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Purpose: The aim of the study was to report our experience with high-dose-rate interstitial brachytherapy (HDR-ISBT) in locally advanced and recurrent vulvar cancer.Material and methods: Between 2004 and 2014, fourteen women with locally advanced or recurrent vulvar cancer were treated using HDR-ISBT in our Centre. High-dose-rate interstitial brachytherapy was performed as a separate treatment or in combination with external beam radiotherapy (EBRT) (given prior to brachytherapy).Results: Patients were divided into: group I (n = 6) with locally advanced tumors, stages III-IVA after an incisional biopsy only, and group II (n = 8) with recurrent vulvar cancer after previous radical surgery. In group I, median follow up was 12 months (range 7-18 months); 1-year overall survival (OS) was 83%. Transient arrest of cancer growth or tumor regression was noticed in all patients but 4/6 developed relapse. Median time to failure was 6.3 months (range 3-11 months). The 1-year progression-free survival (PFS) was 33%. In group II, median follow up was 28 months (range 13-90 months). The 1-year and 3-year OS was 100% and 80%, respectively. The arrest of cancer growth or tumor regression was achieved in all patients. In 4/8 patients neither clinical nor histological symptoms of relapse were observed but 4/8 women experienced relapse. Median time to failure was 31 months (range 13-76 months). The 1-year and 3-year PFS was 100% and 62.5%, respectively. Two patients (14.3%) in group II had severe late toxicity (G3).Conclusions: High-dose-rate interstitial brachytherapy is a well-tolerated treatment option in selected patients with advanced or recurrent vulvar cancer. It is a safe and effective treatment modality for advanced and recurrent vulvar cancer, yielding good local control with acceptable late treatment related side effects. In our study, patients with recurrent vulvar cancer had better results in HDR-ISBT treatment, probably because of the smaller tumor volume. This hypothesis should be verified in a larger group of patients.

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The PDT is a very effective therapeutic method in LS treatment.

Endometrial cancer is the most frequent cancer of female genital tract. Metro- and menorrhagia or postmenopausal bleeding results in its early presentation. It allows radical treatment. However, controversies remain on surgery coverage or adjuvant therapies in early endometrial women cancer. Optimal management should minimize intervention instead of aggressive approach, as showed by recent studies. There is a role for brachytherapy as an adjuvant irradiation. Crucial publications including PORTEC-1, GOG 99, MRC ASTEC, ASTEC/EN.5, PORTEC-2 or Italian lymphadenectomy trial are discussed. Moreover, there is attention paid on adjuvant vaginal brachytherapy analyses for the past fifteen years.

PurposeThe aim of this study was to report individual surface mould multi-catheter high-dose-rate (IMM HDR) application as a salvage treatment for a head and neck angiosarcoma patient, previously treated with surgery followed by external beam radiotherapy.Material and methodsA 74-year-old male reported to our center with an uncommon malignant neoplasm of blood vessels. The patient was qualified for a wide local excision (WLE) of tumor with simultaneous reconstruction using a free-flap collected from the patient’s thigh. After surgery, the patient was qualified for adjuvant external-beam radiotherapy (EBRT). Volumetric arc therapy (VMAT; RapidArc®, Varian Medical Systems) was used to deliver 52.8 Gy/1.6 Gy in 33 fractions. Overall treatment time was 51 days. Six months after radiotherapy, an incisional biopsy of non-healing ulcer of the nasal bridge revealed angiosarcoma. Wide local excision with skin graft reconstruction was planned. Due to multifocal disease and lack of possibility for further margin, the resection surgery was completed after skin graft reconstruction from the right thigh. Surface IMM HDR was considered as an alternative option for further treatment. Total dose of 48 Gy (12 fractions) was planned.ResultsOne month after surface IMM HDR, healing process of the skin was observed in the treated regions and six months later, the irradiated areas recovered. General condition of the patient deteriorated two years after diagnosis and one year after HDR. He was hospitalized to receive palliative care.ConclusionsHDR brachytherapy may be a valuable option for angiosarcoma treatment. Difficult lesion location may yield non-radical surgery. Surface IMM HDR provides highly conformal plan and allow adjusting the dose to individual clinical situation.

This study includes four years of our clinical trials to improve implant quality in multicatheter accelerated partial breast irradiation (APBI). The progress in dosimetric and volumetric parameters of the treatment plans was evaluated. One hundred and ninety-one women, for whom treatment plans were made based on three dimensional imaging, were selected for the study. To evaluate progress made in our APBI procedure, following parameters and indices were taken into account: percentage of the target volume receiving the reference dose (PTVref), minimum dose in the target volume expressed as a percentage of reference dose (PTVmin), dose homogeneity index (DHI), and conformity index (COIN). Additionally, the plan quality index was calculated for every group as the sum of mean values of four evaluated parameters. PTVref have increased from the mean value of 83.4% at the beginning to recent 94.8%. The maximum value equals to 95.4%. The same trend can be observed with PTVmin value, which has been improved from 51.7% to 70.1%, maximally. DHI and COIN mean values present similar progress. DHI value increased from 0.53 level to 0.68, and COIN from 0.58 in 2009 to 0.74. Plan quality index has increased from 2.46 in 2009 to 3.06, recently. The implant quality is crucial for the accurate dose distribution. This paper shows the progress that was made in APBI procedure to improve implant quality. Nowadays, our implant technique is based on three-dimensional CT imaging results in acceptable dose distributions.

SummaryBackground: Recurrences in vulvar cancer are a very important problem. It is estimated that even in multimodality treatment, about 10-20% of patients with the early stage and 50-70% with the advanced disease will develop recurrences. Interstitial High Dose Rate (HDR) Brachytherapy as a "boost" or as a sole treatment is one of the possible techniques in local failures in vulvar cancer therapy.Case report: We report a case of a vulvar cancer local recurrence in a 90-year-old patient after primary surgery who was treated successfully and radically with interstitial HDR brachytherapy.Conclusion: Interstitial HDR Brachytherapy in selected patients with a vulvar cancer local recurrence is an effective and safe method which allows to preserve organ functions with good cosmetic results.