BackgroundRectal spacers are used to limit dose to the anterior rectal wall in high dose external beam radiation therapy of the prostate and have been shown to reduce radiation induced toxicity. Here we report the complication rate and toxicity of the implantation procedure in a large cohort of patients who have either received a gel- or balloon-type spacer.MethodsIn total, 403 patients received rectal spacing, 264 with balloon, 139 with gel. Allocation was non-randomized. Two hundred seventy-six patients were treated with normofractionated regimen, the remaining 125 patients in moderate hypofractionation. Spacer related acute and late rectal toxicity was prospectively assessed by endoscopy using a mucosa scoring system (Vienna Rectoscopy Score) as well as CTCAE V.4. For the balloon subgroup, position and rotation of balloon spacers were additionally correlated to incidence and grade of rectal reactions in a post-hoc analysis of post-implant planning MRIs.ResultsOverall rectal toxicity was very low with average VRS scores of 0.06 at the day after implantation, 0.10 at the end of RT, 0.31 at 6 months and 0.42 at 12 months follow up. Acute Grade 3 toxicity (rectum perforation and urethral damage) directly related to the implantation procedure occurred in 1.49% (n = 6) and was seen exclusively in patients who had received the spacer balloon. Analysis of post implant MR imaging did not identify abnormal or mal-rotated positions of this spacer to be a predictive factors for the occurrence of spacer related G3 toxicities.ConclusionsSpacer technology is an effective means to minimize dose to the anterior rectal wall. However, the benefits in terms of dose sparing need to be weighed against the low, but possible risks of complications such as rectum perforation.
For years physicians have observed a high incidence of upper respiratory tract infections (URTI) after strenuous exercise. Mucosal surfaces represent a first-line-of-defense against infections, and pollutants or organisms entrapped in respiratory secretions are cleared by mucociliary transport. Little is known about this mechanism during exercise. The purpose of this study was to examine the nasal mucociliary clearance (MMCC) in amateur runners competing in a marathon race. Twelve amateur runners entered in an inner-city marathon race and 10 healthy sedentary subjects participated in the study. On the day of the race the outside temperature was 3 degrees C. Nasal mucociliary transit time (NMTT) was measured daily for 1 week before and 1 week after the race by the saccharin sodium/indigo carmine method. Nasal tissue biopsies were taken, and cilia beat frequency (CBF) was measured as viability and function of ciliated epithelial cells were determined. NMTT was significantly prolonged after the race (17.1 +/- 1.2 min vs 8.9 +/- 0.9 min; athletes vs control group; mean +/- SEM) and returned to baseline over several days. CBF was significantly reduced only in the first 24 hours after the race (7.31 +/- 0.65 Hz for athletes vs 9.94 +/- 0.45 Hz, controls. After the race, athletes showed a higher percentage of ciliated cells with immotile cilia (37.1 +/- 1.3% vs 27.8 +/- 1.1%, athletes vs controls) or dead ciliated cells (7.3 +/- 0.9% vs 4.1 +/- 0.8%). The findings suggest impairment of NMCC up to several days after strenuous exercise, which might be partially caused by abnormally functioning ciliated cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Due to its low fractionation sensitivity, also known as “alpha/beta ratio,” in relation to its surrounding organs at risk, prostate cancer is predestined for hypofractionated radiation schedules assuming an increased therapeutic ratio compared to normofractionated regimens. While moderate hypofractionation (2.2–4 Gy) has been proven to be non-inferior to normal fractionation in several large randomized trials for localized prostate cancer, level I evidence for ultrahypofractionation (>4 Gy) was lacking until recently. An accumulating body of non-randomized evidence has recently been strengthened by the publication of two randomized studies comparing ultrahypofractionation with a normofractionated schedule, i.e., the Scandinavian HYPO-RT trial by Widmark et al. and the first toxicity results of the PACE‑B trial. In this review, we aim to give a brief overview of the current evidence of ultrahypofractionation, make an overall assessment of the level of evidence, and provide recommendations and requirements that should be followed before introducing ultrahypofractionation into routine clinical use.
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