Practical Radiation Oncology最新文献

英文中文

Radiation-Induced Acute Lung Pneumonitis After Pencil-Beam Scanning Proton Treatment for Breast Cancer: Correlation With Dose-Volume Parameters and Optimization Objectives to Reduce Lung Toxicities 乳腺癌PBS质子治疗后放射性引起的急性肺肺炎：与剂量-体积参数的相关性和降低肺毒性的优化目标

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.07.005

Jiyeon Park PhD , Julie A. Bradley MD, MHCDS , Nancy P. Mendenhall MD, FACR, FASTRO , Raymond B. Mailhot Vega MD, MPH , Teena Burchianti MSN, APRN, ANP-BC, OCN , Yawei Zhang PhD , Hardev Grewal PhD , Mohammad Saki PhD , Twyla Willoughby PhD, FAAPM , Perry B. Johnson PhD , Mark Artz PhD, MBA

Proton treatment using pencil-beam scanning (PBS) for patients with breast cancer offers advantages in achieving a conformal dose distribution while also reducing the cardiac dose. However, when employing 2 anterior fields to mitigate the effects of respiratory motion on dose delivery, managing the ipsilateral lung doses becomes critical due to the high linear-energy transfer (LET) at the distal end of the beams. Although the incidence of radiation pneumonitis (RP) after breast radiation therapy is relatively low, it is essential to address the cases that develop RP following proton treatment to minimize lung toxicity. We conducted a retrospective case study analyzing follow-up computed tomography images taken at 1 week, 1.5 months, and 4.5 months after the onset of the patient’s pneumonitis symptoms to correlate them with proton doses. The patient’s PBS treatment was prescribed at a dose of 50 Gy with an additional 10 Gy boost, using a relative biological effectiveness (RBE) of 1.1, delivered in 2 Gy daily fractions. Our histogram analysis revealed noticeable increases in Hounsfield units at a dose of 40 Gy (RBE = 1.1), underscoring a potential dose-volume parameter that could help minimize the occurrence of RP. Furthermore, the lung volume associated with the RP was encompassed with an iso-LET level greater than 5.0 keV/μm, with a proton dose exceeding 40 Gy (RBE = 1.1). In examining the LET-dependent RBE-weighted dose using the McNamara model in the original treatment plan, we found the volumes receiving more than 50 Gy (V_50Gy) and 40 Gy (V_40Gy) were 110 cc and 267 cc, respectively. By incorporating dose objectives of V_50Gy and V_40Gy to limit the ipsilateral lung volume into PBS plans, the volumes were successfully reduced to 0 cc and 3 cc, while maintaining target dose coverage and robustness. Optimizing a breast PBS plan (RBE = 1.1) using objectives that addressed both the V_50Gy and V_40Gy to minimize lung exposure was shown to be clinically feasible and should be considered as a strategy to reduce lung toxicity when treating breast cancer with PBS proton therapy.

使用铅笔束扫描（PBS）对乳腺癌患者进行质子治疗在获得适形剂量分布的同时也减少了心脏剂量方面具有优势。然而，当采用两个前场来减轻呼吸运动对剂量传递的影响时，由于光束远端的高线性能量转移（LET），管理同侧肺剂量变得至关重要。虽然乳房放射治疗后放射性肺炎（RP）的发生率相对较低，但必须解决质子治疗后发生RP的病例，以尽量减少肺毒性。我们进行了一项回顾性病例研究，分析了患者肺炎症状出现后1周、1.5个月和4.5个月的随访计算机断层扫描图像，以将其与质子剂量联系起来。患者的PBS治疗剂量为50戈瑞，外加10戈瑞，使用1.1的相对生物有效性（RBE），以每天2戈瑞的剂量给药。我们的直方图分析显示，在40 Gy的剂量下，Hounsfield单位显著增加（RBE = 1.1），强调潜在的剂量-体积参数可以帮助减少RP的发生。此外，与RP相关的肺体积被大于5.0 keV/μm的iso-LET水平包围，质子剂量超过40 Gy （RBE = 1.1）。在原始治疗方案中使用麦克纳马拉模型检查let依赖性rbe加权剂量时，我们发现接受超过50Gy （V50Gy）和40Gy （V40Gy）的体积分别为110 cc和267 cc。通过将V50Gy和V40Gy的剂量靶限制同侧肺体积纳入PBS计划，成功地将体积减少到0 cc和3 cc，同时保持靶剂量覆盖和稳健性。优化乳房PBS计划（RBE = 1.1），同时考虑V50Gy和V40Gy的目标，以最大限度地减少肺暴露，这在临床上是可行的，在使用PBS质子治疗乳腺癌时，应将其视为降低肺毒性的策略。

