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  • 1.
    Johansson, Bengt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Leif
    Örebro University, School of Health and Medical Sciences.
    Hardell, Lennart
    Örebro University, School of Health and Medical Sciences.
    Persliden, Jan
    Örebro University, School of Health and Medical Sciences.
    Pulsed dose rate monobrachytherapy for cancer of the lip: first long time results from a clinical studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background and purpose: To evaluate the long time outcome with regard to local tumour control and side effects of a pulsed dose rate (PDR) monobrachytherapy of primary or recurrent cancr of the lip.

    Patients and methods: Between 1995 and 2007 we treated 43 patients with primary or recurrent T1-T3 lip cancers. The clinical stage was T1N0 for 22 patients (51 %), T2N0 for 16 patients (37 %) and T3N0 for 5 patients (12 %). A median dose of 60 (55-66) Gy was given, depending on the tumour volume. The PDR treatment was given with 0.83 Gy/pulse every second hour for 5.5-6.5 days. The patients were followed for a median of 55 (1-158) months.

    Results: The 2-, 5- and 10-years rates of actuarial local control were 97.6 %, 94.5 % and 94.5 %, overall survival 88.0 %, 58.9 % and 39.1 %, disease free survival 92.7 %, 86.4 % and 86.4 % respectively. The regional control rate was 93 %. One patient (2 %) developed distant metastases. A dosimetrical analysis showed a mean treated volume of 14.9 (3.0-56.2) cm3.  In a review of late complications we found 1 (2 %) soft tissue necrosis and 1 (2 %) osteoradionecrosis. Long-term side effects were very mild and the cosmetic outcome excellent.

    Conclusions: Local outcome is excellent and very similar to other published studies of continuous low dose rate (cLDR) brachytherapy.

  • 2.
    Johansson, Bengt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Leif
    Örebro University, School of Health and Medical Sciences.
    Liljegren, Göran
    Örebro University, School of Health and Medical Sciences.
    Hardell, Lennart
    Persliden, Jan
    Örebro University, School of Health and Medical Sciences.
    Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1-T2 breast cancer: first long time results from a clinical study2009In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 90, no 1, p. 30-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: To evaluate the long time outcome with regard to local tumour control, cosmetic outcome and side effects of a short (5 days) accelerated interstitial brachytherapy treatment delivered to the surroundings of the operated sector. PATIENTS AND METHODS: Between 1993 and 2003 we treated 50 women with early T1 and T2 breast cancer. Radical sector resection was performed and followed later with an interstitial pulsed dose rate (PDR) brachytherapy of 50Gy in 5 days. The treatment was centred on the tumour with a margin of 30mm. One patient was treated bilaterally. The patients were followed for a median of 86 (32-126) months. RESULTS: Ipsilateral breast cancer recurrence was seen in 3 patients (6%). Two of them occurred outside the treated volume. The 5- and 7-year rates of actuarial local control were 96% and 96%, respectively, overall survival 88% and 85%, disease free survival 88% and 88%, respectively. A dosimetrical analysis showed that the partial breast irradiation covered a median of 31% of the total breast volume. Fat necrosis was seen in 12% and local (moderate-strong) fibrosis in 26% of the patients. Independent cosmetic scoring showed good or excellent result in 56% of the patients. CONCLUSIONS: Local outcome is favourable and very similar to other published studies of accelerated partial breast irradiation. Our long time cosmetic results are lower than other published results.

  • 3.
    Johansson, Bengt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Karlsson, Leif
    Örebro University, School of Health and Medical Sciences.
    Reizenstein, Johan
    Örebro University, School of Health and Medical Sciences.
    von Beckerath, Mathias
    Örebro University, School of Health and Medical Sciences.
    Hardell, Lennart
    Örebro University, School of Health and Medical Sciences.
    Persliden, Jan
    Örebro University, School of Health and Medical Sciences.
    Long term results from a uniform clinical series on pulsed dose rate brachytherapy as the boost to external beam irradiation in base of tongue cancerManuscript (preprint) (Other academic)
    Abstract [en]

    Background and purpose: To evaluate the long time outcome with regard to local tumour control, side effects and quality of life of a combined pulsed dose rate (PDR) boost and hyperfractionated accelerated external beam radiotherapy (EBRT) for primary base of tongue (BOT) cancers.

