Journal of Contemporary Brachytherapy最新文献

Purpose: Women with locally advanced cervical cancer treated with chemoradiotherapy followed by brachytherapy are at increased risk of venous thromboembolic events.

Case presentation: This case series reported three women, who experienced near-fatal saddle pulmonary embolisms shortly after undergoing high-dose-rate brachytherapy for locally advanced cervical cancer. In one patient, pulmonary saddle embolism led to hypovolemic shock due to intra-abdominal hemorrhage post-resuscitation, necessitating emergency decompressive laparotomy. Another case was complicated by neurological symptoms consistent with a stuttering stroke, following mechanical pulmonary thrombectomy.

Conclusions: Pulmonary embolism represents a severe complication of chemoradiotherapy and brachytherapy. Given the high morbidity and mortality rates associated with this condition, routine thromboprophylaxis may be warranted.

The aim of this paper was to present a rare complication of orchiepididymitis in a patient treated with brachytherapy (BT) for prostate cancer, who underwent trans-ureteral resection of the prostate (TURP) four weeks after BT. A 73-year-old patient with prostate cancer (intermediate-risk group) was eligible for high-dose-rate (HDR) BT combined with androgen deprivation therapy (ADT) for 6 months (leuprorelin). Due to increased symptoms, such as urinary retention after BT, the patient required catheterization. Additionally, bacterial inflammation in the lower urinary tract and prostate was present. Due to prolonged micturition disorders, TURP was performed, leading to chronic orchiepididymitis four months after completion of BT and three months after catheter removal following TURP. Due to long-term inflammation, which was resistant to treatment, the left testicle with left epididymis was removed. Unfortunately, inflammatory symptoms occurred post-operatively in the bed and the left groin. Since these symptoms of varying severity continued, anti-inflammatory drugs and analgesics were introduced. TURP performed too quickly after HDR-BT might cause severe complications. Extreme caution regarding TURP should be exercised in patients undergoing BT. Conservative and pharmacological treatment must be introduced in the occurrence of urinary disorders after BT, and any intervention (TURP) should be performed at least 3-6 months after BT. This is especially crucial because of the development of radiation effect over time.

Purpose: This study aimed to assess long-term visual acuity outcomes and multiple secondary factors in fellow eyes of uveal melanoma patients treated with either iodine-125 (¹²⁵I) plaque radiotherapy (PRT), transpupillary thermotherapy (TTT), or proton beam therapy (PBT).

Material and methods: A retrospective chart review of 213 patients treated from 2000 to 2022 was performed, with baseline and post-treatment visual acuity data collected at follow-up time points up to 10 years, when available. Paired t-tests compared changes in visual acuity (VA) and intraocular pressure (IOP) over time for affected and fellow eyes. Spearman's rho test assessed correlations between melanoma thickness and VA over time, and repeated measures ANOVA determined interactions between time and comorbidities in VA.

Results: Fellow eyes VA showed no significant change up to a decade post-treatment regardless of treatment modality, except for a likely false positive improvement at 2 years post-PRT. In contrast, affected eyes had significant VA decline post-PRT and PBT, while TTT used in affected eyes demonstrated no significant change. IOP did not show any significant changes in fellow eyes. Tumor thickness and the presence of diabetes, hypertension, or coronary artery disease, did not correlate with fellow eye VA outcomes.

Conclusions: This study suggests that following uveal melanoma treatment with either ¹²⁵I PRT, TTT, or PBT, fellow eyes remain stable regarding VA and other outcomes up to 10 years. This provides important information for treatment choice in patients with ocular melanoma, especially as VA can decline in affected eye post-treatment, leading to reliance on contralateral eye.

Purpose: To evaluate local control, cosmetic outcomes, toxicities, and survival outcomes of interstitial high-dose-rate (HDR) brachytherapy treatment in non-basal cell carcinoma malignancies of the eyelid.

Material and methods: This retrospective study analyzed patients with histopathologically confirmed eyelid malignancies treated with adjuvant HDR interstitial brachytherapy (¹⁹²Ir) between August 2007 and August 2024. Outcomes assessed included loco-regional control (LRC), disease-free survival (DFS), overall survival (OS), and toxicities graded by the Radiation Therapy Oncology Group (RTOG). Kaplan-Meier analysis estimated survival rates, while cosmetic outcomes were evaluated using cosmetic assessment of intraocular brachytherapy (CAIB) scale.

Results: Eighteen patients with sebaceous (72.2%) and squamous (22.2%) histologies received 21-49 Gy in 7-14 frac-tions (3-3.5 Gy/fraction). With a median follow-up of 21.93 (IQR, 10.6-152.83) months, no loco-regional recurrences were observed among 13 patients with documented follow-up (LRC, 100%). Two patients died (one from systemic progression without local failure and the other from COVID-19), and three were lost to follow-up. The 5-year OS and DFS rates were 83.3%. Cosmetic outcomes were rated excellent in 55.55% and very good in 44.44% of patients. No grade 3 and above acute toxicities occurred, and eyelid/eye function was preserved in 88.88% (16/18), ensuring organ preservation without late toxicity.

