Journal of Contemporary Brachytherapy最新文献_第10页

Contact X-ray brachytherapy (CXB) as a salvage treatment for rectal cancer patients who developed local tumor re-growth after watch-and-wait approach 将接触式 X 射线近距离放射治疗 (CXB) 作为观察和等待方法后出现局部肿瘤再生长的直肠癌患者的挽救治疗方法

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-04-23 DOI: 10.5114/jcb.2024.139049

Ngu Wah Than, Mark Pritchard, Carrie. A. Duckworth, David M. Hughes, Helen Wong, Rajaram Sripadam, Arthur Sun Myint

Purpose:
A watch-and-wait approach is an alternative to surgery for rectal cancer patients who have achieved a clinical complete response (cCR) following neoadjuvant (chemo)radiotherapy. However, approximately 25-38% of patients experience subsequent local tumor re-growth that requires salvage surgery. We evaluated the effectiveness of contact X-ray brachytherapy (CXB) as an alternative method of salvage therapy for those patients who were either unfit for or refused surgery. Oncological outcomes, tolerability, and feasibility of subsequent surgery for local treatment failure following CXB were reported.

Material and methods:
From 2009-2021, all patients treated with CXB as salvage therapy for local rectal cancer re-growth after watch-and-wait approach at our center were analyzed.

Results:
Contact X-ray brachytherapy as a salvage treatment (range, 90-110 Gy) was offered to 56 patients who experienced tumor re-growth following (chemo)radiation and watch-and-wait protocol. Median age was 76 (IQR = 66-83) years. Most patients (82%) had early-stage re-growth (ycT1/ycT2, ycN0), and 18% had more advanced stages (ycT3/ycT4, ycN0). After a median of 37-month follow-up (IQR = 19-53), 48% of patients who had early-stage re-growth achieved a sustained complete remission after CXB compared with 20% of those who had more advanced tumor stages. Disease-free and overall survivals for the whole cohort were 69% and 100% at 1-year, 51% and 82% at 3-year, and 51% and 65% at 5-years. CXB effectively controlled local re-growth-related symptoms. Mild post-CXB side effects occurred in 18% of cases. All (100%) eight patients who developed further local relapse, and 29% of those who had residual disease post-CXB salvage were successfully managed with subsequent surgery.

Conclusions:
Contact X-ray brachytherapy offers a new treatment option for patients in this situation whose other therapy options are not suitable for or refused initial surgery. Early local tumor re-growth responded best with minimal treatment-related toxicity and excellent symptom control. Disease-free and overall survival rates were acceptable, and delaying surgical salvage for local re-growth did not compromise patients’ eventual long-term outcomes.

目的：对于在新辅助（化疗）放疗后获得临床完全反应（cCR）的直肠癌患者，观察和等待是手术治疗的一种替代方法。然而，约有25%-38%的患者随后会出现局部肿瘤再次生长，需要进行挽救性手术。我们评估了接触式X射线近距离放射治疗（CXB）作为不适合或拒绝手术的患者的另一种挽救治疗方法的有效性。材料和方法：分析了 2009-2021 年期间，本中心所有采用 CXB 作为挽救疗法治疗观察-等待法后局部直肠癌再生长的患者。结果：56 名患者在接受（化疗）放疗和观察-等待方案后出现肿瘤再生长，我们为他们提供了接触式 X 射线近距离放射治疗作为挽救疗法（范围为 90-110 Gy）。中位年龄为 76 岁（IQR = 66-83 岁）。大多数患者（82%）为早期再生长（ycT1/ycT2，ycN0），18%为晚期（ycT3/ycT4，ycN0）。经过中位数为 37 个月的随访（IQR = 19-53），48% 的早期再生长患者在 CXB 后获得了持续的完全缓解，而 20% 的晚期肿瘤患者在 CXB 后获得了持续的完全缓解。整个组群的无病生存率和总生存率分别为：1年69%和100%，3年51%和82%，5年51%和65%。CXB有效控制了局部再生长相关症状。18%的病例在接受 CXB 治疗后出现了轻微的副作用。结论：接触式X射线近距离放射治疗为不适合或拒绝初次手术的患者提供了一种新的治疗方案。早期局部肿瘤再生长反应最佳，治疗相关毒性最小，症状控制良好。无病生存率和总生存率均可接受，因局部肿瘤再生长而推迟手术抢救不会影响患者最终的长期疗效。

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引用次数: 0

Salvage percutaneous high-dose-rate brachyablation after stereotactic body radiation therapy for early-stage non-small cell lung cancer 早期非小细胞肺癌立体定向体外放射治疗后的抢救性经皮高剂量率支架消融术

