Brachytherapy (BRT) is defined as treatment from a short distance. The word is derived from the word "brachy" that means "short" in Greek. Treatment in BRT is performed by placing the radioactive source in or near the tumor tissue. According to the report 38 of the International Commission on Radiation Units and Measurements (ICRU 38), BRT is divided into three types according to the activity of the radioactive source. Low-dose rate (LDR) implants deliver dose at the rate of 0.4-2 Gy/h, requiring treatment times of 24-144 h. LDR BRT has extensive experience with well-known efficacy and side effects. Medium-dose rate (MDR) BRT, defined as the 2-12 Gy/h range, is rarely used. High-dose rate (HDR) BRT uses dose rates in excess of 0.2 Gy/min (12 Gy/h). Although not defined in ICRU 38, there is also a very-low dose (ultra LDR: ultra-low dose rate (ULDR)) BRT of 0.01-0.3 Gy/h. Pulse dose rate (PDR) BRT is a new BRT concept that is also not defined in ICRU 38. PDR BRT combines physical advantages of HDR BRT technology with the radiobiological advantages of LDR BRT. Each dose rate in the clinic has its advantages and disadvantages. It is difficult to compare the efficacy of dose rates in the clinic because of the lack of prospective randomized studies comparing the defined dose rates with each other. In this review, we aimed to explain the advantages, disadvantages, and common clinical sites of use of different dose rates.

There is limited data regarding to treatment of cervical cancer patients with isolated non-regional lymph node metastasis. Herein we report a case of cervical cancer with left inguinal lymph node metastasis at the time of diagnosis. A 52-year-old woman referred to gynecologic oncology department with postmenopausal vaginal bleeding history for a year. Gynecological examination revealed a bulky cervical tumor with left parametrial invasion. The biopsy of this lesion revealed a squamous cell carcinoma of the cervix. A pelvic magnetic resonance imaging (MRI) demonstrated a bulky cervical mass with a parametrial extension on left side, in addition to the suspicious lymph nodes in the para-aortic, pelvic and left inguinal chains. The patient was underwent extraperitoneal para-aortic lymph node dissection and left inguinal lymphadenectomy. Histopathological examination of the lymph nodes revealed that there were metastatic lymph nodes in the para-ortic, and left inguinal chains. We planned neoadjuvant chemotherapy consisting of paclitaxel and carboplatin; and we decided to plan adjuvant treatment with respect to the treatment response to the induction chemotherapy. The control computed tomography after 6 cycle of chemotherapy showed that there was a good-partial response; therefore definitive radiotherapy was planned. A month after the radiotherapy pelvic MRI was performed and it showed a complete response. After 38 months of follow-up the patient admitted to the emergency department with ileus. The patient developed sepsis and forty months after the completion of the radiotherapy the patient expired because of septic shock.

Objectives: The aim of this retrospective multicenter study was to evaluate the prognostic significance of sarcopenia, prognostic nutritional index (PNI), and inflammatory markers in patients with stage III non-small cell lung cancer (NSCLC) who received definitive chemoradiotherapy. Furthermore, the study aimed to determine the threshold value of disease-specific sarcopenia. Methods: A total of 461 patients with stage III NSCLC were evaluated. Sarcopenia, PNI, and biochemical inflammatory markers were assessed. Kaplan-Meier method and Cox regression analysis were used to analyze overall survival (OS) and progression-free survival (PFS). Results: This study found a disease-specific sarcopenia threshold of LSMI <38.7 cm² / m² for women and <45.1 cm² / m² for men, with 25.2% of patients having disease-specific sarcopenia. The optimal PNI cut-off value was determined to be 34.71, with 75.3% of patients categorized as PNI-high and 24.7% as PNI-low. Multivariate cox regression analysis revealed that low PNI was found to be an independent unfavorable prognostic factor for both PFS (HR =0.67; 95% CI, 0.48-0.92, p= 0.015) and OS (HR =1.49; 95% CI, 1.11-2.01, p= 0.008). Other factors including ECOG PS 3 (HR =7.76; 95% CI, 1.73-34.76, p=0.007), induction CT (HR =0.66; 95% CI, 0.49-0.88, p= 0.004), and disease-specific sarcopenia (HR =1.40; 95% CI, 1.02-1.92, p= 0.038) also had independent effects on prognosis. Conclusion: The present study provides evidence that the presence of sarcopenia and low PNI significantly impacts the prognosis of patients with stage III NSCLC who undergo definitive CRT. Furthermore, our study is notable for being the first multicenter investigation to identify a disease-specific sarcopenia threshold.

Vaginal malignant melanoma is a rare form of mucosal melanoma, and accounts for only <1% of all melanomas and 1.6% of female genital tract melanomas. Due to the rarity of the disease, currently, no standard treatment protocol has been established for the treatment of vaginal melanomas. Unfortunately, vaginal melanomas are often only diagnosed at an advanced stage, and treatment options include local excision with wide margins, radical surgery, radiotherapy, chemotherapy, and immunotherapy. Despite these aggressive treatment approach, the prognosis of vaginal melanoma is poor, and the 5-year overall survival rate is 0-25%. Since patients with vaginal melanoma ultimately develop distant metastatic disease regardless of the primary treatment approach; patient preference and quality-of-life considerations are critical factors in determining initial management. Herein we report two cases of vaginal melanoma. The first case was staged as T4bN0M0 according to the American Joint Committee on Cancer (AJCC) classification system. She denied surgery therefore underwent definitive radiotherapy. The patient is on routine follow-up, and now after 13 months of the completion of the treatment, she is still free of disease. The second case was T4bN1M0 according to AJCC classification system and underwent wide local excision with vaginectomy and bilateral inguinal lymph node dissection followed by adjuvant radiotherapy and immunotherapy. She is still free of disease for 34 months. In these report we discussed the optimal treatment strategy for vaginal melanomas by the light of available literature.

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