IGBT) of cervical cancer using high-dose-rate (HDR) Cobalt-60 source in University of Malaya Medical Centre (UMMC)

    Jamalludin, Z.; Min, U. N.; Ishak, W. Z. Wan; Malik, R. Abdul

    2016-03-01

    This study presents our preliminary work of the computed tomography (CT) image guided brachytherapy (IGBT) implementation on cervical cancer patients. We developed a protocol in which patients undergo two Magnetic Resonance Imaging (MRI) examinations; a) prior to external beam radiotherapy (EBRT) and b) prior to intra-cavitary brachytherapy for tumour identification and delineation during IGBT planning and dosimetry. For each fraction, patients were simulated using CT simulator and images were transferred to the treatment planning system. The HR-CTV, IR-CTV, bladder and rectum were delineated on CT-based contouring for cervical cancer. Plans were optimised to achieve HR-CTV and IR-CTV dose (D90) of total EQD2 80Gy and 60Gy respectively, while limiting the minimum dose to the most irradiated 2cm3 volume (D2cc) of bladder and rectum to total EQD2 90Gy and 75Gy respectively. Data from seven insertions were analysed by comparing the volume-based with traditional point- based doses. Based on our data, there were differences between volume and point doses of HR- CTV, bladder and rectum organs. As the number of patients having the CT-based IGBT increases from day to day in our centre, it is expected that the treatment and dosimetry accuracy will be improved with the implementation.

  6. Realization of radiobiological in vitro cell experiments at conventional X-ray tubes and unconventional radiation sources

    of damage for decreasing photon energy. For this reason, the assumed photon energy dependence was reconfirmed for a cell line other than human lymphocytes, an important finding that was discussed on the 2007 Retreat of the German Commission on Radiological Protection. After successful finalization of the photon experiments the focus of the present dissertation was directed to the realization of in vitro cell irradiation experiments with laser-accelerated electrons. This research was carried out in the frame of the project onCOOPtics that aims on the development of laser-based particle accelerators, which promise accelerators of potentially compact size and more cost-effectiveness suitable for a widespread medical application, especially for high precision hadron therapy. The unique properties, i.e., the ultrashort bunch length and resultant ultrahigh pulse dose rate, of these unconventional particle accelerators demand for extensive investigations with respect to potential effects on the dosimetric and radiobiological characterization. Based on the experiences gained at ELBE first experiments on the radiobiological characterization of laser-accelerated electrons have been performed at the Jena Titanium:Sapphire laser system. After beam optimization, a sophisticated dosimetry system was established that allow for the online control of the beam parameters and for the controlled delivery of dose to the cell sample. Finally, worldwide first systematic in vitro cell irradiation experiments were carried out resulting in a reduced biological effectiveness for laser-accelerated electrons relative to the 200 kV X-ray reference, irrespectively on the biological effect and cell lines examined. These successful results are the basis for future in vivo studies and experiments with laser-accelerated protons.

  7. Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: Results of the French STIC prospective study

    Purpose: In 2005 a French multicentric non randomized prospective study was initiated to compare two groups of patients treated for cervix carcinoma according to brachytherapy (BT) method: 2D vs 3D dosimetry. The BT dosimetric planning method was chosen for each patient in each center according to the availability of the technique. This study describes the results for 705 out of 801 patients available for analysis. Patients and methods: For the 2D arm, dosimetry was planned on orthogonal X-Rays using low dose rate (LDR) or pulsed dose rate (PDR) BT. For the 3D arm, dosimetry was planned on 3D imaging (mainly CT) and performed with PDR BT. Each center could follow the dosimetric method they were used to, according to the chosen radioelement and applicator. Manual or graphical optimization was allowed. Three treatment regimens were defined: Group 1: BT followed by surgery; 165 patients (2D arm: 76; 3D arm: 89); Group 2: EBRT (+chemotherapy), BT, then surgery; 305 patients (2D arm: 142; 3D arm: 163); Group 3: EBRT (+chemotherapy), then BT; 235 patients, (2D arm: 118; 3D arm: 117). The DVH parameters for CTVs (High Risk CTV and Intermediate Risk CTV) and organs at risk (OARs) were computed as recommended by GYN GEC ESTRO guidelines. Total doses were converted to equivalent doses in 2 Gy fractions (EQD2). Side effects were prospectively assessed using the CTCAEv3.0. Results: The 2D and 3D arms were well balanced with regard to age, FIGO stage, histology, EBRT dose and chemotherapy. For each treatment regimen, BT doses and volumes were comparable between the 2D and 3D arms in terms of dose to point A, isodose 60 Gy volume, dose to ICRU rectal points, and TRAK. Dosimetric data in the 3D arm showed that the dose delivered to 90% of the High Risk CTV (HR CTV D90) was respectively, 81.2 Gyα/β10, 63.2 Gyα/β10 and 73.1 Gyα/β10 for groups 1, 2 and 3. The Intermediate Risk (IR) CTV D90 was respectively, 58.5 Gyα/β10, 57.3 Gyα/β10 and 61.7 Gyα/β10 for groups 1, 2 and

  8. Realization of radiobiological in vitro cell experiments at conventional X-ray tubes and unconventional radiation sources

    Beyreuther, Elke

    2010-09-10

    of damage for decreasing photon energy. For this reason, the assumed photon energy dependence was reconfirmed for a cell line other than human lymphocytes, an important finding that was discussed on the 2007 Retreat of the German Commission on Radiological Protection. After successful finalization of the photon experiments the focus of the present dissertation was directed to the realization of in vitro cell irradiation experiments with laser-accelerated electrons. This research was carried out in the frame of the project onCOOPtics that aims on the development of laser-based particle accelerators, which promise accelerators of potentially compact size and more cost-effectiveness suitable for a widespread medical application, especially for high precision hadron therapy. The unique properties, i.e., the ultrashort bunch length and resultant ultrahigh pulse dose rate, of these unconventional particle accelerators demand for extensive investigations with respect to potential effects on the dosimetric and radiobiological characterization. Based on the experiences gained at ELBE first experiments on the radiobiological characterization of laser-accelerated electrons have been performed at the Jena Titanium:Sapphire laser system. After beam optimization, a sophisticated dosimetry system was established that allow for the online control of the beam parameters and for the controlled delivery of dose to the cell sample. Finally, worldwide first systematic in vitro cell irradiation experiments were carried out resulting in a reduced biological effectiveness for laser-accelerated electrons relative to the 200 kV X-ray reference, irrespectively on the biological effect and cell lines examined. These successful results are the basis for future in vivo studies and experiments with laser-accelerated protons.

  9. Brachytherapy seed and applicator localization via iterative forward projection matching algorithm using digital X-ray projections

    Pokhrel, Damodar

    Interstitial and intracavitary brachytherapy plays an essential role in management of several malignancies. However, the achievable accuracy of brachytherapy treatment for prostate and cervical cancer is limited due to the lack of intraoperative planning and adaptive replanning. A major problem in implementing TRUS-based intraoperative planning is an inability of TRUS to accurately localize individual seed poses (positions and orientations) relative to the prostate volume during or after the implantation. For the locally advanced cervical cancer patient, manual drawing of the source positions on orthogonal films can not localize the full 3D intracavitary brachytherapy (ICB) applicator geometry. A new iterative forward projection matching (IFPM) algorithm can explicitly localize each individual seed/applicator by iteratively matching computed projections of the post-implant patient with the measured projections. This thesis describes adaptation and implementation of a novel IFPM algorithm that addresses hitherto unsolved problems in localization of brachytherapy seeds and applicators. The prototype implementation of 3-parameter point-seed IFPM algorithm was experimentally validated using a set of a few cone-beam CT (CBCT) projections of both the phantom and post-implant patient's datasets. Geometric uncertainty due to gantry angle inaccuracy was incorporated. After this, IFPM algorithm was extended to 5-parameter elongated line-seed model which automatically reconstructs individual seed orientation as well as position. The accuracy of this algorithm was tested using both the synthetic-measured projections of clinically-realistic Model-6711 125I seed arrangements and measured projections of an in-house precision-machined prostate implant phantom that allows the orientations and locations of up to 100 seeds to be set to known values. The seed reconstruction error for simulation was less than 0.6 mm/3o. For the physical phantom experiments, IFPM absolute accuracy for

  10. Clinical impact of MRI assisted dose volume adaptation and dose escalation in brachytherapy of locally advanced cervix cancer

    Background: To investigate the clinical impact of MRI based cervix cancer brachytherapy combined with external beam radiochemotherapy applying dose volume adaptation and dose escalation in a consecutive group of patients with locally advanced cervix cancer. Methods: In the period 1998-2003, 145 patients with cervix cancer stages IB-IVA were treated with definitive radiotherapy +/- cisplatin chemotherapy. Median age was 60 years. In 67 patients, the tumour size was 2-5 cm, in 78 patients it was >5 cm. In 29 cases the standard intracavitary technique was combined with interstitial brachytherapy. Total prescribed dose was 80-85 Gy (total biologically equivalent dose in 2 Gy fractions). Since 2001, MRI based treatment planning integrated systematic concepts for High Risk Clinical Target Volume (HR CTV) and organs at risk (OAR), biological modelling, Dose-Volume-Histogram analysis, dose-volume-adaptation (D90, D 2 cm3), and dose escalation, if appropriate and feasible. Findings: Dose volume adaptation was performed in 130/145 patients. The mean D90 during the whole period was 86 Gy, with a mean D90 of 81 Gy and 90 Gy during the first and second period, respectively (p 5 cm it was 71% in 1998-2000 and 90% in 2001-2003 (p = 0.05). Progression free survival (PFS) for true pelvis (local control) was 85%, PFS for distant metastases was 80%, both at 3 years. Local control for tumours >5 cm was 64% in 1998-2000 and 82% in 2001-2003 (p = 0.09) and 100% and 96%, respectively, for tumours 2-5 cm. PFS for distant metastases remained the same during the two treatment periods with 79% and 80%. Overall survival (OS) was 58%, and cancer-specific survival (CSS) was 68% at 3 years. In the two different periods improvement in OS was from 53% to 64% (p = 0.03) and in CSS from 62% to 74% (p = 0.13). Improvement occurred only in tumours >5 cm: OS 28% versus 58% (p = 0.003); CSS 40% versus 62% (p = 0.07). Actuarial late morbidity rate (LENT SOMA, grades 3 and 4) at 3 years was

  11. Physics and quality assurance of low dose rate brachytherapy

    Purpose: The purpose of this course is to review the physical principles underlying design, clinical application and execution of interstitial and intracavitary implants in the classical low dose-rate (LDR) range. This year, the course will focus on quality assurance of sources, applicators and treatment planning software. In addition, development of procedures and QA checks designed optimize treatment delivery accuracy and patient safety during each individual procedure will be reviewed. The level of presentation will be designed to accommodate both physicists and physicians. Implementation of recently published AAPM Task Group reports (no. 40, 'Comprehensive Quality Assurance' and No. 43, 'Dosimetry of Interstitial Brachytherapy Sources') will be reviewed. Outline: (A) General Principles (1) QA endpoints: temporal accuracy, positional accuracy, dose delivery accuracy, and safety of the patient, personnel, and the institution (2) QA procedure development: forms, checklists, test development and design of treatment delivery procedures (B) QA of treatment delivery devices (1) Source acceptance testing and QA a) calibration and source strength specification standards b) leakage tests and source geometry verification (2) Applicator acceptance testing and QA (3) Remote afterloading devices (4) Treatment planning systems a) graphic input/output devices, implant geometry reconstruction, and graphical display b) dose calculation accuracy i) review of brachytherapy dose calculation algorithms ii) dosimetric benchmarks available: Task Group 43 report (C) Procedure-specific QA 1) Organization of treatment delivery team 2) Preplanning and preparation 3) Applicator insertion 4) Radiographic examination of the implant, prescription, and treatment calculation 5) Source insertion 6) Treatment planning and physicist review of treatment plans 7) QA during patient treatment and removal of sources and applicators

  12. Extraterrestrial Hemorrhage Control: Terrestrial Developments in Technique, Technology, and Philosophy with Applicability to Traumatic Hemorrhage in Space

    Kirkpatrick, Andrew; Dawson, David; Campbell, Mark; Jones, Jeff; Ball, Chad G.; Hamilton, Douglas R.; Dulchavsky, Scott; McBeth, Paul; Holcomb, John

    2004-01-01

    Managing injury and illness during long duration space flight limits efforts to explore beyond low earths orbit. Traumatic injury may be expected to occur in space and is a frequent cause of preventable deaths, often related to uncontrolled or ongoing hemorrhage (H). Such bleeding causes 40% of terrestrial injury mortality. Current guidelines emphasize early control of H compared to intravenous infusions. Recent advances in surgical and critical care may be applicable to trauma care in space, with appropriate considerations of the extreme logistical and personnel limitations. Methods: Recent developments in technique, resuscitation fluids, hemoglobin (Hb) substitutes, hemostatic agents, interventional angiography, damage control principles, and concepts related to suspended animation were reviewed. Results: H associated with instability frequently requires definitive intervention. Direct pressure should be applied to all compressible bleeding, but novel approaches are required for intracavitary noncompressible bleeding. Intravenous hemostatic agents such as recombinant Factor VII may facilitate hemostasis especially when combined with a controlled hypotension approach. Both open and laparoscopic techniques could be used in weightlessness, but require technical expertise not likely to be available. Specific rehearsed invasive techniques such as laparotomy with packing, or arterial catherterization with with robotic intravascular embolization might be considered . Hemodynamic support, thermal manipulation, or pharmacologic induction of a state of metabolic down regulation for whole body preservation may be appropriate. Hypertonic saline, with or without dextran, may temporize vascular support and decrease reperfusion injury, with less mass than other solutions. Hb substitutes have other theoretical advantages. Conclusions: Terrestrial developments suggest potential novel strategies to control H in space, but will required a coordinated program of evaluation and

  13. Uterine Fibroids: Correlation of T2 Signal Intensity with Semiquantitative Perfusion MR Parameters in Patients Screened for MR-guided High-Intensity Focused Ultrasound Ablation.

    Kim, Young-Sun; Lee, Jeong-Won; Choi, Chel Hun; Kim, Byoung-Gie; Bae, Duk-Soo; Rhim, Hyunchul; Lim, Hyo Keun

    2016-03-01

    Purpose To evaluate the relationships between T2 signal intensity and semiquantitative perfusion magnetic resonance (MR) parameters of uterine fibroids in patients who were screened for MR-guided high-intensity focused ultrasound (HIFU) ablation. Materials and Methods Institutional review board approval was granted, and informed consents were waived. One hundred seventy most symptom-relevant, nondegenerated uterine fibroids (mean diameter, 7.3 cm; range, 3.0-17.2 cm) in 170 women (mean age, 43.5 years; range, 24-56 years) undergoing screening MR examinations for MR-guided HIFU ablation from October 2009 to April 2014 were retrospectively analyzed. Fibroid signal intensity was assessed as the ratio of the fibroid T2 signal intensity to that of skeletal muscle. Parameters of semiquantitative perfusion MR imaging obtained during screening MR examination (peak enhancement, percentage of relative peak enhancement, time to peak [in seconds], wash-in rate [per seconds], and washout rate [per seconds]) were investigated to assess their relationships with T2 signal ratio by using multiple linear regression analysis. Correlations between T2 signal intensity and independently significant perfusion parameters were then evaluated according to fibroid type by using Spearman correlation test. Results Multiple linear regression analysis revealed that relative peak enhancement showed an independently significant correlation with T2 signal ratio (Β = 0.004, P HIFU ablation, the T2 signal intensity of nondegenerated uterine fibroids showed an independently significant positive correlation with relative peak enhancement in most cases, except those of submucosal intracavitary or type III fibroids. (©) RSNA, 2015. PMID:26313526

  14. Early and late radiotherapeutic morbidity in 442 consecutive patients with locally advanced carcinoma of the uterine cervix

    The purpose of this study was to evaluate the early and late radiotherapeutic morbidity after combined external and intracavitary radiotherapy to the uterine cervix. Early morbidity was most frequently seen in the rectosigmoideum (61%) and urinary bladder (27%). Medication for early morbidity was required 68% and hospitalization in 10% of the patients. The frequencies of each late morbidity grade did not differ in relation to FIGO State while the actuarial estimates increased significantly with increasing stage. This reflects the poor prognosis in the more advanced stages, where few patients survived to develop late morbidity, and also points to the importance of latency in reporting late radiotherapeutic morbidity. In Stage IVA patients, the ratios between the actuarial estimate and the frequency of late severe rectosigmoid and urinary bladder morbidity were as high as 2.5 and 3, respectively. The highest 5-year risk (± 1 SE of the estimate) of late severe morbidity were found for the rectosignoideum (28% ± 3), small intestine (13% ± 2) and urinary bladder (10% ± 2). Rectosigmoid and urinary bladder complications constituted the most important part of the combined organ morbidity. Almost half of the patients developing late moderate rectosigmoid and one-third of those developing late moderate bladder complications, did so within one year after radiotherapy. Almost all complications were developed within 3 to 4 years after radiotherapy. The probability of surviving without recurrence and/or severe combined rectosigmoid and urinary bladder morbidity was low (23% ± 2). Actuarial estimates rather than frequencies should be reported to avoid underestimation of the risk of late radiotherapeutic morbidity in long-term survivors. 29 refs., 5 figs. 7 tabs

  15. A regional cooperative clinical study of radiotherapy for cervical cancer in east and south-east Asian countries

    Purpose: Radiotherapy differed widely in east and south-east Asia because of technical, cultural, and socio-economic differences. With the purpose of standardizing radiotherapy for cervical cancer in the region, an international clinical study was conducted. Materials and methods: Eleven institutions in eight Asian countries participated in the study. Between 1996 and 1998, 210 patients with stage IIIB cervical cancer were enrolled. Patients were treated with a combination of external beam radiotherapy (total dose, 50 Gy) and either high-dose-rate (HDR) or low-dose-rate (LDR) intracavitary brachytherapy (ICBT) according to the institutional practice. The planned point A dose was 20-28 Gy/4 fractions for HDR-ICBT and 30-40 Gy/1-2 fractions for LDR-ICBT. Results: Hundred patients were treated with HDR-ICBT and 110 were treated with LDR-ICBT. The ICBT doses actually delivered to point A ranged widely: 12-32 Gy in the HDR group and 26-52.7 Gy in the LDR group. The 5-year follow-up rate among the countries differed greatly, from 29% to 100%. The 5-year major complication rates were 6% in the HDR group and 10% in the LDR group. The 5-year overall survival rates were 51.1% in the HDR group and 57.5% in the LDR group. Conclusions: Although there were several problems with treatment compliance and patients' follow-up, the study suggests that the protocols provided favorable outcomes with acceptable rates of late complications in the treatment of advanced cervical cancer in east and south-east Asia

  16. Correlation of Traditional Point a With Anatomic Location of Uterine Artery and Ureter in Cancer of the Uterine Cervix

    Purpose: Point A, used for dose specification for intracavitary brachytherapy for cervical cancer, is the point at which the uterine artery and ureter cross. This study assessed compatibility of commonly used traditional point A (TPA) and actual anatomic point A (APA). Methods and Materials: We visualized and placed radiopaque clips at the APA during pelvic and paraaortic lymphadenectomy in 11 patients with cervical carcinoma. Orthogonal and oblique radiographs were obtained after insertion of brachytherapy applicators. We measured the distance between the TPA and APA and estimated the brachytherapy dose to each of the two points. Results: A total of 64 brachytherapy treatments were performed. The mean distances between the TPA and APA were 5.2 ± 1.0 cm on the right and 5.4 ± 1.1 cm on the left. The estimated brachytherapy doses delivered to the APA as a percentage of the presumed 500-cGy fraction size to the TPA were 35.2% (176.6 ± 59.0 cGy) on the right and 30.0% (150.2 ± 42.9 cGy) on the left. The marked discrepancy in the position of the two points was not related to individual kinetic variations during brachytherapy treatment, tumor size, or bladder filling. Conclusions: The conventional TPA does not provide an accurate estimate of the APA determined during lymphadenectomy, indicating a need to reevaluate the current practice for determining the brachytherapy prescription for cervical cancer. ( (ClinicalTrials.gov) Identifier, NCT00319462)

  17. Concurrent radiochemotherapy of locally recurrent or advanced sarcomas of the uterus

    Kortmann, B.; Klautke, G.; Fietkau, R. [Dept. of Radiotherapy, Univ. of Rostock (Germany); Reimer, T.; Gerber, B. [Dept. of Gynecology and Obstetrics, Univ. of Rostock, Suedstadt Hospital (Germany)

    2006-06-15

    Background: uterine sarcomas are rare tumors. Until now, no data on the treatment of recurrent or advanced uterine sarcomas using concurrent radiochemotherapy (RCT) has been available. Patients and methods: from 01/1997 to 03/2004, seven patients with locally recurrent (n = 6) or locally advanced uterine sarcomas (n = 1) received concurrent RCT after tumor surgery (R1/2 resection in 3/7 patients). A total radiation dose of 45 Gy was applied in single doses of 1.8 Gy using an external-beam technique; in addition, three to four intracavitary doses of 5 Gy were applied. Concurrent chemotherapy was generally administered as follows: 1.2 g/m{sup 2} ifosfamide on days 1-5 and 29-33 in combination with 50 or 40 mg/m{sup 2} adriamycin on days 2 and 30. 3/7 patients received further cycles of chemotherapy. The median follow-up was 35 months. Results: all recurrences (before RCT) were localized either in the vagina or in or directly proximal to the vaginal stump. The main side effects of RCT were hemotoxicity (grade 3: n = 3/7; grade 4: n = 4/7; neutropenic fever n = 1/7) and diarrhea (grade 3: n = 5/7). At the median follow-up (35 months), 4/7 patients had recurrences (one local recurrence; one lymph node recurrence outside the irradiated field, two distant metastases). Local control in the irradiated field was 80% {+-} 18% after 3 years. Disease-free survival calculated according to Kaplan-Meier was 57% {+-} 19% after 3 years. Presently, 5/7 patients are still alive, corresponding to a 3-year survival rate of 83% {+-} 15%. Conclusion: concurrent RCT shows good local effectiveness with a good long-term survival. Further evaluation in phase II studies is recommended. (orig.)

  18. Comparison of Dose When Prescribed to Point A and Point H for Brachytherapy in Cervical Cancer

    Gang, Ji Hyeong; Gim, Il Hwan; Hwang, Seon Boong; Kim, Woong; Im, Hyeong Seo; Gang, Jin Mook; Gim, Gi Hwan; Lee, Ah Ram [Dept. of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seou (Korea, Republic of)

    2012-09-15

    The purpose of this study is to compare plans prescribed to point A with these prescribed to point H recommended by ABS (American Brachytherapy Society) in high dose rate intracavitary brachytherapy for cervical carcinoma. This study selected 103 patients who received HDR (High Dose Rate) brachytherapy using tandem and ovoids from March 2010 to January 2012. Point A, bladder point, and rectal point conform with Manchester System. Point H conforms with ABS recommendation. Also Sigmoid colon point, and vagina point were established arbitrarily. We examined distance between point A and point H. The percent dose at point A was calculated when 100% dose was prescribed to point H. Additionally, the percent dose at each reference points when dose is prescribed to point H and point A were calculated. The relative dose at point A was lower when point H was located inferior to point A. The relative doses at bladder, rectal, sigmoid colon, and vagina points were higher when point H was located superior to point A, and lower when point H was located inferior to point A. This study found out that as point H got located much superior to point A, the absorbed dose of surrounding normal organs became higher, and as point H got located much inferior to point A, the absorbed dose of surrounding normal organs became lower. This differences dose not seem to affect the treatment. However, we suggest this new point is worth being considered for the treatment of HDR if dose distribution and absorbed dose at normal organs have large differences between prescribed to point A and H.

