Brachytherapy

Point: Prostate carcinoma treatment for the young patient—The case for brachytherapy

Kent E. Wallner — 2010-07-01

A growing number of long-term series document highly favorable outcomes after brachytherapy or prostatectomy for low-risk prostate cancer . And unlike the case for external beam radiation, the effectiveness of prostate brachytherapy can be measured by post-treatment prostate-specific antigens that match those of prostatectomy . Studies documenting long-term cancer control in younger patients specifically are more limited, but available evidence is that the prognosis for younger patients with either surgery or brachytherapy is similar to that for older patients . Quality-of-life outcomes also seem similar between modalities overall, regardless of age . Although excellent outcomes can be achieved with surgery or brachytherapy in younger prostate cancer patients, it has become clear that achieving those outcomes with either modality is quality dependent.

Counterpoint: Prostate carcinoma treatment for the young patient—The case for radical prostatectomy

Alex Shteynshlyuger, Adam S. Kibel — 2010-07-01

The National Cancer Institute estimates 192,280 new cases of prostate cancer and 27,360 deaths from prostate cancer in 2009 making prostate carcinoma the most common malignancy and second most common cause of cancer death in men. Introduction of prostate specific antigen (PSA)-based screening in the early 1990s, along with increased use of aggressive therapy , has led to a dramatic increase in the number of cases diagnosed, improved disease-free survival, and a 4.1% drop in mortality per year since 1994 .

Rebuttal to Drs. Shteynshlyuger and Kibel

Kent E. Wallner — 2010-07-01

Drs. Shteynshlyuger and Kibel cover several valid points regarding cancer control rates, morbidities, and adjuvant radiation for prostatectomy. I agree that in good hands, both prostatectomy and brachytherapy afford very high, durable cancer control rates . I have little argument with most of their statements. However, their points in no way diminish my concerns over the wildly variable results reported for prostatectomy, even from big-name institutions. Highly variable surgical quality includes perioperative complications, cure rates, and long-term incontinence . Inconsistent quality appears to be far less with brachytherapy and can be minimized with attention to postimplant dose analysis (with touch up of inadequate implants). In contrast, the path to minimization of surgical quality variance is hazy, other than the volume of cases accrued by each surgeon . I would not want to be the 28th patient of a recently minted robotic laparoscopic surgeon.

Rebuttal to Dr. Wallner

Alex Shteynshlyuger, Adam S. Kibel — 2010-07-05

We appreciate the points made in favor of brachytherapy. However, we remain convinced that radical prostatectomy (RP) should be preferred in the younger patient. The first point made by Dr. Wallner is that the learning curve for RP is long and steep. He reports that Vickers et al. found “there was a steady increase in cure rates [for RP] extending out to 1000 cases.” Vickers et al. did demonstrate that the rates of biochemical recurrence improve with surgeon's experience with the 5-year recurrence rates of 17.9% for surgeons who have performed 10 prior cases and 10.7% for those who have performed more than 250 cases. However, although there was a rapid improvement in the first 250 cases, Vickers et al. reported that there was no improvement beyond that point.

The dosimetric quality of brachytherapy implants in patients with small prostate volume depends on the experience of the brachytherapy team

2010-05-31

Abstract: Purpose: To investigate the dosimetric outcome of brachytherapy in patients with small prostate volume (PV).Methods and Materials: Forty-three patients with small PV (<25cm3) as determined using transrectal ultrasound and 120 patients with non–small PV (>25cm3) that had received 125I seed implants were reviewed in a retrospective cohort study. Implantations were performed under transrectal ultrasound guidance, and the prescription dose was 145Gy. A CT and MRI scan of the pelvis were performed 1 month after implantation for dosimetric study.Results: Compared with non–small PV patients, patients with small PV experienced larger 1-month edema (p<0.001); lower dose to 90% (the isodose enclosing 90% of PV and representing a minimum dose to that volume of the prostate [D90]) of the prostate (p=0.03); higher intracapsular seed density (p<0.001); and were less likely to achieve D90≥140Gy (p=0.013) in a postimplant dosimetric study. The number of patients with D90<140Gy decreased steadily in both subsets of patients as the implant program matured (odds ratio=0.56 per year, p<0.001), but the small prostate group exhibited more improvement compared with the non–small prostate patients over the same time period. Multivariate analysis revealed that brachytherapy team experience rather than the size of prostate was a more important predictive factor of implant quality (p<0.001).Conclusions: This single institution experience demonstrated a significant learning curve in the initial years of a prostate brachytherapy program, especially for patients with small prostates. A small prostate itself is not a contraindication of brachytherapy. The quality of implant for patients with small prostates depends more on the skill of the brachytherapy team.

