External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study.

BACKGROUND: We did a randomised phase 3 trial assessing the benefit of addition of long-term androgen suppression with a luteinising-hormone-releasing hormone (LHRH) agonist to external irradiation in patients with prostate cancer with high metastatic risk. In this report, we present the 10-year results. METHODS: For this open-label randomised trial, eligible patients were younger than 80 years and had newly diagnosed histologically proven T1-2 prostatic adenocarcinoma with WHO histological grade 3 or T3-4 prostatic adenocarcinoma of any histological grade, and a WHO performance status of 0-2. Patients were randomly assigned (1:1) to receive radiotherapy alone or radiotherapy plus immediate androgen suppression. Treatment allocation was open label and used a minimisation algorithm with institution, clinical stage of the disease, results of pelvic-lymph-node dissection, and irradiation fields extension as minimisation factors. Patients were irradiated externally, once a day, 5 days a week, for 7 weeks to a total dose of 50 Gy to the whole pelvis, with an additional 20 Gy to the prostate and seminal vesicles. The LHRH agonist, goserelin acetate (3·6 mg subcutaneously every 4 weeks), was started on the first day of irradiation and continued for 3 years; cyproterone acetate (50 mg orally three times a day) was given for 1 month starting a week before the first goserelin injection. The primary endpoint was clinical disease-free survival. Analysis was by intention to treat. The trial is registered at ClinicalTrials.gov, number NCT00849082. FINDINGS: Between May 22, 1987, and Oct 31, 1995, 415 patients were randomly assigned to treatment groups and were included in the analysis (208 radiotherapy alone, 207 combined treatment). Median follow-up was 9·1 years (IQR 5·1-12·6). 10-year clinical disease-free survival was 22·7% (95% CI 16·3-29·7) in the radiotherapy-alone group and 47·7% (39·0-56·0) in the combined treatment group (hazard ratio [HR] 0·42, 95% CI 0·33-0·55, p<0·0001). 10-year overall survival was 39·8% (95% CI 31·9-47·5) in patients receiving radiotherapy alone and 58·1% (49·2-66·0) in those allocated combined treatment (HR 0·60, 95% CI 0·45-0·80, p=0·0004), and 10-year prostate-cancer mortality was 30·4% (95% CI 23·2-37·5) and 10·3% (5·1-15·4), respectively (HR 0·38, 95% CI 0·24-0·60, p<0·0001). No significant difference in cardiovascular mortality was noted between treatment groups both in patients who had cardiovascular problems at study entry (eight of 53 patients in the combined treatment group had a cardiovascular-related cause of death vs 11 of 63 in the radiotherapy group; p=0·60) and in those who did not (14 of 154 vs six of 145; p=0·25). Two fractures were reported in patients allocated combined treatment. INTERPRETATION: In patients with prostate cancer with high metastatic risk, immediate androgen suppression with an LHRH agonist given during and for 3 years after external irradiation improves 10-year disease-free and overall survival without increasing late cardiovascular toxicity.

Analysis of the effects of irradiation in osseointegrated dental implants

Objective: The purpose of the present study was to evaluate the influence of radiation in osseointegrated dental implants installed in tibiae of rats.Material and methods: Screw-shaped implants (2.5 mm diameter by 3.5 mm length) were custom made from commercially pure titanium bars. Titanium implants were blasted and sterilized before implantation. Animals were divided into two groups of 12 animals each and the rats were not paired after the groups' formation. The experimental group (group 1) received external irradiation 4 weeks after surgery while in the control group (group 2) animals were kept free of radiation. The shear strength required to detach the implant from bone was measured by push-out testing and osseointegration was histologically evaluated.Results: Results showed that the compressive strength of irradiated implants (33.49 MPa) was significantly lower than the compressive strength of non-irradiated implants (48.05 MPa).Conclusions: We concluded that the mechanical strength bonding between implants and host tissues decreased after irradiation.

