A slim 198gold-grain implanter loaded with standard Royal Marsden 14-grain magazines

A simple percutaneous inserter for radiopaque gold seeds used in radiotherapy treatment planning

Percutaneous insertion of a radiopaque marker is an important technique used in radiotherapy planning for both external-beam and brachytherapy. It is of particular importance in the oral cavity. We describe the construction and use of a simple inserter for 'cold' gold seeds manufactured from a commercially available Becton Dickinson Brand 5-mL disposable syringe and a Becton Dickinson Brand 18 G 1 1/2 TW (1.25 x 38 mm) hypodermic needle.

Five-year experience with combined operative and radiotherapeutic treatment of recurrent gynecologic tumors infiltrating the pelvic wall

BACKGROUND

Whereas 25 to 50% of selected patients with gynecologic tumors who relapse centrally in an irradiated pelvis can be salvaged by exenteration, postirradiation recurrence infiltrating the pelvic side wall generally has been fatal. We have designed the combined operative and radiotherapeutic treatment (CORT) procedure for the treatment of postirradiation recurrence infiltrating the pelvic wall and developed several new techniques for its realization. The aim of the surgery is as follows: (1) total resection of the tumor with only a microscopic margin (R1) at the pelvic wall, preserving the bony pelvis and the neurovascular support of the leg; (2) modulation of the therapeutic index for a second high-dose irradiation of the pelvic wall by transferring autologous tissue from the abdomen or the thigh, and (3) reconstruction of pelvic organ functions lost due to tumor resection. The tumor bed is irradiated postoperatively with brachytherapy through transcutaneous guide tubes implanted at the pelvic wall.

METHODS

Between April 1989 and December 1994, we treated 48 patients with postirradiation recurrent or persistent gynecologic malignancies infiltrating the pelvic wall with CORT and followed them prospectively with the following endpoints: tumor control, survival, complications, and quality of life.

RESULTS

At a median follow-up of 33 months (range, 3-71 months), the 5-year survival probability calculated with the Kaplan-Meier method was 44%. The overall local control rate was 68%, and 85% in the last 25 patients in the series. The censored severe complication rate at 5 years was 33%. No patient died as a consequence of the treatment. Quality of life was self-assessed with a validated questionnaire by 15 patients without evidence of disease, and was rated with a total of 74% of the maximum score points. Age of the patient, state of resection at the pelvic wall (R1 vs. R2), and recurrent tumor size independently influenced tumor progression after CORT in this series.

CONCLUSIONS

CORT appears to be a feasible, innovative treatment with long term survival potential and acceptable quality of life for selected patients with postirradiation gynecologic tumor recurrence infiltrating the pelvic wall. R1 resection of the tumor at the pelvic wall is mandatory; however, the reconstruction options within the pelvis are limited.

Adenocarcinoma of the prostate: radioactive gold seed implant plus external irradiation

A total of 119 patients with a diagnosis of adenocarcinoma of the prostate (Stage B and C) were treated at St. Joseph Hospital Houston, Texas from 1971 through 1984 using a combination of radioactive gold seed implant and external irradiation. The prognostic significance of tumor grading and pelvic node involvement was analyzed. Five and 10-year survival for Stage B was 100% and 85% respectively; for Stage C it was 68% and 43% respectively. The cumulative 94% local control rate for Stage B and C cases obtained in this report suggests more effectiveness to control the disease locally with acceptable rate of complications, when radioactive gold seed implant is added.