Prostate gland edema after single-fraction high-dose rate brachytherapy before external beam radiation therapy

Fabio L. Cury, Marie Duclos, Armen Aprikian, Horacio Patrocinio, Luis Souhami — 2010-02-10

Abstract: Purpose: High–dose rate brachytherapy (HDRB) is frequently used as a boost to external beam radiation therapy (EBRT) in prostate cancer patients. With the increasing use of small planning target volume margins in EBRT, prostatic edema induced by HDRB can be a contributing factor to geometric miss when HDRB is performed before or during EBRT. We assessed prostate gland volumetric change after single-fraction HDRB and its impact on definition of treatment volume for EBRT.Methods and Materials: Thirty-one consecutive patients with intermediate-risk prostate cancer treated with single-fraction HDRB (10Gy) combined with hypofractionated EBRT were analyzed. A second CT scan was performed 7 days after HDRB, and images were coregistered with the planning CT scan that contained the original clinical target volume (CTV). The post-HDRB prostate CTV volume was compared with the original CTV by a single observer.Results: All patients presented volumetric variation. In most cases (68%), the prostate increased in volume, whereas it decreased in 32%. The mean prostatic volume was 42.2cc before HDRB and 43.6cc after HDRB, representing a mean volume difference of 3.4%, ranging from −14.2% to 23.8% (p=0.756). This difference is the result of mean changes of 0.6mm (−6.1 to 6.6) in the anterior–posterior, 0.5mm (−5.5 to 3.0) in the lateral, and 0.2mm (−5.0 to 5.0) in the superior–inferior axes.Conclusions: Although a nonsignificant volumetric change occurs after single-fraction HDRB, individual variations on specific axis could lead to important uncertainties during EBRT.

The impact of perineural invasion on biochemical outcome after permanent prostate iodine-125 brachytherapy

2009-12-21

Abstract: Purpose: Perineural invasion (PNI) in prostate biopsies is associated with increased risk of higher Gleason score and worse pathologic stage. We report the influence of PNI in biochemical no evidence of disease (bNED) survival after 125I prostate brachytherapy (BT).Methods and Materials: Pathology reports of 700 men with localized prostate cancer who underwent 125I prostate BT in 1999–2008 were reviewed. The presence or absence of PNI in the biopsy was documented in 339 men. Clinical, treatment, and dosimetric parameters, along with PNI status, were evaluated for bNED survival, defined by “nadir+2” definition.Results: Of the 339 patients, 87% had favorable risk and 13% intermediate risk. PNI was present in 89 patients (26%). After a median followup of 32 months, there were five biochemical failures (4: +PNI and 1: −PNI), of which one was local failure (+PNI). Actuarial 5-year bNED survival for the entire group was 97.0% (92.9% for +PNI; 99.2% for −PNI). In univariate analysis age, pretreatment prostate-specific antigen, Gleason score 7, and intermediate risk group predicted for worse biochemical outcome, whereas the presence of PNI showed a trend toward significance (p=0.06). Some of the regression algorithms failed to converge because of low event rates.Conclusions: We report excellent biochemical control in 339 men treated with 125I prostate BT. The presence of PNI showed a trend toward significance in predicting 5-year bNED survival but did not impact on local control and should not influence the decision to recommend BT for localized prostate cancer.

