Brachytherapy最新文献

{"title":"Development and implementation of a 3d-HDR brachytherapy program for cervical cancer in a sub-Saharan African centre","authors":"Adedayo Joseph ,&nbsp;Onyinye Balogun ,&nbsp;Bolanle Adegboyega ,&nbsp;Omolola Salako ,&nbsp;Omoruyi Credit Irabor ,&nbsp;Azeezat Ajose ,&nbsp;Samuel Adeneye ,&nbsp;Adewumi Alabi ,&nbsp;Ephraim Ohazurike ,&nbsp;Chibuzor F. Ogamba ,&nbsp;Aishat Oladipo ,&nbsp;Olufunmilayo Fagbemide ,&nbsp;Muhammad Habeebu ,&nbsp;David Puthoff ,&nbsp;Adedayo Onitilo ,&nbsp;Wilfred Ngwa ,&nbsp;Chika Nwachukwu","doi":"10.1016/j.brachy.2024.10.002","DOIUrl":"10.1016/j.brachy.2024.10.002","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Cervical cancer is the second most common cancer among women in Nigeria where, the gap between need for, and access to, radiation therapy including brachytherapy is significant. This report documents the implementation of the first three-dimensional high-dose-rate (3D-HDR) brachytherapy service for cervical cancer in Nigeria.</div></div><div><h3>PURPOSE</h3><div>This report details the steps taken to implement the 3D-HDR brachytherapy program, the challenges faced, and the adaptive strategies employed to overcome them. Our objective is to provide a guide for teams and centers in similar resource-restricted settings to implement 3D-HDR brachytherapy services, by leveraging our shared experience and lessons learned.</div></div><div><h3>METHOD AND METERIALS</h3><div>The implementation process required investment in infrastructure: creating a dedicated brachytherapy suite equipped with modern technology; and human capital: conducting both virtual and hands-on training for staff; and involving international experts during the initial treatment phases. Quality assurance protocols were established to ensure the accuracy and safety of treatments. Key adaptations included extensive remote training, international experts flying in for the initiation phase, and preemptively re-ordering the radioisotope to prevent delays.</div></div><div><h3>RESULTS</h3><div>The 3D-HDR brachytherapy program was successfully implemented, with five cases treated in the first 2 months despite challenges such as high equipment costs, expertise and proficiency needs, and source replacement delays. Continuous training and quality assurance measures ensured the program's sustainability and effectiveness.</div></div><div><h3>CONCLUSIONS</h3><div>Implementing a 3D-HDR brachytherapy program in a system with restricted resources is possible with thorough planning, flexible strategies, and adaptive measures. We document our experience to provide insights for other institutions aiming to establish similar programs. Collaboration and innovative financial strategies are essential for ensuring sustainable access to cancer treatment in the region. Strategies such as remote training and proactive resource management, are critical for overcoming implementation barriers.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 258-264"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early outcomes following local salvage treatment with MRI-assisted low-dose rate brachytherapy (MARS) for MRI-visible postsurgical bed recurrences and focal intraprostatic recurrences","authors":"Comron Hassanzadeh ,&nbsp;Osama Mohamad ,&nbsp;Teresa Bruno ,&nbsp;Lin Wang ,&nbsp;Rajat Kudchakar ,&nbsp;Tharakeswara Bathala ,&nbsp;Jeremiah Sanders ,&nbsp;Henry Mok ,&nbsp;Sean McGuire ,&nbsp;Deborah Kuban ,&nbsp;Karen Hoffman ,&nbsp;Quynh Nguyen ,&nbsp;Ryan Park ,&nbsp;Howard Thames ,&nbsp;Paul Corn ,&nbsp;Brian Chapin ,&nbsp;Seungtaek Choi ,&nbsp;Chad Tang ,&nbsp;Steven Frank","doi":"10.1016/j.brachy.2024.10.015","DOIUrl":"10.1016/j.brachy.2024.10.015","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>To determine outcomes of MRI-assisted radiosurgery (MARS) for salvage brachytherapy using the radioisotope ¹⁰³Pd after various upfront treatments including surgery, external beam radiotherapy, and brachytherapy.