Journal of Contemporary Brachytherapy最新文献

Purpose: To evaluate the clinical results of nasal feeding nutritional tube (NFNT)-loaded iodine-125 (¹²⁵I) seeds in intra-luminal brachytherapy (ILBT) for esophageal carcinoma (EC) patients with a 3/4 dysphagia score.

Material and methods: From January 2019 to January 2020, 26 patients (female/male: 17/9, mean age: 75.3 years, dysphagia score 3/4: 6/20, mean Karnofsky score: 58.4) with EC underwent NFNT-loaded ¹²⁵I seed placement for both nutrition and brachytherapy. Technical and clinical success, D₉₀ (radiation dose received by 90% of tumor volume) and organ at risk (OAR) dose, complications, dysphagia-free time (DFT), and overall survival (OS) time were documented. Local tumor diameter, Karnofsky score, dysphagia score, and quality of life (QoL) were compared before and 6 weeks after tube placement.

Results: Technical and clinical success rates were 100% and 76.9%, respectively. The D₉₀ and OAR doses were 39.7 Gy and 2.3 Gy, respectively. Eight cases (30.8%) experienced mild complications, but no seed loss, fistula, and massive bleeding were observed. Median DFT and OS were 3.1 months and 13.7 months, respectively. Tumor diameter and dysphagia score significantly decreased (p < 0.05), Karnofsky score significantly improved (p < 0.05), and QoL scores related to physical function, physical functioning, general health, vitality, and emotional functioning improved (p < 0.05).

Conclusions: NFNT-loaded ¹²⁵I brachytherapy for ILBT is technically a safe and effective strategy for EC patients with low Karnofsky scores, and can be a bridging therapy for advanced anti-cancer treatment.

Interventional radiotherapy (IRT, brachytherapy) is a highly effective treatment method for non-melanoma skin cancer (NMSC). Traditionally, the maximum depth of NMSC lesions considered eligible for contact IRT was 5 mm; however, following several national surveys and recent recommendations, such cut-off, lesions thicker than 5 mm may be treated by contact IRT. The use of image guidance in defining the actual depth in treating NMSC to correctly identify clinical target volume (CTV) and prevent unnecessary toxicity is of paramount importance. The aim of the paper was to describe a multilayer arrangement of catheters to treat NMSC lesions thicker than 5 mm, thus proposing an example of dynamic intensity modulated IRT, using different catheter-to-skin distance of sources to reach the best CTV coverage and maximally reduce the excess of dose to the skin.

Purpose: The presentation of results of an ophthalmic plaque displacement as a brachytherapy treatment method of large diffuse uveal melanomas.

Material and methods: This was a retrospective analysis of treatment results of 9 patients with large diffuse uveal melanomas using ophthalmic plaque displacement. Patients were treated with this method in our center between 2012 and 2021 (last follow-up visit in 2023). To achieve appropriate radiation dose distribution for large tumors with a base greater than 18 mm, brachytherapy (¹⁰⁶Ru in 7 patients and ¹²⁵I in 2 patients) with applicator displacement was used as primary treatment. Median follow-up was 2.9 years, and for patients with positive primary treatment results, it was 1.7 months. Median time to local relapse was 2.3 years.

Results: In 5 patients, a positive result of local treatment was obtained, out of whom, one patient underwent enucleation due to complications. In the next 4 cases, local recurrence developed. In all tumors, the use of applicator displacement method caused that planning target volume (PTV) was effectively covered with treatment isodose.

Conclusions: Brachytherapy with ocular applicator displacement allows for the treatment of tumors with base measurements larger than 18 mm. The application of this method may be considered as an alternative for eye enucleation in particular cases of large diffuse tumors, such as a neoplasm of the eye with vison, or when a patient does not consent to enucleation.

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft tissue tumor with a high propensity of local recurrence after surgery. Radiotherapy as an adjuvant therapy has been shown to reduce recurrent rates of this disease. Surface mould brachytherapy is an effective and safe modality for the delivery of radiotherapy in soft tissue tumors, though its utilization and popularity have decreased in recent years. Here, we presented a case of a recurrent DFSP of the scalp who was treated with surgery followed by adjuvant surface mould brachytherapy to avoid dose inhomogeneity likely to occur in this anatomic region with external beam radiotherapy in the absence of intensity-modulated radiotherapy. The treatment was delivered successfully with minimal adverse reactions, and the patient is disease-free at 18 months post-treatment with no treatment toxicity.

Purpose: To report the use of high-dose-rate (HDR) interventional radiotherapy (brachytherapy, IRT) as a salvage treatment for macroscopic histologically confirmed local relapse of prostatic cancer after prostatectomy and subsequent external irradiation.