Differences between intraoperative ultrasound-based dosimetry and postoperative computed tomography-based dosimetry for permanent interstitial prostate brachytherapy

2010-02-01

Abstract: Purpose: To compare the results of intraoperative ultrasound (US)-based dosimetry with those of postimplant computed tomography (CT)-based dosimetry after 125I prostate brachytherapy.Methods and Materials: Subjects comprised 160 patients who underwent prostate brachytherapy using 125I seed implants. Prescribed dose was set as 145Gy to the periphery of the prostate. Implantation was performed using an intraoperative interactive technique. Postimplant dosimetry was performed on Days 1 and 30 after implantation using CT. Dosimetric results for the prostate, urethra, and rectum were compared among intraoperative US and CT on Day 1 (CT1) and Day 30 (CT30).Results: Mean minimal dose received by 90% of prostate volume was 133.7%, 115.6%, and 125.8% of the prescribed dose on US, CT1, and CT30, respectively: This value temporarily decreased on Day 1 and increased on Day 30. Other parameters for the prostate and urethra showed similar trends. Conversely, mean rectal volume receiving 100% of the prescribed dose was 0.69, 0.46, and 1.02mL on US, CT1, and CT30, respectively. Rectal parameters tended to be underestimated on US relative to CT30-based dosimetry. A positive linear relationship was identified between US and CT observations for every prostate parameter and the dose covering 30% of the urethra.Conclusions: Our results demonstrate significant differences between dosimetric parameters obtained by US, CT1, and CT30. However, significant correlations also exist between US and CT, at least in prostate and urethral parameters. Clarification of the degrees of difference might make US planning more feasible.

Prostate brachytherapy seed migration to the left testicular vein

Ba D. Nguyen, Genevieve L. Egnatios — 2010-01-29

Abstract: Purpose: Prostate brachytherapy seeds may detach from their initial insertion sites and migrate to lungs, heart, coronary artery, liver, kidney, and vertebral venous plexus. The authors present the left testicular vein as additional site of seed embolization.Methods and Materials: The authors report a 68-year-old man with seed migration to the left testicular vein shortly after brachytherapeutic procedure. All imaging procedures obtained after the transperineal seed implant insertion are retrospectively analyzed in correlation with the patient's clinical course.Results: The retrospective imaging review shows a left lower abdominal seed anterior to the left psoas muscle. CT re-evaluation localizes the seed in the left testicular vein. This embolized seed was not initially identified on any imaging modality. Although there is no solid cause–effect proof in this case, the fully potent embolized seed may be contributory to the patient's testicular symptomatology.Conclusion: The uncommon seed relocation to the left testicular vein is probably because of periprostatic–pampiniform venous communication.

Efficacy of high-dose-rate interstitial brachytherapy in patients with oral tongue carcinoma

2010-01-29

Abstract: Purpose: To evaluate the results of high-dose-rate (HDR)-interstitial brachytherapy (ISBT) in oral tongue carcinomas.Methods and Materials: Between September 1999 and August 2007, 50 patients were treated for oral tongue carcinoma with HDR-ISBT. The patient's mean age was 58 years. Forty-two patients were in T1–2 stage and 8 patients were in T3 stage; 16 patients were in N+ stage and 34 patients in N0 stage. Exclusive ISBT was given to 17 patients (34%) in T1–2 N0 stage and complementary to external beam radiotherapy (EBRT) to 33 patients (66%). A perioperative technique was performed on 14 patients. The median total dose was 44Gy when HDR was used alone (4Gy per fraction) and 18Gy when complementary to 50Gy EBRT (3Gy per fraction).Results: The median followup was 44 months. Actuarial disease-free survival rates at 3 and 5 years were 81% and 74%, respectively. Local failure developed in 7 patients. Actuarial local control (LC) rates were 87% and 79% at 3 and 5 years in T1–2 stage 94.5% and 91% and T3 stage 43% and 43% (with salvage surgery). Exclusive HDR cases showed LC in 100% of the cases, and the combined group (EBRT+HDR) showed LC in 80% and 69% of the cases at 3 and 5 years (p=0.044). Soft-tissue necrosis developed in 16% and bone necrosis in 4% of the cases.Conclusions: HDR brachytherapy is an effective method for the treatment of oral tongue carcinoma in low-risk cases. Doses per fraction between 3 and 4Gy yield LC and complication rates similar to low-dose rate. The perioperative technique promises encouraging results.

