Objective: To determine the efficacy of intrarectal lidocaine gel alone and a combination of lidocaine gel with 2 different longer-acting local anesthetic (LA) agents that were injected into the periprostatic area before transrectal ultrasound-guided prostate biopsy. Patients and Methods: One hundred patients undergoing transrectal prostate biopsy were randomized into 4 groups of 25 patients each. Before the biopsy, group 1 received no local anesthesia, group 2 received 2% lidocaine gel intrarectally, group 3 received intrarectal lidocaine gel and 5 ml bupivacaine (0.25%) injected into periprostatic area, and group 4 received lidocaine gel intrarectally and a 5-ml ropivacaine injection (0.25%) in the same location as group 3. Pain levels during and after the biopsy were assessed by using a 10-point linear visual analog scale (VAS). Results: Patients in groups 3 and 4 had significantly lower VAS scores than those in groups 1 and 2, both during and 1 h after biopsy. There were no differences in the pain scores between groups 1 and 2. Conclusion: The combination of intrarectal lidocaine gel and periprostatic longer-acting LA agents significantly reduces the pain related to prostate biopsy, whereas intrarectal lidocaine gel administration alone does not reduce pain. Thus, administration of the periprostatic longer-acting LA agents alone is adequate.

BackgroundRadical radiotherapy is the standard treatment for patients with locally advanced cervix uteri carcinoma (FIGO stage IB2–IVA). Worldwide, incidence and mortality rates vary among regions because of differences in lifestyles and treatment standards. Herein, we evaluated the outcomes of radical radiotherapy in patients with locally advanced cervix uteri carcinoma from the middle Black Sea region of Turkey.MethodsWe retrospectively reviewed the records of 64 consecutive patients with locally advanced cervix uteri carcinoma who were treated from January 2013 to 2016 in our radiation oncology department. All patients staging and radiotherapy planning were performed with modern imaging techniques including magnetic resonance imaging and positron-emission-tomography/computed tomography before radical radiotherapy. Thereafter, all of them were treated with external beam radiotherapy and concurrent cis-platinum-based chemotherapy followed by three-dimensional intra-cavitary high-dose-rate brachytherapy.ResultsThe median age at diagnosis was 54.5 years. The median follow-up period was 21 months. Acute grade 3 toxicity was detected in 3.1% of patients. Late toxicity was not detected in any patient. The 1- and 3-year progression-free survival rates were 83.6 and 67.5%, respectively. The 1- and 3-year overall survival rates were 95.7 and 76.9%, respectively. The most important prognostic factor was the FIGO stage. Distant metastasis was the most common cause of death in patients with locally advanced cervix uteri carcinoma despite radical radiotherapy.ConclusionsIn patients with locally-advanced cervix uteri carcinoma from the middle Black Sea region of our developing country, acceptable toxicity and survival rates are achieved similar to the recent literature from developed countries with using of modern staging, planning and radical radiotherapy techniques. However, recurrence was mostly in the form of distant metastases and further investigations on systemic therapies are required.

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Purpose: The standard treatment for locally advanced stage cervical cancer is definitive radiotherapy, the quality of which affects both survival and side effects. Brachytherapy is a major component of definitive radiotherapy; it is administered using different techniques and applicators. The purpose of this study was to dosimetrically compare tandem ovoid (T-ovoid) and tandem ring (T-ring) brachytherapy treatments. Material and methods: Both applicator sets were applied to the same 20 patients, and treatment plans were made three-dimensionally (3D), with high-risk clinical target volume (HR-CTV) and organs at risk contoured. The HR-CTV was defined according to post-external magnetic resonance results. The patients with residual tumors not exceeding one-third of the parametrium were included in this study, while patients with larger masses were excluded and received interstitial therapy. The doses were calculated for both plans. Optimization for the HR-CTV was made with the aim that the equivalent dose according to 2 Gy (EQD 2) of 90% of the HR-CTV (D 90) would be higher than 85 Gy, without exceeding the maximum dose for organs at risk. Then, pairwise dosimetric comparisons were performed. Results: Plans were compared dosimetrically according to the HR-CTV, point A and B doses, and organs at risk. Although the point A and B doses were higher with T-ovoid use, the 3D HR-CTV coverage was statistically better with T-ring application (EQD 2 of HR-CTV D 90 : 97.46 Gy for T-ring and 88.44 Gy for T-ovoid; p < 0.0001). In addition, the rectum and bladder doses were statistically lower with T-ring usage (EQD 2 of rectum, 2 cc; T-ring, 63.10 Gy; T-ovoid, 74.99 Gy; p < 0.0001; EQD 2 of bladder, 2 cc; T-ring, 85.26 Gy; T-ovoid, 89.05 Gy; p < 0.0001). Conclusions: In our study with a limited number of samples, T-ring applicator seems to offer better 3D brachytherapy dosimetry for both HR-CTV and nearby organs at risk.

Background Our purpose was to ensure that the dose constraints of the organs at risk (OARs) were not exceeded while increasing the prescription dose to the planning target volume (PTV) from 45 Gy to 50.4 Gy with the dynamic intensity-modulated radiotherapy (IMRT) technique. While trying for this purpose, a new dynamic IMRT technique that named 90° angled collimated dynamic IMRT (A-IMRT) planning was developed by us. Methods This study was based on the computed tomography data sets of 20 patients with postoperatively diagnosed International Federation of Gynecology and Obstetrics stage 2 endometrial carcinoma. For each patient, conventional dynamic IMRT (C-IMRT, collimator angle of 0° at all gantry angles), A-IMRT (collimator angle of 90° at gantry angles of 110°, 180°, 215°, and 285°), and volumetric modulated arc therapy (VMAT) were planned. Planning techniques were compared with parameters used to evaluate PTV and OARs via dose-volume-histogram analysis using the paired two-tailed Wilcoxon’s signed-rank test; p < 0.05 was considered indicative of statistical significance. Results All plans achieved adequate dose coverage for PTV. Conformality was best obtained with VMAT, whereas homogeneity was best obtained with C-IMRT. The conformality of A-IMRT was inferior to the conformality of C-IMRT; A-IMRT had similar homogeneity to VMAT. The bone marrow dose constraint was exceeded in 4 (20%), 16 (80%), and 18 (90%) patients with VMAT, A-IMRT, and C-IMRT, respectively. The bladder dose constraint was exceeded in no patients with A-IMRT or VMAT, but it was exceeded in 19 (95%) patients with C-IMRT. Dose constraints of the rectum and bilateral femoral heads were exceeded in no patients with A-IMRT or VMAT, but they were exceeded in 20 (100%) patients with C-IMRT. The dose constraint of the bowel (for V40 as in the RTOG 0418 trial) was exceeded in 4 (20%), 5 (25%), and 8 (40%) patients with VMAT, A-IMRT, and C-IMRT, respectively. Conclusions OARs are better protected when external beam radiotherapy is applied to the pelvis at a dose of 50.4 Gy by turning the collimator angle to 90° at some gantry angles with the dynamic IMRT technique in the absence of VMAT.