To prospectively analyze whether cross-linked hyaluronan gel reduces the mean rectal dose and acute rectal toxicity of radiotherapy for prostate cancer.
Between September 2008 and March 2009, we ...transperitoneally injected 9 mL of cross-linked hyaluronan gel (Hylaform; Genzyme Corporation, Cambridge, MA) into the anterior perirectal fat of 10 early-stage prostate cancer patients to increase the separation between the prostate and rectum by 8 to 18 mm at the start of radiotherapy. Patients then underwent high-dose rate brachytherapy to 2,200 cGy followed by intensity-modulated radiation therapy to 5,040 cGy. We assessed acute rectal toxicity using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 grading scheme.
Median follow-up was 3 months. The anteroposterior dimensions of Hylaform at the start and end of radiotherapy were 13 +/- 3mm (mean +/- SD) and 10 +/- 4mm, respectively. At the start of intensity-modulated radiation therapy, daily mean rectal doses were 73 +/- 13 cGy with Hylaform vs. 106 +/- 20 cGy without Hylaform (p = 0.005). There was a 0% incidence of National Cancer Institute Common Terminology Criteria for Adverse Events v3.0 Grade 1, 2, or 3 acute diarrhea in 10 patients who received Hylaform vs. a 29.7% incidence (n = 71) in 239 historical controls who did not receive Hylaform (p = 0.04).
By increasing the separation between the prostate and rectum, Hylaform decreased the mean rectal dose. This led to a significant reduction in the acute rectal toxicity of radiotherapy for prostate cancer.
Testicular Cancer, Version 2.2015 Motzer, Robert J; Jonasch, Eric; Agarwal, Neeraj ...
Journal of the National Comprehensive Cancer Network
13, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Germ cell tumors (GCTs) account for 95% of testicular cancers. Testicular GCTs constitute the most common solid tumor in men between the ages of 20 and 34 years, and the incidence of testicular GCTs ...has been increasing in the past 2 decades. Testicular GCTs are classified into 2 broad groups--pure seminoma and nonseminoma--which are treated differently. Pure seminomas, unlike nonseminomas, are more likely to be localized to the testis at presentation. Nonseminoma is the more clinically aggressive tumor associated with elevated serum concentrations of alphafetoprotein (AFP). The diagnosis of a seminoma is restricted to pure seminoma histology and a normal serum concentration of AFP. When both seminoma and elements of a nonseminoma are present, management follows that for a nonseminoma. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Testicular Cancer outline the diagnosis, workup, risk assessment, treatment, and follow-up schedules for patients with both pure seminoma and nonseminoma.
Cachaça is a beverage of great cultural and economic importance for Brazil. It is made up of several substances that are responsible for the flavor of the beverage. Countless substances of a toxic ...nature can also be present, such as polycyclic aromatic hydrocarbons (PAHs). These contaminants are commonly found in beverages and food. They have been studied because their toxicity is related to their mutagenic and carcinogenic properties, and they pose a risk to human health. The PAHs can be formed in cachaça during different stages of processing. In this work, the presence of PAHs (naphthalene, acenaphene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benzoaanthracene, acephenylene, and benzoapyrene) was investigated during the storage of the beverage in plastic containers. Thus, samples from five producers of cachaça in the state of Minas Gerais were stored for up to 8 months in polyethylene terephthalate (PET) packaging from three different manufacturers. Samples stored for 4 and 8 months were analyzed by high‐performance liquid chromatography, and 10 PAHs (naphthalene, acenaphene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benzoaanthracene, acephenylene, and benzoapyrene) were identified and quantified. An increase in PAH concentration in cachaça samples with the storage time in plastic containers was observed. The three different packages contributed to the contamination of the cachaça samples with different PAHs. The highest concentration (approximately 11.0 µg L–1) of fluorene was observed in sample A from the three packages and during the two storage times. Thus, it can be inferred that the storage of cachaça in bottles of PET is inadequate for maintaining the quality of the beverage.
Practical Application
Therefore, it can be inferred from the results of the analysis that PET packages are sources of PAHs, and the storage time in these packages contributed to the increase in the concentration of these contaminants in the beverage. These results suggest that a review of the legislation regarding the use of PET packaging for beverage storage is necessary, as these compounds are carcinogenic.
