For LDR or PDR brachytherapy,

higher rates are associated with a higher prescribed dose of 65 Gy (27), whereas ulceration rates with 60 Gy are in the order of 12% (19). The risk is higher with tumors greater than 4 cm in diameter and with a larger number of needles. De Crevoisier et al. (27) have shown that two factors predictive of complications were dose rate higher than 0.6 Gy/h and treatment volume greater than 22 cm3. When using PDR, the dose rate EPZ015666 in vitro can be adapted by increasing the pulse frequency and decreasing the pulse dose to keep the hourly dose rate at 0.6 Gy/h or lower. Hyperbaric oxygen therapy can bring about speedy resolution of ulceration when more conservative measures fail, although a prolonged series of “dives” over 6–8 weeks is required (31). Meatal stenosis is reported in 9–45% (1), but is related to proximity of distal sources to the meatus. Crook et al. (19) reported Sirolimus datasheet a rate of 9%, but routinely supplied patients with a commercially available meatal dilator to be used as required to deal with any impairment of urinary stream. This may be beneficial in preventing problematic scarring of the meatus. Brachytherapy provides excellent local control of T1–T2 penile squamous cell carcinoma (and selected T3 lesions), ideally smaller than 4 cm with no or minimal extension

onto the penile shaft. Circumcision preceding brachytherapy is essential. Penile conservation rates of 87% and 70% at 5 and 10 years, respectively, can be achieved with brachytherapy. Lymph node observation is appropriate for small (T1) well-differentiated tumors. Radiographic assessment and directed biopsies are warranted in moderate or poorly differentiated

Liothyronine Sodium or larger tumors. Although surgical management of positive or suspicious lymph nodes is preferred, EBRT is an option if the patient is not a surgical candidate. Because local recurrence can happen even after 5 years, extended followup is mandatory because both local and regional failures can be salvaged surgically. Meatal stenosis and soft tissue ulceration are the most common significant late effects, but can be effectively managed conservatively while retaining penis conservation. LDR and PDR 192Ir brachytherapy fractionation is well established with mature data in the literature. HDR 192Ir brachytherapy for penile cancer is under development. “
“Accelerated partial breast irradiation (APBI) represents an adjuvant radiation therapy (RT) technique that allows the delivery of a biologically equivalent dose to the lumpectomy cavity compared with whole breast irradiation (WBI) delivering 50 Gy while shortening the overall RT course to 1 week or less. At this time, APBI can be delivered using multiple techniques including interstitial catheters, balloon or strut-based single-entry devices, intraoperative applicators, or external beam RT. With several series reporting more than 5 years of follow-up, APBI has been shown to be associated with clinical outcomes comparable with traditional WBI (1).