  19. Prospective Phase I-II Trial of Helical Tomotherapy With or Without Chemotherapy for Postoperative Cervical Cancer Patients

    Purpose: To investigate, in a prospective trial, the acute and chronic toxicity of patients with cervical cancer treated with surgery and postoperative intensity-modulated radiotherapy (RT) delivered using helical tomotherapy, with or without the administration of concurrent chemotherapy. Patients and Methods: A total of 24 evaluable patients entered the study between March 2006 and August 2009. The indications for postoperative RT were tumor size, lymphovascular space invasion, and the depth of cervical stromal invasion in 15 patients; 9 patients underwent postoperative RT because of surgically positive lymph nodes. All patients underwent pelvic RT delivered with helical tomotherapy and intracavitary high-dose-rate brachytherapy. Treatment consisted of concurrent weekly platinum in 17, sequential carboplatin/Taxol in 1, and RT alone in 6. The patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria, version 3.0. Results: The median follow-up was 24 months (range, 4–49). At the last follow-up visit, 23 patients were alive and disease free. Of the 24 patients, 12 (50%) experienced acute Grade 3 gastrointestinal toxicity (anorexia in 5, diarrhea in 4, and nausea in 3). One patient developed acute Grade 4 genitourinary toxicity (vesicovaginal fistula). For patients treated with concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 71% and 24%, respectively. For patients treated without concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 29% and 14%, respectively. Two long-term toxicities occurred (vesicovaginal fistula at 25 months and small bowel obstruction at 30 months). The overall and progression-free survival rate at 3 years for all patients was 100% and 89%, respectively. Conclusion: The results of our study have shown that postoperative external RT for cervical cancer delivered with helical tomotherapy and high-dose-rate brachytherapy and with or without

  20. Concurrent Chemoradiotherapy With Paclitaxel and Nedaplatin Followed by Consolidation Chemotherapy in Locally Advanced Squamous Cell Carcinoma of the Uterine Cervix: Preliminary Results of a Phase II Study

    Purpose: To evaluate the efficacy and toxicities of concurrent chemoradiotherapy (CCRT) and consolidation chemotherapy in patients with locally advanced squamous cell cervical carcinoma. Methods and Materials: Patients with LASCC (FIGO Stage IIB-IIIB) were treated with pelvic external beam radiotherapy (45 Gy for Stage IIB and 50 Gy for Stage III) and high-dose-rate intracavitary brachytherapy (50 Gy for Stage IIB and 35 Gy for Stage III). The cumulative dose at point A was 50 Gy for Stage IIB and 65 Gy for Stage III. Concurrent chemotherapy with paclitaxel (35 mg/m2) and nedaplatin (20 mg/m2) was given every week for 6 weeks. Consolidation chemotherapy with paclitaxel (135 mg/m2) and nedaplatin (60 mg/m2) was administered every 3 weeks for 4 cycles. Results: All patients completed CCRT, and 28 of 34 patients completed consolidation chemotherapy. The complete response rate was 88% (95% CI, 73-96%). The most common Grade 3 or higher toxicities were leukopenia/neutropenia (10.9% of the cycles). During a median follow up of 23 months (range, 14-30 months), 5 patients had locoregional failure and 1 patient had distant metastasis. The estimated 2-year progression-free survival and overall survival were 82% (95% CI, 68-95%) and 93% (95% CI, 83-100%), respectively. Grade 3 late complications occurred in 3 patients (9%). Conclusions: CCRT with paclitaxel and nedaplatin followed by consolidation chemotherapy is well tolerated and effective in patients with locally advanced squamous cell cervical carcinoma. Further randomized trials of comparing this regimen with the standard treatment are worth while.

  1. Pre-operative Concomitant Radio-chemotherapy in Bulky Carcinoma of the Cervix: A Single Institution Study

    Anne de la Rochefordiere

    2008-01-01

    Full Text Available Objective: To evaluate the treatment results of patients (pts with FIGO stage IB2, IIA, IIB cervical carcinoma (CC treated with pre-operative radio-chemotherapy, followed by extended radical hysterectomy.Methods: Retrospective study of 148 women treated to the Institut Curie for operable FIGO Stage IB2 to IIB, biopsy proved CC. Among them, 70 pts, median age 46 years, were treated using the same regimen associating primary radio-cisplatinum based chemotherapy, intracavitary LDR brachytherapy, followed by extended radical hysterectomy. Kaplan-Meier estimates were used to draw survival curves. Comparisons of survival distribution were assessed by the log-rank test. Results: Complete histological local-regional response was obtained in 56% of the pts (n = 39. Residual macroscopic or microscopic disease in the cervix was observed in 28 pts (40%. All but one had in-situ microscopic residual CC. Lateral residual disease in the parametria was also present in 9 pts, all with residual CC. Pelvic lymph nodes were free from microscopic disease in 56 pts (80%. Eight of 55 (11% radiological N0 patients had microscopic nodal involvement, as compared to 6/15 (40% radiological N1 (p = 0.03. Seventeen pts (25% had residual cervix disease but negative nodes. After median follow-up of 40 months (range, 8–141, 38/70 patients (54.1% are still alive and free of disease, 6 (8.6% alive with disease, and 11 (15.8% patients were lost for follow-up but free of disease.In conclusion: The treatment of locally advanced CC needs a new multidisciplinary diagnostic and treatment approach using new therapeutic arms to improve the survival and treatment tolerance among women presenting this disease.

  2. Inter-application displacement of brachytherapy dose received by the bladder and rectum of the patients with inoperable cervical cancer

    The aim of the study was to examine on the CT basis the inter-application displacement of the positions D0.1cc, D1cc and D2cc of the brachytherapy dose applied to the bladder and rectum of the patients with inoperable cervical cancer. This prospective study included 30 patients with cervical cancer who were treated by concomitant chemo-radiotherapy. HDR intracavitary brachytherapy was made by the applicators type Fletcher tandem and ovoids. For each brachytherapy application the position D0.1cc was determined of the bladder and rectum that receive a brachytherapty dose. Then, based on the X, Y, and Z axis displacement, inter-application mean X, Y, and Z axis displacements were calculated as well as their displacement vectors (R). It has been analyzed whether there is statistically significant difference in inter-application displacement of the position of the brachytherapy dose D0.1cc, D1cc and D2cc of the bladder and rectum. The ANOVA test and post-hoc analysis by Tukey method were used for testing statistical importance of differences among the groups analyzed. The difference among the groups analyzed was considered significant if p < 0.05. There are significant inter-application displacements of the position of the brachytherapy dose D0,1cc, D1cc and D2cc of the bladder and rectum. When we calculate the cumulative brachytherapy dose by summing up D0,1cc, D1cc and D2cc of the organs at risk for all the applications, we must bear in mind their inter-application displacement, and the fact that it is less likely that the worst scenario would indeed happen

  3. Interfractional change of high-risk CTV D90 during image-guided brachytherapy for uterine cervical cancer

    The purpose of this study was to evaluate interfractional changes of the minimum dose delivered to 90% of the high-risk clinical target volume (HR-CTV D90) and D2cc of the bladder and rectum during brachytherapy for uterine cervical cancer patients. A total of 52 patients received external beam radiotherapy and high-dose-rate intracavitary brachytherapy (ICBT). For each of four ICBT applications, a pelvic CT scan was performed and the HR-CTV was delineated. Retrospectively, these patients were divided into two groups: (1) the standard dose group with 6 Gy to point A in each ICBT, and (2) the adaptive dose group with a modified dose to point A to cover the HR-CTV with the 6-Gy isodose line as much as possible. The HR-CTV D90 was assessed in every session, and analyzed as interfractional changes. In the standard dose group, the interfractional changes of the HR-CTV D90 showed a linear increase from the first to the third of the four ICBT (average 6.1, 6.6, 7.0 and 7.1 Gy, respectively). In contrast, those of the adaptive dose group remained almost constant (average 7.2, 7.2, 7.3 and 7.4 Gy, respectively). Especially, in the case of a large HR-CTV volume (≥35 cm3) at first ICBT, the total HR-CTV D90 of the adaptive dose group with brachytherapy was significantly higher than that of the standard dose group. There were no significant differences in total D2cc in bladder and rectum between the two groups. Image-guided adaptive brachytherapy based on interfractional tumor volume change improves the dose to the HR-CTV while keeping rectal and bladder doses within acceptable levels. (author)

  4. The diagnosis of intrahepatic peripheral cholangiocarcinoma by CT and MRI with the correlation of pathological findings

    Objective: To study the imaging features of intrahepatic peripheral cholangiocarcinoma (IHPCC) on the CT, MRI and the correlation of these features with histopathologic findings. Methods: Thirty-two patients (17 males and 15 females) with pathologically proven IHPCC were reviewed retrospectively. CT conventional and dynamic enhancement scans were performed in 29 patients. MR imaging were obtained in five patients, and dynamic contrast-enhanced T1-weighted imaging was performed in 2 cases. Results: 24 lesions (75%) were located in the left lobe and 8 lesions (25%) in the right lobe. According to the pathological types, mass-type was found in 18 cases (56.3%), infiltrative-type in 7 cases (21.9%), and intracavitary-type in 4 cases (12.5%). In three patients the tumors were not definable at any imaging phase. The shape of tumor was circular, lobulated, or irregular, and the margins were clouding. No contrast enhancement (13 cases) or mild or moderate rim-like enhancement (8 cases) were the most frequent enhancement patterns observed in early stage. On the delay scan imaging, the center of the tumors showed mottling, reticular, or homogeneous hyperattenuating contrast enhancement. The tumor was consisted of fibrous tissue, tumor cells, and coagulative necrosis at the findings of histopathologic analysis. The content of these portions varied in different positions of tumors. At the edge of tumors, the main component was living tumor cells which was the pathological basis of early contrast enhancement. The delay contrast enhancement tended to be in the fibrosis, which mainly situated in the tumor center, because the contrast material entered the fibrosis very slowly but stagnated in it for long time. Conclusion: Dynamic contrast enhancement scan was a very important technique for the correct diagnosis of IHPCC. The typical features of IHPCC include the hypodensity of hepatic lesion on precontrast scan, peripheral enhancement in the early stage, and tumor central

  5. Standardization of the calibration of brachytherapy sources at the IAEA dosimetry laboratory

    A new service to SSDLs has been initiated at the IAEA Dosimetry Laboratory for providing calibrations of well-type ionisation chambers, used in brachytherapy applications, which are traceable to the International Measurement System. Considering that the most common radionuclide used in the developing countries is 137Cs, two such sources of the type used for gynaecological intracavitary applications have been purchased by the Agency and calibrated at the National Institute of Standards and Technology (NIST), USA. These 137Cs reference sources together with a well-type ionization chamber constitute the IAEA brachytherapy dosimetry standard. Based on the recommendations by a group of experts, a method has been developed for transferring calibrations to SSDLs which is described in this paper. The method is based on the acquisition by the SSDLs of sources and equipment similar to those at the IAEA. The well-type chamber is to be calibrated at the IAEA Dosimetry Laboratory, and this will be used at the SSDL to calibrate its own reference sources. These sources can in turn by used to calibrate well-type chambers from hospital users and to calibrate other type of sources by performing measurements in air. In order to standardize the procedures for the two methods and to provide guidance to the SSDLs, measurements have been carried out at the IAEA Dosimetry Laboratory. The reproducibility of the two type of measurements has been found to be better than 0.5%, and the uncertainty of calibrations estimated to be less than 1.5% (one standard deviation). (author). 8 refs, 8 figs, 2 tabs

  6. Undetected human papillomavirus DNA and uterine cervical carcinoma. Association with cancer recurrence

    The time course of human papillomavirus (HPV) DNA clearance was studied in patients with carcinoma of the cervix during follow-up after primary radical radiotherapy (RT). This study investigated the relationship between timing of HPV clearance and RT effectiveness. A total of 71 consecutive patients who were treated for cervical cancer with primary radical radiotherapy and high-dose rate intracavitary brachytherapy with or without chemotherapy were enrolled in the study. Samples for HPV DNA examination were taken before (1) treatment, (2) every brachytherapy, and (3) every follow-up examination. The times when HPV DNA was undetected were analyzed for association with recurrence-free survival. HPV DNA was not detected in 13 patients (18 %) before RT. Of the 58 patients with HPV DNA detected before treatment, HPV DNA was not detected in 34 % during treatment and in 66 % after the treatment. Within 6 months after RT, HPV DNA was detected in 0 % of all patients. The patients were followed up for a median period of 43 months (range 7-70 months). In all, 20 patients were found to develop recurrence. The 3-year cumulative disease-free survival (DFS) rate was 71 ± 5.4 % for all 71 patients. In multivariate analysis, DFS was significantly associated with HPV (detected vs. not detected) with a hazard ratio of 0.07 (95 % confidence interval 0.008-0.6, p = 0.009). In this study, patients in whom HPV was not detected had the worst prognosis. Six months after RT, HPV DNA was detected in 0 % of the patients. Patients in whom HPV DNA could not be detected before treatment need careful follow-up for recurrence and may be considered for additional, or alternative treatment. (orig.)

  7. Imaging features of cardiac myxoma

    Objective: To study the imaging features of cardiac myxoma and their diagnostic values. Methods: Twenty-two patrents with cardiac myxoma were reviewed retrospectively for the clinical, pathologic, and radiologic findings. Posteroanterior and lateral chest radiographs, American Imatron C-150 XP Electron Beam CT examination, and Germany Siemens 1.5T Magnetom Vision MR scan were performed on every patient. Results: (1) Radiographs of 17 patients with left atrial myxoma showed evidence of mitral valve obstruction in 14(82.3%), radiographs of 5 patients with right atrial myxoma demonstrated right atrium enlargement in 3(60%) respectively. (2) CT scans of 22 myxomas demonstrated 18 (81.8%) lesions were hypoattenuated and 4 (19.1%) were isoattenuated relative to the myocardium. Calcification or ossification was seen in 3 patients. All myxomas apart from massive one were found attaching to the atrial septum. Movie mode could dis- play the movement of myxoma across the atrioventicular valves. (3) MRI studies of 22 myxomas showed 19 (86.3%) heterogeneous signal intensity and 3 (13.7%) homogeneous. They exhibited slight high or homogeneous signal intensity with both T1- and T2-weighted sequences, and low signal intensity with cine gradient recalled echo sequences. Point of attachment was visible in 21 (95.4%) cases. Conclusion: The typical radiograph sign of cardiac myxomas is mitral valve obstruction, CT and MR can demonstrate intracavitary lobular masses attacthing to artrial spetum. The latter two kinds of examinations not only provide accurate assessment of the size, location, and attachment point of these lesions, but also have important qualitative diagnostic advantage. (authors)

  8. Harvesting backscatter electrons for radiation therapy

    Purpose: An innovative technique is used to harvest backscatter electrons for the treatment of superficial small lesions of skin, oral cavity, and rectum where a significant dose gradient and maximum surface dose is desired. Methods and Materials: Backscatter electrons are harvested out of the primary electron beams from the linear accelerators. The design consists of a short cylindrical cone that fits snugly over a long cylindrical electron cone. The short cylindrical cone has a thick circular plate of high atomic number medium (Pb) attached to the distal end, and a lateral slit of variable length and width. The width of the slit could be closed as desired by rotating the two cones and the length can be increased by lowering the short cylindrical cone. Primary electrons strike the Pb plate perpendicularly and produce backscatter electrons that pass through the lateral slit for treatment. Using film and a parallel plate ion chamber, backscattered electron dose characteristics are studied. Results: The depth dose characteristic of the backscatter electron is very similar to that of the 0.2 mm Al half-value layer x-ray beam that is commonly used for the intracavitary and superficial lesions. The backscatter electron energy is nearly constant and effectively ≤ 1 MeV from the clinical megavoltage beams. The backscatter electron dose rate of 0.32-0.8 Gy/min could be achieved from modern accelerators without any modification. The beam flatness is dependent on the slit size and the depth of treatment, but is satisfactory to treat small lesions. Conclusions: The measured data for backscatter electron energy, fluence, depth dose, flatness, dose rate, and absolute dose indicates that the harvested backscattered electrons are suitable for clinical use

  9. Modern operative hysteroscopy.

    Centini, Gabriele; Troia, Libera; Lazzeri, Lucia; Petraglia, Felice; Luisi, Stefano

    2016-04-01

    Hysteroscopy is an endoscopic surgical procedure that has become an important tool to evaluate intrauterine pathology. It offers a direct visualization of the entire uterine cavity and provides the possibility of performing biopsy of suspected lesions that can be missed by dilatation and curettage (D&C). In most cases, the intrauterine pathologies can be diagnosed and treated at the same setting as office hysteroscopy ("see and treat approach"). For example, endometrial polyps can be diagnosed and removed; similarly, intrauterine adhesions can be liberated in the outpatient setting without the need for an operating theatre. Today, many hysteroscopic procedures can be performed in the office or outpatient setting. This is due to the feasibility of operative hysteroscopy using saline as a distending medium, the vaginoscopic approach of hysteroscopy and the availability of mini-hysteroscopic endoscopes. There is good evidence to suggest that hysteroscopy in an ambulatory setting is preferable for the patient, and that it avoids complications, allows a quicker recovery time and lowers cost. Advances in technology have led to miniaturization of high-definition hysteroscopes without compromising optical performance, thereby making hysteroscopy a simple, safe and well-tolerated office procedure. The new surgical technology such as bipolar electrosurgery, endometrial ablation devices, hysteroscopic sterilization, and morcellators has revolutionized this surgical modality. The modern development of hysteroscopy completely transformed the approach to the uterine intracavitary pathologies moving from a blind procedure under general anesthesia to an outpatient procedure performed under direct visualization, offering therapeutic and irreplaceable possibilities of treatment that should belong to every modern gynecologist. PMID:26930389

  10. Computer calculation of dose distributions in radiotherapy. Report of a panel

    As in most areas of scientific endeavour, the advent of electronic computers has made a significant impact on the investigation of the physical aspects of radiotherapy. Since the first paper on the subject was published in 1955 the literature has rapidly expanded to include the application of computer techniques to problems of external beam, and intracavitary and interstitial dosimetry. By removing the tedium of lengthy repetitive calculations, the availability of automatic computers has encouraged physicists and radiotherapists to take a fresh look at many fundamental physical problems of radiotherapy. The most important result of the automation of dosage calculations is not simply an increase in the quantity of data but an improvement in the quality of data available as a treatment guide for the therapist. In October 1965 the International Atomic Energy Agency convened a panel in Vienna on the 'Use of Computers for Calculation of Dose Distributions in Radiotherapy' to assess the current status of work, provide guidelines for future research, explore the possibility of international cooperation and make recommendations to the Agency. The panel meeting was attended by 15 participants from seven countries, one observer, and two representatives of the World Health Organization. Participants contributed 20 working papers which served as the bases of discussion. By the nature of the work, computer techniques have been developed by a few advanced centres with access to large computer installations. However, several computer methods are now becoming 'routine' and can be used by institutions without facilities for research. It is hoped that the report of the Panel will provide a comprehensive view of the automatic computation of radiotherapeutic dose distributions and serve as a means of communication between present and potential users of computers

  11. Implementation of microsource high dose rate (mHDR) brachytherapy in developing countries

    Brachytherapy using remote afterloading of a single high dose rate 192Ir microsource was developed in the 1970s. After its introduction to clinics, this system has spread rapidly among developed Member States and has become a highly desirable modality in cancer treatment. This technique is now gradually being introduced to the developing Member States. The 192Ir sources are produced with a high specific activity. This results in a high dose rate (HDR) to the tumour and shorter treatment times. The high specific activity simultaneously results in a much smaller source (so-called micro source, around I mm in diameter) which may be easily inserted into tissue through a thin delivery tube, the so-called interstitial treatment, as well as easily inserted into body cavities, the so-called intracavitary or endoluminal treatment. Another advantage is the ability to change dwell time (the time a source remains in one position) of the stepping source which allows dose distribution to match the target volume more closely. The purpose of this TECDOC is to advise radiation oncologists, medical physicists and hospital administrators in hospitals which are planning to introduce 192Ir microsource HDR (mHDR) remote afterloading systems. The document supplements IAEA-TECDOC-1040, Design and Implementation of a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects, and will facilitate implementation of this new brachytherapy technology, especially in developing countries. The operation of the system, 'how to use the system', is not within the scope of this document. This TECDOC is based on the recommendations of an Advisory Group meeting held in Vienna in April 1999

  12. Long-Term Survival and Risk of Second Cancers After Radiotherapy for Cervical Cancer

    Purpose: To evaluate the risk of second cancers after cervical cancer treated with radiotherapy for Asian populations. Methods and Materials: We reviewed 2,167 patients with cervical cancer undergoing radiotherapy between 1961 and 1986. Intracavitary brachytherapy was performed with high-dose rate source (82%) or low-dose rate source (12%). Relative risk (RR), absolute excess risk (AR), and cumulative risk of second cancer were calculated using the Japanese disease expectancy table. For 1,031 patients, the impact of smoking habit on the increasing risk of second cancer was also evaluated. Results: The total number of person-years of follow-up was 25,771, with 60 patients being lost to follow-up. Among the 2,167 patients, 1,063 (49%) survived more than 10 years. Second cancers were observed in 210 patients, representing a significant 1.2-fold risk (95% confidence interval [CI], 1.1-1.4) of developing second cancer compared with the general population, 1.6% excess risk per person per decade of follow-up, and elevating cumulative risk up to 23.8% (95% CI, 20.3-27.3) at 30 years after radiotherapy. The RR of second cancer was 1.6-fold for patients with the smoking habit and 1.4-fold for those without. Conclusions: Small but significant increased risk of second cancer was observed among Japanese women with cervical cancer mainly treated with high-dose rate brachytherapy. Considering the fact that about half of the patients survived more than 10 years, the benefit of radiotherapy outweighs the risk of developing second cancer

  13. Oxygen enhancement ratio (OER) and therapeutic gain factor (GF) for californium-252 at low dose rate

    The potential benefit of the introduction of californium-252 in interstitial and intracavitary therapy is related to the greater efficiency of its neutron emission against anoxic cancer cells. In that respect, the oxygen enhancement ratio (OER) of the 252Cf emission has been determined for a continuous low dose rate irradiation. The biological system is growth inhibition in Vicia faba bean roots. A new Vicia faba ''BelB'' strain has been used, which better tolerates long periods (up to about 10 hours) of anoxia. In a first series of experiments, for a 252Cf (Dsub(n+γ)) dose rate of 0.11 Gy.h-1, an OER of 1.4+-0.1 was observed (the γ contribution Dγ to the total absorbed dose Dsub(n+γ) was 0.35 at the position of the root tips). In a second series of experiments, in somewhat different geometrical conditions with a 252Cf (Dsub(n+γ)) dose rate of 0.13 Gy.h-1, an OER of 1.5+-0.1 was observed (Dγ/Dsub(n+γ)=0.42). The OER values observed for similar irradiation times, with iridium-192 γ-rays, were 2.3+-0.2 and 2.6+-0.1 respectively, which leads to therapeutic gain factors (GF) of 1.6 and 1.7 respectively. These GF values are slightly lower than those previously obtained (GF=1.8) on the same system, with d(50)-Be p(75)-Be and 15 MeV neutron beams

  14. Absorbed dose simulations in near-surface regions using high dose rate Iridium-192 sources applied for brachytherapy

    Brachytherapy treatment with Iridium-192 high dose rate (HDR) sources is widely used for various tumours and it could be developed in many anatomic regions. Iridium-192 sources are inserted inside or close to the region that will be treated. Usually, the treatment is performed in prostate, gynaecological, lung, breast and oral cavity regions for a better clinical dose coverage compared with other techniques, such as, high energy photons and Cobalt-60 machines. This work will evaluate absorbed dose distributions in near-surface regions around Ir-192 HDR sources. Near-surface dose measurements are a complex task, due to the contribution of beta particles in the near-surface regions. These dose distributions should be useful for non-tumour treatments, such as keloids, and other non-intracavitary technique. For the absorbed dose distribution simulations the Monte Carlo code PENELOPE with the general code penEasy was used. Ir-192 source geometry and a Polymethylmethacrylate (PMMA) tube, for beta particles shield were modelled to yield the percentage depth dose (PDD) on a cubic water phantom. Absorbed dose simulations were realized at the central axis to yield the Ir-192 dose fall-off along central axis. The results showed that more than 99.2% of the absorbed doses (relative to the surface) are deposited in 5 cm depth but with slower rate at higher distances. Near-surface treatments with Ir-192 HDR sources yields achievable measurements and with proper clinical technique and accessories should apply as an alternative for treatment of lesions where only beta sources were used. - Highlights: ► A PMMA (polymethylmethacrylate) tube was used to surround the HDR Ir-192 to shield the beta particles. ► 99.2% of the absorbed doses (relative to the surface) are deposited in 5 cm depth. ► Near-surface treatments with Ir-192 HDR sources yields achievable measurements

  15. Monte Carlo Investigation on the Effect of Heterogeneities on Strut Adjusted Volume Implant (SAVI) Dosimetry

    Koontz, Craig

    Breast cancer is the most prevalent cancer for women with more than 225,000 new cases diagnosed in the United States in 2012 (ACS, 2012). With the high prevalence, comes an increased emphasis on researching new techniques to treat this disease. Accelerated partial breast irradiation (APBI) has been used as an alternative to whole breast irradiation (WBI) in order to treat occult disease after lumpectomy. Similar recurrence rates have been found using ABPI after lumpectomy as with mastectomy alone, but with the added benefit of improved cosmetic and psychological results. Intracavitary brachytherapy devices have been used to deliver the APBI prescription. However, inability to produce asymmetric dose distributions in order to avoid overdosing skin and chest wall has been an issue with these devices. Multi-lumen devices were introduced to overcome this problem. Of these, the Strut-Adjusted Volume Implant (SAVI) has demonstrated the greatest ability to produce an asymmetric dose distribution, which would have greater ability to avoid skin and chest wall dose, and thus allow more women to receive this type of treatment. However, SAVI treatments come with inherent heterogeneities including variable backscatter due to the proximity to the tissue-air and tissue-lung interfaces and variable contents within the cavity created by the SAVI. The dose calculation protocol based on TG-43 does not account for heterogeneities and thus will not produce accurate dosimetry; however Acuros, a model-based dose calculation algorithm manufactured by Varian Medical Systems, claims to accurately account for heterogeneities. Monte Carlo simulation can calculate the dosimetry with high accuracy. In this thesis, a model of the SAVI will be created for Monte Carlo, specifically using MCNP code, in order to explore the affects of heterogeneities on the dose distribution. This data will be compared to TG-43 and Acuros calculated dosimetry to explore their accuracy.

