Twice-daily high-dose-rate brachytherapy for medically inoperable uterine cancer.

Purpose: Medically inoperable patients with uterine cancer pose a therapeutic challenge. We developed a twice-daily schedule of high-dose-rate brachytherapy (HDRB) after a single insertion procedure that required a hospitalization of 3 days.

Methods And Materials: Favorable patients were offered brachytherapy alone, and all other patients received HDRB after pelvic external beam radiation therapy (EBRT).

External beam radiotherapy boosts to reduce the impact caused by edema in prostate permanent seed implants.

In prostate permanent seed implants, it has been shown that edema caused by the surgical procedure decreases dose coverage and hence may reduce treatment efficacy. This reduction in treatment efficacy has been characterized by an increase in tumour cell survival, and biomathematical models have been developed to calculate the tumour cell survival increases in seed implanted prostates of different edema magnitudes and durations. External beam boosts can be utilized to neutralize the negative impact of edema so that originally desired treatment efficacy can be achieved.

Modern radiation treatment planning and delivery--from Röntgen to real time.

The field of radiation oncology has advanced exponentially since the discovery of X-rays just over 100 years ago. With the advent of three-dimensional treatment planning, the therapeutic index was increased by dose escalation and more accurate shielding of normal tissues. Now, even greater advances are under way with IMRT, image-guided radiation therapy, delineation and control of organ motion, and real-time imaging.

Advances in image-guided radiation therapy--the role of PET-CT.

In the era of image-guided radiation therapy (IGRT), the greatest challenge remains target delineation, as the opportunity to maximize cures while simultaneously decreasing radiation dose to the surrounding normal tissues is to be realized. Over the last 2 decades, technological advances in radiographic imaging, biochemistry, and molecular biology have played an increasing role in radiation treatment planning, delivery, and evaluation of response. Previously, fluoroscopy formed the basis of radiation treatment planning.

Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix.

Objectives: To assess the acute tolerance of delivering concurrent cisplatin and extended field radiotherapy (EFRT) using intensity-modulated radiotherapy technique (IMRT) for cancer of the cervix.

Methods: All patients receiving definitive treatment for cervical cancer were treated with EFRT using IMRT technique and concurrent cisplatin. The treatment volume included the cervix, uterus, parametria, presacral space, upper vagina, pelvic, common iliac, and paraaortic nodes to the top of L1.

A single institutional experience with definitive radiotherapy for cervical cancer using both high- and low-dose-rate brachytherapy.

Objective: To evaluate outcomes in cervical cancer patients treated with high-dose-rate (HDRB) or low-dose-rate (LDRB) brachytherapy.

Methods: A retrospective chart review compared control rates, survival, and complications in the two groups.

Results: All patients received pelvic EBRT (45 Gy/5 weeks).

Does breast size affect the scatter dose to the ipsilateral lung, heart, or contralateral breast in primary breast irradiation using intensity-modulated radiation therapy (IMRT)?

Purpose: To evaluate the relationship between the primary breast volume and dose received by the ipsilateral lung, heart (for left-breast cancers), and contralateral breast during primary breast irradiation using intensity-modulated radiation therapy (IMRT).

Methods And Materials: Sixty-five patients with breast carcinoma were treated using 6-MV photons with IMRT technique using the Eclipse Planning System following breast conserving surgery. All patients had a treatment planning CT scan.

Intensity-modulated radiotherapy for the treatment of vulvar carcinoma: a comparative dosimetric study with early clinical outcome.

Objectives: To assess early clinical outcome of intensity-modulated radiation therapy (IMRT) in the treatment of vulvar cancer and compare dosimetric parameters with 3D conformal radiotherapy (3D CRT).

Methods: Fifteen patients with vulvar cancer were treated with IMRT. Seven patients were treated with preoperative chemoradiation, and 8 patients were treated with adjuvant postoperative radiation therapy.

FDG-PET and PET/CT in Radiation Therapy Simulation and Management of Patients Who Have Primary and Recurrent Breast Cancer.

Radiation therapy is an important component in breast cancer management. Localization and delineation of gross tumor volumes is determined by anatomical imaging using CT and MRI. Recent developments allow the delivering of radiation doses more conformally to tumor tissue; thus precise target definition is needed to spare normal tissues and maximize coverage of tumor volumes in conformal radiation techniques.

Intraoperative (125)I Vicryl mesh brachytherapy after sublobar resection for high-risk stage I non-small cell lung cancer.

Purpose: To assess the feasibility and outcomes of (125)I Vicryl mesh brachytherapy after sublobar resection in stage I non small cell lung cancer (NSCLC) patients with poor pulmonary function.

Methods And Materials: Between January 1997 and July 2004, patients with poor cardiopulmonary reserve who had stage IA and IB (T1-2 N0 M0) NSCLC and a forced expiratory volume in 1s (FEV(1)) of > micro=0.6L were considered for limited surgical resection either by an open or video-assisted thoracoscopic procedure and for a subsequent (125)I Vicryl mesh brachytherapy implant.

A dose verification method using a monitor unit matrix for dynamic IMRT on Varian linear accelerators.

Dosimetry verification is an important step during intensity modulated radiotherapy treatment (IMRT). The verification is usually conducted with measurements and independent dose calculations. However, currently available independent dose calculation methods were developed for step-and-shoot beam delivery methods, and their uses for dynamic multi-leaf collimator (MLC) delivery methods are not efficient.

Intensity modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation.

Purpose: To determine the dose received by the contralateral breast during primary breast irradiation using IMRT compared to conventional tangential field techniques.

