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Characteristics and outcomes for patients with lung cancer treated with brachytherapy
Abstracts / Brachytherapy 7 (2008) 91e194 be delivered. We present our 25-year continuous series with I-125 using two distinct dose prescription points and total dose delivered and report our local control, visual acuity outcomes and complication rates associated with each dose schedule. Methods and Materials: Between 1982 and 2002, 287 patients with OM were treated with EPT. From 1982 through 1990, dose was prescribed to the tumor apex (GR A: n 5 130; total dose 76e120 Gy, in 72e120 hours) after 9/90 dose was prescribed to 3 mm above the retinal surface (GR B: n 5 157; total dose 100e150 Gy, in 96e150 hours). There were 130 males, 157 females, ages ranged from 37e82 years old (med 5 62), posterior location was most common site (67%). Followup has been maintained in all patients and ranges from 27e240 months (med 5 87 mos.). Results: Local control for groups A and B were 93% and 95%, respectively. Sixteen eyes were enucleated; eight for tumor progression, six for vitreous hemorrhage with no LP, and two for retrobulbar pain. Complications were noted in 37% and 17%, respectively. Most commonly noted was retinopathy. Last visual acuity testing was within 2 Snellen lines of the presenting VAT in 62% and 75%, respectively. Conclusions: Use of EPT with dosing to 3 mm above the retinal surface did not result in reduced tumor control when compared with more traditional apical dosing. There was no difference in rate of enucleation between group A and B. However, complication rates in group B were lower although more time will be required to make definitive statements on this issue.
PO74 External beam radiotherapy and interstitial implant boost in early oral cavity cancer: Experience of initial 23 consecutive cases from a new brachytherapy center in India Debnarayan Dutta, M.D.2 Litan Naha Biswas, M.D.1 Asit Ranjan Deb, M.D., DNB1 Santanu Pal, M.D.1 Jayanta Pal, M.Sc.1 1Radiation Oncology, Nilratan Sirkar Medical College, Kolkata, India; 2Radiation Oncology, Tata Memorial Hospital, Mumbai, India. Purpose: HDR brachytherapy is an effective and useful method of treatment in early head & neck cancers. However, in developing countries like India, there are few centers with sufficient experience and expertise on its use with acceptable outcome. The aim of this study is to evaluate the early toxicity and control rate of initial consecutive patients from a relatively inexperienced center. Methods and Materials: In our center with new HDR brachytherapy facility, 23 biopsy proven head and neck cancer patients were treated by EBRT followed by HDR interstitial brachytherapy boost between February 2004 and November 2005. Criteria for selection of brachytherapy were followings: KPS O70, localized biopsy proven early oral cavity cancers, tumor size !4 cm in an easily assessable site. All patients were treated with external beam RT (Cobalt 60) with 50 Gy in 25 fraction in 5 week, followed by 192Ir interstitial implant boost with dose 3.5 Gy/fraction in 7 fractions with twice daily fraction, six hour apart to a total boost dose of 24.5 Gy in carcinoma of anterior tongue and 21 Gy in 3 Gy/Fr, twice daily fraction in carcinoma of buccal mucosa. Results: Among 23 patients (14 male, 9 female; median age 51 yrs, range 42e61 yrs), 16 were carcinoma anterior tongue, 6 carcinoma buccal mucosa and 1 carcinoma floor of mouth. 13 patients had proliferative, 09 ulcero-proliferative and 01 infiltrative lesion. All cases were squamous cell carcinoma with 17 cases well differentiated and 06 moderately differentiated histology. Over all treatment duration was 51e67 days and median gap between EBRT and brachytherapy was 12 days (range 9e17 days). Median followup (FU) was 16 months (mean FU 17.9 months; range 07 e 38 months). Among carcinoma of the tongue patients, three patients had nodal and one local region recurrence. One each carcinoma buccal mucosa patient recurred in nodal and local region. Early severe (grade 3/4) toxicities were seen in 5 patients (20%). Two patients with dryness of mouth, one each patient with trismus, difficulty in swallowing and soft tissue injury in neck region. One carcinoma tongue patient died due to disease progression at 17 month FU. Actuarial disease-free survival was 94% at 1 yr, 55% at 2 yr.
