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When a targeted and image-guided method is employed, salvage therapies for localized radiorecurrent prostate cancer can be conducted safely. Given the low toxicity levels, it is possible to explore a second salvage treatment in the event of a second local prostate cancer recurrence. This report outlines the effectiveness and toxicity of re-salvage high-dose-rate brachytherapy (re-sHDR BT). Between September 2018 and May 2021, we conducted re-sHDR BT due to a second local recurrence of prostate cancer in five patients. In all patients, the diagnosis was based on MR or PSMA PET/CT scans, with histopathological confirmation. The initial salvage HDR brachytherapy treatment consisted of three 10-Gy fractions administered within 28 days. In three cases, the recurrence was found exclusively in the seminal vesicles (SVs). These patients were treated only in the recurrence area, with a total dose of 19 Gy delivered in one fraction. Two patients experienced a recurrence confined to the prostate. They were treated with two doses of 13 Gy each, delivered within 7 days, with one patient receiving therapy to the entire gland and the proximal half of seminal vesicles, and the other patient receiving treatment to the affected lobe only. One patient received androgen deprivation therapy (ADT) before re-irradiation with HDR brachytherapy. Toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The mean and median local control after the first salvage HDR BT were 45.4 and 34 months, respectively (range: 26-83 months). The average follow-up was 43.2 months (range: 32-65 months). The patients' ages ranged from 62 to 74 years, with a median of 74 years and a mean of 70.4 years. The mean and median disease-free survival were 36.8 and 33 months, respectively (range: 20-53 months). All three individuals with lesions in seminal vesicles were diagnosed with local recurrence outside the treated area. Two of them were effectively treated with ADT. One patient was diagnosed with M0 castrate-resistant prostate cancer and was successfully treated with ADT in combination with darolutamide. None of the patients developed regional or distant metastases. No patient experienced toxicity of grade ≥3. Two patients required continuous urinary catheterization, one of whom experienced recurring urinary tract infections. Limited data suggests that either re-sHDR BT may not be beneficial in treating a second recurrence in seminal vesicles, or a total dose of 19 Gy in a single fraction may not be adequate in this setting. Re-sHDR BT for a specific subset of patients with a second locally recurrent prostate cancer is feasible. [ABSTRACT FROM AUTHOR]

Aim: Comparisons of integral dose delivered to the treatment planning volume and to the whole patient body during stereotactic, helical and intensity modulated radiotherapy of prostate., Background: Multifield techniques produce large volumes of low dose inside the patient body. Delivered dose could be the result of the cytotoxic injuries of the cells even away from the treatment field. We calculated the total dose absorbed in the patient body for four radiotherapy techniques to investigate whether some methods have a potential to reduce the exposure to the patient., Materials and Methods: We analyzed CyberKnife plans for 10 patients with localized prostate cancer. Five alternative plans for each patient were calculated with the VMAT, IMRT and TomoTherapy techniques. Alternative dose distributions were calculated to achieve the same coverage for PTV. Integral Dose formula was used to calculate the total dose delivered to the PTV and whole patient body., Results: Analysis showed that the same amount of dose was deposited to the treated volume despite different methods of treatment delivery. The mean values of total dose delivered to the whole patient body differed significantly for each treatment technique. The highest integral dose in the patient's body was at the TomoTherapy and CyberKnife treatment session. VMAT was characterized by the lowest integral dose deposited in the patient body., Conclusions: The highest total dose absorbed in normal tissue was observed with the use of a robotic radiosurgery system and TomoTherapy. These results demonstrate that the exposure of healthy tissue is a dosimetric factor which differentiates the dose delivery methods.

Background: Adenocarcinoma in cervical cancer has poorer response rate to treatment and requires longer time to achieve complete remission than squamous cell carcinoma [1]. Lower response to chemotherapy and radiotherapy is observed [2,3,4,5] and the optimal management remains undefined [1,4,6,7]., Case: We report a case of a 58-year-old woman with bulky mucinous adenocarcinoma endocervical-type G1, treated previously with radiochemotherapy with no visible response. After subsequent interstitial HDR brachytherapy (iHDR-BT) complete local remission was achieved., Conclusion: Interstitial HDR brachytherapy in bulky mucinous adenocarcinoma endocervical-type may be the best treatment choice that allows to receive a complete local response.