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-04-23 DOI: 10.5114/jcb.2024.139103

Trudy C. Wu, Alan Lee, Robert Suh, Talia C. Oughourlian, Fereidoun Abtin, Mary Ann Hagio, Sang-June Park, Albert J. Chang, Drew Moghanaki

Patients with primary tumor progression after stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC) have a second chance at complete tumor eradication with salvage local therapies, including lung resection, repeat course of SBRT, and percutaneous ablative therapies. In this paper, we presented our institution’s initial experience with percutaneous high-dose-rate (HDR) brachyablation for a relapsed stage I NSCLC that had been treated with SBRT 4.3 years earlier. Lung tumor measuring approximately 5 cm in maximum tumor dimension at the time of relapse was histopathologically confirmed to be persistent squamous cell carcinoma, and successfully treated with a single fraction of 24 Gy with HDR brachyablation. Treatment was delivered via two percutaneous catheters inserted under CT-guidance, and treated in less than 20 minutes. The patient was discharged home later the same day without the need for a chest tube, and has been monitored with serial surveillance scans every 3 to 6 months without evidence of further lung cancer progression or complications at 2.8 years post-HDR brachyablation procedure and 7.8 years after initial SBRT.

经立体定向体放射治疗（SBRT）治疗 I 期非小细胞肺癌（NSCLC）后原发肿瘤进展的患者有第二次机会通过挽救性局部治疗（包括肺切除、重复 SBRT 疗程和经皮消融治疗）彻底根除肿瘤。在本文中，我们介绍了本院对 4.3 年前接受过 SBRT 治疗的复发 I 期 NSCLC 患者进行经皮高剂量率 (HDR) brachyablation 治疗的初步经验。复发时肺部肿瘤最大尺寸约为 5 厘米，经组织病理学证实为顽固性鳞状细胞癌，并成功接受了单次 24 Gy HDR 支架消融术治疗。治疗是在CT引导下通过插入两根经皮导管进行的，治疗时间不到20分钟。患者于当天晚些时候出院回家，无需插胸管，每 3 到 6 个月接受一次连续监测扫描，HDR brachyablation 术后 2.8 年和首次 SBRT 术后 7.8 年未发现肺癌进一步发展或并发症。

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引用次数: 0

Intensity-modulated vaginal brachytherapy applicator and single- and multi-channel applicators in vaginal cuff brachytherapy 用于阴道袖带近距离治疗的调强阴道近距离治疗涂抹器以及单通道和多通道涂抹器

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-04-18 DOI: 10.5114/jcb.2024.138979

Fatih Biltekin, Husnu Akyol, Melis Gultekin, Melek Yilmaz, Ferah Yildiz

Purpose:
To compare the dosimetric performance of vaginal intensity-modulated brachytherapy (IM-BRT) applicator and single- (SC-BRT) and multi-channel brachytherapy (MC-BRT) applicators for vaginal cuff brachytherapy (VC-BRT).

Material and methods:
Fifteen patients with uterine-confined endometrium cancer who received adjuvant VC-BRT were included in this study. IM-BRT, SC-BRT, and MC-BRT treatment plans were created for two different clinical target volume (CTV) definitions: 1. Standard CTV, called CTVs; and 2. Virtually defined CTV, called CTVv, with asymmetrical tumor extension > 5 mm in thickness. Plan comparison was performed using dose-volume histogram (DVH) and treatment planning parameters.

Results:
According to DVH analysis, D₉₈ for CTVv and D2 for both CTVs and CTVv showed statistically significant differences between IM-BRT and SC-BRT plans, but there was no significant difference between IM-BRT and MC-BRT plans in terms of D₉₈ and D₂ for both CTVs and CTVv. Additionally, for CTVv plans, IM-BRT was found to be significantly superior to SC-BRT for the rectum (D_2cc, V_5Gy, and V_7Gy), bladder (D_2cc and V_7Gy), and small bowel (D_2cc, V_5Gy, and V_7Gy). On the other hand, DVH parameters of the sigmoid showed large difference between IM-BRT and SC-BRT plans, but it was not statistically significant. Similarly, the use of IM-BRT applicator demonstrated a noticeable dose reduction in all defined OARs when compared with MC-BRT applicator, but statistically significant for the rectum V_7Gy (p = 0.03) only.

Conclusions:
While the IM-BRT applicator is still in pre-clinical phase, our investigation demonstrated the proof-of-concept in real patient treatment plans with promising dosimetric results compared with SC-BRT and MC-BRT plans in selected patient group.