Material and methods: A retrospective study of patients with prostate adenocarcinoma, treated with HDR-IRT for an isolated local relapse after prostatectomy and external irradiation at our institution (2010-2020). Treatment results and treatment related-toxicity were recorded. Clinical outcomes were analyzed.

Results: Ten patients were identified. The median age was 63 years (range, 59-74 years), and the median follow-up time was 34 months (range, 10-68 months). Four patients had a biochemical relapse, and the mean time to prostate specific antigen (PSA) increase was 13 months. One-year biochemical failure-free survival (bFFS), 3-year bFFS, and 4-year bFFS were 80%, 60%, and 60%, respectively. Most of the treatment-related toxicities were grade 1-2. Two patients experienced grade 3 late genitourinary toxicity.

Conclusions: HDR-IRT seems to be an effective treatment option showing acceptable toxicity for prostate cancer patients with isolated macroscopic histologically confirmed local relapse after prostatectomy and subsequent external irradiation.

Purpose: Treatment of recurrent brain metastases is extremely challenging. Here, we evaluated the feasibility and efficacy of an individualized three-dimensional template combined with MR-guided iodine-125 (¹²⁵I) brachytherapy in the treatment of recurrent brain metastases.

Material and methods: Twenty-eight patients with recurrent 38 brain metastases underwent ¹²⁵I brachytherapy from December, 2017 to January, 2021. A pre-treatment brachytherapy plan and three-dimensional template were generated according to isovoxel T1-weighted MR images. ¹²⁵I seeds were implanted under the guidance of three-dimensional template and 1.0-T open MR imaging. Dosimetry verification was performed based on CT/MR fusion images. Pre-operative and post-operative dosimetry parameters of D₉₀, V₁₀₀, and conformity index (CI) were compared. Overall response rate (ORR), disease control rate (DCR) at 6 months, and 1-year survival rate were calculated. Median overall survival (OS) measured from the date of ¹²⁵I brachytherapy was estimated using Kaplan-Meier method.

Results: No significant differences were observed between pre-operative and post-operative D₉₀, V₁₀₀, and CI values (p > 0.05). The ORR and DCR at 6 months were 91.3% and 95.7%, respectively. The 1-year survival rate was 57.1%. The median OS was 14.1 months. Two cases of minor hemorrhage and 5 cases of symptomatic brain edema were observed during the study. All clinical symptoms were alleviated after corticosteroid treatment applied for 7 to 14 days.

Conclusions: A three-dimensional template combined with MR-guided ¹²⁵I brachytherapy in the treatment of recurrent brain metastases is feasible, safe, and effective. This novel ¹²⁵I brachytherapy strategy is an attractive alternative in the treatment of brain metastases.

Purpose: To compare inverse planning simulated annealing (IPSA) and hybrid inverse planning optimization (HIPO) using dosimetric and radiobiological models, and provide a basis for selecting the optimization method for cervical cancer.

Material and methods: This was a retrospective study including 32 patients with radical cervical cancer. Brachytherapy treatment plans were re-optimized using IPSA, HIPO1 (with a locked uterine tube), and HIPO2 (with an unlocked uterine tube). Dosimetric data, including isodose lines, HR-CTV (D₁₀₀, V_150%, V_200%, HI, and CI), and (bladder, rectum, and intestines) D_1cc, D_2cc for organs at risk (OARs) were also collected. Additionally, TCP, NTCP, BED, and EUBED were calculated, and differences were analyzed using matched samples t-test and Friedman test.

Results: Compared with IPSA and HIPO2, HIPO1 had better V_150% and V_200% (p < 0.05). Compared with IPSA and HIPO1, HIPO2 had better D₁₀₀ and CI (p < 0.05). The doses to the bladder D_1cc (4.72 ±0.33 Gy)/D_2cc (4.47 ±0.29 Gy) and rectum D_1cc (4.50 ±0.61 Gy)/D_2cc (4.11 ±0.63 Gy) were lower in HIPO2 than in IPSA and HIPO1. EUBEDs for HR-CTV were higher in HIPO1 and HIPO2 than in IPSA by 1.39-1.63%. However, TCPs were not remarkably different among the three plans (p > 0.05). Also, the NTCP for the bladder was lower in HIPO2 than in IPSA and HIPO1 by 13.04% and 16.67%, respectively.

Conclusions: Although the dosimetric parameters of IPSA, HIPO1, and HIPO2 are comparable, HIPO2 provides better dose conformability and lower NTCP. Therefore, HIPO2 is recommended as an optimization algorithm in IC/ISBT for cervical cancer.