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引用次数: 0

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IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/S1879-8500(25)00284-X

引用次数: 0

In Regard to Ballas et al 关于巴拉斯等人

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.07.009

Parth Aphale PhD, Shashank Dokania BHMS, Himanshu Shekhar BHMS

引用次数: 0

PROshot: Neoadjuvant Radiation for Pancreatic Cancer, Radiation Alone for Oligometastatic Renal Cell Carcinoma, De-escalated Head and Neck Radiation, and Immunotherapy for Glioblastoma 前瞻：胰腺癌的新辅助放疗，少转移性肾细胞癌的单独放疗，降级头颈部放疗，胶质母细胞瘤的免疫治疗

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.10.001

Caleb Dulaney MD , Laura Dover MD, MSPH

引用次数: 0

Potential Value of 68Ga-DOTATATE Positron Emission Tomography for Skull Base Meningioma Radiation Treatment Planning 68Ga-DOTATATE正电子发射断层扫描在颅底脑膜瘤放射治疗规划中的潜在价值

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.08.003

Elizabeth L. McKone MD, William G. Breen MD

引用次数: 0

Clinician- and Patient-Reported Outcomes of Stereotactic Ablative Radiation Therapy for High-Risk Prostate Cancer 临床和患者报告的立体定向消融放疗治疗高危前列腺癌的结果。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.05.007

Helena B.Z. Logar MD, PhD , Angel Montero MD, PhD , Ovidio Hernando MD, PhD , Mercedes Lopez MD , Jeannette Valero MD, PhD , Raquel Ciervide MD, PhD , Beatriz Alvarez MD , Xin Chen-Zhao MD, PhD , Emilio Sanchez MD , Mariola Garcia-Aranda MD , Carmen Saiz MD , Daniel Zucca MSci , Leyre Alonso MSci , Miguel Sanchez MD , Rosa Alonso MD , Pedro Fernandez-Leton MSci , Carmen Rubio MD, PhD

Purpose

This study evaluated the feasibility and tolerability of SABR in patients with high- and very-high-risk prostate cancer.

Methods and Materials

A prospective study included patients with high-risk and N1 prostate cancer. SABR was delivered as 40 Gy in 8 Gy fractions, with optional elective nodal irradiation (26 Gy in 5.2 Gy fractions) and a 40 Gy nodal boost for N1 disease. The treatment protocol involved 24 to 36 months of androgen deprivation therapy, premedication with alpha-1 receptor antagonists, and dexamethasone (4 mg on treatment days). Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0, while quality of life was assessed using the EORTC QLQ-C30 and QLQ-PR25 questionnaires at the final check-up.

Results

The study included 96 patients (median age 77.2 years) with a median follow-up of 29.8 months. Elective nodal radiation therapy was delivered to 66.7% of patients, and 16.8% received a nodal boost. Acute grade 2 (G2) genitourinary and gastrointestinal (GI) events occurred in 5.2% and 7.3% of patients, respectively, with no grade ≥3 acute events. Late grade ≥2 genitourinary and GI events were observed in 7.8% and 15.7% of patients, respectively, including 1 grade 4 GI event. Common late symptoms included nocturia and rectal bleeding. Most patients (86.5%) reported no or minor difficulties posttreatment, though challenges with sexual activity, nocturia, and incontinence were noted. Physicians underestimated urgency and nocturia and overestimated rectal bleeding.

Conclusions

SABR delivering 40 Gy in 5 fractions is feasible and well-tolerated for high-risk prostate cancer, with minimal additional toxicity from elective nodal irradiation and a boost to N1 disease. These findings support SABR as an effective treatment, warranting further long-term studies.

