Search

Background: Endometriosis is typically managed with a medical or surgical approach, though some patients have medically refractory disease and are poor surgical candidates. Case presentation: A 39-year-old woman presented to our facility with uncontrolled bleeding and pain from an endometriotic mass at the vaginal cuff. She had a history of abdominal hysterectomy with bilateral salpingo-oophorectomy, now with medically refractive and inoperable disease due to prior history of vesicovaginal fistula. We prescribed 30 Gy in 10 fractions with 10 MV and 18 MV photons to the target. At follow-up our patient reported a complete resolution of bleeding and pelvic pain. Conclusion: Radiation treatment can be an effective treatment for refractory endometriosis. [ABSTRACT FROM AUTHOR]

PURPOSE Updates to consensus guidelines in October 2018 recommending moderately hypofractionated external beam radiotherapy (mHF-EBRT) in prostate cancer lagged several years after publication of evidence supporting its efficacy. In January 2018, we amended our prostate cancer clinical pathway (CP) to facilitate adoption of mHF-EBRT. Herein, we analyze patterns of care and changes in mHF-EBRT use after the CP modification. METHODS Our prostate CP was amended in January 2018 to make mHF-EBRT the recommended treatment for patients with low- and intermediate-risk prostate cancer pursuing curative EBRT monotherapy. Normal-tissue dose constraints accompanied the CP modification to guide planning. Use of mHF-EBRT from 2015 to 2017 was compared with use in 2018 after the CP modification, using the Cochran-Armitage test for trend. Predictors of mHF-EBRT use and adherence to dose constraints were analyzed with binary logistic regression. RESULTS In 560 patients treated with EBRT monotherapy, mHF-EBRT use increased from 3.7% in 2015- 2017 to 85.6% in 2018 (P, .001), whereas conventionally fractionated EBRT (CF-EBRT) use decreased from 96.3% to 14.4% (P, .001). Consultation year of 2018 (odds ratio [OR], 214.6; 95% CI, 94.5 to 484.6; P, .001), treatment at an academic facility (OR, 4.5; 95% CI, 1.8 to 11.3; P50.001), and having a smaller prostate (OR, 0.99; 95% CI, 0.97 to 1.00; P 5 .028) predicted for mHF-EBRT use. At least five of six recommended bladder and rectal dose constraints were met in 89.4% of patients. CONCLUSION Modification of our prostate cancer CP, in concert with institutional policies to monitor and audit CP compliance, facilitated rapid adoption of mHF-EBRT in our large, integrated cancer center with good adherence to dosimetric constraints. [ABSTRACT FROM AUTHOR]

Brachytherapy (BT) boost with vaginal packing (VP) is standard of care for locally advanced cervical cancer. The goals of VP are to physically displace bladder and rectum (OARs) from the high dose radiation region and to stabilize the BT applicators. The BrachyGel Vaginal Hydrogel Packing System (BrachyGel) was developed as a new technique to improve the quality of VP for cervical cancer BT, including OAR dosimetry, patient comfort, ease of physician use, reproducibility, and visibility on MRI. The purpose of this study was to determine how the use of BrachyGel compares to standard gauze during high dose rate (HDR) BT for cervical cancer. This is a prospective randomized cross-over study. Patients with stage IB1 - IVB cervical cancer receiving definitive chemo-radiation with HDR BT boost (intracavitary +/- interstitial) were enrolled. All patients received gauze for their 1st fraction (Fx) and were subsequently randomized to BrachyGel for either the 3rd and 5th Fx (Arm A) or 2nd and 4th Fx (Arm B). Patient reported discomfort on a 4-point Likert scale was collected. Physicians and physicists evaluated imaging properties, completeness of packing, and ease of use. Adverse events (AEs) were prospectively collected and scored per CTCAE. MRI was not performed after VP insertion for this cohort, but was asynchronously obtained for BT planning. 20 evaluable patients were enrolled. The majority of patients had squamous cell histology (70%), and FIGO IIB (35%) or IIIC (35%) disease. For the primary endpoint of D2cc dosimetry comparison, the mean difference of Bladder D2cc (gauze - BrachyGel) in Fx 2 & 3 was 0.117 Gy ± 0.54 and 0.013 Gy ± 1.24 in Arms A and B, respectively, both in favor of BrachyGel. The mean difference of Rectum D2cc was -0.189 Gy ± 0.48 and -0.19 Gy ± 0.62 in Arms A and B, respectively, both in favor of gauze. The high risk clinical target volume (HR-CTV) D90 mean difference (gauze - BrachyGel) was -0.120 Gy ± 1.48 in Arm A and 0.601 Gy ± 1.48 in Arm B. There were no clinically relevant observed differences between gauze and BrachyGel between arms. Figure 1 displays the OAR dosimetry across 5 Fx for each arm and plots the variability of dosimetry. Patient reported discomfort with the VP experience was scored as none, mild, moderate, or severe for BrachyGel 23.3%, 36.7%, 33.3%, 6.7% as compared to 7.4%, 44.4%, 29.6%, 18.5% with gauze, respectively. The clarity of VP was similar between BrachyGel and gauze with 86.8% and 60.5% of BrachyGel cases scored as "very clear" or "clear" by physicists and physicians, respectively, compared to 89.7% and 66.7% in gauze cases. Completeness of VP was more frequently "excellent" or "good" with BrachyGel (79.0%) compared to gauze (56.4%). The ease of packing was considered "extremely easy" (21.2%) or "somewhat easy" (66.7%) more frequently with BrachyGel cases compared to gauze (0% and 72.4%, respectively). We observed no increase in AEs associated with BrachyGel. This prospective randomized cross-over study of BrachyGel VP for cervical cancer BT reports no difference between gauze and BrachyGel in OAR dosimetry or HR-CTV coverage. Imaging clarity on CT is similar between gauze and BrachyGel, but BrachyGel performs well compared to gauze for the patient and physician experience, including patient-reported discomfort, completeness, and ease of use. [ABSTRACT FROM AUTHOR]