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Conclusions: Even in developing countries with relative inexperience, radical radiotherapy with EBRT and HDR brachytherapy boost is an acceptable treatment option in early head and neck cancers with acceptable outcome.
PO75 The use of a tissue expander to improve the therapeutic ratio of adjuvant radiotherapy for retroperitoneal sarcoma Rahul R. Parikh, M.D.1 Jacqueline Tan, M.D.1 Chad J. Micucci, M.D.2 Scott V. Watkins, M.D.3 Alex H. Frank, M.D.4 Ankesh Nigam, M.D.5 1 Radiation Oncology, Albany Medical College, Albany, NY; 2Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA; 3Radiation Oncology, Western Maryland Health System Regional Cancer Center, Cumberland, M.D; 4Radiation Oncology, Glens Falls Hospital Cancer Center, Glens Falls, NY; 5Surgery, Albany Medical College, Albany, NY. Purpose: Adjuvant radiotherapy for retroperitoneal sarcoma has the potential to significantly decrease local recurrence after surgery, but is limited by toxicity to adjacent viscera. We report our experience using tissue expanders [TE] to limit small bowel toxicity during adjuvant radiotherapy for resected retroperitoneal sarcomas. Methods and Materials: TE were inserted into the retroperitoneum as a second procedure after gross tumor resection with the goal of displacing small bowel from the tumor bed. Each patient received adjuvant external beam radiotherapy (range 4500e5580 cGy); two of the patients also underwent an HDR brachytherapy boost via interstitial catheters (16 Gy/8 fractions/4 days). Following completion of adjuvant radiotherapy, the TE were removed through a small incision. Results: Three patients presented with leiomyosarcomas, and the fourth patient had a liposarcoma. All four had positive macroscopic and microscopic margins. Tumor sizes were 7.5 cm, 13 cm, 19 cm and 45 cm and two patients required vena cava resection with the use of veno-veno bypass. Pre- and post-radiation CT scans demonstrated good TE placement throughout treatment. One patient had an attempt at placing the TE at the initial operation, but required TE re-positioning procedure secondary to massive ascites. One patient with a history of multiple abdominal operations required a laparotomy for small bowel obstruction from adhesions outside of the radiation field 8 months after removal of TE. No other surgery or radiation-related complications have been noted to date. Adjuvant radiotherapy with TE placement was well-tolerated; no patients experienced diarrhea or radiation-induced enteritis. There were no local recurrences in the tumor bed with a followup of 20 to 44 months. One patient developed metastatic disease outside the radiation port. Conclusions: We feel that TE are a safe and effective tool in the delivery of radiation therapy following resection of a retroperitoneal sarcoma. Reducing dose to the small bowel could improve tolerance of standard adjuvant radiotherapy and might facilitate dose escalation.
PO76 Characteristics and outcomes for patients with lung cancer treated with brachytherapy Haider A. Shirazi, M.D., M.Sc., Maryanne H. Marymont, M.D. Radiation Oncology, Northwestern University, Chicago, IL. Purpose: Brachytherapy for lung cancer allows large doses of radiation to be delivered with a high degree of conformity, minimizing normal tissue toxicity to adjacent structures. We surveyed the Surveillance Epidemiology and End Results (SEER) public-access database to elucidate characteristics and outcomes for patients treated with brachytherapy for lung cancer. Methods and Materials: Out of a total of 620,335 lung cancer patients in the SEER database, we identified a subset of 2,180 individuals who received brachytherapy between 1973 and 2004. Data were collected regarding patient age, gender, year of diagnosis, histology, extent of disease, and survival. Statistics were calculated using the Kaplan-Meier method. Results: The median patient age was 67, and 61% of patients were male. On pathology, 17% had small cell carcinoma, 40% had squamous cell, and 22%
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had adenocarcinoma of the lung. The extent of disease was localized in 12% of cases, regional in 47% of cases, and distant in 41% of cases. Median survival was 8 months with a mean of 15 months. Less than 10% of cases were censored. Extent of disease was a significant factor in overall survival on log-rank (p!0.001). Median survival for localized disease was 18 months, 11 months for regional disease, and 8 months for distant disease. At 1 year, 64% of patients with localized, 46% with regional, and 24% of patients with distant disease were living. Fifty percent of cases in the database were treated between 1999 and 2004. Conclusions: Brachytherapy has become more commonly used in the past five years and is being utilized in a wide variety of histologic subtypes of lung cancer, most commonly for squamous cell carcinoma. Moreover, the SEER data shows brachytherapy being used in lung cancer patients presenting with localized, regional, and distant disease. Further investigations may reveal what proportion of cases used brachytherapy in combination with external beam radiation as well as the technique of delivery.