Acquisition of equal or better planning results with interstitial brachytherapy when compared with intensity-modulated radiotherapy in tongue cancers

2010-01-29

Abstract: Purpose: Intensity-modulated radiotherapy (IMRT) technique in external beam radiotherapy and interstitial implant brachytherapy (ISBT) play important role in the treatment of head and neck cancers. Both are proved to be highly conformal techniques of radiotherapy. In this study, we investigated whether ISBT can give treatment planning results similar to those of IMRT.Methods and Materials: Fifteen patients with tongue cancer treated with interstitial high-dose-rate brachytherapy were replanned. They were evaluated with the IMRT planning system. Contouring of target volume, including all critical structures was done on the IMRT treatment planning system to closely match implant brachytherapy planning system. Treatment plans were generated after specifying the goals in the prescription. Conformity index and dose to critical organ were calculated and compared between IMRT and ISBT. Planning time was also recorded for both the techniques in all the cases.Results: Very good dose conformity was observed in ISBT, which was almost the same as that in IMRT. Dose to the critical structure was lower in ISBT in all the cases. Planner time was also less in ISBT for more number of cases.Conclusions: Results show that ISBT treatment modality produces equal or superior planning results when compared with IMRT with our optimization techniques. These results encourage us to continue ISBT practice.

Periauricular mold brachytherapy

Bahadir Ersu, Ibrahim Tulunoglu, Mustafa Cengiz — 2009-10-23

Abstract: Purpose: We present a patient with recurrent basal cell carcinoma (BCCA) who was treated with custom-made mold brachytherapy.Methods and Materials: The patient was admitted to the hospital with the complaint of recurrent BCCA of the auditory canal. He has previously treated by surgery and external beam radiotherapy. We decided to continue with reirradiation to tumor bed after surgical excision. A total of 25Gy to 5mm depth of surgical bed was delivered by mold brachytherapy.Results: The patient did well during the treatment without any acute toxicity. He was lost to followup after 2 years of treatment without any obvious late morbidity.Conclusion: Custom-made mold brachytherapy is an alternative treatment modality, for reirradiation of selected group of patients, with minimal morbidity and good disease control.

Retrospective study of 81 patients treated with brachytherapy for endobronchial primary tumor or metastasis

Anne Dagnault, Annie Ébacher, Éric Vigneault, Serge Boucher — 2010-02-01

Abstract: Purpose: The purpose of this retrospective study is to evaluate the role of endobronchial brachytherapy in the palliation of lung cancer (or metastasis) symptoms and its potential impact on overall survival.Methods and Materials: Eighty-one patients were included in this study. Endobronchial brachytherapy catheter was placed under conscious sedation. The projection of the tumor was drawn by the bronchoscopist to help the radiation oncology team to perform the dosimetry. Patients were treated with iridium-192 high-dose rate afterloading unit. Patients were planned to receive 5Gy in four fractions weekly for a total of 20Gy.Results: Seventy-three percent of the patients were treated for primary lung cancer. The remaining patients were treated for lung metastasis of other primary. Most patients presented dyspnea, cough, or hemoptysis. These three main symptoms were relieved in 85%, 77%, and 100%, respectively. The median survival was 14.7 months and local progression-free survival at 12 months was 77% and at 24 months 64%, respectively.Conclusion: Endobronchial brachytherapy is a very effective palliative treatment for endobronchial lesions.

