PURPOSE: The stenosis or occlusion of transjugular intrahepatic portosystemic shunt (TIPS) occurs in up to 75% of patients within 12 months after treatment. The aim of our investigation was to evaluate the feasibility, safety and efficacy of intraluminal high-dose rate brachytherapy (HDRBT) with Iridium-192 following TIPS revision to prevent restenosis due to pseudointimal hyperplasia. MATERIALS AND METHODS: Between September and November 1996, intraluminal BT was performed in five patients after TIPS revision. The indications for initial TIPS were a Budd-Chiari syndrome in two female patients and recurrent variceal bleeding by alcoholic liver cirrhosis in three male patients. TIPS was created with Wallstents (10 mm diameter in four patients) and Palmaz stent (10 mm diameter in one patient). The re-dilatation was done in all five patients 6 months after first stenting because of restenosis (>50% stent lumen reduction) or occlusion of the stent. A 5-French closed-tip, noncentered BT delivery catheter was used for subsequent radiotherapy. The whole length of the stent and performed dilatation (interventional length - IL) was taken as clinical target length (CTL). A 10-mm safety margin was added proximal and distal to the CTL due to uncertainties of BT source positioning, so forming the planning target length (PTL). To ensure that prescribed dose covers the whole PTL, the active source length (ASL) was 5 mm longer proximal and distal than PTL, so forming the reference isodose length (RIL). A dose of 12 Gy was prescribed in 3 mm distance from the source axis in the mid-plane of the applicator for three patients and in 5 mm distance for two patients. RESULTS: A normal patency (<50% lumen reduction) of the stent was achieved at 44 months follow-up (duplex sonography+portography) in all three patients with liver cirrhosis, whereas further revisions were necessary in two patients with Budd-Chiari syndrome (after 5.5 and 18 months). No acute, subacute or late brachytherapy (BT)-related side effects were seen until now. CONCLUSIONS: HDRBT following TIPS revision was safe and feasible in all patients. The exact impact of BT on the TIPS patency should be evaluated in larger clinical trials. Moderate dose escalation and use of today's commercially available centering radiation catheters seem to be necessary.

Adult↗

PubMedDate not supplied

Brachytherapy in the combined modality treatment of pediatric malignancies. Principles and preliminary experience with treatment of soft tissue sarcoma (recurrence) and Ewing's sarcoma.

Radiotherapy is an integral part in the treatment of soft tissue and Ewing's sarcoma in children. By brachytherapy a high dose can be delivered in a restricted volume with sparing of normal tissues surrounding the target. Taking into account this principle potential benefit brachytherapy may play some role in the local treatment especially in children. However, only limited experience with pediatric brachytherapy has been reported apart from a few centers, which have gained their experience with Low-Dose-Rate (LDR)-brachytherapy. Since 1991 - 12 patients with soft tissue sarcoma and 6 patients with Ewing's sarcoma were treated with High-Dose-Rate (HDR) and Pulse-Dose-Rate (PDR)-brachytherapy at the departments of radiotherapy in Münster, Kiel and Vienna. The combined modality treatment was performed according to the CWS-86/91, EICESS-92 and CESS/CWS-REZ-91 protocols. In 8 patients with soft tissue sarcoma brachytherapy was part of the recurrence treatment regime, in 4 patients brachytherapy was part of the primary treatment alone or in combination with external beam therapy. In HDR-treatment a dose of 15 to 43 Gy was delivered in 3 to 16 fractions, in PDR-treatment 13 to 36 Gy in fractions of 1 Gy/hour. Follow-up is 3-39 months (median 14 months). 7 patients show no evidence of disease, 9 patients are locally controlled and 3 patients progressed locoregionally. In 6 patients with Ewing's sarcoma brachytherapy was performed intraoperatively as a boost treatment after external beam therapy (50-55 Gy), if no wide resection could be achieved within first line-treatment. A dose of 10-12 Gy was applied in one fraction in a limited volume (20-50 ccm) at the time of surgery. Follow-up is 13-26 months (median 21 months). There is no evidence of disease in all patients, perioperative and subacute morbidity was not increased. These encouraging preliminary results with HDR/PDR-brachytherapy must be further evaluated prospectively and systematically within an interdisciplinary approach by some specialized collaborating centers, which not only have the equipment (HDR/PDR/(LDR)-brachytherapy) but also can meet the complex demands to accumulate the necessary experience.

Adolescent↗

PubMedDate not supplied

[Interstitial radiotherapy of maxillofacial tumors with iridium-192 and iodine-125].

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Brachytherapy↗