PO77 Radiation safety with permanent I-125 lung brachytherapy Elizabeth Carey, MSPH, Matthew Manning, M.D., Donald Burney, M.D. Radiation Oncology, Moses Cone Regional Cancer Center, Greensboro, NC. Purpose: Sub-lobar resection and permanent brachytherapy is an emerging treatment option for patients with early stage non-small cell lung cancer and pulmonary dysfunction. Limited information is available regarding the radiation exposure risks to patient relatives and medical staff. We analyzed the radiation exposure data from a series of lung cancer patients who underwent permanent I-125 implants. Methods and Materials: Between 7/2006 and 11/2007, thirty-six patients with early stage lung cancer were treated with sub-lobar resection and permanent I-125 implantation using a vicryl mesh technique. The mean total implant activity was 21.44 mCi (range 17.43 mCi e 25.12 mCi) with 30 to 50 seeds. Postoperative radiation exposure measurements were performed using an ionization chamber survey meter (Victoreen 451P). Exposure to medical staff during the procedure was monitored using radiation safety badges (Landauer Luxel). Results: The mean dose rate at 1 meter from the surgical site was 0.18 mrem/h (range 0.1 mrem/h e 0.3 mrem/h). This mean dose rate is less than the dose rate (0.2 mrem/hr at 1 meter) requiring radiation safety instructions be provided to the patient according to NRC regulatory guide 8.39. The mean exposure to medical staff per case was 0.9 mrem. Conclusions: Our data show that the dose rates at 1 meter from lung brachytherapy patients treated with I-125 are very low. The doses possibly absorbed by the relatives and other members of the general population coming into contact with the treated patients are well below the dose limit set by the NRC. In addition, this procedure results in very low doses to medical staff.
PO78 Use of postoperative brachytherapy in the treatment of keloids Evi Weytens, MB1 Bernard Cambier, M.D.2 Stan Monstrey, M.D., Ph.D.3 Hubert Vermeersch, M.D., Ph.D.4 Serge Van Canneyt, M.D.5 Marc E. Van Eijkeren, M.D., Ph.D.1 1Radiation Oncology, Ghent University Hospital, Gent, OVL, Belgium; 2Plastic Surgery, AZ. St. Blasius, Dendermonde, OVL, Belgium; 3Plastic Surgery, Ghent University Hospital, Gent, OVL, Belgium; 4Head and Neck Surgery, Ghent University Hospital, Gent, OVL, Belgium; 5Plastic Surgery, AZ. St. Elisabeth, Zottegem, OVL, Belgium. Purpose: Development of keloids after surgery can pose important problems. Symptoms of pain or itching do exist but also in asymptomatic patients, cosmetic outcome can be an issue. Brachytherapy has been described as a technique to prevent recurrence. We evaluated the single institution results of using brachytherapy in the postoperative setting.
Methods and Materials: Patients with recurrent keloids treated with postoperative brachytherapy in the period from January 1992 through October 2004 were included. Treatment related parameters were noted using the patient file and a questionnaire was send to all patients to evaluate outcome and their satisfaction of the treatment. For statistical analysis, SPSS vs. 14 was used. The study was approved by the local Ethics Committee. Results: During the study period, 154 keloids in 105 patients (51 males and 54 females) were treated with postoperative brachytherapy. The median age was 28 years (10 to 66 y) . The most frequent localisation was retroauricular (47%) followed by presternal lesions (20%). After excision, a plastic tube was sutured into the wound. After 4 to 6 hours, an Iridium-192 wire was inserted and a dose of 15 Gy at 0.5 cm was given within 24 hrs. Median length of the keloid was 5 cm (1 to 50 cm). Seventy-six percent of the patients signed informed consent to be included in the study. Median followup time was 6.4 years (2.0 to 14.7 y). Apparently, a recurrence rate of 39% was noted with 52% smaller than the initial keloid. Eighty percent recurred within 2 years. No important complications were noted. As for overall satisfaction, 81% was satisfied regarding the treatment. As expected, 90% of the patients without recurrence was satisfied but also 41% of the patients with a recurrence was satisfied with the cosmetic result. Presternal keloids appeared to have a worse cosmetic effect. Conclusions: Brachytherapy in a postoperative setting can be used in recurrent keloids. Even when about 40% of the patients noted some recurrence, overall satisfaction was quite high.