目的：比较用于阴道袖带近距离放射治疗（VC-BRT）的阴道强度调制近距离放射治疗（IM-BRT）应用器与单通道近距离放射治疗（SC-BRT）和多通道近距离放射治疗（MC-BRT）应用器的剂量学性能。针对两种不同的临床靶体积（CTV）定义制定了IM-BRT、SC-BRT和MC-BRT治疗方案：1.标准 CTV，称为 CTV；和 2.2.几乎定义的 CTV，称为 CTVv，肿瘤不对称扩展厚度为 5 毫米。结果：根据DVH分析，IM-BRT和SC-BRT计划中CTVv的D98和CTVs及CTVv的D2在统计学上有显著差异，但IM-BRT和MC-BRT计划中CTVs和CTVv的D98和D2没有显著差异。此外，就 CTVv 计划而言，IM-BRT 在直肠（D2cc、V5Gy 和 V7Gy）、膀胱（D2cc 和 V7Gy）和小肠（D2cc、V5Gy 和 V7Gy）方面明显优于 SC-BRT。另一方面，乙状结肠的 DVH 参数在 IM-BRT 和 SC-BRT 方案之间存在较大差异，但在统计学上并不显著。同样，与 MC-BRT 应用器相比，IM-BRT 应用器在所有确定的 OAR 中都显示出明显的剂量减少，但只有直肠 V7Gy 的剂量减少具有统计学意义（p = 0.03）。

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引用次数: 0

Fletcher suit or ring: A comparison of Fletcher suit and ring applicators for retroverted uteri 弗莱彻套或环弗莱彻套式和上环器治疗子宫后倾的比较

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-04-13 DOI: 10.5114/jcb.2024.138840

Vrushab Rao, Bhooshan Zade, Soumya Singh, Sathiya Narayanan, Pooja Moundekar, Medical Physicist

Purpose:
Approximately 20% of women worldwide have a retroverted uterus. A retroverted uterus is closer to the rectum and may cause toxicity during brachytherapy. Upon manipulation, a small percentage turn anteverted. Conventional brachytherapy applicators are designed for an anteverted uterus and can pose issues during insertion. Modified Fletcher suit and ring applicators have major differences in their geometry to achieve similar target coverage, and were analyzed in this study with respect to immediate adverse events and dosimetry.

Material and methods:
Three hundred seventy-four consecutive applications performed over a 20-month period were studied retrospectively to identify intra-cavitary applications (ICAs) in retroverted uteri. Cases were divided into 2 groups: modified Fletcher suit applicator with hemi-ovoids (group A) and ring applicator (group B). D_2cc for bladder and rectum were noted, and acute adverse events were recorded.

Results:
Seventy-five applications were identified, out of which 47 cases used Fletcher suit applicator, and 28 cases used ring applicator. The median bladder D_2cc for group A and B were 5.98 Gy and 6.3 Gy, respectively, and the median rectum D_2cc was 5.27 Gy and 3.68 Gy, respectively; the median dose prescribed to point A was 6 Gy (range, 5.5-9.0 Gy). All patients had a point A coverage between 97% and 102%. Eighteen cases in both groups complained of pain requiring analgesics. Twenty-five cases (53.2%) and 20 cases (71.4%) in group A and B, respectively, required dose optimization, which was statistically insignificant (p > 0.11). A significant difference was identified (p < 0.00001) in rectal doses. A higher reported pain was noted in ring applicator group (p < 0.03). No patient experienced a profuse bleeding.

Conclusions:
In most parameters, the two applicators demonstrated comparable results. The control of rectal dosage is superior in the ring applicator at the cost of higher pain incidence. Patient’s comfort and rectal dose in EBRT should be taken into consideration, with preference given to the ring applicator.

目的：全世界约有 20% 的女性子宫后倾。后倾的子宫更靠近直肠，可能会在近距离放射治疗过程中产生毒性。在操作过程中，有一小部分会变成前倾。传统近距离放射治疗器是为前倾子宫设计的，在插入时可能会造成问题。材料和方法：我们对 20 个月内连续进行的 374 例应用进行了回顾性研究，以确定后倾子宫腔内应用（ICA）的情况。病例分为两组：改良弗莱彻套式半绒毛涂抹器（A 组）和环形涂抹器（B 组）。结果：共发现 75 例应用，其中 47 例使用 Fletcher 套式涂药器，28 例使用环形涂药器。A 组和 B 组的膀胱 D2cc 中位数分别为 5.98 Gy 和 6.3 Gy，直肠 D2cc 中位数分别为 5.27 Gy 和 3.68 Gy；A 点的中位剂量为 6 Gy（范围为 5.5-9.0 Gy）。所有患者的 A 点覆盖率都在 97% 到 102% 之间。两组中均有 18 例患者主诉疼痛，需要使用镇痛剂。A 组和 B 组分别有 25 例（53.2%）和 20 例（71.4%）患者需要优化剂量，这在统计学上并不显著（p > 0.11）。直肠剂量差异明显（p< 0.00001）。环形涂抹组的疼痛报告较高（p < 0.03）。结论：在大多数参数上，两种涂药器的效果相当。结论：在大多数参数上，两种涂药器的效果相当。环形涂药器对直肠剂量的控制更好，但疼痛发生率更高。在进行 EBRT 时，应考虑患者的舒适度和直肠剂量，优先选择环形涂抹器。

