BackgroundThe role of dose escalation in patients receiving long-term androgen deprivation therapy (ADT) is still a controversial issue. The aim of the current study was to evaluate whether dose escalation for ≥76–80 Gy had any advantage in terms of biochemical disease-free survival (BDFS), distant metastasis-free survival (DMFS), or overall survival outcomes over the dose levels from 70 to <76 Gy.Patients and methodsThe study included a cohort of 24 patients classified with high- and intermediate-risk localized prostate cancer. All patients received ADT, starting at 4–6 months before radiation therapy and continued for a total period of 12–24 months in high-risk patients. The treatment plan was given in two phases. In the first phase, the nodal planning target volume (PTV) and the prostate PTV received 48.6 and 54 Gy, respectively, over 27 fractions. The treatment was applied through intensity-modulated radiation therapy or volumetric modulated arc therapy with a simultaneous integrated boost technique.ResultsMore than half of the patients were in T3–T4 stage, 79.1% of the patients were in the high-risk category, and all patients received ADT. The rate of acute grade II gastrointestinal and genitourinary toxicities in all patients were 41.7% and 62.5%, respectively. The rate of freedom from grade II rectal toxicity at 2 years was 89% and 83% for patients treated with dose levels <76 and ≥76 Gy, respectively. The rate of BDFS at 2 years was 90% and 85% for doses <76 and ≥76 Gy, respectively. The DMFS at 2 years was 100% and 76% for dose levels <76 and ≥76 Gy, respectively.ConclusionIn the current study, there were no significant differences in the BDFS and DMFS between patients treated with a dose of <76 and ≥76 Gy, including elective pelvic lymph nodes irradiation combined with ADT.

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used in the calculation: needle-tip positions identified directly from the ultrasound images (data1), needle-tip positions calculated from the residual needle length (data2), and using the average of the two plus a random uncertainty between 0-5 mm (data3). Treatment plans were generated based on data2 and then recalculated for other two data sets. Results: The average tip position difference between data1 and data2 for all needles from the 40 cases was 3.6 mm while maximum values can be over 10 mm because of imaging artifacts. The average prostate V100% for the original plans was 97.3%, urethra V125% was 0.31 cc, rectum V75% was 0.24 cc and bladder V75% was 0.13 cc. The prostate V100% dropped to 96.8% after recalculated using data1, the number further dropped to 95.4% using data3. Average urethra, rectum and bladder dose kept almost unchanged. New plans were generated to cover a prostate expansion of 2 mm along needle direction as the planning target. The average prostate V100% was 97.6%, urethra V125% was 0.34 cc, rectum V75% was 0.29 cc and bladder V75% was 0.22 cc. The prostate V100% was 97.3% and 97.1% by using data 1 and data3 in this approach. Conclusion: The needle-tip position errors for TRUS-based high-dose-rate prostate brachytherapy can have a considerable dose impact on prostate dose coverage. A small margin along the needle direction can significantly reduce the dose coverage uncertainty while still maintain low dose level to critical structures.

Cancers that are metastasizing to soft tissue are rare. Here we present a case of metastatic breast cancer to the soft tissue of the back.Case Report: A 64 years female patient with a history of previously completed treatment for bilateral breast cancer 3 years ago, presented with hard fixed soft tissue mass in lower part of her back on right side. CT scan of abdomen revealed a mass in right External Oblique muscle of the right lumber region. A biopsy was taken from it showed metastatic carcinoma. Thorough systemic search for the primary tumor was done. Post operative histopathology revealed metastatic mammary duct carcinoma, grade 3. Discussion: Plaza JA et al.[1] had a series of 118 patients having metastasis to the soft tissue and out of those only 13 cases corresponds to metastasis from breast cancer and 3 of those were having metastasis to the back. However, we have not found any other report of soft tissue mass over back as a metastasis from breast cancer. We strongly suggest histological verification and systemic evaluation, whenever soft tissue masses are located elsewhere even after a curative breast cancer operation. Conclusion:Soft tissue metastasis from breast cancer is uncommon but can present. Proper diagnosis is needed to improve the treatment outcome.