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Initial tumor volume as an important predictor for indication of intra-cavitary brachytherapy, intra-cavitary/interstitial brachytherapy, and multi-catheter sole interstitial brachytherapy in cervical cancer patients treated with chemoradiotherapy. 肿瘤初始体积作为宫颈癌放化疗患者腔内近距离放疗、腔内/间质近距离放疗及多导管单间质近距离放疗适应症的重要预测指标
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-06-01 DOI: 10.5114/jcb.2023.128895
Tadashi Takenaka, Hideya Yamazaki, Gen Suzuki, Koji Masui, Daisuke Shimizu, Tadayuki Kotsuma, Eiichi Tanaka, Ken Yoshida, Kei Yamada

Purpose: Advances in three-dimensional image-guided brachytherapy technique allow for using intra-cavitary and interstitial brachytherapy (ICIS-BT), and sole interstitial brachytherapy (ISBT) in addition to conventional intra-cavitary brachytherapy (ICBT). However, no consensus has been reached regarding the choice of these techniques. The aim of this study was to propose the size criteria for indication of interstitial techniques.

Material and methods: We examined initial gross tumor volume (GTV) at presentation and at each brachytherapy session. Also, dose volume histogram parameters for each modality were compared in 112 patients with cervical cancer treated with brachytherapy (ICBT, 54; ICIS-BT, 11; and ISBT, 47).

Results: The average GTV at diagnosis was 80.9 cm3 (range, 4.4-343.2 cm3), which shrank to 20.6 cm3 (25.5% of initial volume, range, 0.0-124.8 cm3) at initial brachytherapy. GTV > 30 cm3 at brachytherapy and high-risk clinical target volume > 40 cm3 were good threshold values for indication of interstitial technique, and tumors with initial GTV > 150 cm3 could be candidates for ISBT. An ISBT dose of 89.10 Gy can be prescribed in equivalent dose in 2 Gy fractions (range, 65.5-107.6 Gy), which was higher than those of ICIS (73.94 Gy, range, 71.44-82.50 Gy) and ICBT (72.83 Gy, range, 62.50-82.27 Gy) (p < 0.0001).

Conclusions: Initial tumor volume is an important predictor for indication of ICBT and ICIS-BT. ISBT or at least an interstitial technique is recommended for initial GTV > 150 cm3.

目的:三维图像引导近距离治疗技术的进步使得在常规的腔内近距离治疗(ICBT)之外,可以使用腔内和间质近距离治疗(ICIS-BT),以及单独的间质近距离治疗(ISBT)。然而,对于这些技术的选择尚未达成共识。本研究的目的是提出间质技术指征的大小标准。材料和方法:我们在就诊时和每次近距离治疗时检查初始总肿瘤体积(GTV)。此外,我们还比较了112例接受近距离放疗的宫颈癌患者的剂量-体积直方图参数(ICBT, 54;ICIS-BT 11;ISBT, 47)。结果:诊断时GTV平均为80.9 cm3(范围4.4 ~ 343.2 cm3),近距离治疗时GTV缩小至20.6 cm3(为初始体积的25.5%,范围0.0 ~ 124.8 cm3)。近距离GTV > 30 cm3和高危临床靶体积> 40 cm3是间质技术适应症的良好阈值,初始GTV > 150 cm3的肿瘤可作为间质技术的候选者。89.10 Gy的ISBT剂量可按2 Gy分数(范围65.5 ~ 107.6 Gy)规定当量剂量,高于ICIS (73.94 Gy,范围71.44 ~ 82.50 Gy)和ICBT (72.83 Gy,范围62.50 ~ 82.27 Gy) (p < 0.0001)。结论:肿瘤初始体积是ICBT和ICIS-BT适应症的重要预测指标。对于初始GTV > 150 cm3的患者,建议采用ISBT或至少间隙技术。
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引用次数: 0
Validation of the bladder neck as an important organ at risk in prostate seed brachytherapy based on D2cc: A single-institution, retrospective review. 基于D2cc的前列腺种子近距离放射治疗中膀胱颈部作为重要危险器官的验证:一项单机构回顾性综述。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.126315
Neil D Wallace, Karen L Olden, Victoria S Brennan, Mohd Mat Samuji, Muhammad Faisal Jamaluddin, Gerard McVey, Mary T Dunne, Paul J Kelly

Purpose: International guidelines recommend urethral dose volume constraints to minimize the risk of urinary toxicity after prostate brachytherapy. An association between dose to the bladder neck (BN) and toxicity has previously been reported, and we sought to evaluate the impact of this organ at risk on urinary toxicity, based on intra-operative contouring.

Material and methods: Rates of acute and late urinary toxicity (AUT and LUT, respectively) were graded according to CTCAE version 5.0 for 209 consecutive patients who underwent low-dose-rate (LDR) brachytherapy monotherapy, with approximately equal numbers treated before and after we began routinely contouring the BN. AUT and LUT were compared in patients treated before and after we began contouring the OAR, and also for those treated after we began contouring who had a D2cc of greater than or less than 50% prescription dose.

Results: AUT and LUT fell after intra-operative BN contouring was instituted. Rates of grade ≥ 2 AUT fell from 15/101 (15%) to 9/104 (8.6%), p = 0.245. Grade ≥ 2 LUT decreased from 32/100 (32%) to 18/100 (18%), p = 0.034. Grade ≥ 2 AUT was observed in 4/63 (6.3%) and 5/34 (15%) of those with a BN D2cc >/≤ 50%, respectively, of prescription dose. Corresponding rates for LUT were 11/62 (18%) and 5/32 (16%).

Conclusions: There were lower urinary toxicity rates for patients treated after we commenced routine intra-operative contouring of the BN. No clear relationship was observed between dosimetry and toxicity in our population.