目的：本研究评估立体定向消融放疗（SABR）治疗高、高危前列腺癌的可行性和耐受性。材料与方法：前瞻性研究纳入高危、N1前列腺癌患者。SABR以40gy / 8gy的剂量进行递送，可选择的节点照射（26gy / 5.2 Gy）和40gy的N1疾病节点强化。治疗方案包括24-36个月的雄激素剥夺治疗，预先使用α -1受体拮抗剂和地塞米松（治疗日4mg）。不良事件按CTCAE v5.0分级，终检时采用EORTC QLQ-C30和QLQ-PR25问卷评估生活质量。结果：研究纳入96例患者（中位年龄77.2岁），中位随访29.8个月。66.7%的患者接受了选择性淋巴结放疗，16.8%的患者接受了淋巴结强化。急性2级（G2）泌尿生殖系统（GU）和胃肠道（GI）事件分别发生在5.2%和7.3%的患者中，无≥3级急性事件。晚期≥2级GU和GI事件分别发生在7.8%和15.7%的患者中，包括1例4级GI事件。常见的晚期症状包括夜尿和直肠出血。大多数患者（86.5%）报告治疗后没有或有轻微困难，但注意到性活动、夜尿和尿失禁的挑战。医生低估了急症和夜尿症，高估了直肠出血。结论：对于高危前列腺癌，分5次给予40 Gy的SABR是可行的，并且耐受性良好，选择性淋巴结照射的额外毒性很小，并且对N1疾病有促进作用。这些发现支持SABR作为一种有效的治疗方法，值得进一步的长期研究。

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引用次数: 0

Shakuntala and the Ring of Recollection: A Lesson in the Theater of Memory and Wisdom 《沙昆塔拉与回忆之环：记忆与智慧剧场的一堂课》。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.08.004

Varun Kumar Chowdhry MD, MBA

引用次数: 0

A Case of Hydrogel Spacer Intravasation of the Internal Iliac Vein and Associated Thrombus Formation During Preparation for Prostate Cancer External Beam Radiation Therapy 前列腺癌外束放疗准备过程中髂内静脉内灌注水凝胶间隔剂及相关血栓形成一例。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.07.001

Jacob Eckstein MD , Mina S. Makary MD , Spero R. Cataland MD , Rebekah Young MD , Russel Palm MD , Dayssy A. Diaz Pardo MD , Therese Andraos MD , Doug Martin MD , Shang Jui Wang MD

Use of rectal spacer gel has been associated with decreased risk of radiation therapy (RT)-related rectal toxicity in clinical trials and has been increasingly adopted. Optimal management of spacer-related toxicities, such as rectal wall and vascular infiltration, remains poorly defined. To address this gap, we present a case of extensive hydrogel intravasation of the periprostatic venous plexus with development of associated bland thrombus extending to the level of the common iliac vein. The patient was evaluated for placement of an inferior vena cava (IVC) filter and anticoagulation by a multidisciplinary team. After undergoing 6 months of anticoagulation without IVC filter placement, both the hydrogel and the associated thrombus resolved asymptomatically. We review the timeline of these events, their associated symptomatology, our rationale in management of this clinical scenario, and propose a treatment paradigm.

在临床试验中，直肠间隔凝胶的使用与降低放射治疗（RT）相关直肠毒性的风险有关，并已被越来越多地采用。最佳管理间隔相关的毒性，如直肠壁和血管浸润，仍然不明确。为了解决这一差距，我们提出了一个病例广泛的水凝胶内渗前列腺周围静脉丛与发展相关的淡性血栓延伸到髂总静脉的水平。由多学科团队评估患者放置下腔静脉（IVC）过滤器和抗凝。经过6个月的抗凝治疗，未放置下腔静脉滤器，水凝胶和相关血栓均无症状消退。我们回顾了这些事件的时间线，它们的相关症状，我们在处理这种临床情况的基本原理，并提出了一种治疗范例。

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引用次数: 0

Volumetric Changes and Acute Toxicity With 68Ga Prostate-Specific Membrane Antigen Versus 18F-Fluciclovine Positron Emission Tomography/Computer Tomography Guided Postprostatectomy Radiation: Final Analysis of a Randomized Trial 68Ga前列腺特异性膜抗原与18f -氟氯梵PET/CT引导下前列腺切除术后放疗的体积变化和急性毒性：一项随机试验的最终分析

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.07.003

Vishal R. Dhere MD , David M. Schuster MD , Subir Goyal PhD , Eduard Schreibmann PhD , Nikhil T. Sebastian MD , Sagar A. Patel MD, MSCR , Sheela Hanasoge MBBS, PhD , Joseph W. Shelton MD , Pretesh R. Patel MD , Bruce W. Hershatter MD , Olayinka A. Abiodun-Ojo MD, MPH , Ismaheel O. Lawal MBBS, PhD , Ashesh B. Jani MD, MSEE

Purpose

We evaluated changes in radiation therapy target volume and acute toxicity using ⁶⁸Ga-prostate specific membrane antigen (PSMA) versus ¹⁸F-fluciclovine positron emission tomography (PET)/computed tomography in postprostatectomy patients with biochemical recurrence. We hypothesized that both fluciclovine and PSMA-guided radiation therapy would (1) significantly change pre-PET radiation therapy volumes and (2) show similar toxicity.