</div></div><div><h3>METHODS</h3><div>We retrospectively reviewed data for patients who underwent salvage MARS for intraprostatic lesions or prostate bed recurrences from 2016 to 2022. Biochemical recurrence, prostate cancer–specific, and overall survival, and the cumulative incidences of toxicities, were determined by Kaplan-Meier estimates. Cox proportional hazards models were used to determine associations between clinical and treatment variables and risk of toxicity.</div></div><div><h3>RESULTS</h3><div>Study included 31 patients with local recurrence after initial definitive treatment. Four (13%) were initially treated with prostatectomy and salvage radiation, twenty-four (77%) with external beam radiation, and three with brachytherapy. Most had intermediate- or high-risk prostate cancer at the time of diagnosis. Twenty-two patients (71%) had focal-gland and nine (29%) had whole-gland MARS LDR salvage brachytherapy. Median follow-up was 35–28 months. By last follow-up, 5 patients (16%) experienced recurrence and started ADT, 3 patients started ADT before experiencing recurrence due to physician discretion, and 23 patients (74%) remained without recurrence. No patients died of prostate cancer. Median PSA nadir for recurrence-free patients was 0.2 ng/mL (range, 0–0.9 ng/mL). Grade 3 toxicities occurred in 4 patients (13%) including 3 patients (13%) with genitourinary events only and 1 patient (3%) with both a grade 3 genitourinary and a grade 3 gastrointestinal event.</div></div><div><h3>CONCLUSIONS</h3><div>In this modern series of patients undergoing salvage MARS with ¹⁰³Pd, we observed acceptable toxicity and early, promising biochemical disease control. These findings highlight the broader applicability of salvage MARS regardless of upfront treatment modality.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 231-237"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of robust optimization on patient specific error thresholds for high dose rate prostate brachytherapy source tracking","authors":"Dylan Koprivec ,&nbsp;Cedric Belanger ,&nbsp;Luc Beaulieu ,&nbsp;Philippe Y. Chatigny ,&nbsp;Anatoly Rosenfeld ,&nbsp;Dean Cutajar ,&nbsp;Marco Petasecca ,&nbsp;Andrew Howie ,&nbsp;Joseph Bucci ,&nbsp;Joel Poder","doi":"10.1016/j.brachy.2024.11.012","DOIUrl":"10.1016/j.brachy.2024.11.012","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The purpose of this study was to compare the effect of catheter shift errors and determine patient specific error thresholds (PSETs) for different high dose rate prostate brachytherapy (HDRPBT) plans generated by different forms of inverse optimization.</div></div><div><h3>METHODS</h3><div>Three plans were generated for 50 HDRPBT patients and PSETs were determined for each of the 3 plans. Plan 1 was the original Oncentra Prostate (v4.2.2.4, Elekta Brachytherapy, Veenendaal, The Netherlands) plan, the second plan used the graphical processor unit multi-criteria optimization (gMCO) algorithm, and plan 3 used gMCO but had a robustness parameter as an additional optimization criterion (gMCOr). gMCO and gMCOr plans were selected from a pool of 2000 pareto optimal plans. gMCO plan selection involved increasing prostate V100% and reducing rectum Dmax/urethra D01.cc progressively until only 1 plan remained. The gMCOr plan was the most robust plan (using robustness parameter) that met the clinical DVH criteria (V100% ≥ 95%, rectum Dmax ≤ 80%, urethra D0.1cc ≤ 118%). PSETs were determined using catheter shift software.