Purpose: In early stage mobile tongue cancer radical radiotherapy offers good local control and organ preservation, which is especially important in the group of young patients. In our department, for many years HDR-BT has been performed in mobile tongue cancers as a sole treatment or as a "boost" with EBRT. The aim of the study was to show our experience with HDR-BT in early stage mobile tongue cancers among young patients., Material and Methods: From 2001 to 2006 in Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, five patients under 45 years with mobile tongue cancer were treated with HDR brachytherapy (T1N0M0 - 3/5 and T2N0M0 - 2/5); 4 with HDR brachytherapy "boost" and 1 as a sole treatment. One woman was previously treated with tumour resection, but because of positive surgical margins was referred for radiotherapy. All patients had clinically negative lymph nodes, without dissection. They were treated with interstitial HDR-BT (3-8 catheters). In 4 patients treated with HDR-BT as a "boost", total doses ranged from 18 to 21 Gy given in 6-7 fractions (twice a day, 3 Gy per fraction). Total doses in EBRT (to local lymph nodes and tumour bed) ranged from 50 to 60 Gy (1.8-2 Gy per fraction 5 days/week). One patient, treated with radical HDR brachytherapy, received 45 Gy in 10 fractions and 50 Gy in EBRT to regional lymph nodes., Results: We did not notice local recurrences or distant metastases in our group of patients. Median follow-up was 67 months (range 47-79 months). All patients preserved normal tongue function. A severe late complication occurred in 1 patient - fracture of the mandible., Conclusions: In the analysed group of young patients with mobile tongue cancer interstitial HDR brachytherapy in combination with EBRT was an effective and well tolerated treatment modality which allowed preservation of the tongue and its function.

Purpose: The aim of the study was to analyze early effects and toxicity of salvage high dose rate brachytherapy for local recurrences of adenocarcinoma of the prostate after external beam radiotherapy (EBRT)., Material and Methods: In MCS Memorial Institute of Oncology in Gliwice a research programme on salvage HDR brachytherapy for local recurrences of prostate cancer treated previously with EBRT has been ongoing since February 2008. The treatment consisted of 3 fractions of 10 Gy each given every 14 days. Maximal urethral doses were constrained to be ≤ 120% of the prescribed dose. Maximal bladder and rectum doses were constrained to be ≤ 70% of the prescribed dose., Results: Fifteen eligible patients were treated and analyzed from February 2008. All patients completed the treatment without major complications. The most common early complications were: macroscopic haematuria, pain in lower part of the abdomen, and transient dysuria. During the first week after the procedure a transient increase in IPSS score was noticed. The Foley catheter was removed on day 2 to 5. No complications after spinal anaesthesia were observed. Acute toxicity according to EORTC/RTOG was low. For bladder EORTC/RTOG score ranged from 0 to 2. Only in two patients grade 1 toxicity for rectum was observed. The follow-up ranged from 3 to 9 months. In one patient grade 2 rectal toxicity was observed, and one had urethral stricture. Other patients did not have any other significant late toxicity of the treatment. Two patients developed bone metastases., Conclusions: Salvage brachytherapy for localized prostate cancer (3 × 10 Gy every 14 days) seems to be a safe and well tolerated procedure. A significant decline in prostate-specific antigen (PSA) level is seen in patients with hormone-responsive cancer. Long-term efficiency and toxicity of the procedure are yet to be established.

Purpose: In this study two different pre-planning methods (2D vs. 3D) were compared in respect to the implant quality as judged by volumetric and dose parameters of the treatment plans. The aim of this work was to evaluate the influence of the imaging modalities used for pre-planning purpose to the treatment plan quality., Material and Methods: Twenty-four patients treated with HDR multicatheter implants were randomly selected for experiment. All patients underwent breast conserving surgery. Flexible catheters were implanted into the breast through the template. Inter-catheter distance, number of planes and catheters were adjusted, in respect to the size and location of the target. Pre-planning was used to evaluate the implant geometry in respect to the target. Needles number and position were modified if necessary. There were two experimental subgroups consisted of 12 patients each. Different pre-planning procedure was employed in each group. In the first group 2D X-ray imaging system was used. In the second one the 3D pre-planning method based on CT was performed. Treatment plans were evaluated with parameters calculated based on dose-volume histograms (DVHs). Volumetric and dose parameters were used for comparison of the dose distribution between the two experimental subgroups., Results: The mean value of target coverage V PTV 100 is higher for 3D pre-planning than for 2D (91.7% vs. 86.1%). The dose that covers 90% of the PTV (D90) is also higher for 3D pre-planning than for 2D (4.2 Gy vs. 3.6 Gy). Similar relation can be observed for the values of dose homogeneity index where DHI obtained for 3D pre-planning is 0.60 and 0.53 for 2D. All differences were statistically significant with p < 0.05., Conclusions: Analysis presented in this paper showed that 3D pre-planning method improves the geometrical quality of the implant.