Methods and Materials

We performed an institutional review board-approved, randomized trial comparing fluciclovine (Arm 1) and PSMA (Arm 2)-guided postprostatectomy radiation therapy in patients with detectable prostate-specific antigen after prostatectomy. Treatment volumes were rigidly defined based on PET, and simultaneous integrated boosts to PET uptake in the prostate bed (70.2-76.0 Gy) or pelvis (54.0-56.0 Gy) were allowed. Clinical target volumes (CTVs) included: prostate bed (CTV_PB); pelvic lymph nodes (CTV_PLV); and volumetric constraints for bladder(-CTV) and rectum. Acute genitourinary and gastrointestinal (GI) toxicity (per Common Terminology Criteria for Adverse Events v5.0) was assessed <90 days from treatment.

Results

In total, 140 patients were enrolled with 70 randomized to each arm; 11 Arm 1 and 10 Arm 2 patients did not receive radiation on study and were excluded. Fluciclovine and PSMA incorporation increased both CTV_PB and CTV_PLV (P < .01). More fluciclovine patients received prostate bed boosts (45 of 59 patients vs 26 of 60 patients; P < .01), but there was no difference in proportion receiving pelvic nodal boosts (10 of 15 patients vs 9of 16 patients, fluciclovine vs PSMA; P = .97). Dose constraints were met for most patients. Rates of grade 2 genitourinary (17.0% vs 6.7%, fluciclovine vs PSMA; P = .15) and GI (5.1% vs 1.7%, fluciclovine vs PSMA; P = .47) toxicity were low, with no grade 3+ events. Higher rectal and bladder dose metrics correlated with GI toxicity (P < .05), but use of simultaneous integrated boosts was not associated with acute toxicity.

Conclusions

Although both PSMA and fluciclovine use modestly increased target volumes, significantly more fluciclovine patients received prostate bed boosts. Planning directives were met for most patients, and acute toxicity was mild in both Arms. Analysis of biochemical control, late toxicity, and patient-reported outcomes are forthcoming.

目的：应用68ga -前列腺特异性膜抗原（PSMA）和18f -氟氯洛夫（氟氯洛夫）PET/CT评价前列腺切除术后生化复发患者放射（XRT）靶体积和急性毒性的变化。我们假设氟氯薇碱和PSMA引导下的XRT会a)显著改变pet前XRT体积，b)显示相似的毒性。方法和材料：我们进行了一项irb批准的随机试验，比较氟氯薇（1组）和PSMA（2组）引导的前列腺切除术后XRT治疗前列腺切除术后可检测到PSA的患者。根据PET严格定义治疗量，允许在前列腺床（70.2-76.0Gy）或骨盆（54.0-56.0Gy）同时进行PET摄取综合增强（SIB）。容积包括：前列腺床（CTVPB）；骨盆淋巴结（CTVPLV）；膀胱（-CTV）和直肠的体积限制。急性CTCAE v5.0泌尿生殖系统（GU）和胃肠道（GI）毒性评估结果：140例患者入组，每组70例；11组1和10组2患者在研究中未接受放疗，因此被排除在外。结论：尽管PSMA和氟氯洛夫的使用都适度地增加了靶体积，但氟氯洛夫患者的前列腺床明显增加。大多数患者符合计划指示，两组急性毒性均为轻度。分析生化控制，晚期毒性和患者报告的结果即将到来。