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引用次数: 0

Brachytherapy and 3D printing for skin cancer: A review paper 治疗皮肤癌的近距离放射治疗和 3D 打印技术：综述论文

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-03-28 DOI: 10.5114/jcb.2024.137357

Michal Poltorak, Pawel Banatkiewicz, Lukasz Poltorak, Piotr Sobolewski, Damian Zimon, Maciej Szwast, Irena Walecka

Brachytherapy is a type of radiation therapy, in which a radiation source is placed directly or close to a tumor. It is commonly used to treat skin cancer, and enables precise irradiation treatment of affected area (planning target volume – PTV) while minimizing exposure dose to surrounding healthy tissue (organs at risk – OARs). Recently, the use of 3D printing has begun revolutionizing brachytherapy, as it allows manufacturing of custom-designed applicators for unique shape of skin topography, tumor, and surrounding tissues. Outcome of the combination of 3D printing and brachytherapy has several advantages over traditional treatment planning methods. Some of the advantages are intuitive, whereas others can be concluded from a literature overview as follows: 1) Possibility of developing patient-specific applicators that precisely match the shape of tumor area; 2) Reduction of the time required for applicator production, especially when custom-made devices are needed; 3) Reduction of manufacturing costs; 4) Treatment procedures improvement; 5) Improvement of safety measures accelerated by the development of smart materials (e.g., polymer filaments with admixture of heavy elements); 6) Possibility of nearly instant adjustment into tumor treatment (applicators can be changed as the tumor is changing its shape); and 7) Applicators designed to securely fit to treatment area to hold radioactive source always in the same place for each fraction. Consequently, tumor-provided dose is accurate and leads to effective treatment. In this review paper, we investigated the current state-of-the-art of the application of 3D printing in brachytherapy. A number of existing reports were chosen and reviewed in terms of printing technology, materials used, treatment effectiveness, and fabrication protocols. Furthermore, the development of future directions that should be considered by collaborative teams bridging different fields of science, such as medicine, physics, chemistry, and material science were summarized. With the indicated topics, we hope to stimulate the innovative progress of 3D printing technology in brachytherapy.

近距离放射治疗是一种将放射源直接或靠近肿瘤的放射治疗方法。它通常用于治疗皮肤癌，可对受影响区域（计划目标体积 - PTV）进行精确照射治疗，同时最大限度地减少对周围健康组织（危险器官 - OAR）的照射剂量。最近，3D 打印技术的使用开始对近距离放射治疗产生革命性影响，因为它可以根据皮肤地形、肿瘤和周围组织的独特形状制造定制设计的涂抹器。与传统的治疗规划方法相比，3D 打印和近距离放射治疗的结合具有多种优势。其中一些优势是直观的，而另一些优势则可以通过文献综述总结如下：1) 可以开发出精确匹配肿瘤区域形状的患者专用涂抹器；2) 减少涂抹器生产所需的时间，尤其是在需要定制设备时；3) 降低制造成本；4) 改进治疗程序；5) 通过开发智能材料（例如，掺有聚合物的丝材）加速改进安全措施、6）几乎可即时调整肿瘤治疗（涂抹器可随着肿瘤形状的改变而改变）；以及 7）涂抹器的设计可牢固地贴合治疗区域，使放射源在每一部分的治疗中始终保持在同一位置。因此，肿瘤提供的剂量是准确的，并能带来有效的治疗。在这篇综述论文中，我们研究了目前近距离放射治疗中应用 3D 打印技术的最新进展。我们从打印技术、所用材料、治疗效果和制造方案等方面选择了一些现有报告并进行了回顾。此外，我们还总结了连接医学、物理学、化学和材料科学等不同科学领域的合作团队应考虑的未来发展方向。我们希望通过上述主题，推动近距离治疗领域 3D 打印技术的创新发展。

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引用次数: 0

Augmented reality in brachytherapy: A narrative review 近距离放射治疗中的增强现实技术：叙述性综述

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-02-29 DOI: 10.5114/jcb.2024.137779

