Background/Aim: To evaluate the treatment outcomes, toxicity and health-related quality of life (HRQOL) in prostate cancer (PCa) patients who underwent singlefraction high-dose-rate brachytherapy (single-fraction HDR-BT) with external beam radiotherapy (EBRT). Materials and Methods: From April 2014 to October 2017, treatment outcomes and toxicity of 85 patients who underwent singlefraction HDR-BT of 13 Gy, followed by 46 Gy EBRT in 23 fractions, were examined. HRQOL of 53 patients was evaluated using the Expanded Prostate Cancer Index Composite (EPIC), International Prostate Symptom Score (IPSS)/QOL index, International Index of Erectile Function 5 (IIEF-5), and 36-Item Short Form Survey (SF-36) scores through one year. Results: The median follow-up period was 28.8 months. Only three patients had biochemical recurrence.Toxicities included less than grade 3 lower urinary tract symptoms and grade 1 diarrhea. Urethral stricture, a problem related to late toxicity in conventional HDR-BT, was not observed. The urinary and bowel functions in EPIC scores significantly worsened until three or six months after treatment, respectively. Conclusion: Single-fraction HDR-BT with EBRT showed promising biochemical control, tolerant toxicities, and preservation of HRQOL, and can be efficiently performed in a shorter time than conventional HDR-BT.With advances in radiation therapy techniques, there are currently several radiation therapy options for localized prostate cancer (PCa). High-dose-rate brachytherapy (HDR-BT) is an effective treatment modality that can be used either alone or in combination with external beam radiotherapy (EBRT) for patients with localized PCa (1-5). The combined use of HDR-BT and EBRT allows considerable dose escalation while decreasing the dose administered to organs at risk, thereby improving PCa treatment outcomes. However, the conventional fractionated irradiation of HDR-BT modality has certain limitations, because it requires the patient to rest on the bed during the treatment period to avoid the accidental removal of the catheter from the perineum, and this may be associated with an increased risk of deep vein thrombosis. To date, it has been reported that the administration of a singlefraction HDR-BT protocol resulted in a high disease control rate and low toxicity (6-13), but there are few institutions in Japan performing a single-fraction HDR-BT protocol, and there is no report from this country. We started a HDR-BT modality from February 1999 in our hospital and previously reported the usefulness of HDR-BT with EBRT (5), but we have changed the single-fraction HDR-BT protocol since April 2014 to relieve the burden of patients.In this study, we intended to evaluate treatment outcomes, safety, and impact on health-related quality of life (HRQOL) in patients with localized and locally advanced PCa who underwent single-fraction HDR-BT with EBRT at the

A 54-year-old man had a 65-mm infrapapillary, circular, and laterally spreading tubular adenoma in the distal second and proximal third parts of the duodenum. The papilla was 15 mm from the proximal margin of the tumor. Because the patient requested organ-preserving laparoscopic surgery, we conducted laparoscopy-assisted pancreas-sparing duodenectomy (LAPSD). LAPSD consists of five major procedures: (i) laparoscopic wide Kocher maneuver and transection of the proximal jejunum; (ii) laparoscopic separation of the duodenum from the pancreas; (iii) creation of a small upper median laparotomy; (iv) extracorporeal completion of the segmental duodenectomy; and (v) extracorporeal intestinal reconstruction. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. Histopathological examination revealed that the circumferential margin of the specimen was negative for tumor cells. LAPSD provided a clear margin without damaging the papilla and eliminated the possibility of peritoneal or port-site seeding of tumor cells because part of the procedure was performed extracorporeally. LAPSD is a useful alternative to pancreatoduodenectomy in patients with a large adenoma extending close to the papilla in the duodenum.