  16. Impact of concurrent chemotherapy on definitive radiotherapy for women with FIGO IIIb cervical cancer

    The purpose of this retrospective study is to investigate the impact of concurrent chemotherapy on definitive radiotherapy for the International Federation of Gynecology and Obstetrics (FIGO) IIIb cervical cancer. Between 2000 and 2009, 131 women with FIGO IIIb cervical cancer were treated by definitive radiotherapy (id est (i.e.) whole pelvic external beam radiotherapy for 40-60 Gy in 20-30 fractions with or without center shielding and concomitant high-dose rate intracavitary brachytherapy with 192-iridium remote after loading system for 6 Gy to point A of the Manchester method). The concurrent chemotherapy regimen was cisplatin (40 mg/m2/week). After a median follow-up period of 44.0 months (range 4.2-114.9 months) and 62.1 months for live patients, the five-year overall survival (OS), loco-regional control (LRC) and distant metastasis-free survival (DMFS) rates were 52.4, 80.1 and 59.9%, respectively. Univariate and multivariate analyses revealed that lack of concurrent chemotherapy was the most significant factor leading to poor prognosis for OS (HR=2.53; 95% CI 1.44-4.47; P=0.001) and DMFS (HR=2.53; 95% CI 1.39-4.61; P=0.002), but not for LRC (HR=1.57; 95% CI 0.64-3.88; P=0.322). The cumulative incidence rates of late rectal complications after definitive radiotherapy were not significantly different with or without concurrent chemotherapy (any grade at five years 23.9 vs 21.7%; P=0.669). In conclusion, concurrent chemotherapy is valuable in definitive radiotherapy for Japanese women with FIGO IIIb cervical cancer. (author)

  17. Accelerated Hyperfractionated Radiotherapy for Cervical Cancer: Multi-Institutional Prospective Study of Forum for Nuclear Cooperation in Asia Among Eight Asian Countries

    Purpose: To evaluate the toxicity and efficacy of accelerated hyperfractionated radiotherapy (RT) for locally advanced cervical cancer. Methods and Materials: A multi-institutional prospective single-arm study was conducted among eight Asian countries. Between 1999 and 2002, 120 patients (64 with Stage IIB and 56 with Stage IIIB) with squamous cell carcinoma of the cervix were treated with accelerated hyperfractionated RT. External beam RT consisted of 30 Gy to the whole pelvis, 1.5 Gy/fraction twice daily, followed by 20 Gy of pelvic RT with central shielding at a dose of 2-Gy fractions daily. A small bowel displacement device was used with the patient in the prone position. In addition to central shielding RT, intracavitary brachytherapy was started. Acute and late morbidities were graded according to the Radiation Therapy Oncology Group and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Results: The median overall treatment time was 35 days. The median follow-up time for surviving patients was 4.7 years. The 5-year pelvic control and overall survival rate for all patients was 84% and 70%, respectively. The 5-year pelvic control and overall survival rate was 78% and 69% for tumors ≥6 cm in diameter, respectively. No treatment-related death occurred. Grade 3-4 late toxicities of the small intestine, large intestine, and bladder were observed in 1, 1, and 2 patients, respectively. The 5-year actuarial rate of Grade 3-4 late toxicity at any site was 5%. Conclusion: The results of our study have shown that accelerated hyperfractionated RT achieved sufficient pelvic control and survival without increasing severe toxicity. This treatment could be feasible in those Asian countries where chemoradiotherapy is not available

  18. Tailored radiotherapeutic strategies for disseminated uterine cervical cancer patients

    To investigate the role of radiotherapy (RT) in and to suggest radiotherapeutic strategies for patients presenting with disseminated cervical cancer. We retrospectively analyzed 50 patients diagnosed as the disseminated cervical cancer with distant lymph nodal or visceral organ metastasis between September 1980 and August 2012. Patients were divided into two subgroups according to visceral organ metastasis: 35 patients diagnosed with distant lymph node metastasis only (group A) and 15 patients with visceral organ metastasis (group B). All patients received external beam RT to the pelvis (median dose 45 Gy) and high-dose rate intracavitary RT (median dose 30 Gy). Thirty-nine patients (78%) received chemotherapy. Median follow-up time was 74 months. The 5-year pelvic control rate (PCR) was 85.8%, and the progression-free survival (PFS), and overall survival (OS) rates were 28.7%, and 36.2%, respectively. The major treatment failure was systemic progression (32 patients, 64%). The 5-year PCRs in groups A and B were 87.4% and 74.7%, respectively (p > 0.05). Meanwhile, PFS and OS rates for group A were significantly better than those for group B (35.3% vs. 13.3%, p = 0.010; and 46.3% vs. 13.3%, p = 0.009, respectively). Our data revealed considerable prognostic heterogeneity in disseminated cervical cancer. Even though a high PCR was achieved in patients treated with definitive RT, survival outcomes were dependent on progression of visceral organ metastasis. Therefore, personalized RT and chemotherapy treatment strategies according to the presence of visceral organ metastasis in disseminated cervical cancer patients may help improve clinical outcomes

  19. An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies

    Purpose: To evaluate the acute morbidity and mortality for high dose-rate (HDR) brachytherapy performed in an outpatient setting in the treatment of gynecological malignancies, and to identify possible risk factors for adverse outcomes. Materials and Methods: One hundred seventy-one patients with cervical (n=129) or uterine (n=42) carcinoma with an intact uterus were evaluated and treated from August 1989 through December 1994, with at least part of their therapy delivered with intracavitary HDR 192Ir radiation. A total of 830 ICR insertions were performed with greater than 95% done on an outpatient basis under heavy intravenous sedation using fentanyl and midazolam. Perioperative morbidity and mortality were recorded for any event occurring within 30 days of the completion of therapy. Anesthesia risk was evaluated retrospectively in all patients based on the American Society of Anesthesiologists' (ASA) Physical Class System. Results: The uterine patients, many treated with radiation alone because of morbid obesity or medical inoperability, had a significantly higher perioperative morbidity and mortality rate as compared to the cervix patient cohort. Thirteen of the 42 (31%) uterine patients and 8 of the 129 (6%) cervix patients required hospitalization within 30 days of treatment completion (p2) experienced greater morbidity and mortality, while the best predictor of complications in the cervix patients was age greater than 70 years. For the entire cohort of patients, no correlation was found between the 30 day morbidity and mortality and the doses of fentanyl and midazolam used or the length of the procedure. Conclusions: The acute complication rate from HDR brachytherapy performed on an outpatient basis with heavy intravenous sedation is acceptable for the great majority of patients who present for treatment. However, the high morbidity and mortality experienced by certain patient cohorts suggests that careful assessment of the risk/benefit ratio for treatment

  20. Cervical necrosis after chemoradiation for cervical cancer: case series and literature review

    The aim of this study was to assess the management of cervical necrosis (CN) following radiotherapy (RT) and the impact of smoking status. This rare complication mimics a neoplastic recurrence, and causes concern among attending physicians. Between July 2008 and March 2013, 5 women on 285 with localized cervical cancer had a CN following RT. Patients were treated with concomitant chemoradiation. The medical records were reviewed to abstract demographic and clinical information until March 2013. 1.75% (95% confidence interval: 0.23 to 3.28%) developed CN. All patients were smokers with a mean of 19.5 pack-years (range: 7.5-45 pack-years). All patients were treated with weekly Cisplatin chemotherapy and external beam radiation to the pelvis, 45 Gy in 25 fractions. Four patients received an extra boost with a median dose of 7.2 Gy (range: 5.4-10 Gy). All patients had intracavitary brachytherapy (range: 27.9 to 30 Gy). Clinical presentation was similar for all the cases: vaginal discharge associated with pain. Mean time for time post-radiation therapy to necrosis was 9.3 months (range: 2.2-20.5 months). Standard workup was done to exclude cancer recurrence: biopsies and radiologic imaging. Conservative treatment was performed with excellent results. Resolution of the necrosis was complete after a few months (range: 1 to 4 months). Median follow-up until March 2013 was 19 months. All the patients were alive with no clinical evidence of disease. This study, the largest to date, shows that conservative management of CN after RT is effective, and should be attempted. This complication is more common in smokers, and counseling intervention should result in fewer complications of CN

  1. Specification of absorbed dose for reporting a therapeutic irradiation

    The problem of dose specification in external beam therapy with photons and electrons has been dealt with in ICRU Report 29 (1978). This problem arises from the fact that the absorbed dose distribution is usually not uniform in the target volume and that for the purpose of treatment reporting a nominal absorbed dose - which will be called target absorbed dose - has to be selected. When comparing the clinical results obtained between radiotherapy centres, the differences in the reported target absorbed doses which can be introduced by differences in the methods of dose specification often are much larger than the differences related to the dosimetric procedures themselves. This shows the importance of the problem. In this paper, some definitions of terms and concepts currently used in radiotherapy are first recalled: tumour volume, target volume, treatment volume, etc. These definitions have been proposed in ICRU Report 29 for photon and electron beams; they can be extended to any kind of irradiation. For external beam therapy with photons and electrons, the target absorbed dose is defined as the absorbed dose at selected point(s) (specification point(s)) having a meaningful relation to the target volume and/or the irradiation beams. Examples are discussed for typical cases. As far as interstitial and intracavitary therapy is concerned, the problem is more complex and no recommendations have so far been made by the ICRU Commission. A major difficulty arises from the sharp dose gradient as a function of the distance to the sources. The particular case of the treatment of cervix carcinoma is considered and some possible methods of specification are discussed: (1) the indication of the sources (in adequate units) and the duration of the application, (2) the absorbed doses at selected reference points (bladder, rectum, bony structures) and (3) the description of the tissue volume (height, width, thickness) encompassed by a given isodose surface (60Gy). (author)

  2. Radiotherapy for stage III cervical cancer with high-dose rate brachytherapy

    This is a retrospective analysis of patients with histologically proven stage III cervical cancer with a minimum follow-up of 1.5 years at Keio University hospital between May 1973 and March 1991. Three hundred and sixty-six patients with stage III cervical cancer were classified into three groups according to the tumor size, those were, small (102 patients), medium (145 patients) and large (119 patients). All patients were treated with external irradiation (50 Gy) and high-dose rate intracavitary brachytherapy (20-34 Gy). The 5 year survival rate of all stage III patients was 47%. However, the survival gradient of small>medium>large was demonstrated and the differences between survival rates in each tumor size was significant. At follow-up visits conducted between 1 and 2 months after completion of radiation, 97 patients had physical findings of persistent disease. The larger the tumor size, the more likely was persistent disease by 2 months. The proportion of recurrent or regrowing tumors increased from small< medium< large. The difference between recurrent rates in patients with persistent tumor and without that was significant. There was no correlation between the incidence of metastasis in each tumor size and persistent disease. In patients with small or medium size tumors, there was no significant correlation between dose to these patients and pelvic tumor control. In large tumor, doses less than 24 Gy to point A resulted in higher pelvic failure and lower survival rate in contrast to doses of over 27 Gy. It was concluded that larger tumor or tumor that does not regress promptly is likely to recur. Such poor-prognosis patients should be targeted for early adjuvant or salvage therapy. (author)

  3. Concurrent pelvic radiation with weekly low-dose cisplatin and gemcitabine as primary treatment of locally advanced cervical cancer: A phase II study

    Hend EL-Hadaad

    2015-09-01

    Full Text Available Purpose: This study was done to evaluate response, compliance and survival of weekly low dose cisplatin (20 mg/m2 and gemcitabine (125 mg/m2 concurrently with pelvic radiation as primary treatment of stage IIB-IIIB cervical cancer.Methods: External radiation consisted of 50 Gy/25 fractions using 6-10 MV photon followed by 600 cGy boost to parametrium if it was still felt thickened. Then, intracavitary radiotherapy to deliver 60 Gy at point A. Chemotherapy consisted of gemcitabine at a dose of 125 mg/ m2 was given by i.v infusion over 30 minutes immediately after cisplatin 20 mg/ m2 weekly for 5 weeks during EBRT. Forty–five eligible patients received the treatment protocol. Results: Toxicity was tolerable and manageable. No grade 4 toxicity while grade 3 was recorded in hematologic one only. In order of frequency; diarrhea, nausea and vomiting, and anemia (50%, 40%, 35.5% were most common adverse events. Overall clinical response rate was 93.4% with pathological complete response of 62.2%. After median follow-up of 20 months, 2-year survival and progression-free survival rates were 90.5% and 81% respectively. Conclusion: Weekly combination of low- dose cisplatin and gemcitabine given concurrently with pelvic radiotherapy in primary treatment of locally advanced cervical cancer resulted in a high response rate with a good compliance. Further exploration is needed for the use of this approach prior to incorporating it into routine clinical care through phase III clinical trial.

  4. Radiotherapy results of uterine cervix cancer stape IIB : overall survival, prognostic facters, patterns of failure and late complications

    Treatment of choice for uterine cervix cancer stage IIB is radiotherapy. We analyzed survivals, prognostic factors, patterns of failure and complications. This is a retrospective analysis of 167 patients with stage IIB carcinoma of uterine cervix treated with curative external pelvic and high dose rate intracavitary radiotherapy at the Department of Therapeutic Radiology, Soonchunhyang University Hospital from August 1985 to August 1994. All the patients followed up from 3 to 141 months(mean 60 months) and age of patients ranged from 31 to 78 years at presentation(mean : 55 years). Overall complete response rate was 84%. The response rate for squamous cell carcimoma and adenocarcinoma were 86% and 60%, respectively. Overall 5-years survival rate and disease free survival rate was 62 and 59%, respectively. Mass size and treatment response were significant prognostic factors for survival. Pathologic type and parametrial involvement were marginally significants prognostic factors. Local failure was 43 cases, distant metastasis was 14 cases and local failure plus distant metastasis was 3 cases, and most of local failures occurred within 24 months, distant metastasis within 12 months after treatment. Twenty eight(16.8%) patients developed late rectal and urinary complications There were tendency to increasing severity and frequency according to increased fractional dose and total(rectal and bladder) dose. Survival rate was significantly related to tumor size and radiotherapy response. Tumor size should be considered in the clinical staging. To increased survival and local control, clinical trials such as decreasing duration of radiotherapy or addition of chemotherapy is needed. To detect early recurrence, regular follow up after RT is important. Because total rectal and bladder dose affected late complications, meticulous vaginal packing is needed to optimize dose of normal tissues and to decrease late complications

  5. Expedience of conventional radiotherapy in locally advanced cervix cancer: A retrospective analysis

    Prakash Bhagat

    2015-02-01

    Full Text Available Objective: Analysis was done to assess the implications of total radiation treatment duration towards locally advanced cervical cancer. Methods: A comparative study was conducted in CNCI, Kolkata. A total of 38 patients were studied with interdigited brachyttherapy during the course of conventional teleradiotherapy and they were compared to a total of 39 patients with conventional sequential teletherapy and brachytherapy. Results: In the experimental arm all the patients had complete response to treatment whereas, 24 patients (85.7% in the conventional arm had complete response [ P = 0.08]. At the last follow up 28 patients (73.68% in the study arm and 17 patients (43.58% in the control arm were free of disease. The failure rate in the conventional control arm was significantly higher [ P = 0.035]. Test of proportion derived from data also showed that the proportion of patients with no evidence of disease at the time of last follow-up was significantly higher in the study arm compared to the control arm [ P < 0.05] and the proportion of patients with persistent disease was significantly less in the stuwdy arm compared to the control arm [ P < 0.05]. The probability of disease-free survival in percentage according to the curve at the time of median follow-up was approximately 70% for study arm and 60% for control arm [log-rank test, P = 0.2463]. Conclusion: we should hence minimize treatment time and avoid any planned or unplanned interruptions or delays by timely integration of external beam and intra-cavitary irradiation that may yield a better local control in locally advanced cervical cancer

  6. Endocavitary Ultrasound Applicator for Hyperthermia Treatment of Cervical Cancer

    Wootton, Jeffery; Chen, Xin; Juang, Titania; Rieke, Viola; Hsu, I.-Chow Joe; Diederich, Chris

    2009-04-01

    An endocavitary ultrasound applicator has been developed for targeted heat delivery to the cervix. The device has multiple sectored tubular transducers for truly 3-D heating control (angular and along the length) and is integrated with an intracavitary HDR brachytherapy applicator for sequential administration of conformal heat and radiation. Brachytherapy treatment planning data are inspected to determine target thermal treatment volumes. Heat treatments are simulated with an acoustic and biothermal model of cervical tissue. Power control to individual elements and sectors is implemented for global maximum and pilot point control to limit rectum and bladder temperature. A parametric analysis of device parameters, tissue properties, and catheter materials is conducted to assess their effects on heating patterns and inform device development. Acoustic output of all devices was characterized. MR thermal imaging is used to analyze 3-D conformal heating capabilities in ex vivo tissue and compare to theoretical predictions. Devices were fabricated with 1-3 transducers at 6.5-8 MHz with sectors from 90-180° and heating length from 15-35 mm housed within a 6 mm diameter water-cooled PET catheter. Directional heating from sectored transducers can extend lateral penetration of therapeutic heating (41° C)>2 cm while maintaining rectum and bladder temperatures within 12 mm below thermal damage thresholds. MR artifacts extended <2 mm beyond the device and real time thermal imaging was used to guide power selection to shape heating profiles in axial and coronal slices. Endocavitary delivery of ultrasound thermal therapy is feasible and 3-D conformal capabilities will benefit targeted cervical hyperthermia.

  7. Metabolic Response on Post-therapy FDG-PET Predicts Patterns of Failure After Radiotherapy for Cervical Cancer

    Schwarz, Julie K., E-mail: jschwarz@radonc.wustl.edu [Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Siegel, Barry A.; Dehdashti, Farrokh [Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Grigsby, Perry W. [Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)

    2012-05-01

    Purpose: To determine the patterns of failure in patients with cervical cancer treated with definitive radiotherapy and evaluated for metabolic response with early posttherapy {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG-PET). Methods and Materials: The records of 238 patients with cervical cancer were reviewed. All patients were treated with a combination of external radiotherapy and intracavitary brachytherapy. Two hundred and nineteen patients (92%) received concurrent chemotherapy. All patients underwent pretreatment FDG-PET, and posttherapy FDG-PET was performed within 8-16 weeks of the completion of radiotherapy. Posttherapy FDG-PET results were categorized as complete metabolic response (CMR), partial metabolic response (PMR), and progressive disease (PD). Failure patterns were categorized as none, isolated local failure (central pelvis {+-} pelvic lymph nodes), distant failure, or combined local plus distant failure. Results: Of the 91 patients (38%) who had a recurrence, 22 had isolated local failures, and 69 had distant failures (49 distant failures and 20 combined local plus distant failures). Of the 173 patients with a CMR, 40 (23%) experienced treatment failure. All 25 patients with PD experienced treatment failure, which was distant in 24 patients (96%). Among the 40 patients with PMR, no failure has been observed for 14 patients (35%). Of the 26 failures within the PMR group, 15 (58%) were limited to the pelvis. Differences in the patterns of failure between the three groups (CMR, PMR, PD) were statistically significant (chi-square test; p < 0.0001). Conclusions: The majority of failures after definitive radiotherapy for cervical cancer include distant failures, even in the setting of concurrent chemotherapy. PMR within the cervix or lymph nodes is more commonly associated with isolated local recurrence.

  8. Radical radiotherapy treatment (EBRT + HDR-ICRT of carcinoma of the uterine cervix: Outcome in patients treated at a rural center in India

    Jain Vandana

    2007-01-01

    Full Text Available Aim: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT and high-dose-rate (HDR intracavitary radiotherapy (ICRT. Materials and Methods: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival. Results: There were 7 (3.27%, 88 (41.1%, 101 (47.1%, and 18 (8.4% patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months. The overall treatment time (OTT ranged from 52 to 73 days (median 61 days. The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97% cases with local residual disease, 35 (16.3% developed local recurrence/distant metastases, 17 (7.9% developed distant metastases, and 9 (4.2% had local recurrence as well. Discussion and Conclusion: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis.

  9. Animal experiments and clinical trials of {sup 166}Ho-chitosan for various cancers

    Lim, Sang Moo; Choi, C. W.; Kim, E. H.; Woo, K. S.; Chung, W. S.; Lee, J. I.; Park, S. Y.; Son, Y. S.; Lee, S. H.; Kim, S. J.; Kim, B. G.; Kim, J. H.; Lee, C. H. [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1997-07-01

    {sup 166}Ho is a good therapeutic radionuclide because of its suitable half-life (26.8 hours), high beta energy and 6% gamma ray for imaging. Chitosan is a kind of N-glucosamine with 400 to 500 kD MW, which chelates metal ions and degrades slowly in vivo. As a preclinical studies, we performed cytotoxic effect of {sup 166}Ho-chitosan in a variety of cancer cell lines derived from stomach or ovarian cancer based on MTT assay and HTCA method. To evaluated the absorbed dose to the cavitary wall from {sup 166}Ho-chitosan, intraperitoneal administration of {sup 166}Ho-chitosan in the rat and simulation of energy transfer from the beta particles to the cavity wall using the Monte Carlo code EGS4 was done, and used as a standard for the planning therapy. Intracavitary {sup 166}Ho-chitosan therapy were tried in peritoneal metastatic ovarian and stomach cancers and cystic brain tumors. Intraarterial injection in inoperable primary liver cancer was also tried. As a radiation synovectomy agent, biocompatibility study in the knee joints of rabbits were performed. {sup 166}Ho-chitosan showed synergistic effects with 5-FU or cisplatin in vitro. 97-99% of {sup 166}Ho-chitosan was localized within the peritoneal cavity, and more than 90% of {sup 166}Ho-chitosan was attached to the peritoneal wall. Partial response were observed in 4 among 5 patients with ovarian cancer without severe toxicity. In the cystic brain tumor, 5 of 8 cysts were shrunken in size with thinning of the wall, 2 out of 8 showed growth retardation. In the primary liver cancer, radioactivity was distributed in the teritory of selected hepatic arterial branch, and partial responses were observed in 2 cases. In the knee joints of the rabbits, more than 98% of {sup 166}Ho-chitosan remained in the joint cavity and was stable upto 1 week. 49 refs., 22 tabs. (author)

  10. Role of transvaginal sonography and hysteroscopy in abnormal uterine bleeding: does the diagnostic yield increase by combining transvaginal sonography, hysteroscopy and biopsy?