Martina Ferioli, Federica Medici, Ludovica Forlani, Savino Cilla, Bruno Fionda, Silvia Cammelli, Luca Tagliaferri, Alessio G. Morganti, Milly Buwenge

Brachytherapy (BRT) plays a pivotal role in the treatment of tumors, offering precise radiation therapy directly to the affected area. However, this technique demands extensive training and skills development, posing challenges for widespread adoption and ensuring patient safety. This narrative review explored the utilization of augmented reality (AR) in BRT, seeking to summarize existing evidence, discuss key findings, limitations, and quality of research as well as outline future research directions. The review revealed promising findings regarding the integration of AR in BRT. Studies have suggested the feasibility and potential benefits of AR in education, training, intra-operative guidance, and treatment planning. However, the evidence remains limited and heterogeneous, with most studies in preliminary phases. Standardization, prospective clinical trials, patient-centered outcomes assessment, and cost-effectiveness analysis emerge as critical areas for future research. Augmented reality holds transformative potential for BRT by enhancing precision, safety, and training efficiency. To fully implement these benefits, the field requires standardized protocols, rigorous clinical trials, and in-depth patient-centered investigations. Policy-makers and healthcare providers should closely monitor developments in AR and consider its implementation in clinical practice, contingent and robust evidence, and cost-effectiveness analysis. The pro-active pursuit of evidence-based practices will contribute to optimizing patient care in BRT.

近距离放射治疗（BRT）在肿瘤治疗中发挥着举足轻重的作用，可直接对患处进行精确的放射治疗。然而，这项技术需要大量的培训和技能开发，给广泛应用和确保患者安全带来了挑战。这篇叙述性综述探讨了增强现实（AR）在 BRT 中的应用，旨在总结现有证据，讨论主要发现、局限性和研究质量，并概述未来的研究方向。综述显示，在快速公交中整合 AR 的研究结果很有前景。研究表明，AR 在教育、培训、术中指导和治疗规划方面具有可行性和潜在优势。然而，证据仍然有限且不尽相同，大多数研究还处于初步阶段。标准化、前瞻性临床试验、以患者为中心的结果评估和成本效益分析成为未来研究的关键领域。增强现实技术通过提高精确度、安全性和训练效率，为 BRT 带来了变革性的潜力。要充分实现这些优势，该领域需要标准化方案、严格的临床试验和以患者为中心的深入调查。政策制定者和医疗服务提供者应密切关注 AR 的发展，并考虑其在临床实践中的应用、应急和有力的证据以及成本效益分析。积极追求循证实践将有助于优化 BRT 患者护理。

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引用次数: 0

Clinical implementation of failure modes and effects analysis for gynecological high-dose-rate brachytherapy 妇科高剂量率近距离放射治疗失效模式与效应分析的临床应用

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-02-29 DOI: 10.5114/jcb.2024.136295

Siyao Liu, Emma Jones

Purpose:
To use failure modes and effects analysis (FMEA) to identify failure modes for gynecological high-dose-rate (HDR) brachytherapy pathway and score with severity, occurrence, and detectability.

Material and methods:
A research team was organized to observe gynecological HDR brachytherapy pathway, and draw detailed process map to identify all potential failure modes (FMs). The whole team scored FMs based on three parameters, including occurrence (O), detectability (D), and severity (S), and then multiplied three scores to obtain risk priority number (RPN). All FMs were ranked according to RPNs and/or severity scores, and FMs with the highest RPN scores (> 100) and severity scores (> 8) were selected for in-depth analysis. Fault tree analysis (FTA) was applied to find progenitor causes of high-risk FMs and their propagation path, and determine which steps in the process need to be changed and optimized. Efficiency of each existing preventive methods to detect and stop FMs was analyzed, and proposals to improve quality management (QM) and ensure patient safety were suggested.

Results:
The whole gynecological HDR brachytherapy pathway consisted of 5 sub-processes and 30 specific steps, in which 57 FMs were identified. Twelve high-risk FMs were found, including 7 FMs with RPNs > 100 and 5 FMs with severity scores > 8. For these FMs, 2 were in the insertion stage, 1 in the imaging stage, 4 in the treatment planning stage, and 5 in the final stage of treatment delivery. The most serious of these FMs was the change in organ at risk (OAR) during treatment delivery (RPN = 245.7). The FM that occurred most frequently was the applicator shift during patient transfer.

Conclusions:
Failure modes and effects analysis is a prospective risk-based tool that can identity high-risk steps before failures occur, provide preventive measures to stop their occurrence, and improve quality management system.

