S1253ESTRO 37(GI) and genitourinary (GU) toxicity were analyzed by univariate analysis. ResultsNeither acute nor late grade 2 to 3 GI toxicities developed.Acute grade 2 GU toxicity occurred in 11.4% (grade 3 in 0.0%).Any predictors of acute grade 2 GU toxicity weren't founded.Late grade 2 to 3 GU toxicity occurred in 23.8% (grade 3 in 2.9%).Grade 2 urethral obstruction, urinary tract pain, urinary urgency, urinary frequency, hematuria, and grade 3 urethral obstruction were observed in 9, 2, 7, 7, 4, and 3 patients, respectively.Any predictors of late grade 2 to 3 GU toxicity weren't also founded. ConclusionThere was no statistically-significant correlation between the incidence of Grade 2 to 3 GI and GU toxicity and the clinical and dosimetric factors after HDR brachytherapy as monotherapy in localized prostate cancer.
espanolEste trabajo recoge el informe del Grupo de Braquiterapia de la Sociedad Espanola de Fisica Medica dedicado a la planificacion en Braquiterapia (BT) ginecologica de cervix basada exclusivamente en Resonancia Magnetica (RM). Esta modalidad de BT ha experimentado un importante desarrollo en los ultimos anos, con la aparicion de aplicadores especiales con componente intersticial, que permiten una notable mejora en la conformacion, una vez definidos los volumenes en RM T2W. Este informe tiene como objetivo el conjugar aspectos practicos y ser resumen de la literatura y de las recomendaciones de sociedades cientificas, para armonizar y servir de base a los miembros de la SEFM en los inicios de la implementacion de esta tecnica. En este trabajo se describen los aplicadores disponibles, centrandonos fundamentalmente en los de componente intersticial. Tras el analisis de las condiciones de uso de la RM y el resumen de recomendaciones de sociedades cientificas y organismos, de acuerdo con la experiencia de los miembros del grupo de trabajo, se van a describir-discutir-proponer procedimientos de planificacion que van desde la reconstruccion hasta la optimizacion, la prescripcion y la elaboracion del informe. En este trabajo, tambien se incluye el uso de ultrasonidos por su gran potencial de futuro, finalizando con la descripcion de los aspectos especificos del Estado de Referencia Inicial (ERI) y analisis de incertidumbres en esta modalidad de planificacion de cervix con RM T2W. English3D image guided brachytherapy, based exclusively on MR has been introduced into clinical practice for the treatment of patients undergoing gynecological brachytherapy for cervical cancer. Recently, this brachytherapy modality shows a significant progress since the appearance of new type of applicators incorporating interstitial components with the aim of better coverage of volumes outlined on MR images. This report gathers the work of the Brachytherapy Group of the Spanish Society of Medical Physics (SEFM), dedicated to gynecological brachytherapy of cervical cancer based exclusively on MR. The goal of this report is to combine practical aspects, summary of literature and recommendations of scientific societies in order to ease other members of the SEFM with the implementation of this technique. This report summarizes many aspects involved in the whole process of the MR brachytherapy. Firstly, a description of the commercially available applicators is done, focusing on those having interstitial component. Secondly, some considerations about the use of MR imaging are described. A summary of recommendations published by relevant organisations or societies are also detailed in the document. Finally, and based on the experience of the members of this task group, many considerations and proposals are discussed about different aspects involved in the planning process, reconstruction alternatives, optimization methods, prescription and reporting. The use of ultrasonography is also included in this report due to its good prospects and increasing role in these procedures. The report ends with a description of specific aspects about commissioning and considerations about uncertainty analysis in this MR image based modality of brachytherapy of cervical cancer.
157 pts (median age 64 years -range 39-84) were enrolled.All pts underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy; patological stage (FIGO 2008) was I in 150 pts and II in 7 pts.Tumour grading was G1 in 49 pts, G2 in 98 and G3 in 10.All pts underwent high-dose-rate vaginal brachytherapy (total dose 21 Gy in three week-fractions), delivered with vaginal cylinder, with the reference isodose covering the proximal ½ of the vagina.The dose was specified at 5 mm distance from the cylinder surface.The Kaplan-Meier method estimated the probability of locoregional relapse free survival (LRFS), distant metastases-free survival (DMFS) and cancer-specific survival (CSS).Univariate analysis investigated the effect of age, grading, number of excised nodes and pathological stage on loco-regional relapse (LRR), metastases, and tumour-related death.Risk factors in univariate analysis were included in proportional hazard multivariate models.Vaginal toxicity was evaluated with the RTOG/EORTC scale and was correlated with the cylinder diameter (2.5, 3 or 3.5 cm).Results: LRFS occurred in 9/157 (5.8%) pts.Three pts (1.9%) developed liver metastases.At median follow-up of 83 months 144 pts (91.8%) are alive and disease free, 2 pts (1.2%) are alive with disease, 7 pts (4.5%) died from disease and 4 pts (2.5%) died from other causes.The 3-year probability of LRFS, DMFS and CSS was 94.5% (95%CI:89.4-97.2),98.7% (95% CI: 94.9-99.7)and 96,5% (95% CI: 91.8-98.5)respectively.Median survival was nor reached for any endpoints.At univariate analysis, risk factors for LRR were stage pII (HR: 3.638; 95% CI:1.3-9.8;p=0.011) and less than 12 excised nodes (HR: 7.057; 95% CI:1.6-29.5;p=0.008), while Stage pII was risk factor for metastasis (HR: 22.7; 95%CI:2.392-215.4;p=0.007) and tumour-related death (HR: 4.043; 95% CI: 1.2-13.2;p=0.021).In multivariate Coxregression analysis, stage pII and less than 12 nodes sampled were significantly associated with LRR (HR: 3.88; 95%CI:1.390-10.878;p=0.010 and HR: 6.952; 95%CI: 1.591-30.385;p=0.010), whereas only stage pII was associated with metastasis (HR: 23.1; 95%CI: 2.296-231.485;p=0.008) and tumour-related death (HR: 4.324; 95% CI: 1.223-15.290;p=0.023).Treatment was well tolerated.No pts developed acute or late grade III-IV toxicity.No correlation between the diameter of the applicator and the onset of acute (p=0.512) and chronic (p=0.433)toxicity was observed .Conclusions: Post-operative VBT in pts with early stage endometrial cancer is effective in ensuring vaginal control, with fewer toxic effects.