    Nivedita Krishnamoorthy

    2014-08-01

    Methods: This was a descriptive cross sectional study between January 2013 to June2014 in Sri Manakula Vinayagar medical college and hospital. After obtaining ethics committee approval, 100 consecutive patients with abnormal uterine bleeding between the age group of 35 and 55 years, who consented to participate in the study, were subjected to transvaginal sonography followed by diagnostic hysteroscopy combined with a directed biopsy. TVS and hysteroscopy was performed by two different investigators. The endometrial curettings and any intracavitary lesion were subjected to histopathological examination. Results tabulated and analysed using MS EXCEL and cross tabulation using Epi-info. Sensitivity, specificity, PPV, NPV for each pathology by TVS and hysteroscopy with HPE as the gold standard was calculated. Also the pathology causing abnormal uterine bleeding was computed by taking into account the endometrial characteristics and the associated lesions diagnosed by TVS, hysteroscopy and histopathological examination report. Results: 61 patients had only single lesions in the form of normal endometrium, atrophic endometrium, endometrial hyperplasia, endometrial polyp, malignancy and IU synechiae whereas 39 patients had lesions like intramural fibroids, adenomyosis, submucus myoma and polyps associated with different types of endometrium. The diagnostic accuracy of TVS and hysteroscopy were comparable for normal endometrium whereas hysteroscopy was found to be more accurate for endometrial polyps, endometrial hyperplasia and atrophic endometrium. Conclusions: The combination of transvaginal sonography, hysteroscopy and directed biopsy was found to increase the diagnostic yield in patients with abnormal uterine bleeding. As the diagnostic accuracy increased by combining the three modalities, an effective and appropriate management can be planned. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 919-923

  11. Prospects in clinical hyperthermia

    A large number of patients have now been entered into a phase I/II protocol to examine the effects of fractionated hyperthermia and radiation on tumor response. Included in the study were 11 different histologies with anatomical locations varying between peripheral and superficial metastases to deep seated, solid tumors. Patients were treated with four fractions of microwave induced hyperthermia (45.0 +- 0.5 deg. C), each separated by intervals of 72 hours. Treatments were 1-1/2 hours in duration to a volume encompassing the tumor. Microwaves at frequencies of 915 MHz or 300 MHz were employed. Patients were given a one-week rest following the first 4 treatments, following which a second series of 4 fractions were administered again at 72-hour intervals. Each of these fractions consisted of a 400 rad dose of radiation followed within 20 minutes by hyperthermia (42.5 +- 0.5 deg. C) for 1-1/2 hours. To date 121 fields have been treated in 82 patients. New technology allows for the treatment of deep seated tumors in the neck, chest and pelvis. Follow-up times range from 2 to 19 months. Total regression is seen in 65% of all cases, partial regression in 35% and no response is seen in only 5% of treatments. Six local and four marginal recurrences have been observed. Adverse effects were rare. Based upon our results (above) and those of other investigators, several modifications have been made in the above protocol. Site specific trials are currently in progress to study both the feasibility of deep seated heating with intracavitary antennas as well as to assess tumor response. In addition, a randomized trial to examine the clinical relevance of thermotolerance has been started. (author)

  12. Postoperative radiotherapy for uterine cervical cancer. Results of the 1995-1997 patterns of care process survey in Japan

    The objective of this study was to determine the average national practice of postoperative radiotherapy (RT) for uterine cervical cancer in Japan. The Japanese Patterns of Care Study (PCS) reviewed the process of care employed for 455 uterine cervical cancer patients who were treated with surgery followed by postoperative RT during 1995-1997. Cases with missing data were excluded from calculations of percentage and significance for each of the surveyed items. According to International Federation of Gynecology and Obstetrics (FIGO) stages, 198 patients (45%) were in stage I, 52 patients (12%) were in stage IIA, 146 patients (33%) were in stage IIB and 46 patients (10%) were in stage III/IVA. The most common surgical procedure among the patients was radical hysterectomy (73%). Three hundred and seventy patients (82%) were treated with external beam RT (ERT) alone, and 74 patients (17%) were treated with a combination of ERT and intracavitary RT (ICRT). A midline block was used for the pelvic field in 63 patients (14%). Only seven patients (2%) were treated with extended field ERT. Pelvic ERT was most often performed using anterior posterior-posterior anterior (AP-PA) opposed fields for 431 patients (97%). A majority of the patients (312 patients, 70%) were treated with a total dose of 45.0-50.4 Gy for ERT. Chemotherapy (CT) was administered to 178 patients (40%), neoadjuvant preoperative CT was administered to 80 patients (22%) and concurrent CT with postoperative RT was administered to 29 patients (8%). This PCS established the national practice average of postoperative RT for uterine cervical cancer. Follow-up studies need to be conducted to determine whether the observed differences in treatment processes affect outcomes. (author)

  13. Locally advanced cervix carcinoma - innovation in combined modality therapy

    Locally advanced cervical carcinoma continues to be a challenge to the clinician due to local failure as well as systemic metastases. Standard intracavitary and external beam techniques result in local control rates of only 35-65%, with long term survival rates of 25-60% in patients with state IIIA-IVA disease, indicating the need to identify new treatment strategies. Optimization programs for remote-afterloading interstitial brachytherapy allow the delivery of higher local doses of radiation to volumes that more closely approximate tumor target volumes as identified on MR scans, leading to improved therapeutic ratios. Identification of subsets of patients more likely to fail standard therapy, either locally or systemically, may be possible through such techniques as in vivo measurements of hypoxia with Eppendorf oxygen electrodes, interstitial fluid pressure measurements, the Comet assay, and nitroimidazole binding methods. Traditional chemotherapies, administered in either a neoadjuvant role or concomitantly with radiation have been disappointing in prospective trials. A variety of new agents are being investigated to determine if they can increase the frequency or duration of complete response. The taxanes, with response rates of 17-23% by themselves, are being assessed as potential radiosensitizers. The camptotheicin CRT-11 (Irinotecan) has demonstrated activity in platinum resistant cervix cancer, with response rates of 24%. Bioradiotherapeutic approaches, using 13-cis-retinoic acid and interferon-2a, are undergoing phase II studies. Neoangiogenesis inhibitors and vaccines against HPV are also being examined. The aggressive pursuit of techniques that help identify those patients most likely to fail, that allow the delivery of higher radiation doses more safely to the target volume, and that incorporate the use of more effective systemic therapies is necessary to improve the outcome for this disease

  14. Interfractional change of high-risk CTV D90 during image-guided brachytherapy for uterine cervical cancer.

    Ohkubo, Yu; Ohno, Tatsuya; Noda, Shin-ei; Kubo, Nobuteru; Nakagawa, Akiko; Kawahara, Masahiro; Abe, Takanori; Kiyohara, Hiroki; Wakatsuki, Masaru; Nakano, Takashi

    2013-11-01

    The purpose of this study was to evaluate interfractional changes of the minimum dose delivered to 90% of the high-risk clinical target volume (HR-CTV D90) and D2cc of the bladder and rectum during brachytherapy for uterine cervical cancer patients. A total of 52 patients received external beam radiotherapy and high-dose-rate intracavitary brachytherapy (ICBT). For each of four ICBT applications, a pelvic CT scan was performed and the HR-CTV was delineated. Retrospectively, these patients were divided into two groups: (i) the standard dose group with 6 Gy to point A in each ICBT, and (ii) the adaptive dose group with a modified dose to point A to cover the HR-CTV with the 6-Gy isodose line as much as possible. The HR-CTV D90 was assessed in every session, and analyzed as interfractional changes. In the standard dose group, the interfractional changes of the HR-CTV D90 showed a linear increase from the first to the third of the four ICBT (average 6.1, 6.6, 7.0 and 7.1 Gy, respectively). In contrast, those of the adaptive dose group remained almost constant (average 7.2, 7.2, 7.3 and 7.4 Gy, respectively). Especially, in the case of a large HR-CTV volume (≥35 cm(3)) at first ICBT, the total HR-CTV D90 of the adaptive dose group with brachytherapy was significantly higher than that of the standard dose group. There were no significant differences in total D2cc in bladder and rectum between the two groups. Image-guided adaptive brachytherapy based on interfractional tumor volume change improves the dose to the HR-CTV while keeping rectal and bladder doses within acceptable levels. PMID:23732770

  15. Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology

    Cunha, Adam; Mellis, Katherine; Siauw, Timmy; Diederich, Chris; Pouliot, Jean; Hsu, I-Chow

    2016-01-01

    Purpose Three-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy. Material and methods Three brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic. Results Patient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences. Conclusions We established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially

  16. Absorbed dose simulations in near-surface regions using high dose rate Iridium-192 sources applied for brachytherapy

    Moura, E. S.; Zeituni, C. A.; Sakuraba, R. K.; Gonçalves, V. D.; Cruz, J. C.; Júnior, D. K.; Souza, C. D.; Rostelato, M. E. C. M.

    2014-02-01

    Brachytherapy treatment with Iridium-192 high dose rate (HDR) sources is widely used for various tumours and it could be developed in many anatomic regions. Iridium-192 sources are inserted inside or close to the region that will be treated. Usually, the treatment is performed in prostate, gynaecological, lung, breast and oral cavity regions for a better clinical dose coverage compared with other techniques, such as, high energy photons and Cobalt-60 machines. This work will evaluate absorbed dose distributions in near-surface regions around Ir-192 HDR sources. Near-surface dose measurements are a complex task, due to the contribution of beta particles in the near-surface regions. These dose distributions should be useful for non-tumour treatments, such as keloids, and other non-intracavitary technique. For the absorbed dose distribution simulations the Monte Carlo code PENELOPE with the general code penEasy was used. Ir-192 source geometry and a Polymethylmethacrylate (PMMA) tube, for beta particles shield were modelled to yield the percentage depth dose (PDD) on a cubic water phantom. Absorbed dose simulations were realized at the central axis to yield the Ir-192 dose fall-off along central axis. The results showed that more than 99.2% of the absorbed doses (relative to the surface) are deposited in 5 cm depth but with slower rate at higher distances. Near-surface treatments with Ir-192 HDR sources yields achievable measurements and with proper clinical technique and accessories should apply as an alternative for treatment of lesions where only beta sources were used.

  17. Dosimetric evaluation of the Fricke gel dosimeter using the spectrophotometric technique for application in electron and neutron dosimetry

    In this work the main dosimetric characteristics of the Fricke Xylenol Gel (FXG) solution were established for further application in the measurement of dose distribution of clinical electron fields. The dose-response curves of the FXG in a neutron field were also evaluated for the research in Boron Neutron Capture Therapy (BNCT) and industrial electron fields. The standard reading technique was the spectrophotometric. For the clinical field, the intra and inter-batch reproducibility are better than 1.4% and 5.1 %, respectively, the response presents a linear behavior for doses ranging from 0.2 to 40 Gy independently of the energy and the dose rate in the studied ranges. Due to the effects of the FXG natural oxidation, the optimum elapsed time between FXG preparation and irradiation was established as 24h period and the behavior of the dose-response curve of the FXG using the variation in the absorbance relative to the non-irradiated dosimeter as a basis during the whole studied period were not altered. The dose-response to the industrial electron beam presented an exponential decreasing behavior and the neutron beam for research in BNCT presented a linear behavior for the complete studied dose range. According to the obtained results for the different types of radiation studied for the FXG, there was no change in the position of the characteristic bands of the absorption spectrum due to the interaction of these radiation types. Additional tests were performed to determine the digital photographic imaging of FXG analyses viability and the application of FXG dosimetry on intracavitary brachytherapy. The good performance of the FXG dosimeter in the tests that were carried out indicates that this dosimeter may be applied to the tri-dimensional dose evaluation in radiotherapic treatments using electrons and neutron beams. (author)

  18. EM-navigated catheter placement for gynecologic brachytherapy: an accuracy study

    Mehrtash, Alireza; Damato, Antonio; Pernelle, Guillaume; Barber, Lauren; Farhat, Nabgha; Viswanathan, Akila; Cormack, Robert; Kapur, Tina

    2014-03-01

    Gynecologic malignancies, including cervical, endometrial, ovarian, vaginal and vulvar cancers, cause significant mortality in women worldwide. The standard care for many primary and recurrent gynecologic cancers consists of chemoradiation followed by brachytherapy. In high dose rate (HDR) brachytherapy, intracavitary applicators and /or interstitial needles are placed directly inside the cancerous tissue so as to provide catheters to deliver high doses of radiation. Although technology for the navigation of catheters and needles is well developed for procedures such as prostate biopsy, brain biopsy, and cardiac ablation, it is notably lacking for gynecologic HDR brachytherapy. Using a benchtop study that closely mimics the clinical interstitial gynecologic brachytherapy procedure, we developed a method for evaluating the accuracy of image-guided catheter placement. Future bedside translation of this technology offers the potential benefit of maximizing tumor coverage during catheter placement while avoiding damage to the adjacent organs, for example bladder, rectum and bowel. In the study, two independent experiments were performed on a phantom model to evaluate the targeting accuracy of an electromagnetic (EM) tracking system. The procedure was carried out using a laptop computer (2.1GHz Intel Core i7 computer, 8GB RAM, Windows 7 64-bit), an EM Aurora tracking system with a 1.3mm diameter 6 DOF sensor, and 6F (2 mm) brachytherapy catheters inserted through a Syed-Neblett applicator. The 3D Slicer and PLUS open source software were used to develop the system. The mean of the targeting error was less than 2.9mm, which is comparable to the targeting errors in commercial clinical navigation systems.

  19. Are recommendations from carcinoma of the cervix Patterns of Care studies (PCS) in the United States of America (USA) applicable to centers in developing countries?

    Purpose: To compare patient demographics, treatment resources, practice patterns, and outcome results for squamous cell carcinoma of the uterine cervix (SCC) between the 1978 and 1983 Patterns of Care studies (PCS) in the United States of America (USA) and a nonacademic center within a developing country. Methods and Materials: Patient details (race, age, stage, and number per year), treatment used, and treatment outcome were retrieved from the charts of the 1160 cases registered at this center with SCC of the cervix between 1976 and 1985. Demographic variables and Kaplan-Meier survival estimates were calculated and compared with results from published PCS reviews. Results: There is a significant difference in the racial group presentation of cervix cancer at this center compared with the PCS reviews (p < 0.005), and median ages are significantly lower at this center (t = p < 0.001). The proportion of patients with Stage III or more was significantly higher at this center than the PCS centers (24 vs. 47%, p < 0.001). There were also vast differences in facility resources. Fewer cases at this center underwent intracavitary insertions than at PCS centers. Mean Point A doses were significantly reduced for this center compared with the PCS reviews. Kaplan-Meier estimates were similar for Stage I and II in PCS centers and this center, but were inferior for this center in Stage III patients (p < 0.05 for OS and p < 0.01 for LC). Late morbidity rates were similar for both PCS centers and this center. Conclusion: PCS recommendations may be applicable to nonacademic centers within developing countries, if the latter use staging techniques that are consistent with the PCS staging guidelines

  20. The heart in inflammatory bowel disease

    Tsianos E.V.

    2007-03-01

    Full Text Available SUMMARY Cardiovascular involvement in inflammatory bowel disease (IBD has been occasionally reported, mainly in the form of case reports. Endocardium derangement in IBD involves endocarditis and subendocardial abscess. Endocarditis may occur as a result of septicemia or due to the prolonged use of total parental nutrition (TPN catheters or/and immunosuppression. The cause of endocarditis may be bacterial or fungal and require surgery in several cases. Prophylaxis for endocarditis in selected IBD patients is discussed. Myocarditis or perimyocarditis in IBD is reported as an autoimmune phenomenon during bowel disease excacerbations or as a side-effect of 5-aminosalicylic acid (5-ASA formulations. Ulcerative colitis (UC patients seem to be at a higher risk for this complication compared to Crohn�s disease (CD patients. Myocardial infarctions, selenium deficiency during TPN, the role of prolonged steroid use and the association with giant cell myocarditis are topics which need further analysis. Pericardium involvement seems to be the most frequent type of cardiovascular complication in IBD caused by drugs (5-ASA, azathioprine, cyclosporine, pericardio-colonic fistulas or unknown causes (idiopathic and it may occasionally be the disease presenting symptom. Coronary artery status and other factors for cardiovascular risk, such as smoking, hyperlipidemia and exercise are also discussed. Electrocardiogram and ultrasonographic changes are not so uncommon and cardiogenic sudden death in IBD is reviewed. Intracavitary coagulation abnormalities, amyloidosis, heart failure and aortitis syndrome are topics included and discussed in this review. A list of tables contributes to a more systemic overview of this current knowledge. Key Words: heart, inflammatory bowel disease, ulcerative colitis, Crohn�s diseas

  1. Endoscopic findings of rectal mucosal damage after pelvic radiotherapy for cervical carcinoma: correlation of rectal mucosal damage with radiation dose and clinical symptoms

    Kim, Tae Gyu; Huh, Seung Jae; Park, Won [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-06-15

    To describe chronic rectal mucosal damage after pelvic radiotherapy (RT) for cervical cancer and correlate these findings with clinical symptoms and radiation dose. Thirty-two patients who underwent pelvic RT were diagnosed with radiation-induced proctitis based on endoscopy findings. The median follow-up period was 35 months after external beam radiotherapy (EBRT) and intracavitary radiotherapy (ICR). The Vienna Rectoscopy Score (VRS) was used to describe the endoscopic findings and compared to the European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) morbidity score and the dosimetric parameters of RT (the ratio of rectal dose calculated at the rectal point [RP] to the prescribed dose, biologically effective dose [BED] at the RP in the ICR and EBRT plans, {alpha}/{beta} = 3). Rectal symptoms were noted in 28 patients (rectal bleeding in 21 patients, bowel habit changes in 6, mucosal stools in 1), and 4 patients had no symptoms. Endoscopic findings included telangiectasia in 18 patients, congested mucosa in 20, ulceration in 5, and stricture in 1. The RP ratio, BEDICR, BEDICR+EBRT was significantly associated with the VRS (RP ratio, median 76.5%; BEDICR, median 37.1 Gy3; BEDICR+EBRT, median 102.5 Gy3; p < 0.001). The VRS was significantly associated with the EORTC/RTOG score (p = 0.038). The most prevalent endoscopic findings of RT-induced proctitis were telangiectasia and congested mucosa. The VRS was significantly associated with the EORTC/RTOG score and RP radiation dose.

  2. An analysis of personnel dose records which justifies the application of cost-benefit analysis techniques in the design of an afterloading facility and the use of controlled areas and systems of work within suite to control occupational exposure.

    Gifford, D; Godden, T J; Kear, D

    1990-03-01

    The sealed source operational policies employed at the Bristol Radiotherapy and Oncology Centre were originally designed to meet the requirements of the 1972 Code of Practice by ensuring that individual personnel doses were kept below the relevant quarterly and annual dose limits. In 1982-1983, measures were taken to improve personnel radiation safety within the brachytherapy treatment facility by (a) making preparations for the introduction of Selectron medium-dose-rate (MDR) afterloading systems at the centre for intracavitary brachytherapy and (b) reviewing the operational policies to ensure that they meet the more stringent requirements of the ALARA (as low as reasonably achievable) principle, a principle subsequently embodied in the 1985 UK ionising Radiations Regulations (IRR 85). When considering the implications of making existing single-bedded side wards, originally designed for low-dose-rate brachytherapy and suitable for the new systems, the cost of the extra protection required to reduce the instantaneous dose rate in the ward corridors adjacent to the treatment room to less than 7.5 microSv h-1 had to be determined. On the basis of the cost-benefit analysis, it was decided not to provide additional shielding but rather to introduce administrative controls based on local rules which contained systems of work and the operational policies for the afterloading systems. After using the MDR afterloading systems for 2 years, a period in which there has also been a marked increase in interstitial brachytherapy, an analysis was made of the doses received by nursing staff over the past 8 years. This has shown that, in spite of higher dose rates in the corridor areas because of the use of an MDR system and the increase in interstitial techniques, the doses to ward nurses have been significantly reduced by encouraging staff to comply with the ALARA principle and the introduction of afterloading systems. PMID:2110492

  3. High dose rate 60Co remote afterloading irradiation in cancer of the cervix in Haiti, 1977-1984

    From 1977 through 1984, 293 previously untreated patients with biopsy proven carcinoma of the uterine cervix were treated by whole pelvis irradiation and high intensity 60Co remote afterloading (RAL) intrauterine tandem techniques in Haiti. The treatment results were analyzed retrospectively to evaluate the therapeutic results and prognostic factors of a strict protocol involving 40 Gy to the whole pelvis (2 Gy/day, 5 days/week). In addition, on the 5th day of the 3rd week, the first outpatient 60Co remote afterloading intracavitary insertion, delivering 7.5 Gy to point A with each insertion, repeated 3 times by a week separation for a total of 4 times. The total TDF for external beam plus RAL was 158 and 175 for early and late effects respectively. One hundred-four patients were evaluable after 1 year or more follow-up, with a median of 26.5 months. No evidence of disease (NED) by Stage at 1 year was: Stage I of 100% (3/3), Stage II of 82% (9/11), Stage III of 80% (47/59), and Stage IV of 58% (18/31). The post-therapeutic complication rate was 7.7%, with no fistulas or requirement of surgical intervention. Those with documented follow-up of at least 2 years (74 patients) had comparable survival to other high dose rate and low dose rate studies. This study shows that outpatient brachytherapy can be carried out without sophisticated and expensive equipment with minimal staff trained in radiation therapy. A detailed description of this outpatient RAL technique and results are described so that this method can be adapted to other developing and industrialized nations where cost containment is becoming a key issue

  4. Endometrial Histology of Depomedroxyprogesterone Acetate Users: A Pilot Study

    2006-01-01

    Full Text Available Objective. To obtain pilot data on the endometrial histology of Depomedroxyprogesterone acetate (Depo-Provera, DMPA users experiencing breakthrough bleeding (BTB versus users with amenorrhea. To compare the endometrial histology of patients who used DMPA continuously for 3–12 months versus those who used it for 13 months or more. Methods. Cross-sectional study. Endometrial biopsy was obtained from all consenting patients who used DMPA for at least 3 months. Patients were divided into those with BTB in the last 3 months versus those with amenorrhea for at least 3 months. Histology results and duration of therapy were compared. Results. The proportion of women with chronic endometritis, uterine polyps, atrophic, proliferative, or progesterone-dominant endometrium did not differ between those DMPA users with BTB versus those with amenorrhea. Duration of therapy did not correlate with symptoms of BTB or endometrial histology. Chronic endometritis was the most common histologic finding (10/40, 25% and occurred more often in women experiencing BTB (35% versus 15% (RR 1.62 CI 0.91–2.87. Moreover, 45% of women with BTB had received DMPA for more than 12 months. Conclusions. BTB was more common than previously reported in women using DMPA for more than 12 months. Chronic endometritis, which may indicate an underlying infectious or intracavitary anatomic etiology, has not been previously reported as a frequent finding in DMPA users, and may be related to ethnic or other sociodemographic characteristics of our patient population. Further study to elucidate the etiology of chronic endometritis in these patients is warranted.

  5. Prospective Phase I-II Trial of Helical Tomotherapy With or Without Chemotherapy for Postoperative Cervical Cancer Patients

    Schwarz, Julie K., E-mail: jschwarz@radonc.wustl.edu [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Cell Biology and Physiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Wahab, Sasa [Cobb Center for Radiation Oncology Center, Austell, GA (United States); Grigsby, Perry W. [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)

    2011-12-01

    Purpose: To investigate, in a prospective trial, the acute and chronic toxicity of patients with cervical cancer treated with surgery and postoperative intensity-modulated radiotherapy (RT) delivered using helical tomotherapy, with or without the administration of concurrent chemotherapy. Patients and Methods: A total of 24 evaluable patients entered the study between March 2006 and August 2009. The indications for postoperative RT were tumor size, lymphovascular space invasion, and the depth of cervical stromal invasion in 15 patients; 9 patients underwent postoperative RT because of surgically positive lymph nodes. All patients underwent pelvic RT delivered with helical tomotherapy and intracavitary high-dose-rate brachytherapy. Treatment consisted of concurrent weekly platinum in 17, sequential carboplatin/Taxol in 1, and RT alone in 6. The patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria, version 3.0. Results: The median follow-up was 24 months (range, 4-49). At the last follow-up visit, 23 patients were alive and disease free. Of the 24 patients, 12 (50%) experienced acute Grade 3 gastrointestinal toxicity (anorexia in 5, diarrhea in 4, and nausea in 3). One patient developed acute Grade 4 genitourinary toxicity (vesicovaginal fistula). For patients treated with concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 71% and 24%, respectively. For patients treated without concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 29% and 14%, respectively. Two long-term toxicities occurred (vesicovaginal fistula at 25 months and small bowel obstruction at 30 months). The overall and progression-free survival rate at 3 years for all patients was 100% and 89%, respectively. Conclusion: The results of our study have shown that postoperative external RT for cervical cancer delivered with helical tomotherapy and high-dose-rate brachytherapy and with or without

  6. Effects of radiation therapy alone and in combination with Sizofiran on immunologic and nutritional changes in patients with carcinoma of the uterine cervix

    A total of 31 patients with carcinoma of the uterine cervix were treated with radiation therapy alone (the R group, n=16) or in combination with Sizofiran (the R+S group, n=15). A dose of 40-50 Gy was delivered to the whole pelvis. Intracavitary irradiation of 15-25 Gy was given with a remote controlled after-loading system in some of the patients. Sizofiran was intramuscularly administered at a dose of 40 mg/week. The number of peripheral white blood cells and lymphocytes was significantly decreased in the R group; however, this was not marked in the R+S group. There was no significant change in monocytes or immunosuppressive acidic protein in either group. An examination of peripheral blood lymphocyte subsets revealed a gradual decrease in CD3 in the R+S group and individually different changes in CD4 and CD8. The CD4/CD8 ratio decreased in the R group; however, it had a tendency for increase in the R+S group. The serum level of albumin, as determined as a nutritional indicator, was significantly decreased in the R group. Other nutritional indicators showed aggravation in the R group. There was, however, no change in these nutritional indicators in the R+S group. Antitumor effects were more markedly improved in the R+S group than the R group. Only half of the patients in the R group had an improvement of performance status, compared with many of the patients in the R+S group. In view of antitumor efficacy and performance status, Sizofiran is a useful adjuvant chemotherapy for radiation in the treatment of cervical carcinoma. (N.K.)

  7. Investigation of rectal complication after RALS-therapy for uterine cervix cancer using multivariate analysis

    Rectal injury is one of the major side effects after radiation therapy for carcinoma of the uterine cervix. According to our previous reports, the cases of rectal complication were mainly related to the measured rectal dose in half of patients, and the other causes were related to the following factors; such as diabetes mellitus, hemorrhagic tendency, syphilis and so on. Concerning to rectal complication, these factors were investigated by means of the discriminant analysis, one of the multivariate analyses, in this paper. Twenty-eight factors as to radiation dose, laboratory tests and physical condition of patients were analyzed. From August 1978 through January 1980, 52 cases of previously untreated carcinoma of the uterine cervix were treated using RALS, remotely controlled high dose rate intracavitary radiotherapy, at our department. The data from 49 out of 52 cases were available for the discriminant analysis. By m eans of this analysis, it was found that these factors, such as the dose of whole pelvic irradiation, Point A dose of RALS, measured rectal dose by RALS, WGC-Z and TPHA were important factors for occurence of rectal complication. According to the discriminant score, 46 out of 49 cases (94 %) could be correctly discriminated. There were two cases of false positive and one false negative. Form February 1980 through July 1980, 27 cases of previously untreated carcinoma of the uterine cervix were treated at our department. The obtained discriminant function was applied to these 27 cases, and 24 out of 27 cases (89 %) were correctly predicted. There were two cases of false positive, and one of false negative. Discriminant analysis is useful for the prediction of rectal complication after radiation therapy for carcinoma of the uterine cervix. (J.P.N.)