PO79 A novel technique of intracavitary 125Iodine brachytherapy for vertebral body metastases Jamie A. Cesaretti, M.D., M.S.1 Ren-Dih Sheu, Ph.D.1 Lo Yeh-Chi, Ph.D.1 Richard G. Stock, M.D.1 Jenkins L. Arthur, M.D.2 1Radiation Oncology, Mount Sinai School of Medicine, New York, NY; 2Neurosurgery, Mount Sinai School of Medicine, New York, NY. Purpose: Vertebral body metastases are common and if refractory to initial treatment can present a considerable therapeutic dilemma to the neurooncology team. We present a novel integration of minimally invasive spine surgery and low-dose-rate brachytherapy with 125I for refractory/ recurrent vertebral body metastases. Methods and Materials: A patient with a prior history of spine radiotherapy who refused vertebrectomy as a salvage maneuver presented to the ER with acute spinal cord compression at the level of T7. A CT based preplan for intracavitary 125I brachytherapy was generated based on the patient’s T7 vertebral body metastasis using a commercially available anatomically accurate spine phantom (Sawbones, Vashon, WA). The volume of the cavity was found to be 3.5 cm3 using Variseed (Varian, Palo Alto, CA). It was determined that 9 sources of 0.6 U were needed to deliver 100 Gy at 0.5 cm from the surface of the cavity. 9 inactive sources were evenly distributed in 3.5 cm3 of Polymethyl methacrylate (PMMA) and CT-based dosimetry was performed on the spine phantom. The verified preplan confirmed that random distribution of the sources within the PMMA delivered the desired dose. Results: A minimally invasive transpedicular vertebrectomy for resection of the tumor within the vertebral body was performed, and then intraoperative placement of the seeds within the PMMA was performed without incident through a minimally invasive surgical access port (METRx, Sofamor/Danek-Medtronic, Memphis, TN) using a 2-cm incision. A PMMA cap was placed over the intracavitary implant to insure that all sources were at least 5 mm from the spinal cord. The patient was discharged from the hospital two days following the procedure with markedly decreased pain and a KPS of 90%. CT-based dosimetry confirmed random placement of the seeds embedded in PMMA within the resection cavity. The patient returned to the medical center at 2 and 4 months following the procedure without evidence of progression at T7, although he did have significant progression at other levels that subsequently required surgery.
PO74 External beam radiotherapy and interstitial implant boost in early oral cavity cancer: Experience of initial 23 consecutive cases from a new brachytherapy center in India Debnarayan Dutta, M.D.2 Litan Naha Biswas, M.D.1 Asit Ranjan Deb, M.D., DNB1 Santanu Pal, M.D.1 Jayanta Pal, M.Sc.1 1Radiation Oncology, Nilratan Sirkar Medical College, Kolkata, India; 2Radiation Oncology, Tata Memorial Hospital, Mumbai, India. Purpose: HDR brachytherapy is an effective and useful method of treatment in early head & neck cancers. However, in developing countries like India, there are few centers with sufficient experience and expertise on its use with acceptable outcome. The aim of this study is to evaluate the early toxicity and control rate of initial consecutive patients from a relatively inexperienced center. Methods and Materials: In our center with new HDR brachytherapy facility, 23 biopsy proven head and neck cancer patients were treated by EBRT followed by HDR interstitial brachytherapy boost between February 2004 and November 2005. Criteria for selection of brachytherapy were followings: KPS O70, localized biopsy proven early oral cavity cancers, tumor size !4 cm in an easily assessable site. All patients were treated with external beam RT (Cobalt 60) with 50 Gy in 25 fraction in 5 week, followed by 192Ir interstitial implant boost with dose 3.5 Gy/fraction in 7 fractions with twice daily fraction, six hour apart to a total boost dose of 24.5 Gy in carcinoma of anterior tongue and 21 Gy in 3 Gy/Fr, twice daily fraction in carcinoma of buccal mucosa. Results: Among 23 patients (14 male, 9 female; median age 51 yrs, range 42e61 yrs), 16 were carcinoma anterior tongue, 6 carcinoma buccal mucosa and 1 carcinoma floor of mouth. 