    Patients and methods: Between 1994 and 2007 we treated 83 patients, median age 60 (38-82) years, with primary T1-T4 BOT cancers. Seven patients (8 %) were T1-2N0 (AJCC stage I-II) and 76 (92 %) patients were T1-2N+ or T3-4N0-3 (AJCC stage III-IV). The mean estimated primary tumour volume was 15 (1-75) cm3.  EBRT was given with 1.7 Gy twice daily to 40,8 Gy to primary tumour and bilateral neck lymph nodes in 2.5 weeks. A PDR boost of 35 Gy and a neck dissection in clinical node positive cases was performed 2-3 weeks later. The patients were followed for a median of 54 (2-168) months.

    Results: The 2-, 5- and 10-years rates of actuarial local control were 91 %, 89 % and 85 %, overall survival 85 %, 65 % and 44 %, disease free survival 86 %, 80 % and 76 % respectively. The regional contral rate was 95 %. Six patients (7 %) developed distant metastases. Analysis of dosimetry showed a mean treated volume of 58 cm3.  In a review of late complications we found 11 (13 %) minor and 4 (5 %) major soft tissue necroses and 6 (7 %) osteoradionecroses. The patients median subjective SOMA/LENT scoring at last follow up was; grade 0 for pain and trismus, grade 1 for dysphagia and taste alteration and grade 2 for xerostomia. Global visual-analog-scale (VAS) scoring of quality of life was 8.

    Conclusions: Local and regional tumour control rate was excellent in this treatment protocol. The data support that PDR boost is at least as effective as published continuous low dose rate (CLDR) results.

  • 4.
    Karlsson, Leif
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Thunberg, Per
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Johansson, Bengt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
    Persliden, Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    The impact of activating source dwell positions outside the CTV on the dose to treated normal tissue volumes in TRUS guided 3D conformal interstitial HDR brachytherapy of prostate cancer2014In: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 6, no 3, p. 282-288Article in journal (Refereed)
    Abstract [en]

    Purpose: Dose coverage is crucial for successful treatment in mono-brachytherapy. Since few and very high dose fractions are used, there is an important balance between dwell positioning outside the clinical target volume (CTV) and possible damage on adjacent normal tissue. The purpose of this study was to evaluate the possibility of having dwell positions close to the CTV surface, while maintaining an acceptable dose distribution, and to investigate the robustness in terms of known geometrical uncertainties of the implant.

    Material and methods: This study included 37 patients who had received brachytherapy for prostate cancer as a monotherapy with the following schedules: 2 x 14 Gy or 3 x 11 Gy, each fraction separated by two weeks. The source dwell positions were activated 5 mm outside CTV. New optimizations were simulated for dwell positions at 3, 2, 1, and 0 mm. Inverse and graphical optimization were applied according to the relative dose constraints: V-100 CTV >= 97%, D-max,D- urethra <= 110%, and D-10 rectal mucosa <= 65%. The V-100 normal tissue outside CTV was used to evaluate dose variations caused by different dwell positions. Prostate geometries and dose distributions for the different dwell positions outside the CTV were used to investigate the impact on the CTV dose distribution due to geometrical uncertainties.

    Results: Both V-100,V- CTV, and V-100,V- normal tissue decreased, 98.6% to 92.2%, and 17 cm(3) to 9.0 cm(3), for dwell activation from 5 rum to 0 mm. The evaluation of both simulated longitudinal geometrical uncertainties and different source dwell activations implied that V-100,V- CTV ranged from 98.6% to 86.3%.

    Conclusions: It is possible to reduce the V-100,V- normal tissue by decreasing the source dwell positions outside the CTV from 5 to 3 mm, while maintaining dose constraints. In combination with the estimated geometrical uncertainties, however, the source dwell positions need to be 5 mm from the surface in order to maintain a robust implant.

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