Conclusions: Adjuvant HDR brachytherapy is a safe and effective treatment for eyelid malignancies, achieving excellent local control, superior cosmetic outcomes, and acceptable toxicity. This modality optimizes tumor control, while preserving function and esthetics in this anatomically sensitive region.

Purpose: Eyelid tumors are uncommon malignancies, where 75% of cases are cutaneous basal cell carcinoma (BCC), and sebaceous cell carcinoma, squamous, adenocarcinoma from meibomian glands are diagnosed in 25%. Post-excision adjuvant radiotherapy (ART) is indicated in high-grade tumors with positive margins and lymphovascular space or perineural invasion. The ideal technique for delivering ART for eyelid tumors is interstitial brachytherapy (ISBT). However, its use is limited by steep learning curve. Here, we described the stepwise procedure of ISBT performed in eyelid tumors with reported outcomes.

Material and methods: Four patients with sebaceous carcinoma of the upper eyelid underwent ART, and 2 of the 4 patients had positive margins. Tumor bed was delineated with a 0.5-1 cm margin circumferentially. Under short general anesthesia, 2-3 hollow ISBT needles were inserted in a single-plane into tumor bed, 1 cm apart. Tarsal margin was avoided by > 2 mm to prevent eyelid contractures. Needles were replaced with 6 Fr flexible nylon catheters and fixed with buttons, ensuring a 5 mm gap from the skin to allow post-procedural edema. 3.5 Gy in 12-14 fractions were planned to achieve EQD₂ dose of 60 Gy for R0 resection and 66 Gy for R1 resection, delivered twice a day with more than 6 hours interval. A wax-coated lead shield was placed to protect the cornea and lens using 0.4% paracaine eye drops. In vivo dosimetry was performed using metal-oxide-semiconductor field-effect transistor (MOSFET).

Results: The mean clinical target volume (CTV) was 2.1 cc, the target D₉₀ was 3.37 Gy/fraction. The target V100% was 86.27%, V150% was 31%, and V200% was 11.33%. The lens D_max (TPS) was 1.28 Gy/fraction, while the mean dose recorded by MOSFET was 0.7 Gy/fraction. No conjunctival acute toxicities were observed. Grade 1 skin reaction (hyperpigmentation) was noted, with no local recurrences at 1 year median follow-up.

Conclusions: ART delivered by ISBT in eyelid tumors is a simple and efficient brachytherapy procedure, providing excellent cosmesis and local control.

Purpose: This study aimed to investigate quality control (QC) strategies to enhance treatment delivery in interventional radiotherapy (IRT) for head and neck (H&N) cancers, focusing on ensuring the accuracy of therapy while addressing specific challenges, such as catheter displacement and tube misconnection.

Material and methods: A retrospective analysis was conducted among 30 patients treated with IRT for nasal vestibule or eyelid cancers at our institutional center from January 2022 to December 2023. All treatments involved 14 fractions over nine days. QC measures were implemented to monitor catheter placement and prevent misconnection, with daily visual checks and mid-course CT evaluations. Distance measurements between catheter markers were compared across scans, and variations exceeding 2 mm prompted re-planning. Statistical analyses included one-way t tests to assess marker displacement significance.

Results: A total of 420 fractions were delivered, and 360 marker distance measurements were analyzed. No significant differences were observed between initial and mid-course CT scans (mean distances, 35.2 ±10.5 mm and 35.9 ±10.5 mm, respectively). However, in 16.6% of cases, re-planning was required due to catheter displacement or marker variation exceeding 2 mm. Notably, patients with nasal vestibule cancers demonstrated higher number of catheters and increased risk of displacement. Dosimetric evaluation confirmed significant dose distribution changes in a sub-set of cases, highlighting the clinical importance of QC.

Conclusions: Quality control strategies are essential to ensure precise treatment delivery in H&N IRT, especially in complex anatomical sites and risk of catheter displacement. Implementation of systematic checks and re-planning criteria enhances patient safety and treatment efficacy. Further research is warranted to refine QC measures and evaluate their impact on clinical outcomes.

Purpose: This study aimed to explore the risk factors associated with difficult-to-control pain (visual analog scale [VAS] score > 3) experienced by patients with advanced non-small cell lung cancer (NSCLC) assessed at two months after receiving iodine-125 (¹²⁵I) radioactive seed implantation combined with chemotherapy, in order to improve pain management and enhance patient quality of life.

Material and methods: A total of 87 patients diagnosed with advanced NSCLC were included in the study, all of whom underwent treatment using ¹²⁵I radioactive seed radiotherapy and chemotherapy. Through univariate and multivariate analyses, the risk factors affecting pain control at two months post-treatment were identified. Predictive and survival analyses were done using ROC curves and Kaplan-Meier survival curves.