Partial vs. whole breast irradiation in a community hospital: A retrospective cohort analysis of 200 patients

2010-02-15

Abstract: Purpose: We compared patients undergoing partial breast irradiation (PBI) with the MammoSite applicator (Cytyc Corp., Marlborough, MA) to a similar group of patients who underwent whole breast irradiation with external beam radiotherapy.Methods and Materials: Stage 0–IIA breast cancer patients satisfying American Brachytherapy Society selection criteria and receiving accelerated PBI with the MammoSite system (n=100) were compared for toxicities with similarly staged patients receiving whole breast irradiation using tangential portals (n=100). The MammoSite applicator treatment was prescribed to a total dose of 34Gy. External beam doses generally ranged from 60 to 66Gy.Results: Based on common toxicity criteria scores for acute toxicities, MammoSite patients experienced less cutaneous toxicity, fatigue, and breast pain and had higher Karnofsky performance status scores during the acute period than external beam patients but experienced more seroma pain during followup. These results were both statistically significant and clinically meaningful.Conclusions: In our institutional experience, PBI using the MammoSite applicator produces less acute toxicity than external beam radiotherapy of the whole breast but is associated with an increased incidence of seroma pain. The rate of disease recurrence in both cohorts was low.

Late nodal metastasis in early-stage node-negative oral cavity cancers after successful sole interstitial brachytherapy: An institutional experience of 42 cases in India

2010-03-12

Abstract: Purposes: Brachytherapy, either alone or in combination with external irradiation, is a useful organ-preserving approach in the treatment of primary head and neck cancers. Treatment of regional nodal drainage area is not warranted in early-stage oral cavity cancers because T1N0 oral cavity cancers have less than 20% likelihood of nodal spread. We reviewed the records of interstitial brachytherapy cases of oral cavity cancers in our brachytherapy unit to assess the clinical outcome of the patients treated.Methods and Materials: We tried to correlate the clinical outcome of the disease with different predictive factors for treatment outcome and to analyze statistically the role of these factors.Results: Cases treated with combined external irradiation with interstitial brachytherapy included higher T stage, with greater risk for nodal spread, though initially node negative. As these were treated with microscopic dose for nodal clinical target volume, nodal recurrence was fewer (18.5%). On the contrary, although the early-stage (T1N0) oral cavity cancers that were treated with brachytherapy alone had initially a less than 20% chance of nodal metastasis, there was an increased risk up to 80% for late nodal metastasis after treatment. Tumor thickness >6mm (p=0.044) and need for a multiplanar implant (p=0.008) were found to be statistically significant risk factors for nodal recurrence. Other factors like high-grade tumors, ulcero-infiltrative lesions, implant of mobile tongue, and low hemoglobin, though relevant, were not found to be statistically significant.Conclusions: We recommend prophylactic nodal irradiation in addition to brachytherapy even for early-stage oral cancers treated with interstitial brachytherapy. Furthermore, the invasive procedure of interstitial brachytherapy causing a disruption of body’s physiologic barrier to localize the disease is itself a probable risk factor for late nodal recurrence. Whether this, apart from the poor prognostic factors, causes increased chance of spread of a localized disease needs to be evaluated by a large prospective randomized study. This is needed to find out exactly the scenario where exclusive brachytherapy will be appropriate for treatment of early-stage oral cavity cancers.

Definitive radiation therapy for endometrial cancer in medically inoperable elderly patients

2010-02-01

Abstract: Purpose: With the increasing elderly population, more women with newly diagnosed endometrial cancer may not be surgical candidates due to medical comorbidities. Definitive radiation therapy with external beam radiation (EBRT) and/or brachytherapy is a reasonable primary treatment for endometrial cancer in patients who cannot undergo surgery.Methods: A retrospective review identified 26 women 75 years and older with endometrial cancer who were not operative candidates due to comorbidities and received definitive radiation.Results: The median age of the treated patients was 83, all of whom had significant medical comorbidities precluding surgical treatment. Seventy-three percent of the patients had stage T1 disease, 19% were stage T2, and 8% were stage T3. Seventy-three percent of patients received EBRT before brachytherapy (median dose: 45 Gy). The median brachytherapy dose was 20 Gy in 5 fractions. The types of brachytherapy used were Rotte Y applicator (42%), tandem and cylinder (42%), and ring and tandem (16%). Median followup was 12 months (1–60 months). No treatment breaks were required for the entire group and only 2 patients (8%) developed late toxicity. The overall survival for all patients was 89% and 28% at 1 and 2 years, respectively. Disease-specific survival for all patients was 93% at 1 year and 73% at 3 years.Conclusions: The results in this study indicate that definitive radiation with EBRT and/or brachytherapy for endometrial cancer is feasible and well tolerated in an elderly population.

