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After removal of the stylets, these catheters are secured with buttons at the submandibular skin surface (Fig. 1). Patients received broad-spectrum antibiotics and steroids during and after the implant procedure. Fig. 1 Interstitial catheter implantation procedure in a tongue cancer patient. (A) Stainless steel stylets are inserted through the ipsilateral submental region. (B) Afterloading catheters are introduced through the stylet. (C, D) Catheters are secured with ... 3. Treatment planning, dose-prescription and treatment delivery All patients underwent computed tomography (CT) simulation for the 3D brachytherapy plan. The target definition and dose calculation were performed using the brachytherapy planning system Plato (until February 2010) or Oncentra (February 2010 to present) (Nucletron). The planning target volume (PTV) is defined selleck chemical as the circumferential area connecting the peripheral catheters encompassing the target plus Sitaxentan 5-mm margins and was limited to the tumor bed in the craniocaudal direction. In addition, the organs-at-risk, particularly the mandible, were delineated. Modification of the PTV was allowed to exclude a critical organ, particularly the mandible. To define the source positions and calculate the dwell times, 3D treatment planning was performed by 3D reconstruction of the target and surrounding structures, such as the mandible, using CT simulation (Fig. 2). The plan was optimized to deliver the prescription dose (the so-called minimum peripheral dose) to cover at least 95% Ku0059436 of the PTV, whereas the dose to the mandible was kept as low as possible to minimize the risks of radio-osteonecrosis. Irradiation was performed by connecting the catheters to our afterloading device (microSelectron HDR; Nucletron). This device uses an 192Ir stepping source, which is moved to different positions, separated by 2.5 mm sequentially in all catheters where it stops for different dwell times. During treatment, wet cotton ball as a spacer and/or customized thin lead plate were placed to reduce radiation exposure to adjacent normal mucosa. Fig. 2 Treatment planning. (A, B) Three-dimensional conformal treatment planning with isodose lines (color codes are shown on the right side). (C) Reconstruction of the target volume, whole implants and mandible. (D) Dose-volume histogram. PTV, planning target ... All of the treatments were delivered by HDR IBT using plastic tubes after-loaded with 192Ir with a source strength in the range of 0.05 cGy/m2