13 patients had proliferative, 09 ulcero-proliferative and 01 infiltrative lesion. All cases were squamous cell carcinoma with 17 cases well differentiated and 06 moderately differentiated histology. Over all treatment duration was 51e67 days and median gap between EBRT and brachytherapy was 12 days (range 9e17 days). Median followup (FU) was 16 months (mean FU 17.9 months; range 07 e 38 months). Among carcinoma of the tongue patients, three patients had nodal and one local region recurrence. One each carcinoma buccal mucosa patient recurred in nodal and local region. Early severe (grade 3/4) toxicities were seen in 5 patients (20%). Two patients with dryness of mouth, one each patient with trismus, difficulty in swallowing and soft tissue injury in neck region. One carcinoma tongue patient died due to disease progression at 17 month FU. Actuarial disease-free survival was 94% at 1 yr, 55% at 2 yr.
163
Conclusions: Even in developing countries with relative inexperience, radical radiotherapy with EBRT and HDR brachytherapy boost is an acceptable treatment option in early head and neck cancers with acceptable outcome.
PO75 The use of a tissue expander to improve the therapeutic ratio of adjuvant radiotherapy for retroperitoneal sarcoma Rahul R. Parikh, M.D.1 Jacqueline Tan, M.D.1 Chad J. Micucci, M.D.2 Scott V. Watkins, M.D.3 Alex H. Frank, M.D.4 Ankesh Nigam, M.D.5 1 Radiation Oncology, Albany Medical College, Albany, NY; 2Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA; 3Radiation Oncology, Western Maryland Health System Regional Cancer Center, Cumberland, M.D; 4Radiation Oncology, Glens Falls Hospital Cancer Center, Glens Falls, NY; 5Surgery, Albany Medical College, Albany, NY. Purpose: Adjuvant radiotherapy for retroperitoneal sarcoma has the potential to significantly decrease local recurrence after surgery, but is limited by toxicity to adjacent viscera. We report our experience using tissue expanders [TE] to limit small bowel toxicity during adjuvant radiotherapy for resected retroperitoneal sarcomas. Methods and Materials: TE were inserted into the retroperitoneum as a second procedure after gross tumor resection with the goal of displacing small bowel from the tumor bed. Each patient received adjuvant external beam radiotherapy (range 4500e5580 cGy); two of the patients also underwent an HDR brachytherapy boost via interstitial catheters (16 Gy/8 fractions/4 days). Following completion of adjuvant radiotherapy, the TE were removed through a small incision. Results: Three patients presented with leiomyosarcomas, and the fourth patient had a liposarcoma. All four had positive macroscopic and microscopic margins. Tumor sizes were 7.5 cm, 13 cm, 19 cm and 45 cm and two patients required vena cava resection with the use of veno-veno bypass. Pre- and post-radiation CT scans demonstrated good TE placement throughout treatment. One patient had an attempt at placing the TE at the initial operation, but required TE re-positioning procedure secondary to massive ascites. One patient with a history of multiple abdominal operations required a laparotomy for small bowel obstruction from adhesions outside of the radiation field 8 months after removal of TE. No other surgery or radiation-related complications have been noted to date. Adjuvant radiotherapy with TE placement was well-tolerated; no patients experienced diarrhea or radiation-induced enteritis. There were no local recurrences in the tumor bed with a followup of 20 to 44 months. One patient developed metastatic disease outside the radiation port. Conclusions: We feel that TE are a safe and effective tool in the delivery of radiation therapy following resection of a retroperitoneal sarcoma. Reducing dose to the small bowel could improve tolerance of standard adjuvant radiotherapy and might facilitate dose escalation.