Results of high dose-rate brachytherapy boost before 2D or 3D external beam irradiation for prostate cancer

Background and purpose: To evaluate biochemical control and treatment related toxicity of patients with localized adenocarcinoma of the prostate treated with high dose-rate brachytherapy (HDRB) combined with conventional 2D or 3D-conformal external beam irradiation (EBI). Material and methods: Four-hundred and three patients treated between December 2000 and March 2004. HDRB was delivered with three fractions of 5.5-7 Gy with a single implant, followed by 45 Gy delivered with 2D or 3D conformal EBI. Results: The median follow-up was 48.4 months. Biochemical failure (BF) occurred in 9.6% according to both ASTRO and Phoenix consensus criteria. Mean time to relapse was 13 and 26 months, respectively. The 5-year BF free survival using the ASTRO criteria was 94.3%, 86.9% and 86.6% for the low, intermediate and high risk groups, respectively; using Phoenix criteria, 92.4%, 88.0% and 85.3%, respectively. The only predictive factor of BF in the multivariate analysis by both ASTRO and Phoenix criteria was the presence of prostate nodules detected by digital palpation, and patients younger than 60 years presented a higher chance of failure using Phoenix criteria only. Conclusions: Treatment scheme is feasible and safe with good efficacy. (C) 2011 Elsevier Ireland Ltd All rights reserved. Radiotherapy and Oncology 98 (2011) 169-174

Temperature variation at the external root surface during 980-nm diode laser irradiation in the root canal

Objective: To assess the temperature variation in the cervical, middle and apical thirds of root external wall, caused by 980-nm diode laser irradiation with different parameters. Methods: The roots of 90 canines, had their canals instrumented and were randomly distributed into 3 groups (n = 30) according to the laser potency (1.5 W, 3.0 W and 5.0 W). Each group was subdivided into 3 (n = 10) according to the frequency (CM, 100 Hz and 1000 Hz), and each subgroup divided into 2 (n = S): dried canal or filled with distilled water. The maximum temperature values were collected by 3 thermocouples located at each third of the root external wall and recorded by digital thermometers. Results: The groups irradiated in the continuous mode (CM) presented the highest values (11.82 +/- 5.78), regardless of the canals were dry or not, which were statistically different (p < 0.01) from those obtained with 100 Hz (6.22 +/- 3.64) and 1000 Hz (6.00 +/- 3.36), which presented no statistical difference between them (p > 0.01). The groups irradiated with 5.0 W presented the greatest temperature variation (12.15 +/- 5.14), followed by 3.0 W (7.88 +/- 3.92) and 1.5 W (4.02 +/- 2.16), differing between them (p < 0.01). The cervical third of the root presented the highest temperature rises (9.68 +/- 5.80), followed by the middle (7.66 +/- 4.87) and apical (6.70 +/- 4.23), with statistical difference among them (p < 0.01). After 30 s from the end of irradiation, all the specimens presented temperature variation lower than 10 degrees C. Conclusions: Application of 980-nm diode laser in the root, at 1.5 W in all operating modes, and 3.0 W, in the pulsed mode, for 20 s, can safely be used in endodontic treatment, irrespective of the presence of humidity. (C) 2008 Elsevier Ltd. All rights reserved.

First-line chemotherapy with local treatment can prevent external-beam irradiation and enucleation in low-stage intraocular retinoblastoma.

PURPOSE: To evaluate the efficacy of first-line chemotherapy (CT) in preventing external-beam radiotherapy (EBR) and/or enucleation in patients with retinoblastoma (Rbl). PATIENTS AND METHODS: Twenty-four patients with newly diagnosed unilateral or bilateral Rbl received CT associated with local treatment (LT). Two to five courses of etoposide and carboplatin were administered at 3- to 4-week intervals, depending on tumor response, and were completed each time by LT. RESULTS: Tumor response was observed in all eyes. Twenty-one of 24 patients showed a complete response (CR) that persisted at a median follow-up (FU) of 31 months (range, 4 to 41 months). Among the three patients who relapsed, two were lost to FU and one died of progressive disease. CR was achieved by CT and LT alone in 15 (71.4%) of 21 patients with less advanced disease (groups I to III). Six other patients with advanced disease (groups IV and V) experienced treatment failure and needed salvage treatment by EBR and/or enucleation. The difference between the two patient groups with regard to disease stage was statistically significant (P <.0001). EBR could be avoided in 13 (68.4%) of 19 patients, who presented with groups I to III (15 eyes) and group V (one eye) disease, whereas enucleation could be avoided in only two (40%) of five. CONCLUSION: CT combined with intensive LT is effective in patients with groups I to III Rbl, permitting the avoidance of EBR in the majority of these young children and, thus, reducing the risk of long-term sequelae. This is in contrast with the disappointing results for patients with groups IV and V Rbl, in whom EBR and/or enucleation was needed.