目的：使用失效模式与效应分析（FMEA）来识别妇科高剂量率（HDR）近距离放射治疗路径的失效模式，并根据严重性、发生率和可探测性进行评分。材料与方法：组织一个研究小组观察妇科高剂量率近距离放射治疗路径，并绘制详细的流程图来识别所有潜在的失效模式（FMs）。整个团队根据发生率（O）、可检测性（D）和严重性（S）等三个参数对故障模式进行评分，然后将三个分数相乘得出风险优先序号（RPN）。根据 RPN 和/或严重性得分对所有故障点进行排序，并选择 RPN 得分最高（100 分）和严重性得分最高（8 分）的故障点进行深入分析。应用故障树分析法（FTA）找出高风险调频的原生原因及其传播路径，并确定需要改变和优化流程中的哪些步骤。结果：整个妇科 HDR 近距离放射治疗流程包括 5 个子流程和 30 个具体步骤，共发现 57 个故障。在这些故障中，2 个发生在插入阶段，1 个发生在成像阶段，4 个发生在治疗计划阶段，5 个发生在治疗的最后阶段。其中最严重的 FM 是治疗过程中危险器官（OAR）的变化（RPN = 245.7）。结论：故障模式与影响分析是一种前瞻性的风险分析工具，可以在故障发生前识别高风险步骤，提供预防措施阻止故障发生，并改进质量管理系统。

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引用次数: 0

Brachytherapy in gynecological malignancies at a tertiary care hospital: An analysis 一家三级医院的妇科恶性肿瘤近距离放射治疗：分析

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-02-27 DOI: 10.5114/jcb.2024.135628

Rasla Parween, Aruna R, Chendil V, Mahita Reddy, Ramyaa S, Varun Chandra, Yuvaraj U, Amrut S Kadam

Purpose:
Brachytherapy plays a crucial role in the standard of care for locally advanced gynecological malignancies. In this report, we present the experience from a tertiary teaching hospital, which is a referral center for image-guided brachytherapy (IGBT) in the management of locally advanced gynecological malignancies.

Material and methods:
This was a retrospective study of 130 patients referred to our hospital for IGBT after receiving initial external beam radiotherapy in their primary healthcare facilities, from January 2021 till January 2023. CT-based planning was done to delineate high-risk clinical target volume (HR-CTV). Dose of 6-7.5 Gy in 3-4 fractions was prescribed. Overall treatment time (OTT) was calculated, and patients were assessed for clinical response and toxicity after three months.

Results:
All patients received IGBT using an intra-cavitary or interstitial technique. The D₉₀ HR-CTV mean EQD₂ dose was 28.34 ±2.78 Gy. The mean EQD₂ dose to 2 cc of the bladder, rectum, and sigmoid was 18.31 ±5.19 Gy, 14.14 ±5.76 Gy, and 17.43 ±4.75 Gy, respectively. The median interval time between the last fraction of external beam radiation therapy (EBRT) and first evaluation in the hospital was 19 (range, 13-28) days (interquartile range [IQR]). The median time between the completion of chemoradiation and brachytherapy procedure was 25 (range, 19-33) days (IQR). The mean overall treatment time (OTT) was 63.5 ±14.7 days.

Conclusions:
This study highlights the established advantages of image-guided interstitial brachytherapy and associated challenges. To optimize the overall treatment duration, it is imperative to prioritize and update the referral processes for brachytherapy centers.

目的：近距离放射治疗在局部晚期妇科恶性肿瘤的标准治疗中发挥着至关重要的作用。材料与方法：这是一项回顾性研究，研究对象是自2021年1月至2023年1月期间，在基层医疗机构接受初次外照射放疗后转诊至我院接受近距离放射治疗的130名患者。通过CT制定计划，划定高危临床靶区（HR-CTV）。剂量为 6-7.5 Gy，分 3-4 次进行。结果：所有患者都接受了腔内或间质技术的IGBT治疗。D90 HR-CTV平均EQD2剂量为28.34 ±2.78 Gy。膀胱、直肠和乙状结肠的2 cc平均EQD2剂量分别为18.31 ±5.19 Gy、14.14 ±5.76 Gy和17.43 ±4.75 Gy。最后一部分体外放射治疗（EBRT）与首次住院评估之间的中位间隔时间为19天（13-28天）（四分位距[IQR]）。完成化学放疗和近距离放射治疗之间的中位时间为25天（19-33天）（IQR）。结论：本研究强调了图像引导下间质近距离放射治疗的既有优势和相关挑战。为了优化总体治疗时间，必须优先考虑并更新近距离治疗中心的转诊流程。