目的:国际指南推荐尿道剂量体积限制,以尽量减少前列腺近距离治疗后尿毒性的风险。膀胱颈(BN)剂量与毒性之间的关系此前已有报道,我们试图根据术中轮廓评估这一危险器官对尿毒性的影响。材料和方法:根据CTCAE 5.0版本对209例连续接受低剂量率(LDR)近距离单药治疗的患者的急性和晚期尿毒性(分别为AUT和LUT)进行分级,在我们开始常规等量化BN之前和之后接受治疗的患者数量大致相等。我们比较了在我们开始进行桨叶轮廓化前后治疗的患者的AUT和LUT,以及在我们开始轮廓化后治疗的D2cc大于或小于处方剂量50%的患者的AUT和LUT。结果:术中BN轮廓术后AUT和LUT下降。≥2级AUT发生率从15/101(15%)降至9/104 (8.6%),p = 0.245。≥2级LUT由32/100(32%)降至18/100 (18%),p = 0.034。在处方剂量BN D2cc >/≤50%的患者中,4/63(6.3%)和5/34(15%)分别出现≥2级AUT。LUT相应的发生率分别为11/62(18%)和5/32(16%)。结论:术中进行常规尿路探查后,患者尿毒性发生率较低。在我们的人群中没有观察到剂量学和毒性之间的明确关系。
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引用次数: 0
Focal salvage high-dose-rate brachytherapy with implantable rectum spacer for locally recurrent prostate cancer after initial low-dose-rate with grade 3 rectal toxicity. 植入式直肠间隔器局部补救性高剂量率近距离治疗原发性低剂量直肠毒性3级前列腺癌复发。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.126051
Thirza Opbroek, Anne Cobussen, Evert J Van Limbergen, Ben G L Vanneste

Purpose: Locally recurrent prostate cancer after previous radiation therapy remains challenging. One of the curative options for these patients is salvage brachytherapy. There are no reports available on the use of a biodegradable rectal balloon implantation (RBI) in combination with brachytherapy in patients with recurrent prostate cancer after previous radiotherapy.

Case presentation: Here, we report on a patient with a local recurrence at five years after previous low-dose-rate brachytherapy with a prescribed dose of 145 Gray (Gy) for a low-risk prostate adenocarcinoma. The patient experienced grade 3 rectal toxicity, which was resolved at the time of local recurrence. He was treated with focal high-dose-rate (HDR) brachytherapy of 2 fr. × 13 Gy after RBI implantation. Four years post-salvage treatment, there was no evidence of biochemical recurrence according Phoenix definition, and no gastro-intestinal or genitourinary toxicity.

Conclusions: This case describes the use of RBI implantation in combination with a focal salvage HDR in a patient with recurrent disease, with significant initial grade 3 rectal toxicity after previous irradiation. The use of a biodegradable RBI proved to be a promising solution for such a patient; however, this method needs to be further investigated.

目的:既往放射治疗后局部复发的前列腺癌仍然具有挑战性。这些患者的治疗选择之一是抢救性近距离放射治疗。目前还没有关于生物可降解直肠球囊植入(RBI)联合近距离放疗治疗前列腺癌复发患者的报道。病例介绍:在这里,我们报告了一个低风险前列腺癌患者,在先前低剂量率近距离放射治疗145 Gy后5年局部复发。患者经历了3级直肠毒性,在局部复发时得到了解决。RBI植入后给予局灶性高剂量率(HDR)近距离治疗2 × 13 Gy。抢救治疗4年后,无凤凰定义生化复发,无胃肠道及泌尿生殖系统毒性。结论:本病例描述了在复发性疾病患者中使用RBI植入联合局灶补救性HDR,先前照射后具有明显的初始3级直肠毒性。使用可生物降解的RBI被证明是一种很有前途的解决方案。然而,这种方法还需要进一步的研究。
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引用次数: 0
Intra-operative interstitial brachytherapy in a novel infra-zygomatic approach for partially resectable head and neck cancers around the base of skull: A technical note. 术中间质近距离放射治疗一种新的颧下入路治疗部分可切除的颅底周围头颈癌:技术说明。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.126861
Siddanna R Palled, Jaswanthi Akkpatti Ramachandra Reddy, Purushottam Chavan, K Siddappa, R A Sunil, Sanjeet Kumar Mondal, Bindu Krishnappa Venugopal, V Lokesh

Purpose: To report an intra-operative catheter insertion technique into the base of skull tumor bed following surgical resection for maxillary tumors.

Material and methods: A 42-year-old male patient diagnosed with carcinoma of the maxilla was treated with neoadjuvant chemotherapy followed by chemo-radiation using external beam technique combined with brachytherapy boost to post-operative bed. Brachytherapy was delivered via intra-operative catheter placement at the base of skull to residual disease, which was surgically unresectable. Initially, catheters were placed cranio-caudally. This was later changed into an infra-zygomatic approach to improve planning and dose coverage. High-risk clinical tumor volume (CTV) was generated with a 3 mm margin to residual gross tumor. Planning was done using Varian Eclipse brachytherapy planning system, and an optimal plan was generated.

Conclusions: An innovative, beneficial, and safe brachytherapy approach is necessary in a difficult and critical area, such as the base of skull. Our novel method of implant insertion through infra-zygomatic approach resulted in a safe and successful procedure.

目的:报道上颌肿瘤切除术后术中颅骨肿瘤床底置管技术。材料与方法:1例男性,42岁,确诊为上颌骨癌,行新辅助化疗+化疗放疗联合近距离放疗至术后床。术中在颅底放置导管,对手术无法切除的残留病变进行近距离放射治疗。最初,导管放置在颅尾侧。这后来被改为颧下入路,以改善计划和剂量覆盖。高危临床肿瘤体积(CTV)产生与残余大体肿瘤有3mm的间隙。使用Varian Eclipse近距离治疗计划系统进行计划,并生成最优计划。结论:一种创新、有益、安全的近距离治疗方法在颅底等困难和关键部位是必要的。我们的新方法是通过颧下入路置入假体,手术安全成功。
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引用次数: 0
Dosimetric comparison between microSelectron iridium-192 and flexi cobalt-60 sources in high-dose-rate brachytherapy using Geant4 Monte Carlo code. 使用Geant4蒙特卡罗代码进行高剂量率近距离治疗的微选择电子铱-192和弹性钴-60源的剂量学比较。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.126238
Tsige Yhidego Gebremariam, Ghazale Geraily, Hussam Hameed Jassim, Somayeh Gholami

Purpose: Manufacturing of miniaturized high activity iridium-192 (192Ir) sources have been made a market preference in modern brachytherapy. Smaller dimensions of the sources are flexible for smaller diameter of the applicators, and it is also suitable for interstitial implants. Presently, cobalt-60 (60Co) sources have been commercialized as an alternative to 192Ir sources for high-dose-rate (HDR) brachytherapy, since 60Co source have an advantage of longer half-life comparing with 192Ir source. One of them is the HDR 60Co Flexisource manufactured by Elekta. The purpose of this study was to compare the TG-43 dosimetric parameters of HDR flexi 60Co and HDR microSelectron 192Ir sources.