In vitro evaluation of the temperature increment at the external root surface after Er,Cr: YSGG laser irradiation of the root canal

Objectives: A study was made to determine the temperature increment at the dental root surface following Er,Cr:YSGG laser irradiation of the root canal. Design. Human canines and incisors previously instrumented to K file number ISO 30 were used. Irradiation was carried out with glass fiber endodontic tips measuring 200 μm in diameter and especially designed for insertion in the root canal. The teeth were irradiated at 1 and 2 W for 30 seconds, without water spraying or air, and applying a continuous circular movement (approximately 2 mm/sec.) in the apico-coronal direction. Results: At the 1 W power setting, the mean temperature increment was 3.84ºC versus 5.01ºC at 2 W. In all cases the difference in mean value obtained after irradiation versus the mean baseline temperature proved statistically significant (p< 0.05). Conclusions: Application of the Er,Cr:YSGG laser gives rise to a statistically significant temperature increment at the external root surface, though this increment is probably clinically irrelevant, since it would appear to damage the tissues (periodontal ligament and alveolar bone) in proximity to the treated tooth

Assessment of external root temperature during root canal irradiation by Nd:YAG and Er:YAG lasers

Different types of laser have been widely studied for applicability in the oral health area. In the endodontic area, investigations with some types of laser have been conducted to establish safe parameters for clinical application in root canals. However, it has not been duly explained whether the temperature increase caused by laser irradiation could cause alteration in the temperature on the external surface of the root and, consequently, alterations in the cells of the periodontal ligament, causing resorption and even loss of the dental element. The proposal in this paper was to gauge the external root temperature in the apical and cervical regions of the roots of human teeth during root canal irradiation with Nd:yttrium aluminum garnet (YAG) and Er:YAG lasers using different parameters. The novel approach of this paper is the use of the technique of laser applications along the total length of the root canal with series of repetitive irradiation, however, using time of 1 s of irradiation associated with 1 s off to avoid cumulative thermal effects. Experimental results confirm the accuracy of the parameters and exposure regimen obtained. All the parameters used in this paper are acceptable from a clinical as well as a biological point of view. (C) 2009 Laser Institute of America.

Effects of Er, Cr:YSGG laser irradiation on external adaptation of restorations in caries-affected cavities

This study evaluated the effect of Er,Cr:YSGG laser irradiation on the external adaptation of composite resin restorations in caries-affected cavities. Mixed class V cavity preparations were performed in 36 intact human third molars, in half of which caries was artificially induced. Both healthy and carious dentin were etched with 35% phosphoric acid (Ultradent Products Inc., South Jordan, Utah, USA), and the teeth were divided into three groups, i.e., (a) untreated etched dentin, (b) application of the Er, Cr:YSGG laser and (c) use of chlorhexidine as an adjunct in the bonding process. Restorations were fabricated with Z350 XT FiltekTM composite resin (3M ESPE) and subsequently the specimens were subjected to thermocycling to simulate artificial ageing. Quantitative analysis of external adaptation was performed by scanning electron microscopy in both healthy and affected dentin using epoxy resin replicas. It was concluded that the application of laser and chlorhexidine did not affect the percentages of marginal adaptation of class V restorations. Furthermore, thermocycling may influence adaptation values.