Investigation of geometric distortions on magnetic resonance and cone beam computed tomography images used for planning and verification of high–dose rate brachytherapy cervical cancer treatment

2010-02-10

Abstract: Purpose: To measure the amount of geometric distortions present in the three-dimensional imaging modalities—cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI)—used at University of California, San Francisco, CA, for gynecologic high dose rate brachytherapy.Methods and Materials: An MRI- and CT–compatible water phantom with two different sets of support structures was designed and built for this study. The support structures were used to precisely position catheters that were filled with either an MRI contrast agent or a string of radio-opaque markers. The first support structure without anatomy was built to test system-based distortions. A second structure included two types of gynecologic applicators as well as several anatomical structures, including bones and rectum to test object-induced distortions. Images were acquired with CT (for reference), kilovoltage CBCT, and MRI (1.5T with T1- and T2-weighted images). The difference in catheter positions between the images and the CT images was analyzed.Results: For CBCT, the mean of the absolute deviations was below 1mm in all directions. The inherent uncertainty in the measurement of distortion was less than 0.5mm. MRI presented mean absolute system-based distortions between 0.6 and 1.1mm in the central region of the image and between 0.7 and 2.3mm in the outer region. Images with the applicator and anatomy in place created mean absolute distortions of 0.4, 0.8, and 0.8mm or less for CBCT, MR-T1, and MR-T2 images, respectively.Conclusions: The distortions measured in the presence of applicators are small enough to validate the use of CBCT and 1.5T MRI for GYN brachytherapy treatment planning and verification.

Technical aspects and perspectives of the vaginal mold applicator for brachytherapy of gynecologic malignancies

2010-02-15

Abstract: Purpose: The importance of the quality of cervical cancer brachytherapy applicators has been reported, suggesting a direct influence of competent technical implant performance on outcome. In our institute, an original brachytherapy technique based on the use of a molded applicator for genital tract brachytherapy has been applied routinely in clinical practice. Here, we report the technical aspects of this customized applicator and perspectives on its use.Technical Aspects: The first step consists of a vaginal impression that accurately shows the topography and extension of the tumor as well as the anatomy of the vagina and cervix. From this impression, an acrylic applicator is made. Then, the intended positions of the vaginal catheters are drawn on the surface of the mold by the radiation oncologist. Two plastic vaginal catheters are introduced and fixed on the internal surface of the molded applicator. A hole for the cervical os is made through which the uterine probe will be positioned.Perspectives: This method allows for high specificity within the framework of a modern brachytherapy procedure, integrating the tumor topography, anatomy of the patient, and internal movements of target and critical volumes. This technique has been successfully extended to other tumor locations, such as genital tract rhabdomyosarcoma in children and postoperative endocavitary brachytherapy in patients with endometrial cancer.Conclusion: Customization of a vaginal brachytherapy applicator allows for the maintenance of morphologic optimization throughout the treatment course, which better takes into account a fourth dimension: internal organ motion during the course of brachytherapy.