Material and methods: Monte Carlo simulation code of Geant4 (v.11.0) was applied. Following the recommendations of AAPM TG-43 formalism report, Monte Carlo code of HDR flexi 60Co and HDR microSelectron 192Ir was validated by calculating radial dose function, anisotropy function, and dose-rate constants in a water phantom. Finally, results of both radionuclide sources were compared.

Results: The calculated dose-rate constants per unit air-kerma strength in water medium were 1.108 cGy h-1U-1 for HDR microSelectron 192Ir, and 1.097 cGy h-1U-1 for HDR flexi 60Co source, with the percentage uncertainty of 1.1% and 0.2%, respectively. The values of radial dose function for distances above 22 cm for HDR flexi 60Co source were higher than that of the other source. The anisotropic values sharply increased to the longitudinal sides of HDR flexi 60Co source, and the rise was comparatively sharper to that of the other source.

Conclusions: The primary photons from the lower-energy HDR microSelectron 192Ir source have a limited range and are partially attenuated when considering the results of radial and anisotropic dose distribution functions. This implies that a HDR flexi 60Co radionuclide could be used to treat tumors beyond the source compared with a HDR microSelectron 192Ir source, despite the fact that 192Ir has a lower exit dose than HDR flexi 60Co radionuclide source.

目的:小型化高活性铱-192 (192Ir)源的制造已成为现代近距离放射治疗的市场首选。较小尺寸的源对于较小直径的施加器是灵活的,并且它也适用于间隙植入物。目前,钴-60 (60Co)源已被商业化,作为192Ir源的替代品,用于高剂量率(HDR)近距离治疗,因为60Co源与192Ir源相比具有更长的半衰期。其中之一是Elekta生产的HDR 60Co Flexisource。本研究的目的是比较HDR flexi 60Co和HDR microSelectron 192Ir源的TG-43剂量学参数。材料与方法:采用genant4 (v.11.0)蒙特卡罗仿真代码。根据AAPM TG-43形式报告的建议,通过计算水幻影中的径向剂量函数、各向异性函数和剂量率常数,对HDR flexi 60Co和HDR microSelectron 192Ir的蒙特卡罗代码进行了验证。最后,对两种放射性核素源的结果进行了比较。结果:HDR微selectron 192Ir和HDR flexi 60Co源在水介质中单位空气强度的剂量率常数分别为1.108 cGy h-1U-1和1.097 cGy h-1U-1,百分比不确定度分别为1.1%和0.2%。HDR柔性60Co源在22 cm以上的径向剂量函数值高于其他源。HDR挠性60Co源纵向各向异性值急剧上升,且上升幅度相对其他源更为明显。结论:考虑径向和各向异性剂量分布函数的结果,低能HDR微电子192Ir源产生的初级光子范围有限,且部分衰减。这意味着,与HDR微选择192Ir源相比,HDR柔性60Co放射性核素可用于治疗源外肿瘤,尽管192Ir的退出剂量低于HDR柔性60Co放射性核素源。
{"title":"Dosimetric comparison between microSelectron iridium-192 and flexi cobalt-60 sources in high-dose-rate brachytherapy using Geant4 Monte Carlo code.","authors":"Tsige Yhidego Gebremariam,&nbsp;Ghazale Geraily,&nbsp;Hussam Hameed Jassim,&nbsp;Somayeh Gholami","doi":"10.5114/jcb.2023.126238","DOIUrl":"https://doi.org/10.5114/jcb.2023.126238","url":null,"abstract":"<p><strong>Purpose: </strong>Manufacturing of miniaturized high activity iridium-192 (<sup>192</sup>Ir) sources have been made a market preference in modern brachytherapy. Smaller dimensions of the sources are flexible for smaller diameter of the applicators, and it is also suitable for interstitial implants. Presently, cobalt-60 (<sup>60</sup>Co) sources have been commercialized as an alternative to <sup>192</sup>Ir sources for high-dose-rate (HDR) brachytherapy, since <sup>60</sup>Co source have an advantage of longer half-life comparing with <sup>192</sup>Ir source. One of them is the HDR <sup>60</sup>Co Flexisource manufactured by Elekta. The purpose of this study was to compare the TG-43 dosimetric parameters of HDR flexi <sup>60</sup>Co and HDR microSelectron <sup>192</sup>Ir sources.</p><p><strong>Material and methods: </strong>Monte Carlo simulation code of Geant4 (v.11.0) was applied. Following the recommendations of AAPM TG-43 formalism report, Monte Carlo code of HDR flexi <sup>60</sup>Co and HDR microSelectron <sup>192</sup>Ir was validated by calculating radial dose function, anisotropy function, and dose-rate constants in a water phantom. Finally, results of both radionuclide sources were compared.</p><p><strong>Results: </strong>The calculated dose-rate constants per unit air-kerma strength in water medium were 1.108 cGy h<sup>-1</sup>U<sup>-1</sup> for HDR microSelectron <sup>192</sup>Ir, and 1.097 cGy h<sup>-1</sup>U<sup>-1</sup> for HDR flexi <sup>60</sup>Co source, with the percentage uncertainty of 1.1% and 0.2%, respectively. The values of radial dose function for distances above 22 cm for HDR flexi <sup>60</sup>Co source were higher than that of the other source. The anisotropic values sharply increased to the longitudinal sides of HDR flexi <sup>60</sup>Co source, and the rise was comparatively sharper to that of the other source.</p><p><strong>Conclusions: </strong>The primary photons from the lower-energy HDR microSelectron <sup>192</sup>Ir source have a limited range and are partially attenuated when considering the results of radial and anisotropic dose distribution functions. This implies that a HDR flexi <sup>60</sup>Co radionuclide could be used to treat tumors beyond the source compared with a HDR microSelectron <sup>192</sup>Ir source, despite the fact that <sup>192</sup>Ir has a lower exit dose than HDR flexi <sup>60</sup>Co radionuclide source.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/67/JCB-15-50437.PMC10196727.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9509134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of life of muscle-invasive bladder cancer patients after brachytherapy-based treatment: A cross-sectional study. 肌侵性膀胱癌患者近距离放疗后的生活质量:一项横断面研究
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.127050
Danique A Scheltes, Elzbieta M van der Steen-Banasik, Geert A H J Smits

Purpose: To determine the quality of life (QoL) of patients with muscle-invasive bladder cancer (MIBC) who underwent bladder-sparing treatment with high-dose-rate brachytherapy, and compare their QoL with an age-matched general Dutch population.

Material and methods: We conducted a single-center, prospective, descriptive cross-sectional study. MIBC patients who underwent brachytherapy-based bladder sparing treatment in Arnhem, The Netherlands from January 2016 to June 2021, were requested to complete the following questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30), bladder cancer-specific (QLQ-BLM30), and expanded prostate cancer index composite bowel (EPIC-50). Mean scores were calculated and compared with general Dutch population.

Results: The mean global health status/QoL score of the treated patients was 80.6. High scores were noted in the functional scales, including physical (86.8), role (85.6), emotional (88.6), cognitive (88.3), and social functioning (88.9), while the main reported complains were related to fatigue (21.9) and urinary symptoms (25.1). Compared to the general Dutch population, significant differences were visible in global health status/QoL (80.6 vs. 75.7), pain (9.0 vs. 17.8), insomnia (23.3 vs. 15.2), and constipation (13.3 vs. 6.8). However, in no case did the mean score differ by more than ten points, which was considered clinically relevant.

Conclusions: With a mean global health status/QoL score of 80.6, the patients after brachytherapy-based bladder sparing treatment have a good QoL. We found no clinically relevant difference in QoL comparing with an age-matched general Dutch population. The outcome strengthens the idea that this treatment option should be discussed with all patients eligible for brachytherapy-based treatment.

目的:确定肌肉侵袭性膀胱癌(MIBC)患者接受保膀胱高剂量近距离放射治疗的生活质量(QoL),并将其与年龄匹配的荷兰普通人群的生活质量进行比较。材料和方法:我们进行了一项单中心、前瞻性、描述性横断面研究。2016年1月至2021年6月在荷兰阿纳姆接受近距离膀胱保留治疗的MIBC患者被要求完成以下问卷:欧洲癌症研究和治疗组织(EORTC)通用(QLQ-C30)、膀胱癌特异性(QLQ-BLM30)和扩大前列腺癌指数复合肠(EPIC-50)。计算平均得分,并与一般荷兰人进行比较。结果:治疗组患者总体健康状况/生活质量平均评分为80.6分。在身体(86.8)、角色(85.6)、情感(88.6)、认知(88.3)和社会功能(88.9)等功能量表中得分较高,而报告的主要抱怨与疲劳(21.9)和泌尿系统症状(25.1)有关。与荷兰普通人群相比,总体健康状况/生活质量(80.6 vs. 75.7)、疼痛(9.0 vs. 17.8)、失眠(23.3 vs. 15.2)和便秘(13.3 vs. 6.8)方面存在显著差异。然而,在任何情况下,平均得分的差异都不超过10分,这被认为是临床相关的。结论:近距离膀胱保留治疗后患者总体健康状况/生活质量平均评分为80.6,生活质量较好。我们发现与年龄匹配的荷兰普通人群相比,生活质量没有临床相关的差异。结果加强了这种治疗方案应该与所有有资格接受近距离治疗的患者讨论的想法。
{"title":"Quality of life of muscle-invasive bladder cancer patients after brachytherapy-based treatment: A cross-sectional study.","authors":"Danique A Scheltes,&nbsp;Elzbieta M van der Steen-Banasik,&nbsp;Geert A H J Smits","doi":"10.5114/jcb.2023.127050","DOIUrl":"https://doi.org/10.5114/jcb.2023.127050","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the quality of life (QoL) of patients with muscle-invasive bladder cancer (MIBC) who underwent bladder-sparing treatment with high-dose-rate brachytherapy, and compare their QoL with an age-matched general Dutch population.</p><p><strong>Material and methods: </strong>We conducted a single-center, prospective, descriptive cross-sectional study. MIBC patients who underwent brachytherapy-based bladder sparing treatment in Arnhem, The Netherlands from January 2016 to June 2021, were requested to complete the following questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30), bladder cancer-specific (QLQ-BLM30), and expanded prostate cancer index composite bowel (EPIC-50). Mean scores were calculated and compared with general Dutch population.</p><p><strong>Results: </strong>The mean global health status/QoL score of the treated patients was 80.6. High scores were noted in the functional scales, including physical (86.8), role (85.6), emotional (88.6), cognitive (88.3), and social functioning (88.9), while the main reported complains were related to fatigue (21.9) and urinary symptoms (25.1). Compared to the general Dutch population, significant differences were visible in global health status/QoL (80.6 vs. 75.7), pain (9.0 vs. 17.8), insomnia (23.3 vs. 15.2), and constipation (13.3 vs. 6.8). However, in no case did the mean score differ by more than ten points, which was considered clinically relevant.</p><p><strong>Conclusions: </strong>With a mean global health status/QoL score of 80.6, the patients after brachytherapy-based bladder sparing treatment have a good QoL. We found no clinically relevant difference in QoL comparing with an age-matched general Dutch population. The outcome strengthens the idea that this treatment option should be discussed with all patients eligible for brachytherapy-based treatment.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/3a/JCB-15-50617.PMC10196731.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9506568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complication and response assessment of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes. 高剂量率直肠内近距离放疗促进局部晚期直肠癌新辅助放化疗的并发症和疗效评估。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.127051
Arefeh Saeedian, Marzieh Lashkari, Reza Ghalehtaki, Maryam Taherioun, Mahdieh Razmkhah, Ali Kazemian, Mahdi Aghili

Purpose: To identify efficacy, complication, and pathologic response of high-dose-rate endorectal brachytherapy (HDR-BRT) boost in neo-adjuvant chemoradiotherapy (nCRT) of locally advanced rectal cancer.

Material and methods: Forty-four patients who met eligibility criteria were included in this non-randomized comparative study. Control group was recruited retrospectively. nCRT (50.40 Gy/28 fr. plus capecitabine 825 mg/m2 twice daily) was administered to both groups before surgery. In the case group, HDR-BRT (8 Gy/2 fr.) was supplemented after chemoradiation. Surgery was done 6-8 weeks after completion of neo-adjuvant therapy. Pathologic complete response (pCR) was the study's primary endpoint.

Results: From 44 patients in the case and control groups, pCR was 11 (50%) and 8 (36.4%), respectively (p = 0.27). According to Ryan's grading system, tumor regression grade (TRG) TRG1, TRG2, and TRG3 were 16 (72.7%), 2 (9.1%), and 4 (18.2%) in the case, and 10 (45.5%), 7 (31.8%), and 5 (22.7%) in the control group (p = 0.118). T down-staging was found in 19 (86.4%) and 13 (59.1%) patients in the case and control groups, respectively. No grade > 2 toxicity was identified in both the groups. Organ preservation was achieved in 42.8% and 15.3% in the case and control arm (p = 0.192). In the case group, 8-year overall survival (OS) and disease-free survival (DFS) were 89% (95% CI: 73-100%) and 78% (95% CI: 58-98%), respectively. Our study did not reach median OS and median DFS.

Conclusions: Treatment schedule was well-tolerated, and neo-adjuvant HDR-BRT could achieve better T down-staging as a boost comparing with nCRT, without significant complication. However, the optimal dose and fractions in the context of HDR-BRT boost needs further studies.

目的:探讨高剂量率直肠内近距离放射治疗(HDR-BRT)在局部晚期直肠癌新辅助放化疗(nCRT)中的疗效、并发症和病理反应。材料和方法:44例符合资格标准的患者纳入了这项非随机比较研究。对照组回顾性招募。两组术前均给予nCRT (50.40 Gy/28 fr,加卡培他滨825 mg/m2,每日2次)。病例组在放化疗后补充HDR-BRT (8 Gy/2 fr.)。手术于新辅助治疗完成后6-8周进行。病理完全缓解(pCR)是研究的主要终点。结果:病例组和对照组44例患者中,pCR分别为11例(50%)和8例(36.4%),差异有统计学意义(p = 0.27)。根据Ryan分级系统,本组肿瘤消退等级(TRG) TRG1、TRG2、TRG3分别为16(72.7%)、2(9.1%)、4(18.2%),对照组为10(45.5%)、7(31.8%)、5(22.7%),差异有统计学意义(p = 0.118)。病例组和对照组分别有19例(86.4%)和13例(59.1%)患者出现T分期下降。两组均未发现2级以上毒性。病例组和对照组的器官保存率分别为42.8%和15.3% (p = 0.192)。在病例组中,8年总生存率(OS)和无病生存率(DFS)分别为89% (95% CI: 73-100%)和78% (95% CI: 58-98%)。我们的研究没有达到中位OS和中位DFS。结论:治疗方案耐受性良好,与nCRT相比,新辅助HDR-BRT可实现更好的T降期,无明显并发症。然而,在HDR-BRT增强的背景下,最佳剂量和分数需要进一步研究。
{"title":"Complication and response assessment of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes.","authors":"Arefeh Saeedian,&nbsp;Marzieh Lashkari,&nbsp;Reza Ghalehtaki,&nbsp;Maryam Taherioun,&nbsp;Mahdieh Razmkhah,&nbsp;Ali Kazemian,&nbsp;Mahdi Aghili","doi":"10.5114/jcb.2023.127051","DOIUrl":"https://doi.org/10.5114/jcb.2023.127051","url":null,"abstract":"<p><strong>Purpose: </strong>To identify efficacy, complication, and pathologic response of high-dose-rate endorectal brachytherapy (HDR-BRT) boost in neo-adjuvant chemoradiotherapy (nCRT) of locally advanced rectal cancer.</p><p><strong>Material and methods: </strong>Forty-four patients who met eligibility criteria were included in this non-randomized comparative study. Control group was recruited retrospectively. nCRT (50.40 Gy/28 fr. plus capecitabine 825 mg/m<sup>2</sup> twice daily) was administered to both groups before surgery. In the case group, HDR-BRT (8 Gy/2 fr.) was supplemented after chemoradiation. Surgery was done 6-8 weeks after completion of neo-adjuvant therapy. Pathologic complete response (pCR) was the study's primary endpoint.</p><p><strong>Results: </strong>From 44 patients in the case and control groups, pCR was 11 (50%) and 8 (36.4%), respectively (<i>p</i> = 0.27). According to Ryan's grading system, tumor regression grade (TRG) TRG1, TRG2, and TRG3 were 16 (72.7%), 2 (9.1%), and 4 (18.2%) in the case, and 10 (45.5%), 7 (31.8%), and 5 (22.7%) in the control group (<i>p</i> = 0.118). T down-staging was found in 19 (86.4%) and 13 (59.1%) patients in the case and control groups, respectively. No grade > 2 toxicity was identified in both the groups. Organ preservation was achieved in 42.8% and 15.3% in the case and control arm (<i>p</i> = 0.192). In the case group, 8-year overall survival (OS) and disease-free survival (DFS) were 89% (95% CI: 73-100%) and 78% (95% CI: 58-98%), respectively. Our study did not reach median OS and median DFS.</p><p><strong>Conclusions: </strong>Treatment schedule was well-tolerated, and neo-adjuvant HDR-BRT could achieve better T down-staging as a boost comparing with nCRT, without significant complication. However, the optimal dose and fractions in the context of HDR-BRT boost needs further studies.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/5e/JCB-15-50618.PMC10196729.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9509133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Automatic reconstruction of interstitial needles using CT images in post-operative cervical cancer brachytherapy based on deep learning. 基于深度学习的宫颈癌术后近距离放疗CT图像间质针自动重建。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.126514
Hongling Xie, Jiahao Wang, Yuanyuan Chen, Yeqiang Tu, Yukai Chen, Yadong Zhao, Pengfei Zhou, Shichun Wang, Zhixin Bai, Qiu Tang

Purpose: The purpose of this study was to investigate the precision of deep learning (DL)-based auto-reconstruction in localizing interstitial needles in post-operative cervical cancer brachytherapy (BT) using three-dimensional (3D) computed tomography (CT) images.

Material and methods: A convolutional neural network (CNN) was developed and presented for automatic reconstruction of interstitial needles. Data of 70 post-operative cervical cancer patients who received CT-based BT were used to train and test this DL model. All patients were treated with three metallic needles. Dice similarity coefficient (DSC), 95% Hausdorff distance (95% HD), and Jaccard coefficient (JC) were applied to evaluate the geometric accuracy of auto-reconstruction for each needle. Dose-volume indexes (DVI) between manual and automatic methods were used to analyze the dosimetric difference. Correlation between geometric metrics and dosimetric difference was evaluated using Spearman correlation analysis.

Results: The mean DSC values of DL-based model were 0.88, 0.89, and 0.90 for three metallic needles. Wilcoxon signed-rank test indicated no significant dosimetric differences in all BT planning structures between manual and automatic reconstruction methods (p > 0.05). Spearman correlation analysis demonstrated weak link between geometric metrics and dosimetry differences.

Conclusions: DL-based reconstruction method can be used to precisely localize the interstitial needles in 3D-CT images. The proposed automatic approach could improve the consistency of treatment planning for post-operative cervical cancer brachytherapy.

目的:本研究的目的是探讨基于深度学习(DL)的自重建在宫颈癌术后近距离放射治疗(BT)中使用三维(3D)计算机断层扫描(CT)图像定位间质针的准确性。材料与方法:提出了一种卷积神经网络(CNN)用于间质针的自动重建。采用70例宫颈癌术后行ct - BT的患者数据对DL模型进行训练和检验。所有患者均用三根金属针治疗。采用骰子相似系数(DSC)、95% Hausdorff距离(95% HD)和Jaccard系数(JC)评价各针自动重建的几何精度。采用手动法和自动法的剂量-体积指数(Dose-volume index, DVI)分析剂量学差异。使用Spearman相关分析评估几何指标与剂量学差异之间的相关性。结果:三种金属针的dl模型DSC平均值分别为0.88、0.89和0.90。Wilcoxon sign -rank检验显示,人工和自动重建方法在所有BT规划结构上的剂量学差异无统计学意义(p > 0.05)。Spearman相关分析表明几何计量学与剂量学差异之间存在微弱联系。结论:基于dl的重建方法可用于3D-CT图像间质针的精确定位。该方法可提高宫颈癌术后近距离放疗方案的一致性。
{"title":"Automatic reconstruction of interstitial needles using CT images in post-operative cervical cancer brachytherapy based on deep learning.","authors":"Hongling Xie,&nbsp;Jiahao Wang,&nbsp;Yuanyuan Chen,&nbsp;Yeqiang Tu,&nbsp;Yukai Chen,&nbsp;Yadong Zhao,&nbsp;Pengfei Zhou,&nbsp;Shichun Wang,&nbsp;Zhixin Bai,&nbsp;Qiu Tang","doi":"10.5114/jcb.2023.126514","DOIUrl":"https://doi.org/10.5114/jcb.2023.126514","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate the precision of deep learning (DL)-based auto-reconstruction in localizing interstitial needles in post-operative cervical cancer brachytherapy (BT) using three-dimensional (3D) computed tomography (CT) images.</p><p><strong>Material and methods: </strong>A convolutional neural network (CNN) was developed and presented for automatic reconstruction of interstitial needles. Data of 70 post-operative cervical cancer patients who received CT-based BT were used to train and test this DL model. All patients were treated with three metallic needles. Dice similarity coefficient (DSC), 95% Hausdorff distance (95% HD), and Jaccard coefficient (JC) were applied to evaluate the geometric accuracy of auto-reconstruction for each needle. Dose-volume indexes (DVI) between manual and automatic methods were used to analyze the dosimetric difference. Correlation between geometric metrics and dosimetric difference was evaluated using Spearman correlation analysis.</p><p><strong>Results: </strong>The mean DSC values of DL-based model were 0.88, 0.89, and 0.90 for three metallic needles. Wilcoxon signed-rank test indicated no significant dosimetric differences in all BT planning structures between manual and automatic reconstruction methods (<i>p</i> > 0.05). Spearman correlation analysis demonstrated weak link between geometric metrics and dosimetry differences.</p><p><strong>Conclusions: </strong>DL-based reconstruction method can be used to precisely localize the interstitial needles in 3D-CT images. The proposed automatic approach could improve the consistency of treatment planning for post-operative cervical cancer brachytherapy.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/2c/JCB-15-50520.PMC10196730.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9506571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The potential of low-dose-rate brachytherapy with iodine-125 in the treatment of local recurrences of prostate cancer after primary high-dose-rate monotherapy. 低剂量-125近距离放射治疗原发性高剂量单药治疗后前列腺癌局部复发的潜力
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.126618
Wojciech M Burchardt, Artur J Chyrek, Grzegorz M Bielęda, Ewa Burchardt, Adam Chicheł

Purpose: The incidence of local prostate cancer recurrences after monotherapy with high-dose-rate brachytherapy (HDR-BT) is low. However, a cumulated number of local recurrences during follow-up is naturally observed in highly specialized oncological centers. This retrospective study aimed to present the treatment of local recurrences after HDR-BT with low-dose-rate brachytherapy (LDR-BT).

Material and methods: Nine patients with low- and intermediate-risk prostate cancer with a median age of 71 years (range, 59-82 years) were diagnosed with local recurrences after previous monotherapy HDR-BT, 3 × 10.5 Gy (from 2010 to 2013). Median time to biochemical recurrence was 59 months (range, 21-80 months). All patients received 145 Gy with salvage LDR-BT (iodine-125). Gastrointestinal and urological toxicities were evaluated based on patients' records following CTCAE v. 4.0 and IPSS scales.

Results: The median follow-up after salvage treatment was 30 months (range, 17-63 months). Local recurrences (LR) were detected in two cases, and the actuarial 2-year local control was 88%. Biochemical failure was observed in four cases. Distant metastases (DM) were observed in 2 patients. In one patient, both LR and DM were diagnosed simultaneously. Four patients had no relapse of the disease, and a 2-year disease-free survival (DSF) was 58.3%. Before salvage treatment, median IPSS scores were 6.5 points (range, 1-23 points). At the first follow-up visit, after one month, the mean IPSS score was 20 points, and at the last follow-up visit, it was 8 points (range, 1-26 points). One patient had urinary retention after treatment. There was no significant change in IPSS scores before and after the treatment (p = 0.68). Two patients had grade 1 toxicity in the gastrointestinal tract.

Conclusions: Salvage LDR-BT for patients with prostate cancer previously treated with HDR-BT monotherapy is characterized by acceptable toxicity, and may result in local disease control.

目的:单次高剂量率近距离放疗(HDR-BT)后前列腺癌局部复发率低。然而,在高度专业化的肿瘤中心,随访期间累积的局部复发数量自然是观察到的。本回顾性研究旨在介绍低剂量率近距离放疗(LDR-BT)治疗HDR-BT术后局部复发的方法。材料与方法:2010 - 2013年9例低、中危前列腺癌患者,中位年龄71岁(范围59-82岁),既往单药HDR-BT治疗3 × 10.5 Gy后诊断为局部复发。到生化复发的中位时间为59个月(范围21-80个月)。所有患者均接受145 Gy补救性LDR-BT(碘-125)治疗。根据CTCAE v. 4.0和IPSS评分对患者的胃肠道和泌尿系统毒性进行评估。结果:抢救治疗后中位随访时间为30个月(范围17-63个月)。2例发现局部复发(LR),精算2年局部控制率为88%。4例出现生化失败。2例患者出现远处转移。1例患者同时诊断为LR和DM。4例患者无复发,2年无病生存率(DSF)为58.3%。打捞治疗前,IPSS评分中位数为6.5分(范围1-23分)。1个月后第一次随访时IPSS平均评分为20分,最后一次随访时IPSS平均评分为8分(范围1-26分)。1例患者治疗后出现尿潴留。治疗前后IPSS评分差异无统计学意义(p = 0.68)。2例患者胃肠道毒性为1级。结论:补救性LDR-BT对既往HDR-BT单药治疗的前列腺癌患者具有可接受的毒性,并可能实现局部疾病控制。
{"title":"The potential of low-dose-rate brachytherapy with iodine-125 in the treatment of local recurrences of prostate cancer after primary high-dose-rate monotherapy.","authors":"Wojciech M Burchardt,&nbsp;Artur J Chyrek,&nbsp;Grzegorz M Bielęda,&nbsp;Ewa Burchardt,&nbsp;Adam Chicheł","doi":"10.5114/jcb.2023.126618","DOIUrl":"https://doi.org/10.5114/jcb.2023.126618","url":null,"abstract":"<p><strong>Purpose: </strong>The incidence of local prostate cancer recurrences after monotherapy with high-dose-rate brachytherapy (HDR-BT) is low. However, a cumulated number of local recurrences during follow-up is naturally observed in highly specialized oncological centers. This retrospective study aimed to present the treatment of local recurrences after HDR-BT with low-dose-rate brachytherapy (LDR-BT).</p><p><strong>Material and methods: </strong>Nine patients with low- and intermediate-risk prostate cancer with a median age of 71 years (range, 59-82 years) were diagnosed with local recurrences after previous monotherapy HDR-BT, 3 × 10.5 Gy (from 2010 to 2013). Median time to biochemical recurrence was 59 months (range, 21-80 months). All patients received 145 Gy with salvage LDR-BT (iodine-125). Gastrointestinal and urological toxicities were evaluated based on patients' records following CTCAE v. 4.0 and IPSS scales.</p><p><strong>Results: </strong>The median follow-up after salvage treatment was 30 months (range, 17-63 months). Local recurrences (LR) were detected in two cases, and the actuarial 2-year local control was 88%. Biochemical failure was observed in four cases. Distant metastases (DM) were observed in 2 patients. In one patient, both LR and DM were diagnosed simultaneously. Four patients had no relapse of the disease, and a 2-year disease-free survival (DSF) was 58.3%. Before salvage treatment, median IPSS scores were 6.5 points (range, 1-23 points). At the first follow-up visit, after one month, the mean IPSS score was 20 points, and at the last follow-up visit, it was 8 points (range, 1-26 points). One patient had urinary retention after treatment. There was no significant change in IPSS scores before and after the treatment (<i>p</i> = 0.68). Two patients had grade 1 toxicity in the gastrointestinal tract.</p><p><strong>Conclusions: </strong>Salvage LDR-BT for patients with prostate cancer previously treated with HDR-BT monotherapy is characterized by acceptable toxicity, and may result in local disease control.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/c5/JCB-15-50544.PMC10196734.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of age on the Quadrella index assessing oncological and functional results after prostate brachytherapy: A 6-year analysis. 年龄对评估前列腺近距离放疗后肿瘤和功能结果的Quadrella指数的影响:一项6年分析。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-04-01 DOI: 10.5114/jcb.2023.127049
Guillaume Tremblay, Truong An Nguyen, Julien Marolleau, Jean-Pierre Malhaire, Alexandre Fourcade, Nicolas Boussion, Gaelle Goasduff, Emmanuelle Martin, Gurvan Dissaux, Olivier Pradier, G Fournier, U Schick, Antoine Valeri

Purpose: As the oncological results of prostate brachytherapy (BT) are excellent for low-risk (LR) or favorable intermediate-risk (FIR) prostate cancer (PCa), evaluating the side effects has become a major issue, especially for young men. The objective of the study was to compare the oncologic and functional results of BT using Quadrella index for patients aged 60 or less compared with older patients.

Material and methods: From June, 2007 to June, 2017, 222 patients, including 70 ≤ 60 years old and 152 > 60 years old, underwent BT for LR-FIR PCa, with good erectile function at baseline according to International Index of Erectile Function-5 (IIEF-5) > 16. Quadrella index was achieved under the following circumstances: 1) Absence of biological recurrence (Phoenix criteria); 2) Absence of erectile dysfunction (ED) (IIEF-5 > 16); 3) No urinary toxicity (international prostate score symptom) IPSS < 15 or IPSS > 15, and ΔIPSS < 5; 4) No rectal toxicity (RT) (Radiation Therapy Oncology Group, RTOG = 0). Patients were treated on demand with phosphodiesterase inhibitors (PDE5i) post-operatively.

Results: The Quadrella index was satisfied for about 40-80% of patients ≤ 60 years vs. 33-46% for older patients during 6-year follow-up (significant difference from the second year). At year 5, 100% of evaluable patients aged ≤ 60 and 91.8% > 60 (p = 0.29) reached Phoenix criteria. The criterion of ED (IIEF-5 < 16) largely explained the validity rate of Quadrella alone. There was no ED for 67.2-81.4% of patients ≤ 60 years compared with 40.0-56.1% for patients > 60 (significant difference since year 4 in favor of young men). After two years of follow-up, more than 90% of patients in both the groups showed neither urinary nor rectal toxicities.

Conclusions: For young men displaying LR-FIR PCa, BT appears to be a first-class therapeutic option, as the oncological results were at least equivalent to those of older patients with good long-term tolerance.

目的:由于前列腺近距离放射治疗(BT)对于低危(LR)或有利的中危(FIR)前列腺癌(PCa)的肿瘤学结果非常好,因此评估其副作用已成为一个主要问题,特别是对于年轻男性。该研究的目的是使用Quadrella指数比较60岁或以下患者与老年患者的BT肿瘤和功能结果。材料与方法:2007年6月至2017年6月,222例患者(其中年龄≤60岁的70例,年龄> 60岁的152例)根据国际勃起功能指数-5 (IIEF-5) > 16,基线勃起功能良好,接受了LR-FIR PCa的BT治疗。在以下情况下获得Quadrella指数:1)无生物复发(Phoenix标准);2)无勃起功能障碍(ED) (ief -5 > 16);3)无尿毒性(国际前列腺评分症状)IPSS < 15或IPSS > 15, ΔIPSS < 5;4)无直肠毒性(RT)(放射治疗肿瘤组,RTOG = 0),术后按需给予磷酸二酯酶抑制剂(PDE5i)治疗。结果:在6年的随访中,≤60岁患者的Quadrella指数满意度约为40-80%,而老年患者的Quadrella指数满意度为33-46%(与第二年相比有显著差异)。在第5年,100%≤60岁的可评估患者和91.8% > 60岁的可评估患者(p = 0.29)达到凤凰标准。ED的判据(ief -5 < 16)在很大程度上解释了Quadrella单独的效度。≤60岁的患者中,67.2-81.4%没有ED,而> 60岁的患者中,40.0-56.1%没有ED(从第4年开始,年轻男性有显著差异)。经过两年的随访,两组中超过90%的患者均未出现泌尿和直肠毒性。结论:对于患有LR-FIR PCa的年轻男性,BT似乎是一种一流的治疗选择,因为肿瘤学结果至少与长期耐受性良好的老年患者相当。
{"title":"Impact of age on the Quadrella index assessing oncological and functional results after prostate brachytherapy: A 6-year analysis.","authors":"Guillaume Tremblay,&nbsp;Truong An Nguyen,&nbsp;Julien Marolleau,&nbsp;Jean-Pierre Malhaire,&nbsp;Alexandre Fourcade,&nbsp;Nicolas Boussion,&nbsp;Gaelle Goasduff,&nbsp;Emmanuelle Martin,&nbsp;Gurvan Dissaux,&nbsp;Olivier Pradier,&nbsp;G Fournier,&nbsp;U Schick,&nbsp;Antoine Valeri","doi":"10.5114/jcb.2023.127049","DOIUrl":"https://doi.org/10.5114/jcb.2023.127049","url":null,"abstract":"<p><strong>Purpose: </strong>As the oncological results of prostate brachytherapy (BT) are excellent for low-risk (LR) or favorable intermediate-risk (FIR) prostate cancer (PCa), evaluating the side effects has become a major issue, especially for young men. The objective of the study was to compare the oncologic and functional results of BT using Quadrella index for patients aged 60 or less compared with older patients.</p><p><strong>Material and methods: </strong>From June, 2007 to June, 2017, 222 patients, including 70 ≤ 60 years old and 152 > 60 years old, underwent BT for LR-FIR PCa, with good erectile function at baseline according to International Index of Erectile Function-5 (IIEF-5) > 16. Quadrella index was achieved under the following circumstances: 1) Absence of biological recurrence (Phoenix criteria); 2) Absence of erectile dysfunction (ED) (IIEF-5 > 16); 3) No urinary toxicity (international prostate score symptom) IPSS < 15 or IPSS > 15, and ΔIPSS < 5; 4) No rectal toxicity (RT) (Radiation Therapy Oncology Group, RTOG = 0). Patients were treated on demand with phosphodiesterase inhibitors (PDE5i) post-operatively.</p><p><strong>Results: </strong>The Quadrella index was satisfied for about 40-80% of patients ≤ 60 years vs. 33-46% for older patients during 6-year follow-up (significant difference from the second year). At year 5, 100% of evaluable patients aged ≤ 60 and 91.8% > 60 (<i>p</i> = 0.29) reached Phoenix criteria. The criterion of ED (IIEF-5 < 16) largely explained the validity rate of Quadrella alone. There was no ED for 67.2-81.4% of patients ≤ 60 years compared with 40.0-56.1% for patients > 60 (significant difference since year 4 in favor of young men). After two years of follow-up, more than 90% of patients in both the groups showed neither urinary nor rectal toxicities.</p><p><strong>Conclusions: </strong>For young men displaying LR-FIR PCa, BT appears to be a first-class therapeutic option, as the oncological results were at least equivalent to those of older patients with good long-term tolerance.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f6/d3/JCB-15-50616.PMC10196736.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9509135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Contemporary Brachytherapy
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