  8. Prognostic value of response to external radiation in stage IIIB cancer cervix in predicting clinical outcomes: A retrospective analysis of 556 patients from India

    Background and purpose: To evaluate the prognostic significance of response to external beam radiation (EBRT) in predicting the clinical outcomes in stage IIIB cancer cervix and to find out factors affecting response to EBRT. Patients and methods: This retrospective study included 556 patients of cancer cervix stage IIIB treated between 1996 and 2001 with EBRT (46 Gy/23fx/4.5 weeks) followed by intracavitary radiotherapy (ICRT). At the end of EBRT, response to EBRT was grouped as 'no gross residual tumor'(NRT) or 'gross residual tumor'(GRT). Results: Follow up ranged from 2 to 93 months with a median of 36 months. Median dose to point A was 81 Gy. At the end of EBRT, 393 patients (70.7%) attained NRT response. NRT responders had significantly better 5 year pelvic control, disease free survival (DFS) and overall survival (OS) than those who had a GRT response (75.6 vs. 54.6%; 60.6 vs. 31.9% and 62.6 vs. 33.7%, respectively; all P values <0.0001). Apart from response to EBRT, overall treatment time also has emerged as an independent factor to affect all clinical outcomes in multivariate analysis but age had significant impact on pelvic control only. Age was the only factor, which significantly influenced the response to EBRT in univariate as well as multivariate analysis (P=<0.001, OR=1.973, 95% C.I. 1.357-2.868). Patients with age more than 50 years had more NRT response (77%) than patients with age less than 50 years (63.8%). Conclusions: Patients who attain NRT response to EBRT will have an impressive long term pelvic control, DFS and OS in stage IIIB cancer cervix. Older patients (≥50 years) attain significantly higher NRT rates than younger patients

  9. Optimum radiotherapy schedule for uterine cervical cancer based-on the detailed information of dose fractionation and radiotherapy technique

    Cho, Jae Ho; Kim, Hyun Chang; Suh, Chang Ok [Yonsei University Medical School, Seoul (Korea, Republic of)] (and others)

    2005-09-15

    The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of 23.4 {approx} 59.4 Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-ICBT) was also performed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of 14.4{approx} 43.2 Gy (Median 36.0) of EBRT in 495 patients, while in the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder and rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ({alpha} / {beta} = 10) and late-responding tissues ({alpha} /{beta} = 3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED Gy{sub 3} and the risk of complication was assessed using serial multiple logistic regressions models. The associations between R

  10. Salvage brachytherapy for patients with locally persistent nasopharyngeal carcinoma

    Purpose: Locally persistent nasopharyngeal carcinoma (NPC) carries an increased risk of local failure if additional treatment is not given. This study was conducted to evaluate the outcomes of patients with locally persistent NPC as treated by high-dose-rate (HDR) intracavitary brachytherapy, and to explore whether routine brachytherapy boost could improve the local control. Methods and Materials: Eighty-seven patients with locally persistent NPC treated during 1990-1998 with HDR intracavitary brachytherapy were retrospectively analyzed. Fibreoptic nasopharyngoscopy was performed 3-6 weeks after completion of the primary external radiation therapy (ERT). Biopsies were only taken from suspicious areas. Those with complete regression of local disease were put on observation. Eighty-seven patients were shown to have persistent viable disease at a median time of 6 weeks post-RT. The distribution according to Ho's staging system at initial diagnosis was as follows: Stage I-8, II-33, III-41, IV-5; T1-19, T2-48, T3-20; N0-32, N1-22, N2-28, N3-5. CT scan for restaging was not performed after the documentation of persistent disease. Our policy was to treat all patients with persistent disease with brachytherapy irrespective of the extent of disease just prior to brachytherapy. They were treated with HDR intracavitary brachytherapy, with either cobalt sources or an iridium source, giving 22.5-24 Gy in 3 weekly sessions in all but 4 patients. This dose was prescribed at a distance of 1.5 cm from the center of the surface as defined by the sources in the first six patients and subsequently reduced to 1 cm for the others. Twelve patients were treated with neoadjuvant chemotherapy. To compare the efficacy of brachytherapy, another 383 consecutive nonmetastatic patients, treated with curative intent by ERT, during the years 1990-1993, were evaluated. Multivariate analysis was performed using the Cox regression proportional hazards model. Results: The 5-year actuarial local

  11. Change in interstitial fluid pressure measurements in carcinoma of the uterine cervix as an early predictor of radioresponsiveness

    Purpose/Objective: Interstitial fluid pressure (IFP) has been found to be elevated in cervical carcinomas. This study sought to evaluate IFP as a potential early measure of tumor response to radiation therapy. Identification of poor responders early in the course of treatment may allow the clinician to modify the treatment strategy early in the course of therapy. Materials and Methods: IFP was measured using the wick-in-needle technique in 42 patients undergoing definitive radiotherapy for carcinoma of the cervix. Measurements were taken before and after external beam radiation treatment (EBRT) in 25, after intracavitary treatment (ICT) in 7, and after both EBRT and ICT in 10 patients. An additional 10 patients had weekly measurements during radiotherapy. Tumor stage, size, hemoglobin, and clinical response were assessed and correlated with IFP readings. Results: All initial IFP readings were elevated. The extent of elevation did not correlate with outcome (p=0.76) or stage (p=0.6). Smaller tumors had a higher initial IFP (p=0.02). Tumor response correlated with change in IFP readings (p=0.01), tumor size (0.04), hemoglobin (p=0.01), and stage (0.04). On multivariate analysis, change in IFP remained an independent predictor of response. The IFP change from pretreatment to post-EBRT was - 13±3 in complete responders versus 4±11 and 18±10 in the partial and nonresponders respectively (p=0.01). In those with post-ICT readings, the change was -18±4 in complete responders versus 54±18 in the partial responders (p=0.01). In 10 patients undergoing weekly measurement, 8 complete responders had decreasing IFP measurements. An average fall of 51.6% was seen in five patients at < 1620cGy despite little or no change in tumor size, and by 2700cGy (average decrease 31%) in the remaining 3 complete responders. Nonresponders had either no change or an increase in IFP throughout EBRT. Conclusion: IFP is elevated in tumors of the uterine cervix. Decreasing IFP measurement

  12. DVH parameters and outcome for patients with early-stage cervical cancer treated with preoperative MRI-based low dose rate brachytherapy followed by surgery

    Background: To our knowledge no DVH data have so far been reported for MRI-guided BT in the preoperative setting of early-stage cervical cancer. We assessed DVH parameters and clinical outcome using 3D MRI-guided preoperative intracavitary LDR BT. Patients and methods: Thirty-nine patients with primary early cervical carcinoma (IB1 37, IIA 1 and IIB 1) were treated with preoperative MRI-based LDR BT, consisting of uterovaginal BT to a total dose of 60 Gy to the intermediate-risk CTV, followed 6 weeks later by bilateral salpingo-oophorectomy and extrafascial hysterectomy plus pelvic node dissection. Adjuvant chemoradiation was delivered to patients with pelvic lymph node involvement. Results: With a median follow-up of 4.4 years (range 2.6-6.6 years), local recurrence occurred in 1 patient (a lateropelvic relapse) (2.6%). The 4-year actuarial overall survival and disease-free survival were 94% (95% CI, 82-98), and 86% (95% CI, 67-95), respectively. The 2- and 4-year actuarial local relapse-free survival were 94 (95% CI, 86-100) and 91% (95% CI, 81-100), respectively. For intermediate-risk CTV, median D100 and D90 were 43 Gyα/β10 (range 2-74 Gyα/β10) and 75 Gyα/β10, respectively (range 29-129 Gyα/β10). For high-risk CTV, the median D100 and D90 were 69 Gyα/β10 (range 24-137 Gyα/β10) and 109 Gyα/β10 (range 37-198 Gyα/β10), respectively. Twenty grade 1-2 late complications were observed in 13 patients (33.3%): 10 bladder, 3 ureteral, 1 rectal, 1 small bowel, 1 vaginal, 1 pelvic fibrosis, 1 peripheral nerve, and 2 others. No grade 3 or 4 complication occurred. Conclusion: MRI-guided brachytherapy with adaptation of the time duration and/or the length of each radioactive source allows both high local control and low toxicity in the preoperative settings of early-stage cervical cancers.

  13. Irradiation with or without misonidazole for patients with stages IIIb and IVa carcinoma of the cervix: final results of RTOG 80-05

    Purpose: The purpose of this study was to evaluate tumor response, progression-free survival, local tumor control, patterns of relapse, and toxicity in patients with Stages IIIb and IVa squamous cell carcinoma of the uterine cervix treated with irradiation or irradiation and misonidazole. This is a report of the final results of the study. Methods: This study was a prospective randomized Phase III trial performed by the Radiation Therapy Oncology Group (RTOG). Between August 1980 and November 1984, 120 patients with Stages IIIb and IVa squamous cell carcinoma of the cervix were randomized to receive either standard irradiation or standard irradiation and misonidazole. Irradiation consisted of 46 Gy to the pelvis plus a 10 Gy parametrial boost followed by intracavitary brachytherapy or external irradiation boost to the primary tumor. Misonidazole was administered at 400 mg/m2 daily, 2-4 h before irradiation. Patients in the 2 treatment groups were evenly distributed by stage, Karnofsky Performance Status, and positive para-aortic lymph nodes. Results: Sixty-one patients were treated with irradiation alone, and 59 patients received irradiation and misonidazole. Complete response in the pelvis occurred in 44 (75%) of those treated with irradiation and in 38 (64%) of those treated with irradiation and misonidazole. The progression-free survivals were 22% at 5 years for the control group, and 29% at 5 years for the misonidazole group. At the time of last follow-up, 18 patients in the control arm were free of disease, and in the experimental arm, 19 were free of disease. The patterns of failure for those treated with irradiation alone were local-only in 9 patients, distant-only in 8 patients, and local and distant in 11 patients. The patterns of failure for those receiving irradiation and misonidazole were local-only in 3 patients, distant-only in 8 patients, and local and distant in 8 patients. The maximum toxicity experienced per patient was grade 3 in 18%, grade 4 in

  14. SU-E-T-579: Impact of Cylinder Size in High-Dose Rate Brachytherapy (HDRBT) for Primary Cancer in the Vagina

    Zhang, H; Gopalakrishnan, M; Lee, P; Sathiaseelan, V [Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL (United States)

    2014-06-01

    Purpose: To evaluate the dosimetric impact of cylinder size in high dose rate Brachytherapy for primary vaginal cancers. Methods: Patients treated with HDR vaginal vault radiation in a list of cylinders ranging from 2.5 to 4 cm in diameter at 0.5 cm increment were analyzed. All patients’ doses were prescribed at the 0.5 cm from the vaginal surface with different treatment lengths. A series of reference points were created to optimize the dose distribution. The fraction dose was 5.5 Gy, the treatment was repeated for 4 times in two weeks. A cylinder volume was contoured in each case according to the prescribed treatment length, and then expanded to 5 mm to get a volume Cylinder-5mm-exp. A volume of PTV-Eval was obtained by subtracting the cylinder volume from the Cylinder-5mm-exp. The shell volume, PTV-Eval serves as the target volume for dosimetric evaluation. Results: DVH curves and average doses of PTV-Eval were obtained. Our results indicated that the DVH curves shifted toward higher dose side when larger cylinder was used instead of smaller ones. When 3.0 cm cylinder was used instead of 2.5 cm, for 3.0 cm treatment length, the average dose only increased 1%, from 790 to 799 cGy. However, the average doses for 3.5 and 4 cm cylinders respectively are 932 and 1137 cGy at the same treatment length. For 5.0 cm treatment length, the average dose is 741 cGy for 2.5 cm cylinder, and 859 cGy for 3 cm cylinder. Conclusion: Our data analysis suggests that for the vaginal intracavitary HDRBT, the average dose is at least 35% larger than the prescribed dose in the studied cases; the size of the cylinder will impact the dose delivered to the target volume. The cylinder with bigger diameter tends to deliver larger average dose to the PTV-Eval.

  15. Adjuvant postoperative radiation therapy for carcinoma of the uterine cervix

    Lee, Kyung Ja; Moon, Hye Seong; Kim, Seung Cheol; Kim, Chong Il; Ahn, Jung Ja [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

    2003-09-01

    This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelvic lymph node dissection. Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study, The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, Iymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy. All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy. The radiation dose from the external beam to the whole pelvis was 45 - 50 Gy. Vagina cuff irradiation was performed, after completion of the external beam irradiation, al a low-dose rate of CS-137, with the total dose of 4488-4932 chy (median: 4500 chy) at 5 mm depth from the vagina surface. The median follow-up period was 44 months (15-108 months), The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95% and 94%, respectively. A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002) and parametrial extension (p=0.0001) affected the disease-free survival. From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival. Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients) and lymphedema of the leg (1 patient). No patient had grade 3 or 4 complications. Our results indicate that postoperative radiation therapy can

  16. Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

    further assessed. Conclusion: dMR-HSG with cervical cannulation and intracavitary gadolinium injection is feasible and allows assessment of the uterus, the fallopian tubes, and extra-uterine pelvic structures, while avoiding all ionizing radiation in infertile women aiming at pregnancy

  17. FIGO Stage IIIB squamous cell carcinoma of the uterine cervix: natural history, treatment results, and prognostic factors

    Purpose: To define patient, tumor, and treatment factors that influence the outcome of patients with FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix. Materials and Methods: The hospital and radiotherapy records of 1007 consecutive patients treated between 1960 and 1989 for FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix were reviewed retrospectively. All patients were treated with radiation therapy (RT) either with curative intent (903 patients) or to palliate symptoms (104 patients). Patients who were selected for palliative treatment usually had a combination of adverse characteristics including massive tumor with bilateral pelvic wall fixation, hydronephrosis, bulky adenopathy, pathologic evidence of extrapelvic disease, and poor performance status. 64 (7%) of 903 patients failed to complete planned curative RT either because of progressive disease, complications, or poor compliance. Of 903 patients treated with curative intent, 319 (35%) were treated with external beam radiotherapy (EBRT) alone and 586 (65%) were treated with a combination of EBRT and intracavitary irradiation (ICRT). EBRT was usually delivered using 18-25 MV photons and ICRT was administered with Fletcher-Suit-Delclos applicators. Treatment philosophies evolved during the study period with greater emphasis placed on EBRT between 1966 and 1979 (52% treated with EBRT alone) compared with the other study years (15% treated with EBRT alone). 206 patients received investigational treatments including neutrons (69 pts), hyperbaric oxygen (66 pts), concurrent chemotherapy (29 pts), or neoadjuvant chemotherapy (42 pts). 875 patients have been followed until death. Median follow up for surviving patients is 171 months with only 9 surviving patients followed for 10%, or hgb < 10 gm% before treatment or at any time during radiotherapy. DSS was significantly better for patients whose treatment included ICRT (43% vs 21%; P< 0.0001). Also, patients who received

  18. Dynamic rotating-shield brachytherapy

    Purpose: To present dynamic rotating shield brachytherapy (D-RSBT), a novel form of high-dose-rate brachytherapy (HDR-BT) with electronic brachytherapy source, where the radiation shield is capable of changing emission angles during the radiation delivery process.Methods: A D-RSBT system uses two layers of independently rotating tungsten alloy shields, each with a 180° azimuthal emission angle. The D-RSBT planning is separated into two stages: anchor plan optimization and optimal sequencing. In the anchor plan optimization, anchor plans are generated by maximizing the D90 for the high-risk clinical-tumor-volume (HR-CTV) assuming a fixed azimuthal emission angle of 11.25°. In the optimal sequencing, treatment plans that most closely approximate the anchor plans under the delivery-time constraint will be efficiently computed. Treatment plans for five cervical cancer patients were generated for D-RSBT, single-shield RSBT (S-RSBT), and 192Ir-based intracavitary brachytherapy with supplementary interstitial brachytherapy (IS + ICBT) assuming five treatment fractions. External beam radiotherapy doses of 45 Gy in 25 fractions of 1.8 Gy each were accounted for. The high-risk clinical target volume (HR-CTV) doses were escalated such that the D2cc of the rectum, sigmoid colon, or bladder reached its tolerance equivalent dose in 2 Gy fractions (EQD2 with α/β= 3 Gy) of 75 Gy, 75 Gy, or 90 Gy, respectively.Results: For the patients considered, IS + ICBT had an average total dwell time of 5.7 minutes/fraction (min/fx) assuming a 10 Ci192Ir source, and the average HR-CTV D90 was 78.9 Gy. In order to match the HR-CTV D90 of IS + ICBT, D-RSBT required an average of 10.1 min/fx more delivery time, and S-RSBT required 6.7 min/fx more. If an additional 20 min/fx of delivery time is allowed beyond that of the IS + ICBT case, D-RSBT and S-RSBT increased the HR-CTV D90 above IS + ICBT by an average of 16.3 Gy and 9.1 Gy, respectively.Conclusions: For cervical cancer patients, D

  19. Risk groups in pathologic stage III endometrial carcinoma

    Purpose: Pathologic stage III (pIII) endometrial carcinoma is a heterogeneous group ranging from patients (pts) with positive washings alone to those with involved lymph nodes and multiple extra-uterine disease sites. Patients are traditionally grouped into two subsets (A and C). This approach, however, may fail to differentiate between pt groups with markedly different prognoses. Our goal was to stratify pIII pts into prognostic groups based on sites of extrauterine disease and pathologic features in the surgical specimen. Methods/Materials: Seventy-six pIII (46 IIIA, 30 IIIC) endometrial carcinoma pts were treated between (6(80)) and (6(95)). Median age was 65 years (range, 25-83). Stage IIIA subsets included isolated washings, serosal or adnexal involvement in 14, 11 and 11 pts, respectively. Ten had multiple extrau-terine sites without nodal involvement. Most tumors were adenocarcinomas (ACA) (59%), were grades II-III (87%) and had deep myometrial invasion (71%). Patients underwent TAH-BSO with lymph node sampling (in 79%) and evaluation of washings (in 78%). Sixty-one (79%) received radiation therapy (RT), predominantly pelvic +/- para-aortic/intracavitary RT. Chemo- and hormonal therapy were given in 22% and 21%, respectively. After first stratifying pts into 3 prognostic groups (Low, Intermediate and High risk) based on sites of extrauterine disease (washings, adnexa, serosal involvement and lymph nodes), we evaluated the prognostic impact of pathologic features (grade, histology, cervical involvement, myometrial and lymphovascular invasion) within each risk group. Median followup (surviving pts) was 50 months (range, 5-157). Results: The 5-year actuarial disease-free (DFS) and cause-specific (CSS) survivals of the entire group were 49.1% and 62.3%, respectively. Low risk pts were identified to have either positive washings alone or adnexal involvement alone. Intermediate risk pts had either serosal involvement alone or synchronous positive washings and

  20. Long-term survival of hypoxia radiotherapy for carcinoma of uterine cervix

    Objective: To evaluate the relationship between long-term survival rate and protection to marrow and lymphoid tissues in the pelvis with hypoxia radiotherapy for uterine cervical carcinoma. Methods: 113 patients, confirmed as having carcinoma of uterine cervix by pathology, were randomly divided by the envelope method into two groups: hypoxia radiotherapy group (HRG, 57 patients) and conventional radiotherapy group (CRG, 56 patients). HRG was given by sustained inhaling hypoxia gas (oxygen physical volume = 0.105) for two minutes before the start of radiotherapy till the end of radiotherapy of each field and then repeated for the other field in the same way. The duration of irradiation to each field was less than five minutes. CRG was given with conventional radiotherapy. The irradiation dose in the midpelvical plane was 20-50 Gy depending on the different stages of cervical carcinomatous lesion. The dose of four-divided-field in the parametria was 15-34 Gy. The dose at point A of intracavitary therapy was 15-35 Gy. Results: The decreased value of peripheral blood white cells after treatment was (1.36 ± 1.27) x 109/L in HRG and (2.97±1.19) x 109/L in CRG(P<0.05). E flower ring test (EFRT) increased by (6.00 ± 2.39)% and lymphocyte transformation rate(LTR) increased by (3.78±1.83)% in HRG, but decreased by (3.97±1.88)% and (4.47±1.73)% in CGR(P<0.01). The 5-year survival rate was 65% in HRG and 57% in CRG(P<0.05). The incidence of complications such as radiation proctitis and radiocystitis was also of statistically significant (P< 0.01, 0.05). Conclusions: Hematopoisis and columnar immunity can be protected by hypoxia radiotherapy for uterine cervical cancer. As a result, both long-term survival rate and life quality of patients are expected to be improved. (authors)

  1. Maximum and mean bladder dose defined from ultrasonography. Comparison with the ICRU reference in gynaecological brachytherapy

    The reference bladder dose for gynaecological intracavitary brachytherapy (BT), as defined by the ICRU 38 Report, is often criticised as it is seldom representative of the highest bladder dose nor it gives an idea of the area exposed to a significant dose. Since November 1990, ultrasound measurements are routinely made in order to determine the actual dose delivered to the bladder of each patient. The technique was as follows. (1) the bladder is filled up with 150-200 cm3 of sterile isotonic saline. (2) The intra-uterine position of the tube is checked. (3) The bladder anatomy is controlled. (4) Points of measurements are identified: ICRU bladder reference, minimum distance between bladder mucosa, uterine tube and other similar measurements taken ever 15 mm along the radio-active line. Maximum and mean doses are calculated at the sagittal plane. Measurements are performed by moving the transducer along the skin of the patient and included in the calculation of dose distribution. Doses delivered to each relevant point are compared. This enables determination to be made of the differences between the ICRU and the doses actually observed at the bladder wall with aid of ultrasonography. BT applications were checked in 58 patients (69 measurements). The method was feasible in all cases. The comparison between ICRU dose from orthogonal films and the ICRU dose from ultrasonography resulted in a 90% accuracy. The maximum and mean doses for utero-vaginal BT are higher than the ICRU dose in 75% of cases (range, 2-8). Measurements are now abandoned for vaginal applications as the ICRU dose only could be measured. A single G3 complication was observed after 20 months in a patient in whom a high bladder dose was planned intentionally. The conclusion is that it is expected that this new approach will be of help to decrease the rate of severe complications by pointing out those patients in which there is a large discrepancy between the ICRU dose and doses determined with aid of

  2. Analysis of the perception of risk of radiotherapy services in the metropolitan region of Rio de Janeiro using the risk evaluation system in radiotherapy (SEVRRA / FORUM)

    In this work it was possible to analyze the perception of risks associated with existing processes in the high-dose rate brachytherapy and teletherapy using linear accelerators of radiotherapy services in the metropolitan area of Rio de Janeiro, through the combined use of two proposed methods: FMECA and risk matrix, using a general analysis and other more specific ones. The database software (SEVRRA) was used to identify possible existing processes in radiotherapy services (brachytherapy and teletherapy) and to classify the sequence of events in risk levels. The risk levels were analyzed at each stage and sub-stage, present in the treatment of patients undergoing high dose rate gynecological intracavitary brachytherapy and teletherapy treatments with the use of linear accelerators applying electron or photon beams in order to establish recommendations to the risks of highest priority for each case. The results show that although the procedure of high dose rate brachytherapy be automated and less susceptible to errors or failures, daily, one can still find considerable amounts of processes with worrying levels of risk perception. The processes that are more subject to radiological accident risks was associated with procedures, for of which the majority of the failures record and planning step of the treatment. The controls analyzed showed low efficiency, warning of the need to seek and implement new more efficient controls in routine brachytherapy for each participant service. About teletherapy procedure it was found that most of the failures were related to the registration and planning of treatment and equipment stages. The controls analyzed to teletherapy showed a poor result with a first type of analysis performed by suggesting a new type of more appropriate analysis. With a second type of analysis, these controls could be better analyzed and showed an order of importance according to a percentage of efficiency. Controls such as 'Double-check', &apos

  3. Analysis of the perception of risk of radiotherapy services in the metropolitan region of Rio de Janeiro using the risk evaluation system in radiotherapy (SEVRRA / FORUM); Analise da percepcao de risco de servicos de radioterapia da regiao metropolitana do Rio de Janeiro usando o sistema de avaliacao de risco em radioterapia (SEVRRA/FORO)

    Burgos, Adam de Freitas

    2015-07-01

    In this work it was possible to analyze the perception of risks associated with existing processes in the high-dose rate brachytherapy and teletherapy using linear accelerators of radiotherapy services in the metropolitan area of Rio de Janeiro, through the combined use of two proposed methods: FMECA and risk matrix, using a general analysis and other more specific ones. The database software (SEVRRA) was used to identify possible existing processes in radiotherapy services (brachytherapy and teletherapy) and to classify the sequence of events in risk levels. The risk levels were analyzed at each stage and sub-stage, present in the treatment of patients undergoing high dose rate gynecological intracavitary brachytherapy and teletherapy treatments with the use of linear accelerators applying electron or photon beams in order to establish recommendations to the risks of highest priority for each case. The results show that although the procedure of high dose rate brachytherapy be automated and less susceptible to errors or failures, daily, one can still find considerable amounts of processes with worrying levels of risk perception. The processes that are more subject to radiological accident risks was associated with procedures, for of which the majority of the failures record and planning step of the treatment. The controls analyzed showed low efficiency, warning of the need to seek and implement new more efficient controls in routine brachytherapy for each participant service. About teletherapy procedure it was found that most of the failures were related to the registration and planning of treatment and equipment stages. The controls analyzed to teletherapy showed a poor result with a first type of analysis performed by suggesting a new type of more appropriate analysis. With a second type of analysis, these controls could be better analyzed and showed an order of importance according to a percentage of efficiency. Controls such as 'Double-check', &apos

  4. Injuries of the sigmoid colon following radiation therapy for carcinoma of the uterine cervix

    Grade 2 or 3 injuries of the sigmoid colon were observed in 4 of 42 patients with carcinoma of the uterine cervix who were treated by radiation therapy. The irradiation was planned as the combination of the external irradiation (whole pelvic 30 Gy and 20 Gy with central shielding by 25 fractions, 5 weeks) and the intracavitary irradiation (RALS, 19 Gy at point A by 3 fractions). To analyze the causes of the radiation sigmoiditis, we have investigated the following factors: age, dose at point A, dose at point C, grade of tandem dislocation, uterine angle, obesity score, evidence of previous surgery to the pelvic cavity and hypertension. The dose at point C and the grade of tandem dislocation were determined from the confirming X-Ps at RALS therapy and external irradiation. The superimposition of these films was performed with corrections for the angle between the projection direction of the X-Ps and the vertical magnification factor of the central shielding area. Point C was defined as a point 2 cm anterior to the intersection of the tandem axis and a curvilinear line 1 cm outside from the margin of central shield on the X-Ps. Grades of tandem disclocation were decided as the number of tandem tips outside of the central shielding area on X-Ps. The doses at point C showed very high statistical significance (p<0.001) with the evidence of radiation sigmoiditis. All the cases with radiation sigmoiditis received over 1290 cGy at point C. Age had also some significance (p<0.05) with radiation sigmoiditis. Other factors showed no significant relationship. Among the patients receiving more than 1280 cGy at point C, injury free cases had over 30% obesity score except for one case. This exceptional patient had 12% obesity score and was in special condition of hydrometra. In conclusion, the dose at point C will be an index of injuries of the sigmoid colon following radiation therapy, and obesity score and condition of the uterus seem to be additional factors. (J.P.N.)