This case study reports the feasibility, safety, and efficacy of interstitial brachytherapy for internal mammary nodal recurrence in a 68-year-old woman with triple-negative breast cancer. The patient had previously undergone mastectomy followed by chemotherapy and radiotherapy. However, an internal mammary node was discovered during a routine follow-up a year later, which was confirmed as metastatic carcinoma by fine needle aspiration, with no other metastatic lesions. The patient underwent interstitial brachytherapy under ultrasound and computed tomography (CT) guidance, with a prescribed dose of 20 Gray in one fraction. Follow-up CT scan imaging over a 2-year period of treatment showed a complete resolution of internal mammary node. Therefore, brachytherapy may be considered a potential treatment option for cases of isolated internal mammary node recurrence in breast cancer.

Purpose: For patients with high-intermediate risk (HIR) endometrial cancer, adjuvant radiation (RT) reduces the risk of recurrence, but many patients do not receive RT. Under the Affordable Care Act (ACA), most states expanded Medicaid coverage. Our hypothesis was patients would be more likely to receive indicated adjuvant RT in states that expanded Medicaid compared with patients in states that did not expand Medicaid.

Material and methods: National Cancer Database (NCDB) was used to identify patients aged 40-64 years with HIR endometrial adenocarcinoma, stage IA and grade 3 or stage IB and grade 1 or 2, diagnosed from 2010-2018. We conducted a difference-in-differences (DID) cross-sectional retrospective analysis comparing receipt of adjuvant RT among patients residing in Medicaid expansion and non-expansion states before and after ACA implementation (January 2014).

Results: Expansion states had higher rates of adjuvant RT prior to January 2014 compared with non-expansion states (49.21% vs. 36.46%), and the proportion of patients who received adjuvant RT increased over the study period across both Medicaid expansion and non-expansion states. After Medicaid expansion, the non-expansion states had a larger absolute increase in adjuvant radiation resulting in a non-significant change in the difference in adjuvant radiation rates compared with baseline (crude increase: 9.63% vs. 7.45%, adjusted DID: -2.68 [95% CI: -7.12-1.75], p = 0.236).

Conclusions: Medicaid expansion is likely not the most significant factor affecting access or receipt of adjuvant RT for HIR endometrial cancer patients. Further study could help inform policy and efforts to ensure all patients have access to guideline-recommended RT.

Purpose: To report the feasibility of performing hybrid intra-cavitary and interstitial (IC/IS) brachytherapy in patients with carcinoma cervix under trans-rectal ultrasound (TRUS) guidance.

Material and methods: All patients who received an external beam radiotherapy (EBRT) dose of 50 Gy in 25 fractions with weekly chemotherapy, followed by a brachytherapy boost (21 Gy in 3 fractions) were prospectively included for analysis. IC/IS brachytherapy was performed using Fletcher style tandem and ovoid applicator with interstitial component under TRUS guidance. Parameters of implant quality analyzed included ability to insert tandem, ratio of needles loaded to the number of needles inserted, and incidence of uterine or organ at risk (OARs) perforation. Dosimetric parameters evaluated were dose to point A*, TRAK, D₉₀ high-risk clinical target volume (HR-CTV), and D_2cc to OARs (bladder, rectum, and sigmoid). Width and thickness of the target was compared between TRUS (TRUS_w and TRUS_t) and MRI (MRI_w and MRI_t).

Results: Twenty carcinoma cervix patients treated with IC/IS brachytherapy were included for analysis. The mean HR-CTV volume was 36 cc. The median number of needles used were 6 (range, 2-10 needles). None of the patients had uterine perforation. Two patients had bowel and bladder perforation. The mean D₉₀ HR-CTV and D₉₈ HR-CTV were 87.3 Gy and 82 Gy EQD₂, respectively. The mean D_2cc to the bladder, rectum, and sigmoid were 80 Gy, 70 Gy, and 64 Gy EQD₂, respectively. The mean dose to point A* was 70.4 Gy EQD₂. The mean TRAK was 0.40. The mean TRUS_w (±SD) and MRI_w (±SD) were 4.58 cm (±0.44) and 4.49 cm (±0.50), respectively. The mean TRUS_t (±SD) and MRI_t (±SD) were 2.7 cm (±0.59) and 2.62 cm (±0.59), respectively. On statistical analysis, there was a significant correlation between TRUS_w and MRI_w (r = 0.93), and TRUS_t and MRI_t (r = 0.98).

Conclusions: TRUS-guided IC/IS brachytherapy is feasible and provides adequate coverage of the target, with acceptable doses to OARs.