Excellent Long-term Breast Preservation Rate After Accelerated Partial Breast Irradiation Using a Balloon Device.

Background: Accelerated partial breast irradiation (APBI) using a balloon device has been well tolerated. A recent retrospective population-based study showed an increase in the rate of subsequent mastectomy for patients who undergo APBI compared with whole breast radiation therapy. Our aim was to analyze the long-term results of patients treated with APBI at our institution to determine the salvage mastectomy and locoregional recurrence rates and cosmesis outcomes.

MammoSite multilumen catheter: dosimetry considerations.

Purpose: To explore the dosimetric advantages of the new MammoSite multilumen (ML) balloon for breast brachytherapy treatment compared to conventional single lumen (SL) device plan.

Materials And Methods: Patients deemed appropriate for accelerated partial breast irradiation (APBI) were implanted with the MammoSite ML balloon. Two plans were generated in each patient for the same target coverage (PTV_EVAL) and dose to normal structures were plotted.

Influence of volumes of prostate, rectum, and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image-guided IMRT.

Purpose: The purpose of this study was to analyze the relationship between prostate, bladder, and rectum volumes on treatment planning CT day and prostate shifts in the XYZ directions on treatment days.

Methods: Prostate, seminal vesicles, bladder, and rectum were contoured on CT images obtained in supine position. Intensity modulated radiation therapy plans was prepared.

Intraoperative placement of MammoSite for breast brachytherapy treatment and seroma incidence.

Purpose: To identify possible risk factors for development of clinically significant seroma (CSS) (seroma requiring intervention) and to report on incidence of infection after intraoperative placement of MammoSite for breast brachytherapy.

Methods And Materials: Fifty-eight postmenopausal patients with early stage breast cancer and no nodal metastases, treated with partial breast irradiation using the MammoSite catheter from June 2003 to November 2007 were analyzed retrospectively for CSS predictive factors and incidence of infection. After a lumpectomy, a MammoSite catheter was placed by intraoperative open-cavity technique (OCT).

The potential for dose dumping in normal tissues with IMRT for pelvic and H&N cancers.

The purpose of this study is to understand the potential for dose dumping in normal tissues (>85% of prescription dose) and to analyze effectiveness of techniques used in reducing dose dumping during IMRT. Two hundred sixty-five intensity modulated radiation therapy (IMRT) plans for 55 patients with prostate, head-and-neck (H&N), and cervix cancers with 6-MV photon beams and >5 fields were reviewed to analyze why dose dumping occurred, and the techniques used to reduce dose dumping. Various factors including gantry angles, depth of beams (100-SSD), duration of optimization, severity of dose-volume constraints (DVC) on normal structures, and spatial location of planning treatment volumes (PTV) were reviewed in relation to dose dumping.

Single course IMRT plan to deliver 45 Gy to seminal vesicles and 81 Gy to prostate in 45 fractions.

We treat prostate and seminal vesicles (SV) to 45 Gy in 25 fractions (course 1) and boost prostate to 81 Gy in 20 more fractions (course 2) with Intensity Modulated Radiation Therapy (IMRT). This two-course IMRT with 45 fractions delivered a non-uniform dose to SV and required two plans and two QA procedures. We used Linear Quadratic (LQ) model to develop a single course IMRT plan to treat SV to a uniform dose, which has the same biological effective dose (BED) as that of 45 Gy in 25 fractions and prostate to 81 Gy, in 45 fractions.

External beam radiation therapy to prevent postangioplasty dialysis access restenosis: a feasibility study.

Purpose: To evaluate the feasibility and short-term side-effects of postangioplasty external beam radiation for patients with compromised arteriovenous dialysis accesses.

Materials And Methods: Ten patients with compromised arteriovenous dialysis accesses were studied. Following confirmation of access compromise by an angiogram, patients were treated by a standard angioplasty +/- stent deployment.

Practical considerations in setting up an intracoronary brachytherapy program: results of a multicenter survey.

Purpose: To identify logistic issues faced by radiation oncologists in initiating intracoronary radiation therapy (RT) and to delineate their role in these procedures.

Materials And Methods: Radiation oncologists from 12 sites (with combined experience of >500 cases) that participated in a randomized, double-blinded study of intracoronary RT completed a questionnaire that included demographics and experience, regulatory issues, scheduling and interaction with patients, time commitment, involvement of the radiation oncologist, and ideas for overcoming hurdles.

Results: Licensing was perceived as a substantial hurdle; Nuclear Regulatory Commission approval took more than 5 months at five of 12 sites.

Palladium-103: a new radioactive source in the treatment of unresectable carcinoma of the pancreas: a phase I-II study.

Palladium-103 (Pd-103) is introduced in brachytherapy procedures because of its favorable physical properties, including its low energy, rapid dose fall-off, short half-life, and total cumulative dose delivery at a higher dose rate than iodine-125 (I-125) isotope. Intraoperative brachytherapy using I-125 pellets was reported to provide significant palliation and meaningful prolongation of life in highly selected patients with unresectable carcinoma of the pancreas. After considering some of the advantages of Pd-103 over I-125, we designed a phase I-II clinical trial to assess the feasibility of intraoperative Pd-103 in unresectable carcinoma of the pancreas to study the related morbidity when combined with chemotherapy and external beam radiation, and to evaluate the impact on palliation and local control rates.

High dose-rate intraluminal irradiation in bronchogenic carcinoma. Technique and results.

Patients who present with symptomatic airway obstruction often have limited therapeutic options. Intraluminal irradiation has been used in an attempt to obtain sustained palliation. Patients treated with high dose-rate endobronchial irradiation have shown good to excellent palliation of symptoms, as well as a high rate of local control; however, these results have not always been devoid of complications.

A versatile method for planning stereotactic brain implants.

Our approach to planning stereotactic 125I brachytherapy of brain tumors has involved least-squares optimization of individual seed positions within the target contour, followed by repeated combining of seeds from nearest-neighbor catheters in order to achieve an acceptably low number of catheters and an acceptable-separation of entry points. In one option, the catheters diverge from an extra-cranial point that can be close to the skull if all catheters are to be placed through a small craniectomy to treat a larger-diameter target. In another option, catheters converge toward a point beyond the target, to facilitate perpendicularity at the skull surface if a separate opening is to be drilled for each catheter.

Treatment planning for permanent and temporary percutaneous implants with custom made templates.

Nine patients who were presented at MSKCC with primary or recurrent pelvic or head and neck tumors and for whom surgery or further external radiation were excluded, were treated with percutaneous permanent or temporary implants, with individual pre-treatment planning and custom made templates. The tumor dose distributions achieved were as good as for implants performed at the time of surgical exploration. No serious complications have been encountered.