  5. Trends in the use of radiation and chemotherapy in the initial management of patients with carcinoma of the uterine cervix

    Purpose: The Commission on Cancer of the American College of Surgeons conducts Patient Care Evaluation studies to describe practice patterns and trends in disease management. This report surveys changing strategies in the initial treatment of patients with invasive cancer of the uterine cervix. Methods and Materials: Using a standard data collection form designed by a multidisciplinary committee of specialists, cancer registrars at 703 hospitals submitted anonymous data on 11,721 total cervical cancer patients diagnosed in 1984 and 1990. Results: Between the two study years, the use of radiation as all, or a component, of the initial course of therapy declined from 70 to 60.3%, coincident with a 32.3% increase in the use of hysterectomy alone and a 33.7% reduction in the use of radiation alone. The percentage of all patients receiving combined hysterectomy and radiation (preoperative or postoperative) remained virtually unchanged--10.2% in 1984, and 9.3% in 1990. However, women who were treated by hysterectomy in 1990 were less likely to receive radiation as part of their treatment than patients treated by hysterectomy in 1984. Among patients treated by radiation without hysterectomy, the use of intracavitary brachytherapy techniques substantially exceeded interstitial brachytherapy techniques in both study years. Among patients treated by local radiation without hysterectomy, the frequency of adjunctive chemotherapy use increased from 6.9% in 1984 to 24.8% in 1990, with chemotherapy and radiation increasingly administered concurrently rather than sequentially. Although differences based on age, histology, race/ethnicity, and insurance status were observed, these general management trends were seen in all groups. Conclusions: Changes in the utilization of radiation and surgery may reflect the increasing surgical involvement of gynecologic oncologists in the management of early stage cervical cancer, rather than significant alterations in the demographics of the

  6. Dosimetry experience of 192IR sources used In HDR brachytherapy for cervical cancer

    Purpose/Objective: The 192IR Sources are the most commonly used in radiotherapy treatments HDR worldwide. According to international recommendations on quality assurance in HDR brachytherapy, an acceptance test based on the determination of the source strength of any new source shall be carried out before first application to verify the manufacturer’s calibration data. The present paper gives the experimental determination of the source strength for our brachytherapy sources used until now in brachytherapy treatments. Materials/Methods: At Mother Teresa University Hospital we have a cost-effective gynecological brachytherapy unit from Eckert & Ziegler BEBIG named GyneSource® that is a five channel HDR after loader equipped with an 192IR source. The software used is HDR plus™ 2.5 that delivers an optimized treatment plan and makes the process especially fast and we use intracavitary BEBIG applicators. From April 2009 up to December 2012, we have imported nine HDR 192IR Sources. The exchange of the source and acceptance test is done by the physicist of the clinic once the source is imported. The measurements are done with a Well-type ionization chamber HDR1000 Plus and the electrometer used is MAX4000. Only seven sources are compared as we miss the dosimetry data of the first source, and the forth source was not measured and not used because the machine was not working in that time. Results/Conclusions: Eight sources were accepted for clinically use as the measurement were within the tolerance. The source number four with e deviation of -1.92% has been double checked compared with a free in-air measurement with farmer type chamber that gave a deviation to source certificate of 4% that is still inside the tolerance to accept a source for clinical use. The deviations of measured Air Kerma rate to the value of the sources certificates of all our used 192IR sources are less than 2%, which are within the tolerance. The checked value of updated source strength in

  7. MR thermometry characterization of a hyperthermia ultrasound array designed using the k-space computational method

    Lee Hotaik

    2006-10-01

    Full Text Available Abstract Background Ultrasound induced hyperthermia is a useful adjuvant to radiation therapy in the treatment of prostate cancer. A uniform thermal dose (43°C for 30 minutes is required within the targeted cancerous volume for effective therapy. This requires specific ultrasound phased array design and appropriate thermometry method. Inhomogeneous, acoustical, three-dimensional (3D prostate models and economical computational methods provide necessary tools to predict the appropriate shape of hyperthermia phased arrays for better focusing. This research utilizes the k-space computational method and a 3D human prostate model to design an intracavitary ultrasound probe for hyperthermia treatment of prostate cancer. Evaluation of the probe includes ex vivo and in vivo controlled hyperthermia experiments using the noninvasive magnetic resonance imaging (MRI thermometry. Methods A 3D acoustical prostate model was created using photographic data from the Visible Human Project®. The k-space computational method was used on this coarse grid and inhomogeneous tissue model to simulate the steady state pressure wavefield of the designed phased array using the linear acoustic wave equation. To ensure the uniformity and spread of the pressure in the length of the array, and the focusing capability in the width of the array, the equally-sized elements of the 4 × 20 elements phased array were 1 × 14 mm. A probe was constructed according to the design in simulation using lead zerconate titanate (PZT-8 ceramic and a Delrin® plastic housing. Noninvasive MRI thermometry and a switching feedback controller were used to accomplish ex vivo and in vivo hyperthermia evaluations of the probe. Results Both exposimetry and k-space simulation results demonstrated acceptable agreement within 9%. With a desired temperature plateau of 43.0°C, ex vivo and in vivo controlled hyperthermia experiments showed that the MRI temperature at the steady state was 42.9 ± 0.38

  8. Radiotherapy for superficial esophageal cancer of poor risk patients

    Purpose/Objective: The reported incidence of superficial esophageal cancer (SEC) has steadily increased in Japan as result of endoscopic examination has been become common. In Japan, treatment of SEC is endoscopical mucosal resection (EMR) for mucosal cancer or esophagectomy with 3 fields lymph nodes resection for submucosal cancer. Radiotherapy is little place for the management of SEC. Because of some reasons, we treated patients with SEC by radiotherapy alternative to surgery. Purpose of this report is to evaluate efficacy of radiotherapy for SEC. Methods and Materials: Between 1989 to 1996, eighteen patients with SEC were treated with radiotherapy at our hospital. Reasons of radiotherapy that was chosen as the primary methods of treatment were refusal of surgery in one patient, poor medical condition in 4 patients and double primary cancer in 13 patients (head and neck: 11, simultaneously: 11). No patients had indication of EMR. Diagnosis was made by endoscopy and radiography. Some patients were examined with endoscopic ultrasound. Two patients (11.1%) had tumor limited to the mucosa and 16 patients (88.9%) had tumor invaded the submucosa. Seven of these tumors (38.9%) were multicentric. All patients had squamous cell carcinoma. There were 17 male patients and one female patient. The age range was 49 years to 87 years with a median of 62 years. Stage of all patients was T1N0M0 according to UICC staging system. Ten patients underwent external radiotherapy (Ex) (50 Gy - 66 Gy) alone and 8 patients did both Ex and intracavitary radiotherapy (IC) (30-60 Gy of Ex with 5-15 Gy of IC). No patients received chemotherapy. Duration of follow-up was 6 months to 96 months with a median of 30 months. Results: The overall survival rate was 55.9% in 3-year and 14% in 5-year, and the cause-specific 5-year survival rate was 100%. Causes of death were malignant tumor other than esophageal cancer in 4 patients, intercurrent disease other than malignant tumor in 3 patients and no

  9. Targeting of pegylated liposomal mitomycin-C prodrug to the folate receptor of cancer cells: Intracellular activation and enhanced cytotoxicity.

    Patil, Yogita; Amitay, Yasmine; Ohana, Patricia; Shmeeda, Hilary; Gabizon, Alberto

    2016-03-10

    FR lymphoma cells, the tumor cell levels of MLP were significantly greater with the folate-targeted liposomes. Thus, folate targeting enhances liposome uptake by tumor cells enabling intracellular activation of prodrug in the absence of exogenous reducing agents, and leading to increased cytotoxicity. These results may be particularly relevant to the application of folate-targeted PL-MLP in intracavitary or intravesical treatment of cancer. PMID:26809007

  10. Animal experiments and clinical trials of 166Ho-Chitosan for various cancers

    166Ho-Chitosan is a complex of 166Ho and N-glucosamine with 400 to 500 kD MW, which chelates metal ions and degrades slowly in vivo. In mice, 166H-Chitosan administered intraperitoneally was uniformly bound to the peritoneal wall (94%), and the surface dose calculated by Monte Carlo simulation (EGS 4 code) was 81 Gy/uCi/cm2. 166Ho-Chitosan was administered intraperitoneally as an adjunct in the treatment of ovarian cancer with diffuse spread of malignant cells in the peritoneal surfaces including the diaphragm. 97-99% of 166Ho-Chitosan was localized within the peritoneal cavity, and more than 90% of 166Ho-Chitosan was attached to the peritoneal wall. Partial response were observed in 4 among 5 patients with ovarian cancer without severe toxicity. Intracavitary radiation therapy with 166Ho-Chitosan in the cystic brain tumor, 5 or 8 cysts were shrunken in size with thinning of the wall, 2 out of 8 showed growth retardation. For large or multiple primary liver cancers, which were inoperable and resistent to chemotherapy. 166Ho-Chitosan was used for intraarterial injection, because this solution became gel with neutral pH. In the primary liver cancer, radioactivity was distributed in the territory of selected hepatic arterial branch, and partial responses were observed in 2 cases. For the large solitary liver tumor, which was not operable due to its location, direct intratumoral injection of the radioisotope had a limited response. 18FDG PET was a useful tool to follow up those radionuclide therapy, and guide to plan the next therapy. In one case of the large single metastatic stomach cancer in the liver, 18FDG PET was done two weeks after intratumoral injection of 166Ho-Chitosan, which showed cold defects matched with distribution of 166Ho-Chitosan, and second injection was guided by PET image. Various methods of the administration of 166Ho-Chitosan could be used for the treatment of the cancers. (author)

  11. Carcinoma of the cervix: patterns of care studies: review of 1978, 1983, and 1988-1989 surveys

    Purpose: A review of the Patterns of Care Studies Process Survey data on carcinoma of the cervix conducted on patients in 1978, 1983, and 1988-89 was carried out to identify changes or trends in the demographics, evaluation, and treatment that might have occurred over this time period. Methods and Materials: Patterns of Care Studies conducted surveys on patients treated by radiation therapy for cervical carcinoma in 1978, 1983, and 1988-89. These surveys have compiled demographic and treatment data on a total of 993 patients. There is outcome data for the 1978 and 1983 surveys, but not for the 1988-89 survey because follow-up has not been collected yet. The demographic and treatment delivery data on all three surveys has been reviewed and analyzed and is the subject of this study. Results: There was no difference in the age distribution at the time of diagnosis of the patients in these surveys. The percentage of black patients remained constant in the three surveys, 19%, 17%, and 21%, respectively. The percentage of white patients was 76%, 78%, and 67%, but that of nonwhite/nonblack patients was 3%, 4%, and 12% (p 60Co units decreased from 35 to 2% from the first to the third survey [6 to 0% for short source-surface distance (SSD) 60Co units]. Point dose calculations for the intracavitary therapy increased from 78% in the 1978 survey to 95% in the third survey. As determined by the total dose delivered to the paracentral points, more patients (75.1%) were treated according to the Patterns of Care recommended guidelines in the 1988-89 survey than in the 1983 survey (63.6%). Chemotherapy was given to 12% of the patients undergoing radiation therapy during the period of the third survey, but these data are not available for the first and second surveys. Conclusion: Review of the Carcinoma of the Cervix Patterns of Care studies discloses significant changes in the demographics, patient evaluation, and radiation therapy techniques during the period of the studies. The

  12. Insufficiency Fractures After Pelvic Radiation Therapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

    Tokumaru, Sunao, E-mail: tokumaru@cc.saga-u.ac.jp [Department of Heavy Particle Therapy and Radiation Oncology, Saga University, Saga (Japan); Toita, Takafumi [Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa (Japan); Oguchi, Masahiko [Radiation Oncology Department, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kato, Shingo [Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (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, Matsuyama (Japan); Shikama, Naoto [Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (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, Tuskuba (Japan); Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita (Japan); Kagami, Yoshikazu [Department of Radiology, Showa University School of Medicine, 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); and others

    2012-10-01

    Purpose: To investigate pelvic insufficiency fractures (IF) after definitive pelvic radiation therapy for early-stage uterine cervical cancer, by analyzing subjects of a prospective, multi-institutional study. Materials and Methods: Between September 2004 and July 2007, 59 eligible patients were analyzed. The median age was 73 years (range, 37-84 years). The International Federation of Gynecologic Oncology and Obstetrics stages were Ib1 in 35, IIa in 12, and IIb in 12 patients. Patients were treated with the constant method, which consisted of whole-pelvic external-beam radiation therapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions without chemotherapy. After radiation therapy the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. The CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as signal intensity changes in the bones, both on T1- and T2-weighted images. Results: The median follow-up was 24 months. The 2-year pelvic IF cumulative occurrence rate was 36.9% (21 patients). Using Common Terminology Criteria for Adverse Events version 3.0, grade 1, 2, and 3 IF were seen in 12 (21%), 6 (10%), and 3 patients (5%), respectively. Sixteen patients had multiple fractures, so IF were identified at 44 sites. The pelvic IF were frequently seen at the sacroileal joints (32 sites, 72%). Nine patients complained of pain. All patients' pains were palliated by rest or non-narcotic analgesic drugs. Higher age (>70 years) and low body weight (<50 kg) were thought to be risk factors for pelvic IF (P=.007 and P=.013, Cox hazard test). Conclusions: Cervical cancer patients with higher age and low body weight may be at some risk for the development of pelvic IF after pelvic radiation therapy.

  13. Evaluation of intra- and inter-fraction movement of the cervix during intensity modulated radiation therapy

    Background and purpose: To assess the degree of intra- and inter-fraction cervical motion throughout a course of intensity modulated radiation therapy (IMRT) for cervical cancer patients. Materials and methods: A retrospective study of 10 women with stage 1B1-3B cervical cancer diagnosed from September 2007 to July 2008 was conducted. All patients were treated with chemoradiation using IMRT followed by intracavitary brachytherapy. Pretreatment, patients had 2 seeds placed at a depth of 10 mm into the cervix. On-Board Imaging (OBI) was used to obtain anterior/posterior (AP) and lateral X-rays before and after each treatment. OBI images were rigidly aligned to baseline digitally reconstructed radiographs (DRRs), and movement of cervical seeds was determined in the lateral, vertical, and AP directions. Mean differences in cervical seed position and standard error of the mean (SEM) were calculated. Results: A total of 922 images were reviewed, with approximately 90 images per patient. The mean intra-fractional movement in cervical seed position in the lateral, vertical, and AP directions were 1.6 mm (SD ± 2.0), 2.6 mm (SD ± 2.4), and 2.9 mm (SD ± 2.7), respectively, with a range from 0 to 15 mm for each direction. The mean inter-fractional movement in the lateral, vertical, and AP directions were 1.9 mm (SD ± 1.9), 4.1 mm (SD ± 3.2), and 4.2 mm (SD ± 3.5), respectively, with a range from 0 to 18 mm for each direction. Conclusions: This is the first study to assess intra- and inter-fractional movement of the cervix using daily imaging before and after each fraction. Within and between radiation treatments, cervical motion averages approximately 3 mm in any given direction. However, maximal movement of the cervix can be as far as 18 mm from baseline. This wide range of motion needs to be accounted for when generating planning treatment volumes.

  14. Ambulatory patient classifications and the regressive nature of medicare reform: is the reduction in outpatient health care reimbursement worth the price?

    Purpose: To evaluate the impact of the proposed Ambulatory Patient Classification (APC) system on reimbursement for hospital outpatient Medicare procedures at the Massachusetts General Hospital (MGH) Department of Radiation Oncology. Methods and Materials: Treatment and cost data for the MGH Department of Radiation Oncology for the fiscal year 1997 were analyzed. This represented 66,981 technical procedures and 41 CPT-4 codes. The cost of each procedure was calculated by allocating departmental costs to the relative value units (RVUs) for each procedure according to accepted accounting principles. Net reimbursement for each CPT-4 procedure was then calculated by subtracting its cost from the allowed 1998 Boston area Medicare reimbursement or from the proposed Boston area APC reimbursement. The impact of the proposed APC reimbursement system on changes in reimbursement per procedure and on volume-adjusted changes in overall net reimbursements per procedure was determined. Results: Although the overall effect of APCs on volume-adjusted net reimbursements for Medicare patients was projected to be budget-neutral, treatment planning revenues would have decreased by 514% and treatment delivery revenues would have increased by 151%. Net reimbursements for less complicated courses of treatment would have increased while those for treatment courses requiring more complicated or more frequent treatment planning would have decreased. Net reimbursements for a typical prostate interstitial implant and a three-treatment high-dose-rate intracavitary application would have decreased by 481% and 632%, respectively. Conclusion: The financial incentives designed into the proposed APC reimbursement structure could lead to compromises in currently accepted standards of care, and may make it increasingly difficult for academic institutions to continue to fulfill their missions of research and service to their communities. The ability of many smaller, low patient volume, high Medicare

  15. Californium-252 Neutron Therapy in China

    Californium-252 brachytherapy, believed to be the most successful source for neutron therapy, gives most of the cures as well as long-term and complication-free survivals. Chinese radiation oncologists were interested in californium neutron therapy (Cf-NT) in the early 1980s, but 252Cf sources for medical use were not available in China until 1992 when a californium joint venture was established by the China Institute of Atomic Energy (Beijing) and the Research Institute for Nuclear Reactors (Dimitrovgrad) of Russia. In 1995, 25 seeds of 252Cf with a strength of 3 μg each were sent to China for preclinical investigation. Three years later, a high dose rate (HDR) 252Cf source was imported and transferred into a home-made remote after-loader for intracavitary treatment in Chongqing, and a clinical trail was started in February 1999. This is the first time that Cf-NT was performed for cancer patients in China. Since then, Cf-NT in China has developed rapidly. It is estimated that one-tenth of those radiation oncology centers with brachytherapy practice will be equipped with californium units in 5 yr. That means more than 30 units will be in use in hospitals. That is significant compared with other countries, but it is just one, on average, for each province or one per 40 million people in China. Progress also has been achieved in the 252Cf treatment delivery equipment. Preliminary clinical trails showed complete response observed in all cases treated, with a rapid clearance of tumors and mild reactions in normal tissues. The short-term results are quite encouraging. To deal with problems due to the demand for Cf-NT in China, attention should be paid to the following particulars: (1) A high-strength miniature source is needed for HDR/MDR interstitial therapy to extend the Cf-NT coverage. (2) Basic work on radiophysics and radiobiology needs to be done, including source calibration, clinical dosimetry, clinical RBE determination, and Cf-NT quality assurance

  16. Adjuvant postoperative radiation therapy for carcinoma of the uterine cervix

    This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelvic lymph node dissection. Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study, The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, Iymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy. All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy. The radiation dose from the external beam to the whole pelvis was 45 - 50 Gy. Vagina cuff irradiation was performed, after completion of the external beam irradiation, al a low-dose rate of CS-137, with the total dose of 4488-4932 chy (median: 4500 chy) at 5 mm depth from the vagina surface. The median follow-up period was 44 months (15-108 months), The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95% and 94%, respectively. A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002) and parametrial extension (p=0.0001) affected the disease-free survival. From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival. Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients) and lymphedema of the leg (1 patient). No patient had grade 3 or 4 complications. Our results indicate that postoperative radiation therapy can

  17. Assessing cumulative dose distributions in combined radiotherapy for cervical cancer using deformable image registration with pre-imaging preparations

    The purpose of the study was to evaluate the feasibility of deformable image registration (DIR) in assessing cumulative dose distributions of the combination of external beam radiotherapy (EBRT) and fractionated intracavitary brachytherapy (ICBT) for cervical cancer. Three-dimensional image data sets of five consecutive patients were used. The treatment plan consisted of whole pelvic EBRT (total dose: 45 Gy in 25 fractions) combined with computed tomography (CT)-based high-dose rate ICBT (≥24 Gy in 4 fractions to the high risk clinical target volume (HR-CTV)). Organs at risk and HR-CTV were contoured on each CT images and dose-volume parameters were acquired. Pre-imaging preparations were performed prior to each ICBT to minimize the uncertainty of the organ position. Physical doses of each treatment were converted to biologically equivalent doses in 2 Gy daily fractions by the linear quadratic model. Three-dimensional dose distributions of each treatment were accumulated on CT images of the first ICBT using DIR with commercially available image registration software (MIM Maestro®). To compare with DIR, 3D dose distributions were fused by rigid registration based on bony structure matching. To evaluate the accuracy of DIR, the Dice similarity coefficient (DSC) was measured between deformed contours and initial contours. The cumulative dose distributions were successfully illustrated on the CT images using DIR. Mean DSCs of the HR-CTV, rectum, and bladder were 0.46, 0.62 and 0.69, respectively, with rigid registration; and 0.78, 0.76, and 0.87, respectively, with DIR (p <0.05). The mean DSCs derived from our DIR procedure were comparable to those of previous reports describing the quality of DIR algorithms in the pelvic region. DVH parameters derived from the 2 methods showed no significant difference. Our results suggest that DIR-based dose accumulation may be acceptable for assessing cumulative dose distributions to assess doses to the tumor and organs at risk

  18. Carbon-ion radiotherapy for marginal lymph node recurrences of cervical cancer after definitive radiotherapy: a case report

    Recurrences of cervical cancer after definitive radiotherapy often occur at common iliac or para-aortic lymph nodes as marginal lymph node recurrences. Patients with these recurrences have a chance of long-term survival by optimal re-treatment with radiotherapy. However, the re-irradiation often overlaps the initial and the secondary radiotherapy fields and can result in increased normal tissue toxicities in the bowels or the stomach. Carbon-ion radiotherapy, a form of particle beam radiotherapy using accelerated carbon ions, offers more conformal and sharp dose distribution than X-ray radiotherapy. Therefore, this approach enables the delivery of high radiation doses to the target while sparing its surrounding normal tissues. Marginal lymph node recurrences in common iliac lymph nodes after radiotherapy were treated successfully by carbon-ion radiotherapy in two patients. These two patients were initially treated with a combination of external beam radiotherapy and intracavitary and interstitial brachytherapy. However, the diseases recurred in the lymph nodes near the border of the initial radiotherapy fields after 22 months and 23 months. Because re-irradiation with X-ray radiotherapy may deliver high doses to a section of the bowels, carbon-ion radiotherapy was selected to treat the lymph node recurrences. A total dose of 48 Gy (RBE) in 12 fractions over 3 weeks was given to the lymph node recurrences, and the tumors disappeared completely with no severe acute toxicities. The two patients showed no evidence of disease for 75 months and 63 months after the initial radiotherapy and for 50 months and 37 months after the carbon-ion radiotherapy, respectively. No severe late adverse effects are observed in these patients. The two presented cases suggest that the highly conformal dose distribution of carbon-ion radiotherapy may be beneficial in the treatment of marginal lymph node recurrences after radiotherapy. In addition, the higher biological effect of carbon

  19. Radisynoviorthesis of small and medium joints by means of rhenium sulfide and erbium citrate

    . Conclusions: RSO of medium and small joints reduces volume and activity of synovial tissue and volume of synovial fluid. It decreases intracavitary pressure, pain and secondary destruction of articular structures and postpones surgical invasive therapy. It reduces possible risks from surgical therapy and costs of further treatment. RSO provides these advantages: semi-invasive method with good effect; it can be repeated during the treatment series and it is possible to use RSO as separate therapeutic intervention or as supplement of surgical therapy. (author)

  20. The inSIGHT study: costs and effects of routine hysteroscopy prior to a first IVF treatment cycle. A randomised controlled trial

    Smit Janine G

    2012-08-01

    Full Text Available Abstract Background In in vitro fertilization (IVF and intracytoplasmatic sperm injection (ICSI treatment a large drop is present between embryo transfer and occurrence of pregnancy. The implantation rate per embryo transferred is only 30%. Studies have shown that minor intrauterine abnormalities can be found in 11–45% of infertile women with a normal transvaginal sonography or hysterosalpingography. Two randomised controlled trials have indicated that detection and treatment of these abnormalities by office hysteroscopy after two failed IVF cycles leads to a 9–13% increase in pregnancy rate. Therefore, screening of all infertile women for intracavitary pathology prior to the start of IVF/ICSI is increasingly advocated. In absence of a scientific basis for such a policy, this study will assess the effects and costs of screening for and treatment of unsuspected intrauterine abnormalities by routine office hysteroscopy, with or without saline infusion sonography (SIS, prior to a first IVF/ICSI cycle. Methods/design Multicenter randomised controlled trial in asymptomatic subfertile women, indicated for a first IVF/ICSI treatment cycle, with normal findings at transvaginal sonography. Women with recurrent miscarriages, prior hysteroscopy treatment and intermenstrual blood loss will not be included. Participants will be randomised for a routine fertility work-up with additional (SIS and hysteroscopy with on-the-spot-treatment of predefined intrauterine abnormalities versus the regular fertility work-up without additional diagnostic tests. The primary study outcome is the cumulative ongoing pregnancy rate resulting in live birth achieved within 18 months of IVF/ICSI treatment after randomisation. Secondary study outcome parameters are the cumulative implantation rate; cumulative miscarriage rate; patient preference and patient tolerance of a SIS and hysteroscopy procedure. All data will be analysed according to the intention-to-treat principle