{"title":"Volumetric Changes and Acute Toxicity With 68Ga Prostate-Specific Membrane Antigen Versus 18F-Fluciclovine Positron Emission Tomography/Computer Tomography Guided Postprostatectomy Radiation: Final Analysis of a Randomized Trial","authors":"Vishal R. Dhere MD , David M. Schuster MD , Subir Goyal PhD , Eduard Schreibmann PhD , Nikhil T. Sebastian MD , Sagar A. Patel MD, MSCR , Sheela Hanasoge MBBS, PhD , Joseph W. Shelton MD , Pretesh R. Patel MD , Bruce W. Hershatter MD , Olayinka A. Abiodun-Ojo MD, MPH , Ismaheel O. Lawal MBBS, PhD , Ashesh B. Jani MD, MSEE","doi":"10.1016/j.prro.2025.07.003","DOIUrl":"10.1016/j.prro.2025.07.003","url":null,"abstract":"<div><h3>Purpose</h3><div>We evaluated changes in radiation therapy target volume and acute toxicity using <sup>68</sup>Ga-prostate specific membrane antigen (PSMA) versus <sup>18</sup>F-fluciclovine positron emission tomography (PET)/computed tomography in postprostatectomy patients with biochemical recurrence. We hypothesized that both fluciclovine and PSMA-guided radiation therapy would (1) significantly change pre-PET radiation therapy volumes and (2) show similar toxicity.</div></div><div><h3>Methods and Materials</h3><div>We performed an institutional review board-approved, randomized trial comparing fluciclovine (Arm 1) and PSMA (Arm 2)-guided postprostatectomy radiation therapy in patients with detectable prostate-specific antigen after prostatectomy. Treatment volumes were rigidly defined based on PET, and simultaneous integrated boosts to PET uptake in the prostate bed (70.2-76.0 Gy) or pelvis (54.0-56.0 Gy) were allowed. Clinical target volumes (CTVs) included: prostate bed (CTV<sub>PB</sub>); pelvic lymph nodes (CTV<sub>PLV</sub>); and volumetric constraints for bladder(-CTV) and rectum. Acute genitourinary and gastrointestinal (GI) toxicity (per Common Terminology Criteria for Adverse Events v5.0) was assessed <90 days from treatment.</div></div><div><h3>Results</h3><div>In total, 140 patients were enrolled with 70 randomized to each arm; 11 Arm 1 and 10 Arm 2 patients did not receive radiation on study and were excluded. Fluciclovine and PSMA incorporation increased both CTV<sub>PB</sub> and CTV<sub>PLV</sub> (<em>P</em> < .01). More fluciclovine patients received prostate bed boosts (45 of 59 patients vs 26 of 60 patients; <em>P</em> < .01), but there was no difference in proportion receiving pelvic nodal boosts (10 of 15 patients vs 9of 16 patients, fluciclovine vs PSMA; <em>P</em> = .97). Dose constraints were met for most patients. Rates of grade 2 genitourinary (17.0% vs 6.7%, fluciclovine vs PSMA; <em>P</em> = .15) and GI (5.1% vs 1.7%, fluciclovine vs PSMA; <em>P</em> = .47) toxicity were low, with no grade 3+ events. Higher rectal and bladder dose metrics correlated with GI toxicity (<em>P</em> < .05), but use of simultaneous integrated boosts was not associated with acute toxicity.</div></div><div><h3>Conclusions</h3><div>Although both PSMA and fluciclovine use modestly increased target volumes, significantly more fluciclovine patients received prostate bed boosts. Planning directives were met for most patients, and acute toxicity was mild in both Arms. Analysis of biochemical control, late toxicity, and patient-reported outcomes are forthcoming.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages e38-e46"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Computed Tomography Guided Brachytherapy With Hybrid Applicators: An Effective Curative Treatment for Vaginal Cuff Recurrences 计算机断层扫描（ct）引导下的混合涂抹器近距离治疗：阴道袖口复发的有效治疗方法。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.06.004

Evrim Duman MD , Sinem Karahan MSc , Busra Tavli MSc , Huseyin Sertel MSc , Merdan Fayda MD

Purpose

This study evaluated the clinical feasibility of hybrid brachytherapy and the benefits of computed tomography (CT) guidance for optimizing applicator position and needle placement via Utrecht or Venezia applicators in the curative treatment of vaginal cuff recurrence.

Methods and Materials

Sixteen previously operated patients with gynecological cancer treated with hybrid brachytherapy for vaginal cuff recurrence from 2018 to 2022 were included. The applicators were selected according to vaginal diameter and tumor location. CT scans were conducted before and after needle insertion. The high-risk clinical target volume (CTV-HR), including residual disease and suspicious regions, as well as normal tissues, was contoured. The dosimetry goal was to ensure that the reference isodose (100%) adequately covered the CTV-HR while minimizing overlap with organs at risk. The needle shifts were assessed according to their locations. Outcome measures, including disease-free survival and overall survival, were analyzed.

Results

A total of 64 fractions were administered, with Utrecht applicators used for 62.5% (n = 40). The median equivalent doses in 2 Gy fractions (EQD2 D90) for 90% of the CTV-HR and intermediate-risk CTV were 87.64 Gy (57.45-97.78 Gy) and 69 Gy (31.33-76.73 Gy), respectively. Among the 696 possible needle positions, 419 interstitial needles (60%) were successfully inserted. The median number of needles per fraction was 6 (range, 1-12). Needle shifts occurred in 93% of the patients, predominantly in the anteromedial direction, with a mean magnitude of 0.21 ± 0.14 cm. The median follow-up was 14 months, with a 90% local tumor control rate and an 85% overall survival rate over 2 years, without severe side effects.