Radiotherapy treatment planning for testicular seminoma Wilder, Richard B; Buyyounouski, Mark K; Efstathiou, Jason A ...
International journal of radiation oncology, biology, physics,
07/2012, Letnik:
83, Številka:
4
Journal Article
Recenzirano
Virtually all patients with Stage I testicular seminoma are cured regardless of postorchiectomy management. For patients treated with adjuvant radiotherapy, late toxicity is a major concern. However, ...toxicity may be limited by radiotherapy techniques that minimize radiation exposure of healthy normal tissues. This article is an evidence-based review that provides radiotherapy treatment planning recommendations for testicular seminoma. The minority of Stage I patients who choose adjuvant treatment over surveillance may be considered for (1) para-aortic irradiation to 20 Gy in 10 fractions, or (2) carboplatin chemotherapy consisting of area under the curve, AUC = 7 × 1-2 cycles. Two-dimensional radiotherapy based on bony anatomy is a simple and effective treatment for Stage IIA or IIB testicular seminoma. Centers with expertise in vascular and nodal anatomy may consider use of anteroposterior-posteroanterior fields based on three-dimensional conformal radiotherapy instead. For modified dog-leg fields delivering 20 Gy in 10 fractions, clinical studies support placement of the inferior border at the top of the acetabulum. Clinical and nodal mapping studies support placement of the superior border of all radiotherapy fields at the top of the T12 vertebral body. For Stage IIA and IIB patients, an anteroposterior-posteroanterior boost is then delivered to the adenopathy with a 2-cm margin to the block edge. The boost dose consists of 10 Gy in 5 fractions for Stage IIA and 16 Gy in 8 fractions for Stage IIB. Alternatively, bleomycin, etoposide, and cisplatin chemotherapy for 3 cycles or etoposide and cisplatin chemotherapy for 4 cycles may be delivered to Stage IIA or IIB patients (e.g., if they have a horseshoe kidney, inflammatory bowel disease, or a history of radiotherapy).
To prospectively analyze prostate intrafraction motion in the prone vs. supine position and to assess patient satisfaction with these two positions.
Fifteen prostate cancer patients underwent ...implantation of five fiducial gold seeds in their prostate for localization. Patients were treated with high-dose-rate brachytherapy to 2,200 cGy followed by intensity-modulated radiation therapy (IMRT) to 5,040 cGy. Patients underwent computed tomography simulation and IMRT in the prone position. For the first five IMRT treatments, an electronic portal imaging system was used to acquire anteroposterior (AP) and lateral images pretreatment and posttreatment. We then repositioned each patient supine and repeated the process, resulting in 600 images.
Mean +/- standard deviation intrafraction prostate motion was 2.1 +/- 1.2 mm and 1.7 +/- 1.4 mm (AP, p = 0.47), 2.2 +/- 2.0 mm and 1.6 +/- 1.8 mm (superoinferior, p = 0.16), and 1.0 +/- 1.2 mm and 0.6 +/- 0.9 mm (left-right, p = 0.03) in the prone and supine positions, respectively. Eighty percent of patients stated that they were more comfortable in the supine position (p = 0.02).
Prone and supine positions resulted in a similar magnitude of AP and superoinferior intrafraction prostate motion (2 mm). Because there was no significant difference in the magnitude of AP and superoinferior prostate motion prone vs. supine and patients were more comfortable in the supine position, patients now undergo IMRT to the prostate and seminal vesicles at our center in the supine position.
Background
The objectives are to determine predictors of a prostate-specific antigen (PSA) bounce, whether a PSA bounce after radiotherapy for prostate cancer is associated with biochemical ...disease-free survival (bDFS), and the time course to a PSA bounce versus a biochemical failure post-irradiation.
Methods
Between July 2000 and December 2012, 691 prostate cancer patients without regional or distant metastases were treated with external beam radiation therapy and/or brachytherapy, and had at least 12 months of follow-up. A PSA bounce was defined as a temporary PSA increase of ≥0.4 ng/mL. bDFS was defined according to the nadir + 2 definition.