  1. Dynamic rotating-shield brachytherapy

    Liu, Yunlong [Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center, Iowa City, Iowa 52242 (United States); Flynn, Ryan T.; Kim, Yusung [Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States); Yang, Wenjun [Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, Wisconsin 53705 (United States); Wu, Xiaodong [Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center, Iowa City, Iowa 52242 and Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States)

    2013-12-15

    Purpose: To present dynamic rotating shield brachytherapy (D-RSBT), a novel form of high-dose-rate brachytherapy (HDR-BT) with electronic brachytherapy source, where the radiation shield is capable of changing emission angles during the radiation delivery process.Methods: A D-RSBT system uses two layers of independently rotating tungsten alloy shields, each with a 180° azimuthal emission angle. The D-RSBT planning is separated into two stages: anchor plan optimization and optimal sequencing. In the anchor plan optimization, anchor plans are generated by maximizing the D{sub 90} for the high-risk clinical-tumor-volume (HR-CTV) assuming a fixed azimuthal emission angle of 11.25°. In the optimal sequencing, treatment plans that most closely approximate the anchor plans under the delivery-time constraint will be efficiently computed. Treatment plans for five cervical cancer patients were generated for D-RSBT, single-shield RSBT (S-RSBT), and {sup 192}Ir-based intracavitary brachytherapy with supplementary interstitial brachytherapy (IS + ICBT) assuming five treatment fractions. External beam radiotherapy doses of 45 Gy in 25 fractions of 1.8 Gy each were accounted for. The high-risk clinical target volume (HR-CTV) doses were escalated such that the D{sub 2cc} of the rectum, sigmoid colon, or bladder reached its tolerance equivalent dose in 2 Gy fractions (EQD2 with α/β= 3 Gy) of 75 Gy, 75 Gy, or 90 Gy, respectively.Results: For the patients considered, IS + ICBT had an average total dwell time of 5.7 minutes/fraction (min/fx) assuming a 10 Ci{sup 192}Ir source, and the average HR-CTV D{sub 90} was 78.9 Gy. In order to match the HR-CTV D{sub 90} of IS + ICBT, D-RSBT required an average of 10.1 min/fx more delivery time, and S-RSBT required 6.7 min/fx more. If an additional 20 min/fx of delivery time is allowed beyond that of the IS + ICBT case, D-RSBT and S-RSBT increased the HR-CTV D{sub 90} above IS + ICBT by an average of 16.3 Gy and 9.1 Gy, respectively

  2. Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

    Winter, Leopold; Gluecker, Thomas; Steinbrich, Wolfgang; Pegios, Wassilios (Dept. of Radiology, Univ. Hospital Basel (Switzerland)), e-mail: winterl@uhbs.ch; Steimann, Sabine; De Geyter, Christian (Women' s Hospital, Univ. Hospital Basel (Switzerland)); Froehlich, Johannes M. (Guerbet AG, Zuerich (Switzerland))

    2010-07-15

    further assessed. Conclusion: dMR-HSG with cervical cannulation and intracavitary gadolinium injection is feasible and allows assessment of the uterus, the fallopian tubes, and extra-uterine pelvic structures, while avoiding all ionizing radiation in infertile women aiming at pregnancy

  3. Insufficiency Fractures After Pelvic Radiation Therapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

    Purpose: To investigate pelvic insufficiency fractures (IF) after definitive pelvic radiation therapy for early-stage uterine cervical cancer, by analyzing subjects of a prospective, multi-institutional study. Materials and Methods: Between September 2004 and July 2007, 59 eligible patients were analyzed. The median age was 73 years (range, 37-84 years). The International Federation of Gynecologic Oncology and Obstetrics stages were Ib1 in 35, IIa in 12, and IIb in 12 patients. Patients were treated with the constant method, which consisted of whole-pelvic external-beam radiation therapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions without chemotherapy. After radiation therapy the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. The CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as signal intensity changes in the bones, both on T1- and T2-weighted images. Results: The median follow-up was 24 months. The 2-year pelvic IF cumulative occurrence rate was 36.9% (21 patients). Using Common Terminology Criteria for Adverse Events version 3.0, grade 1, 2, and 3 IF were seen in 12 (21%), 6 (10%), and 3 patients (5%), respectively. Sixteen patients had multiple fractures, so IF were identified at 44 sites. The pelvic IF were frequently seen at the sacroileal joints (32 sites, 72%). Nine patients complained of pain. All patients' pains were palliated by rest or non-narcotic analgesic drugs. Higher age (>70 years) and low body weight (<50 kg) were thought to be risk factors for pelvic IF (P=.007 and P=.013, Cox hazard test). Conclusions: Cervical cancer patients with higher age and low body weight may be at some risk for the development of pelvic IF after pelvic radiation therapy.

  4. 毛细血管扩张型骨肉瘤MRI特征

    2013-01-01

      目的探讨毛细血管扩张型骨肉瘤MRI表现特征。方法回顾性分析13例毛细血管扩张型骨肉瘤MRI表现。结果13例毛细血管扩张型骨肉瘤发生于股骨远端4例、肱骨近端7例、腓骨上段2例。膨胀性骨质破坏9例(骨质破坏区大部分边缘不清并无硬化边),12例骨皮质筛孔样改变,13例均可见不同程度骨膜反应,9例出现Codman三角,均可见软组织肿块,软组织肿块大部或完全由多发囊腔构成,其中11例囊腔内见大小不一液-液平面,9例病变区可见斑点状肿瘤骨,增强扫描病变呈包膜和分隔样明显强化。结论毛细血管扩张型骨肉瘤具有相对MRI特征,认识这些特征有助于临床及时正确诊断。%Objective To investigate the characteristics of the telangiectasia osteosarcoma MRI findings. Methods A retrospective analysis of 13 cases of telangiectasia osteosarcoma MRI findings. Results 13 cases of telangiectasia osteosarcoma four cases occurred in the distal femur,proximal humerus 7 cases,the upper fibular 2 cases,the expansion of bone destruction of nine cases,most of the areas of bone destruction there is no clear edge hardened edge 12 cases of cortical bone sieve-like changes,13 patients were seen varying degrees of periosteal reaction,9 cases of Codman triangle are visible soft tissue mass,most of soft tissue mass or multiple cysts,11 cases of intracavitary see the size of mixed liquid - liquid plane,9 lesions punctate tumor bone envelope and separated like enhanced scan lesions were significantly enhanced. Conclusion telangiectatic osteosarcoma tumor has a relatively MRI characteristics,understanding these features contribute to the timely and correct clinical diagnosis.

  5. Literature analysis of high dose rate brachytherapy fractionation schedules in the treatment of cervical cancer: is there an optimal fractionation schedule?

    Purpose: A literature review and analysis was performed to determine whether or not efficacious high dose rate (HDR) brachytherapy fractionation schedules exist for the treatment of cervical cancer. Methods and Materials: English language publications from peer reviewed journals were assessed to calculate the total contribution of dose to Point A from both the external and intracavitary portions of radiation for each stage of cervical cancer. Using the linear quadratic formula, the biologically effective dose to the tumor, using an α/β = 10, was calculated to Point A (Gy10) in order to determine a dose response relationship for local control and survival. Significant complications were assessed by calculating the dose to the late-responding tissues at Point A using an α/β = 3 (Gy3) as a surrogate for normal tissue tolerance, since few publications list the actual bladder and rectal doses. Results: For all stages combined, the median external beam fractionation schedule to Point A was 40 Gy in 20 fractions, while the median HDR fractionation schedule was 28 Gy in 4 fractions. For stages IB, IIB, and IIIB the median biologically effective dose to Point A (Gy10) was 96, 96 and 100 Gy10s, respectively. No correlation was identified between Point A BED (Gy10s) to either survival or pelvic control. A dose response relationship could also not be identified when correlating Point A Gy3s to complications. Conclusion: A dose response relationship could not be identified for either tumor control nor late tissue complications. These findings do not necessarily question the validity of the linear quadratic model, as much as they question the quality of the current HDR brachytherapy literature as it is currently presented and reported. Most of the HDR publications report inadequate details of the dose fractionation schedules. Only a minority of publications report significant complications using the actuarial method. In the future, all HDR publications for the treatment of

  6. Prognostic factors and patterns of failure in pathologic stage II endometrial cancer

    Purpose: Numerous studies have identified prognostic factors and failure patterns in stage I and clinical stage II endometrial cancer. These issues are less defined in pathologic stage II disease (pII) due to a paucity of patient data. Herein, we describe the prognostic significance of patient and tumor factors and patterns of failure in patients with pII disease. Methods/Materials: Fifty-three pts with pII (38 pIIA, 15 pIIB) endometrial cancer were treated between (6(80)) and (6(95)). Median age was 63 years (range, 35-90). Thirty-four pts (64%) were White, 16 (30%) Black and 3 (6%) Hispanic. Most tumors were pure adenocarcinoma (ACA) (66%) and grade 2-3 (77%). All patients underwent TAH-BSO. Nodal sampling and peritoneal washings were performed in 72% and 76%, respectively. Forty-eight (91%) received postoperative external beam pelvic (EBRT) +/- intracavitary RT (ICRT). Patient age ( 60), race (black vs other), stage (pIIA v pIIB), histology (ACA v other), myometrial invasion ( 50%) and grade ((1(2)) v 3) were evaluated. Sites of failure were defined as vaginal cuff, pelvis, para-aortic, and distant. Median followup was 40 months (range, 11-159 months) with 25% of pts followed for > 10 years. Results: The 5-year actuarial vaginal (VC), pelvic (PC) and para-aortic (PAC) controls for the entire group were 86.2%, 95.4% and 89.2%, respectively. The 5-year distant-free (DistFS), disease-free (DFS) and cause-specific (CSS) survivals were 79.6%, 63.7% and 77.5%, respectively. Conclusion: Our results demonstrate the prognostic significance of race and myometrial invasion as well as confirm the significance of stage, histology and grade in pII disease. Postoperative RT is associated with excellent locoregional control in these pts with the predominance of failure in para-aortic and distant sites

  7. Late Rectal Complication in Patients Treated with High Dose Rate Brachytherapy for Stage IIB Carcinoma of the Cervix

    Purpose : This paper reports a dosimetric study of 88 patients treated with a combination of external radiotherapy and high dose rate ICR for FIGO stage IIB carcinoma of the cervix. The purpose is to investigate the correlation between the radiation doses to the rectum. external radiation dose to the whole pelvis. ICR reference volume. TDF, BED and the incidence of late rectal complications, retrospectively. Methods and Materials : From November 1989 through December 1992, 88 patients with stage IIB cervical carcinoma received radical radiotherapy at Department or Radiation Oncology in Yonsei University Hospital. Radiotherapy consisted of 44-54 Gy(median 49 Gy) external beam irradiation plus high dose rate intracavitary brachy therapy with 5 Gy per fraction twice a week to a total dose of 30 Gy on point A. The maximum dose to the rectum by contrast(r,R) and reference rectal dose by ICRU 38(dr, DR) were calculated. The ICR reference volume was calculated by Gamma Dot 3.11 HDR planning system, retrospectively. The time-dose factor(TDF) and the biologically effective dose (BED) were calculated. Results : Twenty seven(30.7%) of the 88 patients developed late rectal complications : 12 patients(13.6%) for grade 1, 12 patients(13.6%) for grade 2 and 3 patients(3.4%) for grade 3. We found a significant correlation between the external whole pelvis irradiation dose and grade 2, 3 rectal complication. The mean dose to the whole pelvis for the group of patients with grade 2, 3 complication was higher, 4093.3±453.1 cGy, than that for the patients without complication 3873.8±415.6 (0.05< p<0.1). This investigation has revealed a significant correlation between the dose calculated at the rectal dose by ICRU 38(DR) or the most anterior rectal dose by contrast(R), dose to the whole pelvis and the incidence of grade 2, 3 late rectal complications in patients with stage IIB cervical cancer undergoing external beam radiotherapy and HDR ICR. Thus these rectal reference points doses

  8. SU-E-T-579: Impact of Cylinder Size in High-Dose Rate Brachytherapy (HDRBT) for Primary Cancer in the Vagina

    Purpose: To evaluate the dosimetric impact of cylinder size in high dose rate Brachytherapy for primary vaginal cancers. Methods: Patients treated with HDR vaginal vault radiation in a list of cylinders ranging from 2.5 to 4 cm in diameter at 0.5 cm increment were analyzed. All patients’ doses were prescribed at the 0.5 cm from the vaginal surface with different treatment lengths. A series of reference points were created to optimize the dose distribution. The fraction dose was 5.5 Gy, the treatment was repeated for 4 times in two weeks. A cylinder volume was contoured in each case according to the prescribed treatment length, and then expanded to 5 mm to get a volume Cylinder-5mm-exp. A volume of PTV-Eval was obtained by subtracting the cylinder volume from the Cylinder-5mm-exp. The shell volume, PTV-Eval serves as the target volume for dosimetric evaluation. Results: DVH curves and average doses of PTV-Eval were obtained. Our results indicated that the DVH curves shifted toward higher dose side when larger cylinder was used instead of smaller ones. When 3.0 cm cylinder was used instead of 2.5 cm, for 3.0 cm treatment length, the average dose only increased 1%, from 790 to 799 cGy. However, the average doses for 3.5 and 4 cm cylinders respectively are 932 and 1137 cGy at the same treatment length. For 5.0 cm treatment length, the average dose is 741 cGy for 2.5 cm cylinder, and 859 cGy for 3 cm cylinder. Conclusion: Our data analysis suggests that for the vaginal intracavitary HDRBT, the average dose is at least 35% larger than the prescribed dose in the studied cases; the size of the cylinder will impact the dose delivered to the target volume. The cylinder with bigger diameter tends to deliver larger average dose to the PTV-Eval

  9. [Ultrasonography in acute pelvic pain].

    Kupesić, Sanja; Aksamija, Alenka; Vucić, Niksa; Tripalo, Ana; Kurjak, Asim

    2002-01-01

    normal intrauterine pregnancy from threatened or spontaneous abortion, ectopic pregnancy and other complications that may occur in patients with positive pregnancy test. Incomplete abortion is visualized as thickened and irregular endometrial echo with certain amount of intracavitary fluid. If applied, color Doppler ultrasound reveals low vascular resistance signals in richly perfused intracavitary area. Transvaginal sonography has high sensitivity and specificity in visualization of uterine and adnexal signs of ectopic pregnancy. Color Doppler examination may aid in detection of the peritrophoblastic flow. Furthermore, it facilitates detection of ectopic living embryo, tubal ring or unspecific adnexal tumor. Corpus luteum cysts and leiomyomas are another cause of pelvic pain during pregnancy, which can be correctly diagnosed by ultrasound. Detection of uterine dehiscence and rupture in patients with history of prior surgical intervention on uterine wall relies exclusively on correct ultrasound diagnosis. In patients with placental abruption sonographer detects hypoechoic complex representing either retroplacental hematoma, subchorionic hematoma or subamniotic hemorrhage. In closing, ultrasound has already become important and easily available tool which can efficiently recognize patients with possibly threatening conditions of different origins. PMID:12768897

  10. Brachytherapy: Physical and clinical aspects

    Brachytherapy is a term used to describe the short distance treatment of cancer with radiation from small, encapsulated radionuclide sources. This type of treatment is given by placing sources directly into or near the volume to be treated. The dose is then delivered continuously, either over a short period of time (temporary implants) or over the lifetime of the source to a complete decay (permanent implants). Most common brachytherapy sources emit photons; however, in a few specialized situations b or neutron emitting sources are used. There are two main types of brachytherapy treatment: 1) Intracavitary, in which the sources are placed in body cavities close to the tumour volume; 2) Interstitial, in which the sources are implanted within the tumour volume. Intracavitary treatments are always temporary, of short duration, while interstitial treatments may be temporary or permanent. Temporary implants are inserted using either manual or remote afterloading procedures. Other, less common forms of brachytherapy treatments include surface plaque, intraluminal, intraoperative and intravascular source applications; for these treatments either g or b emitting sources are used. The physical advantage of brachytherapy treatments compared with external beam radiotherapy is the improved localized delivery of dose to the target volume of interest. The disadvantage is that brachytherapy can only be used in cases in which the tumour is well localized and relatively small. In a typical radiotherapy department about 10-20% of all radiotherapy patients are treated with brachytherapy. Several aspects must be considered when giving brachytherapy treatments. Of importance is the way in which the sources are positioned relative to the volume to be treated, and several different models have been developed over the past decades for this purpose. The advantage of using a well established model is that one benefits from the long experience associated with such models and that one can

  11. Percutaneous Transluminal Angioplasty Combine with Salvia Injection Cura the Below Knee Vascular Lesion of Diabetic By Pressurize Injection%长球囊联合丹参注射液加压注射治疗糖尿病膝下血管病变

    路延平; 张健; 张孟增; 王瑞锋

    2012-01-01

    目的 观察长球囊血管腔内成形术(percutaneous transluminal angioplasty,PTA)联合丹参注射液,腔内加压注射治疗糖尿病膝下血管病变的疗效.方法 19例糖尿病患者共23条膝下动脉硬化闭塞肢体,首先采用长球囊开通狭窄、闭塞的血管,再联合丹参注射液腔内加压注射治疗.术后观察踝/肱指数、通畅率、溃疡愈合时间及临床症状的改善.结果 21条患肢得到成功治疗,技术成功率91.3%(21/23).踝/肱指数(ankle brachial index,ABI)由术前的0.31±0.14上升为术后的0.71±0.18,与术前比较差异有统计学意义(P<0.05).术后随访3~10个月,13条患肢(61.9%)间歇性跛行、患肢静息痛等临床症状基本消失,足背或胫后动脉搏动恢复;8条(38.1%)患肢明显缓解.6条肢体术前伴足趾溃疡者,术后创面均愈合;1条足趾坏疽肢体清创换药23天后行截趾术,术后切口愈合良好.术后1、3、6个月通畅率分别为95.2%、85.7%、61.9%.结论 腔内加压注射丹参注射液作为长球囊PTA微创治疗糖尿病合并膝下血管病变的补充,可促进动脉侧支血管生成,改善血供,改善微循环,促进糖尿病足溃疡面愈合,近期疗效好、通畅率高,值得推广.%Objective Review the curative effect of percutaneous transluminal angioplasty ( PTA) combined with salvia injection to the below knee vascular lesion of diabetic. Methods Collect 19 diabetics with together 23 inferior genicular artery blunting. First, remove obstacles from angusty or obliterative blood vessel by percutaneous transluminal angioplasty (PTA) , then begin intracavitary pressurize injection used the salvia miltiorrhiza, and observe the ankle brachial index (ABI) ,patency rate, the time of anabrosis healing and the amelioration of clinical symptom. Results The 21 affected limb of them were Curat successfully,the achievement ratio of technique was 91.3% (21/23). ABI ascensus from 0. 31 ± 0. 14 of preoperative to 0. 71

  12. Curative high dose rate vaginal apex brachytherapy in stage I papillary serous carcinoma of the endometrium

    Introduction: Uterine papillary serous carcinoma (UPSC) is a morphologically distinct variant of endometrial carcinoma that is associated with a poor prognosis, high recurrence rate, clinical understaging, and poor response to salvage treatment. We describe the presentation, local and distant control, survival, salvage rate, and complications for patients undergoing whole abdominal radiation therapy (WART), low dose rate (LDR) intracavitary brachytherapy, or high dose rate (HDR) vaginal brachytherapy in patients with stage I UPSC. Methods: Between 1976 and 1994 more than 1700 patients with endometrial carcinoma were treated with radiation therapy, 30 patients with stage I UPSC (1.8%) were treated with radiation before or following TAH/BSO. All patients underwent either preoperative Simon's packing or tandem and plaque which delivered 30-40 Gy to the serosa, WART, or HDR Ir-192 vaginal apex brachytherapy to a total dose of 21 Gy in 3 fractions at 0.5 cm from the vaginal mucosa. A total of 14 patients received HDR vaginal brachytherapy and (5(14)) patients received systemic chemotherapy. All patients presented with vaginal bleeding at a median age of 67 years (range 34-88). The group of 30 patients underwent TAH/BSO, 17 patients were completely staged pathologically (pelvic and para-aortic lymph nodes, omentectomy, and pelvic washings), and 2 patients underwent omental biopsy and pelvic washings only. All specimens revealed UPSC, nuclear grade 3, and lymphovascular invasion (23%). The pathologic stage was IA: 23% (7), IB: 67% (20), and IC: 10% (3). The median follow-up for all patients was 49 months (range 13-187 months). For the patients receiving postoperative HDR vaginal brachytherapy the median time from surgery to radiation was 42 days (range 29-91). Results: The 5-year actuarial disease free survival for Figo stage I UPSC patients treated with postoperative HDR vaginal brachytherapy and systemic chemotherapy was 100% compared to 74% for stage I UPSC patient

  13. Fístulas de anastomose superior pós-gastroplastia redutora pela técnica de Higa para tratamento da obesidade mórbida: aspectos por imagem Anastomotic leaks after Roux-en-Y gastric bypass surgery by Higa's technique for treatment of morbid obesity: radiological findings

    Ester Moraes Labrunie

    2008-04-01

    . Nineteen patients were radiologically diagnosed with anastomotic leaks, and ten of them presented contrast material extravasation, which is considered as a direct sign of the presence of anastomotic leaks. Seven of the remainder nine patients demonstrated contrast extravasation on subsequent studies, and indirect signs were also observed in six cases. Indirect signs were also observed in the patients with contrast material extravasation, the most frequent finding being pneumoperitoneum. Later follow-up examinations demonstrated contrast extravasation in one, and indirect signs in four of the five patients who had not been radiologically diagnosed. CONCLUSION: The most frequent radiological finding was contrast material extravasation (a direct sign of leak. Indirect signs were: unusual air-fluid levels, intracavitary fluid collections, disproportionate postoperative pneumoperitoneum, presence of fluid in the peritoneal cavity, anastomotic edema and small-bowel distention.