Conclusions

Despite challenges in treating vaginal cuff recurrence in patients with gynecological cancers, hybrid brachytherapy provides an effective and personalized approach. Although needle shifts are common, they do not significantly impact dosimetric outcomes, highlighting the method's adaptability and reliability.

目的：本研究评估了混合近距离放射治疗的临床可行性，以及计算机断层扫描（CT）指导下通过Utrecht®或Venezia®涂敷器优化涂敷器位置和针头放置在阴道袖带复发治疗中的益处。方法与材料：选取2018-2022年接受混合近距离治疗阴道袖口复发的16例既往手术妇科癌症患者。根据阴道直径和肿瘤位置选择施药器。穿刺前后分别进行CT扫描。高危临床靶体积（CTV-HR），包括残留病变和可疑区域，以及正常组织。剂量学的目标是确保参考等剂量（100%）充分覆盖CTV-HR，同时尽量减少与危险器官的重叠。针的移动是根据它们的位置来评估的。结果指标，包括无病生存期和总生存期进行了分析。结果：共给药64个部位，使用乌得勒支®涂药器占62.5% （n=40）。对于90%的CTV- hr和中危CTV， 2 Gy分数（EQD2 D90）的中位等效剂量分别为87.64 Gy （57.45-97.78 Gy）和69 Gy （31.33-76.73 Gy）。在696个可能的针位中，有419根间质针（60%）成功插入。每个分数的针数中位数为6（范围：1-12）。93%的患者发生针移，以前内侧方向为主，平均移位幅度为0.21±0.14 cm。中位随访14个月，局部肿瘤控制率90%，两年总生存率85%，无严重副作用。结论：尽管在治疗妇科癌症患者阴道袖口复发方面存在挑战，但混合近距离放疗提供了一种有效且个性化的方法。虽然针头移动很常见，但它们不会显著影响剂量学结果，突出了该方法的适应性和可靠性。

{"title":"Computed Tomography Guided Brachytherapy With Hybrid Applicators: An Effective Curative Treatment for Vaginal Cuff Recurrences","authors":"Evrim Duman MD , Sinem Karahan MSc , Busra Tavli MSc , Huseyin Sertel MSc , Merdan Fayda MD","doi":"10.1016/j.prro.2025.06.004","DOIUrl":"10.1016/j.prro.2025.06.004","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluated the clinical feasibility of hybrid brachytherapy and the benefits of computed tomography (CT) guidance for optimizing applicator position and needle placement via Utrecht or Venezia applicators in the curative treatment of vaginal cuff recurrence.</div></div><div><h3>Methods and Materials</h3><div>Sixteen previously operated patients with gynecological cancer treated with hybrid brachytherapy for vaginal cuff recurrence from 2018 to 2022 were included. The applicators were selected according to vaginal diameter and tumor location. CT scans were conducted before and after needle insertion. The high-risk clinical target volume (CTV-HR), including residual disease and suspicious regions, as well as normal tissues, was contoured. The dosimetry goal was to ensure that the reference isodose (100%) adequately covered the CTV-HR while minimizing overlap with organs at risk. The needle shifts were assessed according to their locations. Outcome measures, including disease-free survival and overall survival, were analyzed.</div></div><div><h3>Results</h3><div>A total of 64 fractions were administered, with Utrecht applicators used for 62.5% (<em>n</em> = 40). The median equivalent doses in 2 Gy fractions (EQD2 D90) for 90% of the CTV-HR and intermediate-risk CTV were 87.64 Gy (57.45-97.78 Gy) and 69 Gy (31.33-76.73 Gy), respectively. Among the 696 possible needle positions, 419 interstitial needles (60%) were successfully inserted. The median number of needles per fraction was 6 (range, 1-12). Needle shifts occurred in 93% of the patients, predominantly in the anteromedial direction, with a mean magnitude of 0.21 ± 0.14 cm. The median follow-up was 14 months, with a 90% local tumor control rate and an 85% overall survival rate over 2 years, without severe side effects.</div></div><div><h3>Conclusions</h3><div>Despite challenges in treating vaginal cuff recurrence in patients with gynecological cancers, hybrid brachytherapy provides an effective and personalized approach. Although needle shifts are common, they do not significantly impact dosimetric outcomes, highlighting the method's adaptability and reliability.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages 74-85"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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