Electron beam irradiation of Matricaria chamomilla L. for microbial decontamination

Wild chamomile (Matricaria chamomilla L.) is one of the most popular herbal materials with both internal and external use to cure different health disturbances. As a consequence of its origin, chamomile could carry various microbial contaminants which offer different hazards to the final consumer. Reduction of the microbial load to the in force regulation limits represents an important phase in the technological process of vegetal materials, and the electron beam treatment might be an efficient alternative to the classical methods of hygienic quality assurance. The purpose of the study was to analyze the potential application of the electron beam treatment in order to assure the microbial safety of the wild chamomile. Samples of chamomile dry inflorescences were treated in electron beam (e-beam) of 6 MeV mean energy, at room temperature and ambient pressure. Some loss of the chemical compounds with bioactive role could be noticed, but the number of microorganisms decreased as a function on the absorbed dose. Consequently, the microbial quality of studied vegetal material inflorescences was improved by e-beam. irradiation. (C) 2008 Elsevier B.V. All rights reserved.

Mammography findings following electron intraoperative radiotherapy or external radiotherapy for breast cancer treatment

Radiotherapy following breast cancer conserving surgery decreases the risks of local recurrence. Because 85% of breast cancers relapse in or around the surgical bed there has been some debate on the need for irradiating the whole breast. Electron intraoperative radiotherapy (ELIOT) has been used as a viable alternative for conventional external radiotherapy (RT). While the former requires a single dose of 21 Gy in the tumoral bed, the latter requires 5-6 weeks of irradiation with a total dose of 50 Gy and a boost of 10 Gy that irradiates the surgical bed. Herein, we investigated whether any significant differences exist between the mammography findings obtained from patients submitted to one of the two techniques. Two groups of 30 patients each were included in this study. All patients had mammographies taken at 12 and 24 months after finishing treatment. The mammography findings evaluated were: cutaneous thickening (>2 mm), architectural distortion secondary to fibrosis, edema, calcifications (both benign and malignant), and fat necrosis. For all variables studied, there was no statistical difference between the two groups. This indicates that the mammography findings obtained in either 12- or 24-month follow-up periods after breast cancer conserving surgery are similar, regardless of which of the two radiotherapy techniques (ELIOT or RT) is employed as a treatment for breast cancer. (C) 2010 Published by Elsevier Ireland Ltd.

In vivo dosimetry with thermoluminescent dosimeters in external photon beam radiotherapy

The ultimate check of the actual dose delivered to a patient in radiotherapy can only be achieved by using in vivo dosimetry. This work reports a pilot study to test the applicability of a thermoluminescent dosimetric system for performing in vivo entrance dose measurements in external photon beam radiotherapy. The measurements demonstrated the value of thermoluminescent dosimetry as a treatment verification method and its applicability as a part of a quality assurance program in radiotherapy. (c) 2009 Elsevier Ltd. All rights reserved.

European French-speaking study from the GEMO group on bone metastases management: a special focus on external beam radiotherapy practice survey.

This study seeks to perform a survey of patterns of practice among the different physicians involved in the bone metastases management, with special focus on external beam radiotherapy (EBRT).A questionnaire about bone metastases based on clinical cases and supplemented with general questions, including medical therapies, EBRT and metabolic radiotherapy strategies, surgery, and supportive care approaches, was sent to 4,706 French-speaking physicians in Belgium, France, Luxemburg, and Switzerland.Overall, 644 questionnaires were analyzed. Twenty-eight percent concerned the radiotherapy approach and were judged adequate to respond to the part dedicated to EBRT. Sixty-nine percent of physicians used a total dose irradiation of 30 Gy delivered in ten fractions. A large majority (75%) used two opposed fields prescribed at mid-depth (30%), or with non-equally weighted fields (45%). Seventy percent irradiated also above and below the concerned vertebra. A dosimetry planning treatment was done in 85% and high-energy megavoltage photons were used in 42%. Moreover, 54% physicians used short course radiotherapy in routine.Radiotherapy remains the mainstay of treatment of bone metastases, but there is substantial heterogeneity in clinical practice. Guidelines and treatment protocols are required to improve the treatment quality.