Methods And Materials: Between March 2003 and March 2004, 83 patients with breast carcinoma were treated using 6, 10, or mixed 6/18 MV photons (65 with tangential IMRT technique and 18 with 3-dimensional technique using tangential fields with wedges) for primary breast irradiation following breast-conserving surgery. Paired thermoluminescent dosimeters (TLDs) were placed on each patient's contralateral breast, 4 and 8 cm from the center of the medial border of the tangential field.

Prescription dose in permanent (131)Cs seed prostate implants.

Recently, 131Cs seeds have been introduced for prostate permanent seed implants. This type of seed has a relatively short half-life of 9.7 days and has its most prominent emitted photon energy peaks in the 29-34 keV region.

Contralateral uptake and metastases in sentinel lymph node mapping for recurrent breast cancer.

Background And Objectives: Sentinel lymph node mapping as a constitutive component in the staging process for invasive breast cancer continues to gain acceptance. We have identified two patients with recurrent invasive breast cancer in whom contralateral sentinel lymph node uptake and metastases, respectively, were detected. Such findings have not been previously reported in our review of the medical literature between 1966 and October 2004.

Perineural invasion of squamous cell carcinoma of the lip with occult involvement of the infra-orbital nerve detected by PET-CT and treated with MRI-based IMRT: a case report.

A 51 year old male with a history of right facial numbness developed progressive upper lip swelling for one year, but an MRI of the head was unremarkable. A wide local excision of the upper lip was performed and pathology revealed a 1.7 cm mass, poorly differentiated squamous cell carcinoma with perineural invasion.

Intensity-modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation: initial report.

Purpose: This study was designed to compare the dose received by the contralateral breast during primary breast irradiation using intensity-modulated radiotherapy with the dose received via conventional tangential field techniques.

Methods/materials: Between March 2003 and March 2004, 44 patients with breast carcinoma were treated using 6-, 10-, or mixed 6/18-MV photons(36 with tangential intensity-modulated radiotherapy technique and eight with three-dimensional technique using tangential fields with wedges) for primary breast irradiation after breast-conserving surgery. Paired thermoluminescent dosimeters were placed on each patient's contralateral breast, 4 cm from the center of the medial border of the tangential field.

Positive microscopic margins alter outcome in lymph node-negative cholangiocarcinoma when resection is combined with adjuvant radiotherapy.

Purpose: The purpose of this study was to evaluate the prognostic significance of positive microscopic margins in hilar cholangiocarcinoma in patients treated with resection and adjuvant radiotherapy.

Materials And Methods: Between January 1983 and December 1997, 65 patients were definitively diagnosed with hilar cholangiocarcinoma and treated at our institution. Twenty-eight patients underwent curative resection.

Hybrid PET-CT simulation for radiation treatment planning in head-and-neck cancers: a brief technical report.

Purpose: To prospectively study the impact on tumor and normal tissue delineation for RT planning by use of hybrid PET-CT simulation for patients with head-and-neck cancer.

Methods And Materials: Twenty-one patients were simulated in treatment position on a hybrid PET-CT scanner. Images were transferred to the Varian Eclipse planning system.

Cholangiocarcinoma: the impact of tumor location and treatment strategy on outcome.

The purpose of this study was to evaluate how the outcome of patients with extrahepatic cholangiocarcinoma (EHBC) may have been influenced by tumor location and treatment selection. The primary endpoint of this study is overall survival (OS). Between January 1983 and December 1997, 221 patients with biliary tumors were evaluated at Thomas Jefferson University Hospital.

Advances in brachytherapy: new approaches to target breast cancer.

Advances in breast brachytherapy techniques have led to the development of new approaches for treatment of patients with early-stage breast cancer. This article reviews the indications, clinical utility, and nursing interventions for the Mammosite Radiation Therapy System (Proxima Therapeutics, Alpharetta, GA) and INTRABEAM (Photoelectron Corporation, North Billerica, MA) radiation therapy system. Each uses a slightly different approach to provide definitive radiotherapy to the breast tumor bed following excision.

Radiation medicine innovations for the new millenium.

Purpose Of The Study: To review technological advances in the field of radiation oncology in the management of benign and malignant diseases.

Basic Procedures: We reviewed major advances in the field of radiation oncology in the past decade with special emphasis on reduction of treatment related toxicities, and technological improvements in planning and delivery of radiation. Modalities reviewed include computerized three-dimensional conformal treatment planning, stereotactic radiosurgery, intensity-modulated radiation therapy, ultrasound-guided transperineal permanent brachytherapy of the prostate, and high-dose rate brachytherapy.

Anaplastic thyroid carcinoma: comparison of conventional radiotherapy and hyperfractionation chemoradiotherapy in two groups.

Anaplastic thyroid carcinoma (ATC) is a highly aggressive neoplasm with a poor prognosis. Curative management of these tumors has been difficult secondary to delayed diagnosis and advanced disease at presentation. Treatment modalities including surgery and fractionated radiotherapy have had limited success in controlling these tumors.

Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy.

Purpose: Positive surgical margins adversely influence local tumor control in breast conservation therapy (BCT). However, reports have conflicted regarding whether an increased radiation dose can overcome this poor prognostic factor. In this study, we evaluated the influence of an increased radiation dose on tumor control in women with positive surgical margins undergoing BCT.

Analysis of repeat stereotactic radiosurgery for progressive primary and metastatic CNS tumors.

Purpose: To identify and evaluate the pretreatment and patient factors that would predict for complications after repeat radiosurgery.

Methods And Materials: The data from 26 patients who underwent re-irradiation with Gamma Knife surgery after a previous procedure in the same or subjacent location were available for evaluation. The range of follow-up was 1-45 months (mean 10).