The choice of a brachytherapy applicator in patients with cervical cancer in whom contraindication

W brachyterapii ginekologicznej w zależności od warunków anatomicznych mogą być stosowane różnego rodzaju aplikatory. Znajomość zasad ich stosowania może być kluczowa w uzyskaniu dobrych wyników leczenia mierzonych indeksem terapeutycznym. W pracy przedstawiono analizę porównawczą zastosowania aplikatora pierścieniowego z sondą z komercyjnie dostępnymi innymi aplikatorami – typu fletcherowskiego, manchesterskiego oraz cylindra z sondą u kobiet chorych na raka szyjki macicy, u których stwierdzono brak lub asymetrię sklepień pochwy lub zwężenie 1/3 górnej części pochwy. Przedmiotem porównania były dawki fizyczne w pęcherzu moczowym, odbytnicy, przymaciczach i ścianie pochwy uzyskane u tej samej chorej przy założeniach różnego rodzaju aplikatorach. Badania własne wykazały, że optymalny rozkład dawki w tej grupie chorych jest uzyskiwany przy wykorzystaniu aplikatora pierścieniowego z sondą. Zdaniem autorów zastąpienie aplikatora cylindrycznego pierścieniowym może przyczynić się do poprawy jakości napromieniania i zmniejszenia ryzyka powikłań.We compared dose distributions of the tandem and ring with different commercial available applicators – tandem and ovoids, tandem and cylinder and tandem and ring to verify if this is a suitable replacement in specific clinical situations. The knowledge of the benefits and limitations of the applicators is important in deciding about the clinical applicability. We have limited our research to patients treated for cervical cancer in whom absence (asymmetry) of vaginal fornices or a narrow proximal vagina were detected. These patients have suboptimal applicator geometry with tandem and ovoids applications and have usually undergone tandem and cylinder insertions, which are associated with a higher risk of rectal complications. Point doses to the bladder, rectum, point B and vaginal wall were calculated and compared for different applicators in the same patients. Our experience has shown that the tandem and ring applicator provides a better dose distribution particularly when compared with that tandem and cylindral applications. The ease of insertion and a predictable geometry make this arrangement an applicator of choice in clinical conditions and make it possible to decrease the complication rate

Real-time brachytherapy for prostate cancer – implant analysis

SummaryBackgroundIn HDR brachytherapy precision of catheter implantation is crucial for conformal treatment planning as a starting point for better optimization process.AimThe aim was to investigate differences between virtual and real needle position and the effect of needle displacement on dosimetric parameters as a function of prostate volume for better evaluation of “real” implant with respect to final dose distribution.Materials/MethodsThirty treatment plans calculated by Nucletron SWIFT™ were randomly selected. Dosimetric data including V100 for prostate gland and D10 for urethra were analyzed as a function of prostate volume and needle displacement.Needle displacement was determined by measuring the distance between virtual and real positions of respective needles in three sectional images: at the base, apex of the prostate gland and reference image. Dosimetric parameters were determined for consecutive computer plans: virtual (before implantation), live (after implantation and renewed optimization). For the purpose of this study a new parameter, VD (Volume-Dose), was created.ResultsVD indicates the quality of “real” dose distribution with respect to “virtual” treatment plan. In order to realize the assumption of virtual plan (VD<1) for a given prostate volume, mean values of needle displacement r should not exceed racceptable according to the formula: racceptable (Vp) ∝ Vp2. For larger glands (above 30cc) final dose distribution is less dependent on needle displacement than smaller ones.ConclusionsThe experiment determined maximum values of needle displacement for a given Vp parameter, allowing one to take advantage of optimization algorithms and to improve the final dose distribution

High-dose-rate interstitial brachytherapy for mucinous adenocarcinoma endocervical-type – a case study

Background: Adenocarcinoma in cervical cancer has poorer response rate to treatment and requires longer time to achieve complete remission than squamous cell carcinoma [1]. Lower response to chemotherapy and radiotherapy is observed [2,3,4,5] and the optimal management remains undefined [1,4,6,7]. Case: We report a case of a 58-year-old woman with bulky mucinous adenocarcinoma endocervical-type G1, treated previously with radiochemotherapy with no visible response. After subsequent interstitial HDR brachytherapy (iHDR-BT) complete local remission was achieved. Conclusion: Interstitial HDR brachytherapy in bulky mucinous adenocarcinoma endocervical-type may be the best treatment choice that allows to receive a complete local response

Interstitial high-dose-rate brachytherapy in locally advanced and recurrent vulvar cancer

Purpose: The aim of the study was to report our experience with high-dose-rate interstitial brachytherapy (HDR-ISBT) in locally advanced and recurrent vulvar cancer. Material and methods: Between 2004 and 2014, fourteen women with locally advanced or recurrent vulvar cancer were treated using HDR-ISBT in our Centre. High-dose-rate interstitial brachytherapy was performed as a separate treatment or in combination with external beam radiotherapy (EBRT) (given prior to brachytherapy). Results: Patients were divided into: group I (n = 6) with locally advanced tumors, stages III-IVA after an incisional biopsy only, and group II (n = 8) with recurrent vulvar cancer after previous radical surgery. In group I, median follow up was 12 months (range 7-18 months); 1-year overall survival (OS) was 83%. Transient arrest of cancer growth or tumor regression was noticed in all patients but 4/6 developed relapse. Median time to failure was 6.3 months (range 3-11 months). The 1-year progression-free survival (PFS) was 33%. In group II, median follow up was 28 months (range 13-90 months). The 1-year and 3-year OS was 100% and 80%, respectively. The arrest of cancer growth or tumor regression was achieved in all patients. In 4/8 patients neither clinical nor histological symptoms of relapse were observed but 4/8 women experienced relapse. Median time to failure was 31 months (range 13-76 months). The 1-year and 3-year PFS was 100% and 62.5%, respectively. Two patients (14.3%) in group II had severe late toxicity (G3). Conclusions: High-dose-rate interstitial brachytherapy is a well-tolerated treatment option in selected patients with advanced or recurrent vulvar cancer. It is a safe and effective treatment modality for advanced and recurrent vulvar cancer, yielding good local control with acceptable late treatment related side effects. In our study, patients with recurrent vulvar cancer had better results in HDR-ISBT treatment, probably because of the smaller tumor volume. This hypothesis should be verified in a larger group of patients