PO76 Characteristics and outcomes for patients with lung cancer treated with brachytherapy Haider A. Shirazi, M.D., M.Sc., Maryanne H. Marymont, M.D. Radiation Oncology, Northwestern University, Chicago, IL. Purpose: Brachytherapy for lung cancer allows large doses of radiation to be delivered with a high degree of conformity, minimizing normal tissue toxicity to adjacent structures. We surveyed the Surveillance Epidemiology and End Results (SEER) public-access database to elucidate characteristics and outcomes for patients treated with brachytherapy for lung cancer. Methods and Materials: Out of a total of 620,335 lung cancer patients in the SEER database, we identified a subset of 2,180 individuals who received brachytherapy between 1973 and 2004. Data were collected regarding patient age, gender, year of diagnosis, histology, extent of disease, and survival. Statistics were calculated using the Kaplan-Meier method. Results: The median patient age was 67, and 61% of patients were male. On pathology, 17% had small cell carcinoma, 40% had squamous cell, and 22%
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had adenocarcinoma of the lung. The extent of disease was localized in 12% of cases, regional in 47% of cases, and distant in 41% of cases. Median survival was 8 months with a mean of 15 months. Less than 10% of cases were censored. Extent of disease was a significant factor in overall survival on log-rank (p!0.001). Median survival for localized disease was 18 months, 11 months for regional disease, and 8 months for distant disease. At 1 year, 64% of patients with localized, 46% with regional, and 24% of patients with distant disease were living. Fifty percent of cases in the database were treated between 1999 and 2004. Conclusions: Brachytherapy has become more commonly used in the past five years and is being utilized in a wide variety of histologic subtypes of lung cancer, most commonly for squamous cell carcinoma. Moreover, the SEER data shows brachytherapy being used in lung cancer patients presenting with localized, regional, and distant disease. Further investigations may reveal what proportion of cases used brachytherapy in combination with external beam radiation as well as the technique of delivery.
PO77 Radiation safety with permanent I-125 lung brachytherapy Elizabeth Carey, MSPH, Matthew Manning, M.D., Donald Burney, M.D. Radiation Oncology, Moses Cone Regional Cancer Center, Greensboro, NC. Purpose: Sub-lobar resection and permanent brachytherapy is an emerging treatment option for patients with early stage non-small cell lung cancer and pulmonary dysfunction. Limited information is available regarding the radiation exposure risks to patient relatives and medical staff. We analyzed the radiation exposure data from a series of lung cancer patients who underwent permanent I-125 implants. Methods and Materials: Between 7/2006 and 11/2007, thirty-six patients with early stage lung cancer were treated with sub-lobar resection and permanent I-125 implantation using a vicryl mesh technique. The mean total implant activity was 21.44 mCi (range 17.43 mCi e 25.12 mCi) with 30 to 50 seeds. Postoperative radiation exposure measurements were performed using an ionization chamber survey meter (Victoreen 451P). Exposure to medical staff during the procedure was monitored using radiation safety badges (Landauer Luxel). Results: The mean dose rate at 1 meter from the surgical site was 0.18 mrem/h (range 0.1 mrem/h e 0.3 mrem/h). This mean dose rate is less than the dose rate (0.2 mrem/hr at 1 meter) requiring radiation safety instructions be provided to the patient according to NRC regulatory guide 8.39. The mean exposure to medical staff per case was 0.9 mrem. Conclusions: Our data show that the dose rates at 1 meter from lung brachytherapy patients treated with I-125 are very low. The doses possibly absorbed by the relatives and other members of the general population coming into contact with the treated patients are well below the dose limit set by the NRC. In addition, this procedure results in very low doses to medical staff.
PO78 Use of postoperative brachytherapy in the treatment of keloids Evi Weytens, MB1 Bernard Cambier, M.D.2 Stan Monstrey, M.D., Ph.D.3 Hubert Vermeersch, M.D., Ph.D.4 Serge Van Canneyt, M.D.5 Marc E. Van Eijkeren, M.D., Ph.D.1 1Radiation Oncology, Ghent University Hospital, Gent, OVL, Belgium; 2Plastic Surgery, AZ. St. Blasius, Dendermonde, OVL, Belgium; 3Plastic Surgery, Ghent University Hospital, Gent, OVL, Belgium; 4Head and Neck Surgery, Ghent University Hospital, Gent, OVL, Belgium; 5Plastic Surgery, AZ. St. Elisabeth, Zottegem, OVL, Belgium. Purpose: Development of keloids after surgery can pose important problems. Symptoms of pain or itching do exist but also in asymptomatic patients, cosmetic outcome can be an issue. Brachytherapy has been described as a technique to prevent recurrence. We evaluated the single institution results of using brachytherapy in the postoperative setting.
