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Purpose To evaluate the long-term toxicity, cosmesis, and local control of accelerated partial breast irradiation with implant brachytherapy after wide local excision for Stage T1N0 breast cancer (BCa). Materials and Methods Between 1997 and 2001, 50 patients with Stage T1N0M0 BCa were treated in a Phase I–II protocol using low-dose-rate accelerated partial breast irradiation with implant brachytherapy after wide local excision and lymph node surgery. The total dose was escalated in three groups: 50 Gy (n = 20), 55 Gy (n = 17), and 60 Gy (n = 13). Patient- and physician-assessed breast cosmesis, patient satisfaction, toxicity, mammographic abnormalities, repeat biopsies, and disease status were prospectively evaluated at each visit. Kendall’s tau (τβ) and logistic regression analyses were used to correlate outcomes with dose, implant volume, patient age, and systemic therapy. Results The median follow-up period was 11.2 years (range, 4–14). The patient satisfaction rate was 67%, 67% reported good-excellent cosmesis, and 54% had moderate-severe fibrosis. Higher dose was correlated with worse cosmetic outcome (τβ 0.6, p < .0001), lower patient satisfaction (τβ 0.5, p < .001), and worse fibrosis (τβ 0.4, p = .0024). Of the 50 patients, 35% had fat necrosis and 34% developed telangiectasias ≥1 cm2. Grade 3–4 late skin and subcutaneous toxicities were seen in 4 patients (9%) and 6 patients (13%), respectively, and both correlated with higher dose (τβ 0.3–0.5, p ≤ .01). One patient had Grade 4 skin ulceration and fat necrosis requiring surgery. Mammographic abnormalities were seen in 32% of the patients, and 30% underwent repeat biopsy, of which 73% were benign. Six patients had ipsilateral breast recurrence: five elsewhere in the breast, and one at the implant site. One patient died of metastatic BCa after recurrence. The 12-year actuarial local control, recurrence-free survival, and overall survival rate was 85% (95% confidence interval, 70–97%), 72% (95% confidence interval, 54–86%), and 87% (95% confidence interval, 73–99%), respectively. Conclusion Low-dose-rate accelerated partial breast irradiation with implant brachytherapy provides acceptable local control in select early-stage BCa patients. However, treatment-related toxicity and cosmetic complications were significant with longer follow-up and at higher doses.

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BACKGROUND Recurrent atypical and malignant meningiomas have poor outcomes with surgical therapy alone. Neither adjuvant chemotherapy nor postoperative radiation therapy remedies this problem. OBJECTIVE To evaluate our experience with the treatment of 15 patients treated with I-125 or Cs-131 brachytherapy radiation seeds as an adjuvant in these difficult cases. METHODS Patients with high-grade recurrent meningioma who underwent resection and intraoperative placement of brachytherapy seeds at our institution from 2002 to 2014 were identified and studied by retrospective chart review. RESULTS Fifteen patients with median age of 68.8 yr were treated with I-125 (n = 13) or Cs-131 (n = 2) brachytherapy seeds for cases of recurrent, grade II (n = 8), or grade III (n = 7) meningioma at our institution from 2002 to 2014. These lesions originated from a variety of locations including, convexity (3), falcine (3), frontal (2), occipital (1), parietal (2), 2 sphenoid wing (2), and temporal (2), based recurrent meningiomas. Patients had a median of 2 prior open surgical interventions and received local radiation therapy with a median dose of 55 Gy prior to brachytherapy. Survival at 2.5 yr was 56% for grade II and 17% for grade III lesions. Survival was significantly associated with patient age but not tumoral pathology. Forty percent of patients required reoperations for wound complications following brachytherapy. CONCLUSION Brachytherapy with implantation of permanent radiation seeds provides a viable alternative treatment for recurrent meningioma while carrying a significant clinical risk of wound infection and need for reoperation.

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Traditionally, measurements have been made in heterogeneous phantoms to determine the factors which should be applied to dose calculations, when calculating a dose to a heterogeneous medium. Almost all measurements have relied on relatively thin-walled ion chambers, with no attempt to match ion chamber wall material to the measuring medium. The recent AAPM dosimetry protocol has established that a mismatch between ion chamber wall and phantom material can have an effect on dose measurement. To investigate the affect of this mismatch of ion chamber wall material to phantom material, two parallel-plate ion chambers were constructed. One ion chamber from solid water, for measurements in a solid water phantom and the other from plastic lung material, for measurements in a plastic lung material phantom. Correction factors measured by matching ion chamber to media were compared to correction factors measured by using a thin-walled cavity ion chamber with no regard for matching wall and media for cobalt-60, 6-, 10- and 20-MV photon beams. The results demonstrated that the matching of ion chamber to measuring media can be ignored, provided that a small, approximately tissue-equivalent, thin-walled ion chamber is used for measuring the correction factors.

RESULTSThree reported cases of pregnancy showed the men to have viable counts of within several or all of the parameters of the World Health Organisation criteria for normal semen analysis. CONCLUSIONSThese cases provide a cautionary tale and suggest that all men being treated with prostate brachytherapy should be counselled about the possibility of continued fertility. Documentation of this 'risk' on the consent form will allow for proper discussion of this issue in a clinical and medicolegal context. The key to addressing this problem is to propagate much better patient information. The topic should be addressed clearly in information booklets for the patients. Prostate brachytherapy may allow for pregnancy to be achieved in the fertile partners of patients, even after full radiation treatment of the patient. KEYWORDSprostate brachytherapy, fertility, pregnancy OBJECTIVESTo examine several cases of unusual and unexpected pregnancy in the female partners of men treated with brachytherapy for cancer of the prostate PATIENTS AND METHODSSelf-reported pregnancy of partners of patients who had had prostate brachytherapy was assessed. The dosimetry to the testicles and sperm counts were used to examine the feasibility of pregnancy in the partners.

case were generated with two-, three-, and four-fields. Intensity modulated tangential or near tangential 6MV beams were used to minimize low dose scatter to normal tissue, especially lungs. Target coverage and normal tissue dose were compared using dose volume histograms. Results:The extent of interfraction variation is depicted in the composite of all images for a representative patient seen in figure on left. From the composite, the maximum chest wall and breast variation can be measured to be up to 2 cm. The intrafractional movement is depicted in the composite of all images seen in figure on right. The maximum chest wall and breast movement can be measured to be up to 1 cm. The diaphragm motion reached up to 1.5 cm. The 3 and 4 field IMRT plans demonstrated excellent dose distribution with the elimination of multiple fields and junctions, and kept lung dose-volume parameters below our published institutional limits only when internal mammary nodes were not included as a target. Conclusions:The magnitude of interfractional setup error was significantly greater than the intrafractional variation. The magnitude of intrafractional motion was much less than we expected. Interfraction variation indicates a need for improved patient positioning, either with better immobilization or image guided patient setup technology. Intrafraction movement (primarily breathing motion) must also be taken into account in the implementation of IMRT in the treatment of breast cancer patients. IMRT allows elimination of junctions and fewer fields to be used to treat breast cancer.