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引用次数: 0

Post- versus intra-operative implant for breast cancer interstitial brachytherapy: How to choose? 乳腺癌间质近距离治疗术后植入与术中植入：如何选择？

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-02-23 DOI: 10.5114/jcb.2024.135635

Marta Gimeno-Morales, Laura Motisi, Natalia Rodriguez-Spiteri, Fernando Martínez-Regueira, Tucker Worthington, Vratislav Strnad, Jean Michel Hannoun-Levi, Cristina Gutierrez

Purpose:
Breast brachytherapy (BB) represents an important radiation therapy modality in modern breast cancer treatments. Currently, BB is mainly used for accelerated partial breast irradiation (APBI), local boost after whole breast radiation therapy (WBRT), and as salvage re-irradiation after second lumpectomy (APBrl). Two multi-catheter interstitial brachytherapy (MIB) techniques can be offered: intra-operative (IOB) and post-operative (POB) brachytherapy. The aim of this article was to summarize current available data on these two different brachytherapy approaches for breast cancer.

Material and methods:
A literature search was performed, and different experiences published by BB expert teams were analyzed and compared. These two different brachytherapy approaches for breast cancer have also been presented and discussed during meetings of the GEC-ESTRO BCWG. In addition, expert recommendations were defined.

Results:
A comprehensive description and practical comparison of both the techniques, i.e., IOB and POB, considering the latest available published data were presented. Different technical, logistic, and clinical aspects of both the methods were thoroughly examined and analyzed. This detailed comparison of the two breast brachytherapy techniques was supported by scientific data from extensive experience of experts, facilitating an objective analysis that, to our knowledge, has not been previously published.

Conclusions:
Based on the comprehensive analysis of both the brachytherapy techniques available, this article serves as a valuable resource to guide breast teams in selecting the optimal BB technique (POB or IOB), considering hospital environment, multi-disciplinary collaboration, and patient logistics.

目的：乳腺近距离放射治疗（BB）是现代乳腺癌治疗中的一种重要放射治疗方式。目前，乳腺近距离放射治疗主要用于加速乳腺部分照射（APBI）、全乳腺放射治疗（WBRT）后的局部增量以及第二次肿块切除术后的挽救性再照射（APBrl）。可提供两种多导管间质近距离放射治疗（MIB）技术：术中（IOB）和术后（POB）近距离放射治疗。本文旨在总结这两种不同的乳腺癌近距离治疗方法的现有数据。材料和方法：我们进行了文献检索，并对 BB 专家团队发表的不同经验进行了分析和比较。在 GEC-ESTRO BCWG 会议上也介绍并讨论了这两种不同的乳腺癌近距离治疗方法。结果：考虑到最新发表的数据，对这两种技术（即 IOB 和 POB）进行了全面描述和实际比较。对两种方法的不同技术、后勤和临床方面进行了深入的研究和分析。结论：基于对两种近距离放射治疗技术的全面分析，这篇文章是指导乳腺团队选择最佳近距离放射治疗技术（POB 或 IOB）的宝贵资源，同时考虑到了医院环境、多学科协作和患者后勤保障。

{"title":"Post- versus intra-operative implant for breast cancer interstitial brachytherapy: How to choose?","authors":"Marta Gimeno-Morales, Laura Motisi, Natalia Rodriguez-Spiteri, Fernando Martínez-Regueira, Tucker Worthington, Vratislav Strnad, Jean Michel Hannoun-Levi, Cristina Gutierrez","doi":"10.5114/jcb.2024.135635","DOIUrl":"https://doi.org/10.5114/jcb.2024.135635","url":null,"abstract":"Purpose: Breast brachytherapy (BB) represents an important radiation therapy modality in modern breast cancer treatments. Currently, BB is mainly used for accelerated partial breast irradiation (APBI), local boost after whole breast radiation therapy (WBRT), and as salvage re-irradiation after second lumpectomy (APBrl). Two multi-catheter interstitial brachytherapy (MIB) techniques can be offered: intra-operative (IOB) and post-operative (POB) brachytherapy. The aim of this article was to summarize current available data on these two different brachytherapy approaches for breast cancer. Material and methods: A literature search was performed, and different experiences published by BB expert teams were analyzed and compared. These two different brachytherapy approaches for breast cancer have also been presented and discussed during meetings of the GEC-ESTRO BCWG. In addition, expert recommendations were defined. Results: A comprehensive description and practical comparison of both the techniques, i.e., IOB and POB, considering the latest available published data were presented. Different technical, logistic, and clinical aspects of both the methods were thoroughly examined and analyzed. This detailed comparison of the two breast brachytherapy techniques was supported by scientific data from extensive experience of experts, facilitating an objective analysis that, to our knowledge, has not been previously published. Conclusions: Based on the comprehensive analysis of both the brachytherapy techniques available, this article serves as a valuable resource to guide breast teams in selecting the optimal BB technique (POB or IOB), considering hospital environment, multi-disciplinary collaboration, and patient logistics. ","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"17 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140324508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Feasibility and clinical implementation of MRI-guided surface brachytherapy 核磁共振成像引导下表面近距离放射治疗的可行性和临床应用