Real-time brachytherapy for prostate cancer – implant analysis

BackgroundIn HDR brachytherapy precision of catheter implantation is crucial for conformal treatment planning as a starting point for better optimization process.AimThe aim was to investigate differences between virtual and real needle position and the effect of needle displacement on dosimetric parameters as a function of prostate volume for better evaluation of “real” implant with respect to final dose distribution.Materials/MethodsThirty treatment plans calculated by Nucletron SWIFT™ were randomly selected. Dosimetric data including V100 for prostate gland and D10 for urethra were analyzed as a function of prostate volume and needle displacement.Needle displacement was determined by measuring the distance between virtual and real positions of respective needles in three sectional images: at the base, apex of the prostate gland and reference image. Dosimetric parameters were determined for consecutive computer plans: virtual (before implantation), live (after implantation and renewed optimization). For the purpose of this study a new parameter, VD (Volume-Dose), was created.ResultsVD indicates the quality of “real” dose distribution with respect to “virtual” treatment plan. In order to realize the assumption of virtual plan (V

Comparison of early and late efficacy of percutaneous transluminal renal angioplasty with or without subsequent brachytherapy: The effect on blood pressure in patients with renovascular hypertension

Background: Scarce data exist concerning the long-term effect of percutaneous transluminal renal angioplasty (PTRA) enhanced with intravascular gamma brachytherapy (IVBT) in patients with renovascular hypertension. Methods: Seventy one patients aged 52 &#177; 8 years with refractory renovascular hypertension were randomized to Group I (PTRA + IVBT) or Group II (PTRA). For the IVBT procedure, the PARIS catheter and Microselectron HDR (Nucletron) system was employed. Both baseline and 9-month follow-up quantitative computerized angiography (QCA) and ambulatory blood pressure monitoring analysis was performed to assess luminal parameters of restenosis and the effect of treatment on blood pressure. Results: Thirty three patients from Group I and 29 patients from Group II underwent successful procedure. During nine months of follow-up, three patients died; including two patients in Group I (cardiac causes) and one patient in Group II (stroke). The follow-up lumen diameter stenosis was 30.6 &#177; 13.7% and 40.4 &#177; 11% in Groups I and II, respectively (p = 0.004). Late lumen loss in quantitative computerized angiography was 1.2 &#177; 0.7 mm and 1.7 &#177; 0.7 mm in Groups I and II, respectively (p = 0.004)

Porównanie wczesnej i odległej skuteczności przezskórnej śródnaczyniowej angioplastyki tętnic nerkowych z następową brachyterapią lub bez niej u chorych z nadciśnieniem naczyniowo-nerkowym

Wstęp: Istnieje niewiele danych dotyczących odległych efektów przezskórnej śródnaczyniowej angioplastyki tętnic nerkowych (PTRA) z następową brachyterapią śródnaczyniową promieniami gamma (IVBT) u chorych z nadciśnieniem naczyniowo-nerkowym. bMetody: Do grupy I (PTRA + IVBT) lub grupy II (PTRA) losowo przydzielono 71 chorych w wieku 52 &#177; 8 lat z nadciśnieniem naczyniowo-nerkowym opornym na farmakoterapię. Procedurę IVBT przeprowadzono z użyciem cewnika PARIS i systemu Microselectron HDR (Nucletron). Wyjściowo i po 9 miesiącach obserwacji dokonano analizy angiografii ilościowej (QCA) i zapisu ambulatoryjnego pomiaru ciśnienia tętniczego, aby ocenić parametry restenozy i wartości ciśnienia tętniczego krwi. Wyniki: U 33 chorych z grupy I i 29 z grupy II wykonano skuteczny zabieg PTRA. W ciągu 9-miesięcznej obserwacji zmarło 3 chorych; 2 osoby z grupy I (śmierć sercowa) i 1 osoba z grupy II (udar mózgu). Redukcja średnicy naczynia w obserwacji odległej wynosiła 30,6 &#177; 13,7% i 40,4 &#177; 11%, odpowiednio w grupie I i II (p = 0,004). Utrata światła naczynia w obserwacji odległej w QCA wynosiła 1,2 &#177; 0,7 mm i 1,7 &#177; 0,7 mm, odpowiednio w grupie I i II (p = 0,004). Wnioski: Śródnaczyniowa brachyterapia promieniami gamma, stosowna jako uzupełnienie angioplastyki balonowej z użyciem cewnika samocentrującego, jest bezpieczną i skuteczną metodą zapobiegania restenozie po zabiegu angioplastyki balonowej u chorych z nadciśnieniem naczyniowo-nerkowym. Folia Cardiologica Exerpta 2010; 5, 1: 31-3

Guidelines of the Polish Respiratory Society on the Diagnosis and Treatment of Progressive Fibrosing Interstitial Lung Diseases Other than Idiopathic Pulmonary Fibrosis

The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF