Journal of Contemporary Brachytherapy最新文献

Purpose: This study outlined the prevalent use of brachytherapy in skin cancers, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The importance of customized applicator fabrication for optimal treatment delivery was highlighted, focusing on adaptable devices tailored to individual patient anatomy, often facilitated by 3D printing technology. The purpose of this work was to investigate the association of medical science and 3D printing in customized applicator fabrication for brachytherapy, leveraging the advancements in fabrication techniques to enhance treatment precision and patient outcomes.

Material and methods: The study enrolled five patients with tumor lesions unsuitable for surgical intervention, situated across various anatomical locations, such as earlobe, temple, hand, and cheek. Customized applicators were fabricated via 3D printing (fused deposition modeling) for each patient, followed by radiotherapy protocol delivering a total dose of 51 Gy in 17 fractions. Patient assessments during and post-radiotherapy were done by radiation oncologist using RTOG scale as well as dermatological evaluations with dermatoscopy and reflectance confocal microscopy. Methodologically, applicators were 3D-printed using fused deposition modeling technology. Printing parameters were optimized in Prusa Slicer software, ensuring precise control in printout shape correlated with treatment efficacy.

Results: This study examined the therapeutic outcomes of brachytherapy in five patients with inoperable skin cancer lesions. Utilizing customized 3D-printed applicators, the patients underwent brachytherapy regimen delivering a cumulative dose of 51 Gy in 17 fractions. The evaluation with RTOG scale revealed varied treatment responses, with complete remission achieved in all cases. Reflectance confocal microscopy showed post-treatment normalization of epidermal morphology and notable scar formation. Optical profilometry demonstrated consistent micro-structures on the applicator surfaces, without compromising treatment efficacy. These findings indicated the potential of 3D-printed applicators in optimizing brachytherapy outcomes in skin cancer management.

Conclusions: Our study demonstrates the effectiveness of 3D-printed applicators in treating inoperable skin cancer lesions with high precision. In personalized fabrication, optimal conformity with anatomical features was achieved, resulting in complete remission in all patients. This approach minimizes treatment-related side effects and enhances overall patient outcomes, suggesting a promising future for 3D printing technology in skin cancer treatment applications. Further research and clinical validation are needed to establish 3D printing as a standard practice in skin cancer treatment.

Purpose: To compare the dosimetric differences in vaginal brachytherapy (VBT) using single-channel vaginal cylinder (SCVC) and free-hand interstitial needles (FIN).

Material and methods: Twenty-two women with malignant gynecologic tumors were prospectively treated with image-guided high-dose-rate (HDR) brachytherapy after surgery and external beam radiation therapy (EBRT). All HDR treatments were delivered using FIN implant technique. For dosimetric comparison purposes only, SCVCs of 2.5 cm diameter were placed in all patients. No sources were dwelled in cylinder applicator during clinical treatment. CT-guided brachytherapy treatment planning was performed according to GEC-ESTRO guidelines, with high-risk clinical target volume (HR-CTV) delineated based on clinical exams and MRI T2 sequences. Dose-volume parameters to HR-CTV and surrounding organs at risk (OARs) from interstitial plans were compared with those achieved from cylinder plans.

Results: Compared with SCVC group, FIN group showed the same HR-CTV coverage. FIN group had higher V_150% and V_200% (p < 0.05). In addition, it had lower HI (p < 0.05). However, doses to the rectum D_0.1cc (538.5 ±119.8 cGy), D_1cc (415.4 ±73.3 cGy), D_2cc (355.7 ±66.6 cGy), and D_mean (162.8 ±43.7 cGy) as well as the bladder D_0.1cc (516.1 ±85.2 cGy) and D_1cc (392.9 ±59.8 cGy) were lower in FIN group than in SCVC group (p < 0.05).

Conclusions: FIN technique can be a dosimetrically preferable alternative to the commonly used SCVC for HDR VBT boost in patients with gynecological malignancies. It provides adequate coverage of target volumes, with minimal radiation dose to surrounding organs at risk.

Purpose: Cervical cancer is a significant global health burden, with advancements in treatment modalities improving outcomes. However, vaginal toxicities following definitive chemoradiation remain a concern, impacting patients' quality of life. The aim of this systematic review and meta-analysis was to estimate the incidence of vaginal toxicities, explore associated factors, and assess the relationship with radiation dose in intact cervical cancer patients undergoing radical chemoradiation.

Material and methods: A systematic search of PubMed, Google Scholar, and Cochrane databases was conducted. Studies reporting on vaginal toxicities post-radical chemoradiation in intact cervical cancer patients were included. Data extraction and analysis were performed according to PRISMA guidelines.

Results: Twenty-four studies with various designs were included. The meta-analysis revealed a pooled estimate of 39% (95% CI: 21-56%) for overall vaginal toxicities among cervical cancer patients following definitive chemoradiation. Vaginal stenosis was the most commonly reported toxicity, with a median incidence of 61.5% (range, 20-77.8%) across the studies. Severe toxicities (grade ≥ 3) were reported at rates of 12.74% (CTCAE v. 4.0), 0.98% (CTCAE v. 3.0), 10.41% (RTOG/EORTC), and 0% (LENT-SOMA). Factors, such as age, initial vaginal involvement, and radiation dose were associated with increased toxicity risk. Significant heterogeneity was observed in study populations and methodologies.

Conclusions: Vaginal toxicities are common following definitive chemoradiation in intact cervical cancer patients, with vaginal stenosis being predominant. Standardization of toxicity scoring methods and radiotherapy dose reporting parameters is crucial for accurate comparison and interpretation of findings. Future research should focus on optimizing treatment strategies to minimize vaginal toxicities while maximizing efficacy and patient outcomes.

Purpose: In the current study, the clinical efficacy of iodine-125 (¹²⁵I) radioactive particle implantation with deep hyperthermia in malignant tumor treatment was retrospectively analyzed.

Material and methods: Sixty patients with malignant tumors treated at Zhongshan Hospital affiliated with Dalian University, from January 2021 to January 2023, were included in this retrospective analysis. Computed tomography (CT)-guided ¹²⁵I radioactive particles were implanted into lesions, followed by deep hyperthermia administered for 3 days after surgery. Lesion size was evaluated monthly using CT or magnetic resonance imaging (MRI), and objective response rate (ORR) and local control rate (DCR) were calculated. Mean pain numerical score and European Organization for Research and Treatment of Cancer quality of life core scale C30 (EORTC QLQ-C30 v. 3.0) were assessed pre-treatment and post-treatment, and post-operative adverse reactions were comparatively analyzed.

Results: After 6 months, the combined treatment resulted in a 73.33% ORR and an 81.67% DCR among 60 patients experiencing pre-treatment pain, and 49 (81.67%) exhibited effective pain relief. EORTC QLQ-C30 v. 3.0 evaluation revealed improved quality of life post-treatment. Adverse reactions during combined treatment were mitigated with targeted supportive measures, and no adverse reactions of level 2 or higher were observed.

Conclusions: ¹²⁵I radioactive particle implantation with deep hyperthermia is shown to be an effective combination therapy for malignant tumors, yielding significant clinical efficacy. Notably, it enhances patient quality of life, reduces tumor burden, mitigates adverse reactions, and alleviates pain. Given its minimal trauma and mild adverse reactions, this combination therapy warrants widespread clinical application.