  14. Transesophageal access to the cardiac cavities and descending thoracic aorta via echoendoscopy: An experimental study Acceso transesofágico a cavidades cardiacas y aorta torácica descendente mediante ecoendoscopia: Estudio experimental

    A. López Martín

    2009-09-01

    Full Text Available Objective: the applications of endoscopic ultrasonography have diversified over recent years. The possibility of reaching cardiac territory has been successfully explored in experimental models, opening up a new field of possibilities for diagnostic and therapeutic interventions that were unthinkable until very recently. The aims set out in this study are to evaluate cardiac anatomy, its approach, the safety of the experimental procedure and the resulting morphological and histological changes after the procedure. Material and methods: the study has been performed on two adult pigs. They have undergone different surgical approaches to the cardiac cavities and descending thoracic aorta with excellent results. Results: different cardiac structures have been identified and operated upon (right auricle, left auricle, left ventricle, cardiac valves, as well as major vessels. The use of contrast, both intracavitary and from a peripheral vein, enabled us to verify the anatomical spaces studied. During the procedures we monitored for arrhythmias, hemodynamic behavior, possibility of infection by obtaining sample hemocultures before and after procedures, and response to punctures. Conclusions: the present study has enabled us to evaluate access to the heart from the esophageal lumen using endoscopic ultrasonography, with results that are very similar to those described in the current bibliography. However, we offer two novelties: puncture of the right auricle through the interauricular partition and puncture of the descending thoracic aorta, both performed with ease and apparent safety.Objetivo: las aplicaciones de la ultrasonografía endoscópica se han diversificado en los últimos tiempos. La posibilidad de acceder al territorio cardiaco se ha explorado en modelos experimentales con buenos resultados, abriendo un campo de nuevas posibilidades de intervencionismo diagnóstico y terapéutico hasta hace poco impensables. Los objetivos planteados en este

  15. Ultrasonografía transvaginal e histerosonografía en el diagnóstico de patologías endometriales

    Ronald Salazar Mora

    2001-10-01

    Full Text Available Justificación y Objetivo: A pesar que en los últimos años la ultrasonografía transvaginal se ha convertido en una gran herramienta en la evaluación de pacientes con sangrado uterino anormal, ha mostrado cierta limitación en el diagnóstico de patología endometrial. La infusión salina intracavitaria en el momento de la realización de la sonografía ha demostrado ser un método más preciso. En el siguiente trabajo el objetivo principal fue comparar la sensibilidad y especificidad del ultrasonido transvaginal versus el uso de la histerosonografía en el diagnóstico de estas patologías. Metodología: treinta y seis pacientes con sangrado uterino anormal fueron seleccionadas de forma consecutiva, según referencia para ultrasonografía vaginal. A todas se les realizó un ultrasonido transvaginal y luego la histerosonografía, siendo los resultados comparados con el diagnóstico histológico, el cual fue considerado como el "estándar dorado". Resultados: 38% de las pacientes mostraron un endometrio normal, el 30% tuvo pólipo endometrial, 30% tuvo hiperplasia endometrial, 19% miomas intramurales y/o adenomiosis y 7.6% miomas submucosos. La sensibilidad y especificidad del ultrasonido transvaginal fue de un 42,8%, y 91,6% respectivamente, comparada con de 92.8% y 100% para al histerosonografía. Conclusiones: La histerosonografía es más precisa en el diagnóstico de patología endometrial enpacientes con sangrado uterino anormal.Justification and objectives: In spite than in the last year the vaginal ultrasound has become a powerful tool in the evaluation of patients with abnormal uterine bleeding, it has shown some limitations for the diagnosis of endometrial pathology. Intracavitary saline infusion during the ultrasonographic procedure, has shown to be a more sensitive method. Our main objetive was to compare the sensitivity and specificity of the vaginal ultrasound versus the histerosonography in the diagnosis of various endometrial

  16. 耻骨后途径膀胱颈部分结扎与经尿道途径尿道部分结扎制作犬膀胱出口梗阻模型的比较∗%Comparison of Retropubic Bladder Neck Partial Ligation and Transurethral Urethral Partial Ligation in the Establishment of ;Bladder Outlet Obstruction Model in Dogs

    李磊; 吴越; 张国飞; 邓玮; 陈安龙

    2016-01-01

    Objective To compare two methods for establishing an animal model of overactivity bladder caused by bladder outlet obstruction in beagle dogs. Methods Twenty-six healthy female beagles were randomly divided into three groups, which were group A ( n =10 ) , group B ( n =10 ) , and control group ( n =6 ) . The group A was given a retropubic approach midprostatic obstruction. The group B was given an urethral partial ligation through transurethral way. The control group underwent just exposure of the bladder neck without midprostatic obstruction through retropubic approach. Urodynamic study was carried out in these groups after 12 weeks. Results The operation time of the group B (10. 7 ± 3. 9 min) was shorter than the control group (15. 2 ± 2. 1) min, which was further shorter than the group A (18.4 ±3.2 min) (F=67.97, P=0.02). Urinary dynamics test showed no significant difference among the 3 groups before the operation of (P>0. 05). At 12 weeks after the operation, 8 dogs from the group A and 10 dogs from group B were found with detrusor contraction wave in urine storage period, while the control group did not appear. The detrusor pressure, maximum bladder capacity, residual urine in the group A and group B were significantly higher than the control group and before operation (P0. 05), and there was no significant difference in the control group between preoperation and postoperation (P>0. 05). Conclusions Both retropubic and transurethral approaches can be used to successfully establish bladder outlet obsteuction in female beagles. As compared to retropubic approach, the transurethral approach has advantages such as shorter operation time, better reproducibility and stability of the animal models, which is suitable for studying transurethral intracavitary treated by minimally invasive surgery.%目的:比较两种犬膀胱出口梗阻( bladder outlet obstruction,BOO)诱导膀胱过度活动症( overactivity bladder, OAB)模型制备方法的效果。方法将26

  17. Cerebral Scintigraphy in the Child and Nursing Infant

    Cerebral scintigraphy in the child is dealt with in only a few published studies. However, a separate study of this subject would appear to be justified in view of particular features of neurosurgical pathology in the child. In attacking this problem, one must first discuss the dosimetric data and then consider the problem of the detectability of tumours of the fovea posterior, median tumours of the base of the skull and astrocytomas, which are the tumours most frequently encountered in child pathology. The child and the nursing infant are subjects of choice for the application of scintigraphic techniques following local injection of radioactive compounds via the subarachnoid, intraventricular or intracavitary routes, for the study of communicating hydrocephalus or hydrocephalus due to stenosis, meningo-encephalitic malformations and chronic subdural haematomas. Over a period of five years, 400 nursing infants and children ranging in age from two months to 16 years were examined, i.e., 10% of the 4000 cranial examinations made in the authors' laboratory. Of these children, 105 had verifiable tumours, 12 subdural or extradural haematomas and 14 vascular malformations. Twenty-five examinations were made after local injection of RISA, for the purpose of studying the cerebral fluid cavities or tracing the circulation of the cerebrospinal fluid. Two techniques were used and compared: measurement of radioactivity in contact with the skull (technique of T. Planiol) and automatic scintigraphy with a device having a 3-in. crystal and permitting recording in colour and on radiological film. The RISA was gradually replaced by 197Hg-Neohydrin, 131I-iodate and, lastly, by 99mTc; these irradiated the body to a much smaller degree. After making a comparative study of the dose distribution in children for the various radioactive compounds, the authors discuss their results in terms, mainly, of lesion site, nature of lesion, technique and radioelement used. The overall results of

  18. Alpha particle emitters in cancer therapy: establishing the rationale and overcoming the difficulties

    rapidly accessible disease. Alpha particles will be most useful in situations in which targeting is rapid, killing of isolated single-cells is important and access to normal tissue is minimized. The latter may be achieved by intracavitary administration or by labeling an agent that does not reach normal tissues before the radionuclide has decayed below an acceptable level. Although alpha-particle emitters have shown promise in animal models, they have not been examined in patients. The decay of 212Bi is accompanied by emission of high energy (2.6 MeV) photons which are difficult to shield; 211At is cyclotron produced and of limited availability. The initial obstacles to the use of alpha-particle emitters for therapy are availability, handling and radiochemistry. These are being overcome with the introduction of new radionuclides and better radiochemistry. Bismuth-213, for example, is similar to Bi-212 in its alpha particle emissions but does not emit the highly energetic photon seen with Bi-212. Once the initial, logistical obstacles are surmounted, the dosimetry and normal tissue toxicity must be investigated

  19. Cuban Monoclonal Antibodies for Radioimmunodiagnosis and Radioimmunotherapy of Cancer Diseases

    The Centre of Molecular Immunology produces monoclonal antibodies for treating cancer diseases. We are mainly focus on two target systems; one is the epidermal growth factor receptor (EGF-R) because there is a tremendous relationship between the EGF/EGF-R system and several human tumours such as lung, head and neck, ovarian breast and brain cancers; the second one is the ganglioside system, the relevance of certain gangliosides in tumour growth and metastatic dissemination has been well documented, GM3(NeuGc) ganglioside is particularly interesting due to its restrictive expression in normal human tissues. Nimotuzumab (h-R3) is a humanized monoclonal antibody (mAb) that was obtained by complementarity-determining regions grafting of a murine mAb (ior egf/r3) to a human framework having remarkable antiproliferative, pro-apoptotic, and antiangiogenic effects. A Phase I clinical trial was performed to evaluate the toxicity and clinical effect of an intracavitary (intracerebral) administration of a single dose of nimotuzumab (h-R3) labelled with increasing doses of 188Re. All patients bearing astrocytomas grade III/IV should be treated previously with conventional therapies and have an EGF-R overexpression in the tumour, demonstrated by immunohistochemical study. Maximal tolerated dose was 3 mg of the h-R3 labelled with 10 mCi of 188Re. The radioimmunoconjugate showed a high retention in the surgical created resection cavity and the brain adjacent tissues with a mean value of 85.5% of the injected dose one hour post-administration. This radioimmunoconjugate may be relatively safe and a promising therapeutic approach for treating high grade gliomas. GM3(NeuGc) ganglioside is particularly interesting due to its restrictive expression in normal human tissues according to immunohistochemical studies, using either polyclonal or monoclonal antibodies. But both immunohistochemical and biochemical methods have strongly suggested its over-expression in human breast and colon

  20. Radiolabeled nucleoside analogs in cancer diagnosis and therapy.

    Kassis, A I; Adelstein, S J; Mariani, G

    1996-09-01

    Radiolabeled nucleosides, specifically 5-iodo-2'-deoxyuridine (IUdR) radioiodinated with the Auger-electronemitting 123I or 125I, have been shown to produce extensive DNA damage in mammalian cell systems in vitro. Such nucleosides are cycle-dependent agents that are taken up by mitotically dividing cells in the S phase of the cell cycle. The degree of damage that occurs is related to the fact that these nucleosides bind covalently to DNA bringing the decaying Augerelectron-emitting radionuclide in close proximity to the genome. The use of these radiohalogenated nucleosides in vivo is associated with several problems. The first relates to their extremely short biologic half-life in blood (T1/2 of minutes in humans). The second involves achieving therapeutic ratios in tumor cells in the face of efficient hepatic dehalogenation. The third concerns the uptake of these radiopharmaceuticals by actively proliferating normal cell renewal systems, thus potentially causing toxic side effects. The fourth, one shared with other cycle-dependent drugs, relates to the matter of labeling the whole tumor cell population. To facilitate targeting to tumors, investigators have been examining the direct introduction of these agents into the targeted area or into an arterial blood supply that immediately precedes the target. For example, radiopharmaceutical administration could be intracavitary (bladder, spinal fluid, peritoneum), intralesional (brain tumor, breast mass) or intra-arterial (liver, pancreas). In all these situations, the following conditions must be met: (a) once within the vicinity of the tumor the agent can freely diffuse through the tissues and is selectively taken up by cancerous cells; (b) once the agent has left the target area it is converted quickly into a nontoxic form and/or excreted from the body; and finally, (c) the biologic behavior of the agent is not altered by repeated injections. We report herein our experience and that of others with [123I/125I/131I

  1. Cytotoxic effect of replication-competent adenoviral vectors carrying L-plastin promoter regulated E1A and cytosine deaminase genes in cancers of the breast, ovary and colon.

    Akbulut, Hakan; Zhang, Lixin; Tang, Yucheng; Deisseroth, Albert

    2003-05-01

    nude mice was potentiated by administering 5-FC by intraperitoneal injection. This treatment resulted in a decreased tumor size and a decreased tumor cell growth rate. The mice treated with a combination of the AdLpCDIRESE1a vector intratumoral injection and intraperitoneal 5FC injections lived much longer than the other experimental groups exposed to the viral vector alone or to the combination of the intratumoral AdLpCD replication incompetent vector injections plus intraperitoneal 5-FC injections. These encouraging results with our newly constructed AdLpCDIRESE1a vector suggest a need for further study of its utility in a preclinical model of intracavitary therapy of pleural or peritoneal carcinomatosis. PMID:12719708

  2. Undetected human papillomavirus DNA and uterine cervical carcinoma. Association with cancer recurrence

    Okuma, Kae; Yamashita, Hideomi; Nakagawa, Keiichi [University of Tokyo Hospital, Departments of Radiology, Tokyo (Japan); Yokoyama, Terufumi; Kawana, Kei [University of Tokyo Hospital, Departments Obstetrics and Gynecology, Tokyo (Japan)

    2016-01-15

    The time course of human papillomavirus (HPV) DNA clearance was studied in patients with carcinoma of the cervix during follow-up after primary radical radiotherapy (RT). This study investigated the relationship between timing of HPV clearance and RT effectiveness. A total of 71 consecutive patients who were treated for cervical cancer with primary radical radiotherapy and high-dose rate intracavitary brachytherapy with or without chemotherapy were enrolled in the study. Samples for HPV DNA examination were taken before (1) treatment, (2) every brachytherapy, and (3) every follow-up examination. The times when HPV DNA was undetected were analyzed for association with recurrence-free survival. HPV DNA was not detected in 13 patients (18 %) before RT. Of the 58 patients with HPV DNA detected before treatment, HPV DNA was not detected in 34 % during treatment and in 66 % after the treatment. Within 6 months after RT, HPV DNA was detected in 0 % of all patients. The patients were followed up for a median period of 43 months (range 7-70 months). In all, 20 patients were found to develop recurrence. The 3-year cumulative disease-free survival (DFS) rate was 71 ± 5.4 % for all 71 patients. In multivariate analysis, DFS was significantly associated with HPV (detected vs. not detected) with a hazard ratio of 0.07 (95 % confidence interval 0.008-0.6, p = 0.009). In this study, patients in whom HPV was not detected had the worst prognosis. Six months after RT, HPV DNA was detected in 0 % of the patients. Patients in whom HPV DNA could not be detected before treatment need careful follow-up for recurrence and may be considered for additional, or alternative treatment. (orig.) [German] Gegenstand der Untersuchung war der Zeitverlauf der Eliminierung von humaner Papillomvirus-(HPV-)DNA bei Patienten mit Zervixkarzinomen waehrend der Nachfolgeuntersuchungen nach einer primaeren radikalen Strahlentherapie (RT). Diese Studie untersuchte den Zusammenhang zwischen dem Zeitpunkt der

  3. Avaliação dosimétrica de uma combinação de aplicadores para braquiterapia de tumores do colo uterino com acometimento da porção distal da vagina Dosimetric evaluation of a combination of brachytherapy applicators for uterine cervix cancer with involvement of the distal vagina

    Roger Guilherme Rodrigues Guimarães

    2009-08-01

    Full Text Available OBJETIVO: Avaliar uma alternativa de braquiterapia para tumores do colo uterino acometendo a porção distal da vagina, sem aumentar os riscos de toxicidade. MATERIAIS E MÉTODOS: Estudo teórico comparando três diferentes aplicadores de braquiterapia intracavitária de alta taxa de dose: sonda intrauterina e cilindro vaginal (SC; sonda e anel associado ao cilindro vaginal (SA+C e um aplicador virtual com sonda, anel e cilindro vaginal em um único conjunto (SAC. Foram prescritas doses de 7 Gy no ponto A e 5 Gy na superfície ou a 5 mm de profundidade na mucosa vaginal, mantendo as doses nos pontos de reto, bexiga e sigmoide abaixo dos limites de tolerância. Foram comparados os volumes englobados pelas isodoses de 50% (V50, 100% (V100, 150% (V150 e 200% (V200, respectivamente. RESULTADOS: Tanto SA+C quanto SAC apresentaram melhor distribuição de dose quando comparados ao aplicador SC. A distribuição de dose obtida com SA+C foi semelhante à do aplicador SAC, sendo V150 e V200 cerca de 50% maiores para SA+C, todavia, dentro do cilindro. CONCLUSÃO: A utilização de SA+C em uma única aplicação em dois tempos pode ser uma alternativa de tratamento para pacientes que apresentam tumores de colo uterino com acometimento distal da vagina.OBJECTIVE: To evaluate an alternative brachytherapy technique for uterine cervix cancer involving the distal vagina, without increasing the risk of toxicity. MATERIALS AND METHODS: Theoretical study comparing three different high-dose rate intracavitary brachytherapy applicators: intrauterine tandem and vaginal cylinder (TC; tandem/ring applicator combined with vaginal cylinder (TR+C; and a virtual applicator combining both the tandem/ring and vaginal cylinder in a single device (TRC. Prescribed doses were 7 Gy at point A, and 5 Gy on the surface or at a 5 mm depth of the vaginal mucosa. Doses delivered to the rectum, bladder and sigmoid colon were kept below the tolerance limits. Volumes covered by the

  4. Factors determining acute normal tissue reactions during postoperative radiotherapy in endometrial cancer: analysis of 317 consecutive cases

    Background and purpose: Acute radiotherapy reactions are commonly underestimated and under-reported in the literature. Our aim was to evaluate the incidence and risk factors for acute reactions during postoperative radiotherapy in endometrial cancer patients. Material and methods: Performed was detailed retrospective analysis of 317 endometrial cancer patients given postoperative radiotherapy. Two hundred forty seven patients (78%) received both intracavitary (BRT) and external beam irradiation (EBRT), 49 patients (15%) received only BRT and 21 patients (7%) - only EBRT. BRT included radium (Ra) or cesium (Cs). The mean total dose at 0.5 cm for Ra and Cs was 50.5±10.3 Gy and 48.4±15.0 Gy, respectively, and the mean dose rate - 0.47±0.06 Gy/h and 1.42±0.41 Gy/h, respectively. Mean EBRT dose in the ICRU reference point was 49.0±3.7 Gy given in fractions of 1.54-2.49 Gy (mean 2.0±0.17 Gy). Radiotherapy and Oncology Group classification system was employed to score acute reactions. The impact of patient- and treatment-related factors on the risk of acute bowel and urinary bladder reactions was assessed with uni- and multivariate tests. Results: Acute radiotherapy reactions of any grade occurred in 265 patients (84%) including bowel complications in 66% and urinary bladder complications in 36%. There were 21 severe (grade 3 or 4) reactions, all but one seen in the patients treated with combined EBRT and BRT. Higher total dose (P=0.024), higher EBRT dose (P=0.022) and higher age (P=0.026) were correlated with increased acute bowel toxicity in univariate analysis. Multivariate analysis showed that higher EBRT dose (P=0.015) and older age (P=0.016) were independently correlated with the risk of acute bowel events. Higher total dose (P=0.009), BRT dose (P=0.029), BRT dose rate (P=0.004), EBRT fraction size (P=0.007), the use of Cs BRT (P=0.001) and lower parity (P=0.041) were correlated with increased risk of acute bladder toxicity in univariate test. Multivariate

  5. 8. national congress of radiation protection 'SFRP 2011' - Proceedings

    radiation protection and related domains; 22 - O'CLOC study - cataracts in interventional cardiologists; 23 - Doses received in extremities and eye lens by medical personnel: results of the ORAMED European project; 24 - Use of operational dosemeters in interventional radiology/cardiology: results of the ORAMED European project; 25 - Sub-ungual multi-parametric capillaroscopy of occupational chronic exposure in interventional radiology; 26 - Example of workplace and zoning analysis in interventional neuro-radiology; 27 - Dosimetric study of various work places in prostate brachytherapy; 28 - Contribution to radiation protection of the partial redesigning of a nuclear medicine service; 29 - Committed effective doses evaluated by the IRSN after internal contamination of nuclear medicine personnel - 2006-2010 status; 30 - Why and how developing a quality approach in radiation protection?; 31 - 2011 status and perspectives of radiation protection in medical environment. The ASN's viewpoint; 32 - Doses in scanography: results of a multi-centric inquiry; 33 - Status of the optimization approach of patients dosimetry in interventional radiology at Clermont Ferrand univ. health centre; 34 - Can we define reference levels in interventional neuro-radiology with diagnostic and therapeutic purposes?; 35 - EMAN: implementation of an ALARA european network in the medical domain; 36 - In-vivo surface and intra-cavitary dosimetry in patient's radiotherapy using multi-channel OSL/FO technique; 37 - Estimation of secondary cancers after robotized stereotactic radiotherapy of lung cancer; 38 - Medical-surgical management of an injured person after radio-contamination by plutonium or americium (Percy area); 39 - Industrial radiography incident at Flamanville nuclear site; 40 - Incorporated activity mapping using Monte-Carlo simulations in case of complex contaminations; 41 - IRSN's metrology teams preparedness for crisis; 42 - Alpha irradiation problem following an internal contamination: dose

  6. 8. national congress of radiation protection 'SFRP 2011' - Proceedings; Huitieme congres national de radioprotection 'SFRP 2011' - Recueil des presentations

    Souques, M.; Lambrozo, J.; Perrin, A.; Magne, I.; Bedja, M.; Fleury, G.; Le Brusquet, L.; Barbe, R.; Lahaye, T.; Laurier, D.; Tomasek, L.; Tirmarche, M.; Guseva Canu, I.; Garsi, J.P.; Caer-Lorho, S.; Jacob, S.; Acker, A.; Fernandez, F.; Bertho, J.M.; Synhaeve, N.; Stefani, J.; Desbree, A.; Blanchardon, E.; Dublineau, I.; Petitot, F.; Lestaevel, P.; Tourlonias, E.; Mazzucco, C.; Jacquinot, S.; Dhieux, B.; Delissen, O.; Tournier, B.; Gensdarmes, F.; Godet, J.L.; Perrin, M.L.; Saad, N.; Bardelay, C.; Voytchev, M.; Doursout, T.; Chapalain, E.; Dandrieux, G.; Cazala, C.; Gay, D.; Chabanis, O.; Palut-Laurent, O.; Ringeard, C.; Thomassin, A.; Roxin, A.M.; Gschwind, R.; Makovicka, L.; Roxin, I.; Henriet, J.; Martin, E.; Klopfenstein, J.F.; Lochard, J.; Guillaumont, R.; Marignac, Y.; Petitfrere, M.; Catelinois, O.; Devin, P.; Sene, M.; Barbey, P.; Reaud, C.; Schneider, T.; Achikian, S.; Le Clerc, A.; Rochereau, S.; Schneider, C.; Vigneron, H.; Charron, S.; Delattre, A.; Luccioni, C.; Monti, P.; Bernaud, J.Y.; Michielsen, N.; Bondiguel, S.; Bordy, J.M.; Daures, J.; Denoziere, M.; Gualdrini, G.; Mariotti, F.; Barre, A.; Beauval, A.; Davi, J.N.; Dupic, S.; Grincourt, D.; Kandil, A.; Marteel, C.; Vrammout, D.; Saintamon, F.; Aberkane, J.; Paquet, F.; Barbey, P.; Bardies, M.; Biau, A.; Blanchardon, E.; Chetioui, A.; Lebaron-Jacobs, L.; Pasquier, J.L.; Broggio, D.; Beurrier, J.; Farah, J.; Franck, D.; Sauget, M.; Bertrand, A.; Boveda, S.; Bar, O.; Brezin, A.; Maccia, C.; Bernier, M.O.; Struelens, L.; Carinou, E.; Dominiek, J.; Brodecki, M.; Donadille, L.; Ferrari, P.; Koukorava, C.; Krim, S.; Nikodemova, D.; Ruiz-Lopez, N.; Sans Merce, M.; Vanhavere, F.; Clairand, I.; Bordy, J.M.; Debroas, J.; Ginjaume, M.; Itie, C.; Krim, S.; Lebacq, A.L.; Martin, P.; Struelens, L.; Sans-Merce, M.; Vanhavere, F.; Gauron, C.; Wild, P.; Grzebyk, M.; Derock, C.; Champion, K.; Cohen, P.; Menez, C.; Tellart, A.S.; Thiel, H.; Pennarola, R.; Choudat, D.; Dillenseger, P.; Rehel, J.L. [and others

    2011-06-15

    -learning techniques in radiation protection and related domains; 22 - O'CLOC study - cataracts in interventional cardiologists; 23 - Doses received in extremities and eye lens by medical personnel: results of the ORAMED European project; 24 - Use of operational dosemeters in interventional radiology/cardiology: results of the ORAMED European project; 25 - Sub-ungual multi-parametric capillaroscopy of occupational chronic exposure in interventional radiology; 26 - Example of workplace and zoning analysis in interventional neuro-radiology; 27 - Dosimetric study of various work places in prostate brachytherapy; 28 - Contribution to radiation protection of the partial redesigning of a nuclear medicine service; 29 - Committed effective doses evaluated by the IRSN after internal contamination of nuclear medicine personnel - 2006-2010 status; 30 - Why and how developing a quality approach in radiation protection?; 31 - 2011 status and perspectives of radiation protection in medical environment. The ASN's viewpoint; 32 - Doses in scanography: results of a multi-centric inquiry; 33 - Status of the optimization approach of patients dosimetry in interventional radiology at Clermont Ferrand univ. health centre; 34 - Can we define reference levels in interventional neuro-radiology with diagnostic and therapeutic purposes?; 35 - EMAN: implementation of an ALARA european network in the medical domain; 36 - In-vivo surface and intra-cavitary dosimetry in patient's radiotherapy using multi-channel OSL/FO technique; 37 - Estimation of secondary cancers after robotized stereotactic radiotherapy of lung cancer; 38 - Medical-surgical management of an injured person after radio-contamination by plutonium or americium (Percy area); 39 - Industrial radiography incident at Flamanville nuclear site; 40 - Incorporated activity mapping using Monte-Carlo simulations in case of complex contaminations; 41 - IRSN's metrology teams preparedness for crisis; 42 - Alpha irradiation problem following

  7. Anestesia para tratamento de aspergilose cardíaca em paciente com trombocitopenia: o uso criterioso da aprotinina Anestesia para tratamiento de aspergilosis cardiaca en paciente con trombocitopenia: el uso con criterio de la aprotinina Anesthesia for treatment of cardiac aspergillosis in a patient with thrombocytopenia and the judicious use of aprotinin

    Raquel Reis Soares

    2007-12-01

    : Aprotinin has been widely used in cardiac surgeries as a therapeutic resource for reducing the effects of cardiopulmonary bypass (CPB on coagulation and fibrinolysis. Recovery of adequate hemostasia at the end of the procedure is one of the objectives of the anesthesiologist. However, aprotinin has specific indications. The objective of this report was to present the case of a patient with severe thrombocytopenia undergoing cardiac surgery in which consultation with Hematology and adequate planning were responsible for the success of the procedure. CASE REPORT: An 18-year old male patient, weighing 64 kg, physical status ASA IV, with a diagnosis of bone marrow aplasia, was being investigated to undergo bone marrow transplantation. He had persistent fever for a month, which did not improve with antibiotics. During the investigation with imaging exams, a left atrial mass was discovered. Laboratory exams revealed hemoglobin 9 g.dL-1 and thrombocytopenia with 6,000 platelets.mm³. He underwent a sternotomy with CPB to remove the intracavitary thrombus. In order to control intraoperative bleeding, the following was administered: plateletpheresis, hydrocortisone, and aprotinin. Increased bleeding and hemodynamic instability did not develop during the surgery, and the patient was transferred to the Intensive Care Unit (ICU without intercurrences. The anatomo-pathologic exam revealed the thrombus to be filled with Aspergillus (fungal mass. On the seventh postoperative day the patient developed respiratory failure and cardiorespiratory arrest that did not respond to resuscitation maneuvers. CONCLUSIONS: Despite the increased risk of bleeding in this patient, cardiac surgery with CPB was performed without intercurrences due to the use of aprotinin and plateletpheresis.