Autologous fat transfer as prostate-rectal spacer: Technique description and early results

Purpose: Several attempts have been made to increase the distance between the prostate and the rectum through injection of different synthetic compounds, generating space between organs. To report an original technique to increase the distance between the rectum and the prostate, by autologous fat implantation into the rectoprostatic space, with the aim of providing physical dosimetry protection and rectal dose sparing.Methods: We prospectively evaluated twelve patients subjected to autologous fat implantation as recto-prostatic spacer subsequently receiving prostate either radical (n = 6), or salvage brachytherapy for local recurrence after external beam radiation therapy (EBRT) (n = 6). Standard permanent prostate brachytherapy seed implantation was performed through transperineal approach and under transrectal ultrasonography (TRUS) and template guidance. Prescribed D90 dose for Iodine - 125 monotherapy was 140 - 160 Gy, reduced by 30% for rescue cases to obtain a Rectum V100 under 1 cc.Results: Lipo-transfer was completed in all 12 patients. Control CT scan at 1 month showed average distances of: 10.7 mm (range) (2.8 - 15.9 mm), 7.6 (1.8 - 11.6 mm) and 6.8 (4.2 - 8.3) mm at prostate base, middle and apex, respectively. Shortest separation distance observed was at apex and midline, while largest was observed the sides and at seminal vesicles level. Control CT at 3 months showed average distances of 9.6 mm (1.9 - 14.6 mm), 6.3 mm (1.8 - 10.2 mm) and 5.4 mm (3.8 - 7.2 mm) at prostate base, middle and apex, respectively. Most complications were minor.Conclusion: Autologous fat transfer is a feasible and simple procedure for experienced practitioners with low complication rates, which allows dose escalation to the prostate.

Moderately hypofractionated post-operative radiation therapy for breast cancer: Preferences amongst radiation oncologists from countries in Latin America and the Caribbean

Background: The safety and effectiveness of moderately hypofractionated post-operative radiation therapy for breast cancer were demonstrated by several trials. This study aimed to evaluate the current patterns of practice and prescription preference about moderately hypofractionated post-operative radiation therapy to assess possible aspects that affect the decision-making process regarding the use of fractionation in breast cancer patients in Latin America and the Caribbean (LAC). We also aimed to identify factors that can restrain the utilization of moderately hypofractionated post-operative radiation therapy for breast cancer. Materials an methods: Radiation oncologists from LAC were invited to contribute to this study. A 38-question survey was used to evaluate their opinions. Results: A total of 173 radiation oncologists from 13 countries answered the questionnaire. The majority of respondents (84.9%) preferred moderately hypofractionated post-operative radiation therapy as their first choice in cases of whole breast irradiation. Whole breast plus regional nodal irradiation, post-mastectomy (chest wall and regional nodal irradiation) without reconstruction, and post-mastectomy (chest wall and regional node irradiation) with reconstruction hypofractionated post-operative radiation therapy was preferred by 72.2% 71.1%, and 53.7% of respondents, respectively. Breast cancer stage, and flap-based breast reconstruction were the factors associated with absolute contraindications for the use of hypofractionated schedules. Conclusion: Even though moderately hypofractionated post-operative radiation therapy for breast cancer is considered a new standard to the vast majority of the patients, its unrestricted application in clinical practice across LAC still faces reluctance