Results
The median follow-up was 42 months. The median time to first PSA bounce was 17 months (95 % confidence interval 15–18 months). In contrast, the median time to biochemical failure was 41 months (95 % confidence interval 28–53 months). Two hundred and twenty-six of 691 (33 %) patients had at least one PSA bounce with a median magnitude of 1.0 ng/mL (range 0.4–17.0). A Gleason score of 6 (
p
< 0.0001) predicted a PSA bounce on multivariate analysis. Patients with a PSA bounce experienced improved bDFS on multivariate analysis (
p
= 0.002).
Conclusions
Patients with a Gleason score of 6 were more likely to experience a PSA bounce which was associated with improved bDFS. A PSA bounce occurred sooner after radiotherapy than a biochemical failure. The authors recommend against performing prostate biopsies within 24–30 months of radiotherapy since an elevated PSA may simply represent a benign PSA bounce.
Conventionally fractionated radiotherapy is delivered in 1.8- to 2.0-Gy fractions. With increases in understanding of radiation and tumor biology, various alterations of radiotherapy schedules have ...been tested in clinical trials and are now regarded by some as standard treatment options. Hyperfractionation is delivered through a greater number of smaller treatment doses. Accelerated fractionation decreases the amount of time over which radiotherapy is delivered typically by increasing the number of treatments per day. Hypofractionation decreases the number of fractions delivered by increasing daily treatment doses. Furthermore, many of these schedules have been tested with concurrent chemotherapy regimens. In this review, we summarize the major clinical studies that have been conducted on altered fractionation in various disease sites.
Introduction To describe the technique of injecting Lipiodol in the submucosa of the urinary bladder wall as a novel modality to improve localization of muscle-invasive bladder tumors before ...image-guided radiation therapy. Technical Considerations Eight patients underwent submucosal Lipiodol injections at transurethral bladder tumor reresection. A rigid cystoscope with a working port was used to inject Lipiodol into bladder submucosa circumferentially around the tumor bed (2-3 mm from margin of resection). Approximately 20-30 injections were used to demarcate the tumor bed for external beam radiation therapy, which was used as part of a bladder-sparing approach. All patients were diagnosed with clinically localized, high-grade, muscle-invasive carcinoma and were deemed nonsurgical candidates or were unwilling to undergo radical cystectomy. Five of the 8 patients received radiation at our institution. Lipiodol injections (95%) were visible on treatment planning computed tomographic scans and kilovoltage portal images throughout the 7-week course of image-guided radiation therapy. In 2 of 5 patients, the tumor bed based on Lipiodol extended outside a planning target volume that would have been treated with radiation therapy based on cystoscopy reports and computed tomographic scans without Lipiodol. There were no adverse events or treatment-related toxicities secondary to Lipiodol injection. Conclusion Intravesical Lipiodol injection is an easy-to-perform technique that is safe and effective. Lipiodol serves as a fiducial marker that improves tumor bed localization for radiation therapy, thereby reducing the likelihood of missing the tumor.
Abstract Background and purpose We sought to analyze the effect of polyethylene glycol (PEG) hydrogel on rectal doses in prostate cancer patients undergoing radiotherapy. Materials and methods ...Between July 2009 and April 2013, we treated 200 clinically localized prostate cancer patients with high-dose rate (HDR) brachytherapy ± intensity modulated radiation therapy. Half of the patients received a transrectal ultrasound (TRUS)-guided transperineal injection of 10 mL PEG hydrogel (DuraSeal™ Spinal Sealant System; Covidien, Mansfield, MA) in their anterior perirectal fat immediately prior to the first HDR brachytherapy treatment and 5 mL PEG hydrogel prior to the second HDR brachytherapy treatment. Prostate, rectal, and bladder doses and prostate–rectal distances were calculated based upon treatment planning CT scans. Results There was a success rate of 100% (100/100) with PEG hydrogel implantation. PEG hydrogel significantly increased the prostate–rectal separation (mean ± SD, 12 ± 4 mm with gel vs. 4 ± 2 mm without gel, p < 0.001) and significantly decreased the mean rectal D2 mL (47 ± 9% with gel vs. 60 ± 8% without gel, p < 0.001). Gel decreased rectal doses regardless of body mass index (BMI). Conclusions PEG hydrogel temporarily displaced the rectum away from the prostate by an average of 12 mm and led to a significant reduction in rectal radiation doses, regardless of BMI.
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