Methods and Materials: Patients with recurrent keloids treated with postoperative brachytherapy in the period from January 1992 through October 2004 were included. Treatment related parameters were noted using the patient file and a questionnaire was send to all patients to evaluate outcome and their satisfaction of the treatment. For statistical analysis, SPSS vs. 14 was used. The study was approved by the local Ethics Committee. Results: During the study period, 154 keloids in 105 patients (51 males and 54 females) were treated with postoperative brachytherapy. The median age was 28 years (10 to 66 y) . The most frequent localisation was retroauricular (47%) followed by presternal lesions (20%). After excision, a plastic tube was sutured into the wound. After 4 to 6 hours, an Iridium-192 wire was inserted and a dose of 15 Gy at 0.5 cm was given within 24 hrs. Median length of the keloid was 5 cm (1 to 50 cm). Seventy-six percent of the patients signed informed consent to be included in the study. Median followup time was 6.4 years (2.0 to 14.7 y). Apparently, a recurrence rate of 39% was noted with 52% smaller than the initial keloid. Eighty percent recurred within 2 years. No important complications were noted. As for overall satisfaction, 81% was satisfied regarding the treatment. As expected, 90% of the patients without recurrence was satisfied but also 41% of the patients with a recurrence was satisfied with the cosmetic result. Presternal keloids appeared to have a worse cosmetic effect. Conclusions: Brachytherapy in a postoperative setting can be used in recurrent keloids. Even when about 40% of the patients noted some recurrence, overall satisfaction was quite high.
PO79 A novel technique of intracavitary 125Iodine brachytherapy for vertebral body metastases Jamie A. Cesaretti, M.D., M.S.1 Ren-Dih Sheu, Ph.D.1 Lo Yeh-Chi, Ph.D.1 Richard G. Stock, M.D.1 Jenkins L. Arthur, M.D.2 1Radiation Oncology, Mount Sinai School of Medicine, New York, NY; 2Neurosurgery, Mount Sinai School of Medicine, New York, NY. Purpose: Vertebral body metastases are common and if refractory to initial treatment can present a considerable therapeutic dilemma to the neurooncology team. We present a novel integration of minimally invasive spine surgery and low-dose-rate brachytherapy with 125I for refractory/ recurrent vertebral body metastases. Methods and Materials: A patient with a prior history of spine radiotherapy who refused vertebrectomy as a salvage maneuver presented to the ER with acute spinal cord compression at the level of T7. A CT based preplan for intracavitary 125I brachytherapy was generated based on the patient’s T7 vertebral body metastasis using a commercially available anatomically accurate spine phantom (Sawbones, Vashon, WA). The volume of the cavity was found to be 3.5 cm3 using Variseed (Varian, Palo Alto, CA). It was determined that 9 sources of 0.6 U were needed to deliver 100 Gy at 0.5 cm from the surface of the cavity. 9 inactive sources were evenly distributed in 3.5 cm3 of Polymethyl methacrylate (PMMA) and CT-based dosimetry was performed on the spine phantom. The verified preplan confirmed that random distribution of the sources within the PMMA delivered the desired dose. Results: A minimally invasive transpedicular vertebrectomy for resection of the tumor within the vertebral body was performed, and then intraoperative placement of the seeds within the PMMA was performed without incident through a minimally invasive surgical access port (METRx, Sofamor/Danek-Medtronic, Memphis, TN) using a 2-cm incision. A PMMA cap was placed over the intracavitary implant to insure that all sources were at least 5 mm from the spinal cord. The patient was discharged from the hospital two days following the procedure with markedly decreased pain and a KPS of 90%. CT-based dosimetry confirmed random placement of the seeds embedded in PMMA within the resection cavity. The patient returned to the medical center at 2 and 4 months following the procedure without evidence of progression at T7, although he did have significant progression at other levels that subsequently required surgery.