Results: The results indicated that minimal pleural distance, smoking history, and pleural effusion were independent risk factors influencing the control of pain shown in VAS scores. Moreover, a non-linear relationship between minimal pleural distance and difficulty of pain control was observed, indicating that the risk of uncontrolled pain decreases when the minimal pleural distance reaches ≥ 10.84 millimeters. ROC curve analysis demonstrated that the predictive capability of minimal pleural distance was the highest.

Conclusions: Minimal pleural distance, smoking history, and pleural effusion are significant factors in predicting the difficulty of pain control in patients with advanced NSCLC receiving ¹²⁵I radioactive seed implantation combined with chemotherapy at two months post-treatment. Patients with a minimal pleural distance of less than 10.84 millimeters are more likely to experience uncontrolled pain after treatment. Therefore, developing predictive models may assist clinicians in more accurately evaluating treatment efficacy and patients' pain management needs.

Major systemic complications during and immediately after brachytherapy are rare. Herein, we described a case of acute myocardial infarction due to Kounis syndrome after low-dose-rate brachytherapy in a 70-year-old man with a banana allergy. Following low-dose-rate brachytherapy under general anesthesia, the patient complained of itching throughout his body; electrocardiography showed ventricular fibrillation. Cardiac catheterization revealed 99% stenosis in the left anterior descending artery; consequently, percutaneous coronary intervention was performed promptly. In this case, Kounis syndrome was considered, which was caused by latex allergy to condoms used during trans-rectal ultrasound examinations.

Purpose: High-dose-rate intracavitary brachytherapy delivers high radiation doses to tumors while minimizing exposure to surrounding normal cells. However, inappropriate administration can lead to radiation-induced toxicity by overdosing organs at risk. This study evaluated and compared the rectum doses planned by treatment planning system and measured using a thermoluminescent dosimeter.

Material and methods: Thermoluminescent dosimeters (TLD) were employed to measure radiation dose to the rectum across two patient groups: one treated using first fraction-based planning (FFP), and the other with each fraction planned individually (EFP).

Results: The mean dose measured by TLD (3.99 ±1.63 Gy) was higher than the mean dose planned by TPS (3.23 ±1.16 Gy, p < 0.001). The mean dose difference was higher in second fraction (0.87 ±1.89 Gy) for first fraction-based planning group; however, the differences between first and second fractions were not statistically significant in either group.

Conclusions: For patients transferred from a brachytherapy couch to a hospital stretcher during applicator insertion and dose delivery, first fraction-based planning is feasible. However, caution is needed to minimize applicator shifts, as these changes can alter the geometric position between fractions.

Purpose: This study evaluated dosimetry and clinical correlations between intensity modulated radiation therapy (IMRT) boost and image-guided multicatheter interstitial brachytherapy (MIBT) boost, after whole breast hypofractionated radiation post-breast conserving surgery.

Material and methods: A mono-institutional randomized prospective controlled trial was conducted in the Department of Radiotherapy and Clinical Oncology at PGIMER, Chandigarh, India, among fifty patients (n = 50) enrolled between September 2018 and January 2020. Each patient received 3D-CRT whole breast radiotherapy (WBRT), 40 Gy in 16 fractions was administered, and delivered within 3.5 weeks. Subsequently, either an IMRT boost (n = 25) with 16 Gy in 8 fractions, or a MIBT boost (n = 25) with 15 Gy in 5 fractions (bid) were delivered. Follow-up visits were scheduled at 6 months, 1 year, 2 years, and 5 years post-treatment to assess toxicity and cosmesis. Cumulative EQD₂ and boost phase EQD₂ doses for dosimetry comparisons were computed. Toxicity was evaluated using RTOG grading, whereas cosmesis was assessed with patient-reported number scores and physician-reported standards based on Harvard criteria. Dosimetry was compared using t-tests, toxicity and cosmesis with a likelihood ratio test, and loco-regional recurrence (LRR) was estimated using Fisher's exact test. Progression-free survival (PFS) and overall survival (OS) were analyzed with Kaplan-Meier method and log-rank test.

Results: The MIBT group had significantly lower mean cumulative skin and rib D_max (54.3 Gy and 57.4 Gy) than the IMRT group (62.8 Gy and 64.5 Gy), with a p-value of less than 0.001. This also applied to all organs at risk (OARs) EQD₂ doses during the boost phase, with a p-value of less than 0.001, except for NTB V₉₀ and V₅₀. Nonetheless, there were no significant differences in the cumulative EQD₂ doses of other OARs, or acute toxicity, late toxicity, patient- and physician-reported cosmesis as well as LRR, PFS, and OS.

Conclusions: In left-sided breast cancer, image-guided MIBT outperforms photon boost by reducing the cardiac dose. Despite no statistical significance in cosmesis differences, MIBT exhibited marginally enhanced cosmesis than IMRT boost.