Three-dimensional image-based planning for cervix brachytherapy with bilateral hip prostheses: A solution using MVCT with helical tomotherapy

2010-03-02

Abstract: Purpose: We present a method of three-dimensional image-based planning for cervix high-dose-rate (HDR) brachytherapy for patients with bilateral metal hip prostheses using megavoltage computed tomography (MVCT) imaging.Methods and Materials: Two patients with bilateral metal hip prostheses were treated with our standard HDR brachytherapy fractionation and critical structure tolerance limits for cervical cancer. MVCT imaging was used for treatment planning because of artifacts present in kilovoltage computed tomography (kVCT), which did not allow visualization of the organs of interest.Results: The MVCT images provided adequate contrast to allow the contouring of organs at risk and the digitization of HDR applicators. HDR brachytherapy treatment planning was successfully accomplished based on MVCT images for 2 patients with bilateral metal hip prostheses.Conclusions: Using MVCT imaging eliminated streak artifacts, which improved the image quality for treatment planning. MVCT offers an option for three-dimensional planning for cervix brachytherapy in patients with bilateral hip prostheses.

Practical considerations for prostate HDR brachytherapy

Eric D. Slessinger — 2009-10-23

Abstract: Purpose: A process for prostate high-dose-rate (HDR) brachytherapy was developed and implemented successfully in the community hospital setting. The practical aspects of the program are reviewed and may serve as a foundation for clinics interested in offering this clinical service.Methods and Materials: A generic needle distribution geometry was established to accommodate target volumes of variable size. A system to identify and assign treatment channels to each implant needle was devised. The computerized tomography (CT)–based treatment planning was used with dose constraints defined for sensitive structures and target uniformity. Implant needle stability was promoted by supporting the patient on a CT compatible padded sliding board. A process that aligns dwell position to CT imaging without the use of radiographic markers was followed. Graphical optimization of dwell times was used to generate the treatment dose distributions.Results: Prostate HDR brachytherapy as a boost or as monotherapy has been offered in a program that has evolved over the past 8 years. Practical aspects of the program promote its feasibility and precision. Collaboration with commercial entities has also led to the development of products that support the technique.Conclusions: Prostate HDR brachytherapy offers a relatively high degree of dose distribution control in comparison with other prostate radiotherapy modalities. The practical aspects described offer assurance to achieve that goal.

Masthead

2010-07-01

Editorial Board

2010-07-01

Guide for Authors

2010-07-01

Brachytherapy

Point: Prostate carcinoma treatment for the young patient—The case for brachytherapy

Counterpoint: Prostate carcinoma treatment for the young patient—The case for radical prostatectomy

Rebuttal to Drs. Shteynshlyuger and Kibel

Rebuttal to Dr. Wallner

The dosimetric quality of brachytherapy implants in patients with small prostate volume depends on the experience of the brachytherapy team

Prostate gland edema after single-fraction high-dose rate brachytherapy before external beam radiation therapy

The impact of perineural invasion on biochemical outcome after permanent prostate iodine-125 brachytherapy

Differences between intraoperative ultrasound-based dosimetry and postoperative computed tomography-based dosimetry for permanent interstitial prostate brachytherapy

Prostate brachytherapy seed migration to the left testicular vein

Efficacy of high-dose-rate interstitial brachytherapy in patients with oral tongue carcinoma

Acquisition of equal or better planning results with interstitial brachytherapy when compared with intensity-modulated radiotherapy in tongue cancers

Periauricular mold brachytherapy

Retrospective study of 81 patients treated with brachytherapy for endobronchial primary tumor or metastasis

Partial vs. whole breast irradiation in a community hospital: A retrospective cohort analysis of 200 patients

Late nodal metastasis in early-stage node-negative oral cavity cancers after successful sole interstitial brachytherapy: An institutional experience of 42 cases in India

Definitive radiation therapy for endometrial cancer in medically inoperable elderly patients

Investigation of geometric distortions on magnetic resonance and cone beam computed tomography images used for planning and verification of high–dose rate brachytherapy cervical cancer treatment

Technical aspects and perspectives of the vaginal mold applicator for brachytherapy of gynecologic malignancies

Three-dimensional image-based planning for cervix brachytherapy with bilateral hip prostheses: A solution using MVCT with helical tomotherapy

Practical considerations for prostate HDR brachytherapy

Masthead

Table of Contents

Editorial Board

Guide for Authors