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Gynecologic interstitial brachytherapy (ISBT) is the placement of catheters into and surrounding a tumor, with either a high-dose-rate (HDR) and low-dose-rate (LDR) technique. Using an HDR technique, the catheters are afterloaded with radioactive sources, the most common isotope being 192Ir. Brachytherapy (BT) is a key component in the treatment of gynecological cancers, as it allows for dose escalation to the tumor while minimizing the dose to surrounding critical organs at risk, such as the sigmoid, bladder, and rectum. Patterns of care studies established the essential role of BT in the management of cervical cancer and linked its use to improvements in pelvic control and disease-free survival. Furthermore, the use of image-guided BT shows improvement in pelvic control and disease-free survival based on a large review from the American Brachytherapy Cervical Cancer Task Force.

Background Breast conservation therapy (BCT) has equal efficacy compared to mastectomy in treating breast cancer. Accurate pre-operative measurement of tumor size can limit re-excision procedures. Breast MRI may improve pre-operative evaluation of extent of disease. Objective To examine the correlation of extent of disease on breast MRI with pathologic data to determine the utility of breast MRI in surgical planning of BCT. Methods We retrospectively reviewed our prospective database of women undergoing breast MRI. We identified 115 women with breast cancer who underwent a breast MRI and a surgical resection from 2000 to 2003. We compared patients with high-grade tumors (HG, n = 40) to patients with low grade (LG, n = 75). Results The size of the tumor on MRI correlated with the pathologic size for HG tumors (HG R = 0.76 vs. LG R = 0.45, P = 0.033). Mastectomy was performed in 53 patients. In 10 patients with LG tumors, the MRI findings overestimated their disease. In 11 out of 115 patients the primary tumor or a second tumor was only seen by MRI. Conclusion Breast MRI does change surgical management by detecting additional malignancies. Breast MRI is accurate in staging extent of disease in the breast in patients with HG tumors. J. Surg. Oncol. 2006;94:220–225. © 2006 Wiley-Liss, Inc.

Introduction With the publication of several trials demonstrating equivalence between partial breast irradiation and whole breast irradiation, the popularity of partial breast radiation has increased. Methods of delivery include interstitial brachytherapy, intracavitary brachytherapy, and 3D conformal irradiation, although the least amount of data exists on 3D conformal. Despite the relative paucity of data on 3D conformal, it is the most common method delivered on the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39 trial. To date, minimal toxicities and good cosmetic results have been associated with accelerated partial breast irradiation. Methods and Material In this case study, we present a 64-year-old female patient, diagnosed with Grade 1 tubular carcinoma, who developed both expected and unexpected toxicities after 3D conformal accelerated partial breast irradiation. Discussion/Results/Conclusion Along with chest wall pain, she developed hyperpigmentation of the skin as well as fibrosis of the skin, pectoralis minor, and pectoralis major. The fibrosis she developed limited her comfortable range of motion in the ipsilateral arm. She also developed symptomatic fractures of the fourth and fifth ribs in the anterior axillary line. Upon fusing the treatment-planning CT with a diagnostic CT, it was evident that the rib fractures fell within the 100% isodose line of the 3D conformal plan.