IF 1.4 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy

Pub Date : 2024-02-23 DOI: 10.5114/jcb.2024.135647

Michael J. Lavelle, Evangelia Kaza, Christian V. Guthier, Desmond A. O’Farrell, Thomas C. Harris, Robert A. Cormack, Phillip M. Devlin, Ivan M. Buzurovic

Purpose:
Best practices for high-dose-rate surface applicator brachytherapy treatment (SABT) have long relied on computed tomography (CT)-based imaging to visualize diseased sites for treatment planning. Compared with magnetic resonance (MR)-based imaging, CT provides insufficient soft tissue contrast. This work described the feasibility of clinical implementation of MR-based imaging in SABT planning to provide individualized treatment optimization.

Material and methods:
A 3D-printed phantom was used to fit Freiberg flap-style (Elekta, The Netherlands) applicator. Images were taken using an optimized pointwise encoding time reduction with radial acquisition (PETRA) MR sequence for catheter visualization, and a helical CT scan to generate parallel treatment plans. This clinical study included three patients undergoing SABT for Dupuytren’s contracture/palmar fascial fibromatosis imaged with the same modalities. SABT planning was performed in Oncentra Brachy (Elekta Brachytherapy, The Netherlands) treatment planning software. A geometric analysis was conducted by comparing CT-based digitization with MR-based digitization. CT and MR dwell positions underwent a rigid registration, and average Euclidean distances between dwell positions were calculated. A dosimetric comparison was performed, including point-based dose difference calculations and volumetric segmentations with Dice similarity coefficient (DSC) calculations.

Results:
Euclidean distances between dwell positions from CT-based and MR-based plans were on average 0.68 ±0.05 mm and 1.35 ±0.17 mm for the phantom and patients, respectively. The point dose difference calculations were on average 0.92% for the phantom and 1.98% for the patients. The D₉₅ and D₉₀ DSC calculations were both 97.9% for the phantom, and on average 93.6% and 94.2%, respectively, for the patients.

Conclusions:
The sub-millimeter accuracy of dwell positions and high DSC’s (> 0.95) of the phantom demonstrated that digitization was clinically acceptable, and accurate treatment plans were produced using MR-only imaging. This novel approach, MRI-guided SABT, will lead to individualized prescriptions for potentially improved patient outcomes.

目的：长期以来，高剂量率表面涂敷近距离治疗（SABT）的最佳实践一直依赖于基于计算机断层扫描（CT）的成像来观察病变部位，以便制定治疗计划。与基于磁共振（MR）的成像相比，CT 提供的软组织对比度不足。这项工作描述了在 SABT 计划中临床实施基于 MR 的成像以提供个体化治疗优化的可行性。材料和方法：使用 3D 打印的模型来安装 Freiberg 瓣式（Elekta，荷兰）涂抹器。使用径向采集（PETRA）的优化点状编码时间缩短磁共振序列拍摄导管图像，并使用螺旋 CT 扫描生成平行治疗计划。这项临床研究包括三名接受 SABT 治疗的杜普伊特伦挛缩症/掌筋膜纤维瘤病患者，采用相同的模式进行成像。SABT 计划在 Oncentra Brachy（荷兰 Elekta Brachytherapy）治疗计划软件中进行。通过比较基于 CT 的数字化和基于 MR 的数字化，进行了几何分析。对 CT 和 MR 驻留位置进行了刚性配准，并计算了驻留位置之间的平均欧氏距离。结果：对于模型和患者，基于 CT 和基于 MR 计划的停留位置之间的欧氏距离平均分别为 0.68 ±0.05 毫米和 1.35 ±0.17 毫米。模型和患者的点剂量差计算结果分别为平均 0.92% 和 1.98%。模型的 D95 和 D90 DSC 计算结果均为 97.9%，患者的平均值分别为 93.6% 和 94.2%。结论：模型停留位置的亚毫米级精度和高 DSC（> 0.95）表明，数字化在临床上是可以接受的，而且只使用磁共振成像就能生成精确的治疗计划。MRI 引导下的 SABT 这种新方法将实现个性化处方，从而改善患者的治疗效果。

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引用次数: 0