</div></div><div><h3>RESULTS</h3><div>The initial dose volume histogram (DVH) characteristics showed all 50 patient plans met a prostate V100% &gt; 95% and resulted in significant reduction in rectum Dmax and urethra D0.1cc for gMCO and gMCOr plans. No single plan showed benefits in PSETs for all shift directions compared to the other plans, however gMCO and gMCOr plans exhibit the best initial DVH characteristics assuming no errors occur. The robustness parameter showed no significant impact when considered in plan optimization.</div></div><div><h3>CONCLUSIONS</h3><div>PSETs were found to be equivalent regardless of optimization method. Indicating, no single optimization method can significantly increase the patient specific thresholds.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 281-292"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mature effectiveness and toxicity outcomes associated with three treatment schedules of high-dose-rate brachytherapy monotherapy for favorable-risk prostate cancer","authors":"Kamran Salari ,&nbsp;Hong Ye ,&nbsp;Alvaro A. Martinez ,&nbsp;Evelyn Sebastian ,&nbsp;Amy Limbacher ,&nbsp;Kim Marvin ,&nbsp;Andrew B. Thompson ,&nbsp;Sirisha R. Nandalur ,&nbsp;Peter Y. Chen ,&nbsp;Daniel J. Krauss","doi":"10.1016/j.brachy.2024.10.008","DOIUrl":"10.1016/j.brachy.2024.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To present long-term toxicity and effectiveness outcomes of three prostate high-dose-rate (HDR) brachytherapy schedules: 38 Gy in 4 fractions, 24 Gy in 2 fractions, and 27 Gy in 2 fractions for men with low- or intermediate-risk prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>Patients treated with HDR brachytherapy monotherapy for prostate cancer were identified in a prospectively maintained, single institution database. Patients with AJCC T-stage ≤ T2b, Gleason score ≤ 7, prostate-specific antigen level ≤ 20 ng/mL, and ≥2 years of follow-up were included.</div></div><div><h3>Results</h3><div>671 patients were evaluated. 310 patients received 38 Gy in 4 fractions, 129 received 24 Gy in 2 fractions, and 232 received 27 Gy in 2 fractions. Median follow-up was 12.8 years, 10.6 years, and 8.1 years (<em>p</em> &lt; 0.001), respectively. 231 (74.5%), 92 (71.3%), and 81 (34.9%) patients (<em>p</em> &lt; 0.001) had low-risk disease. Rates of acute grade ≥2 GU toxicity were 11.1%, 12.3%, and 25.0% (<em>p</em> = 0.004), while chronic grade ≥2 GU toxicity were 17.0%, 22.6%, and 26.5% (<em>p</em> = 0.06). For low-risk patients, 10-year overall survival (OS), freedom from biochemical failure (ffBF), local control (LC), and freedom from distant metastasis (ffDM) were 86.6%, 93.3%, 97.9%, and 99.3%. For intermediate-risk patients, 10-year OS, ffBF, LC, and ffDM were 89.5%, 82.6%, 90.5%, and 97.4%. Higher PSA, higher Gleason score, perineural invasion, and 24 Gy or 27 Gy treatment schedules were predictors of biochemical failure.</div></div><div><h3>Conclusions</h3><div>HDR brachytherapy monotherapy with 38 Gy in 4 fractions was associated with improved long-term ffBF compared with 24 Gy/27 Gy in 2 fractions, without any associated increase in GI or GU toxicity rates.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 210-222"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of time and implants in high-dose rate image-guided adaptive brachytherapy for locally advanced cervical cancer","authors":"Leonel Varela Cagetti ,&nbsp;Laurence Gonzague-Casabianca ,&nbsp;Marjorie Ferré ,&nbsp;Julia Gilhodes ,&nbsp;Eric Lambaudie ,&nbsp;Guillaume Blache ,&nbsp;Camille Jauffret ,&nbsp;Magalie Provansal ,&nbsp;Renaud Sabatier ,&nbsp;Agnès Tallet","doi":"10.1016/j.brachy.2024.11.010","DOIUrl":"10.1016/j.brachy.2024.11.010","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To compare the clinical outcomes of two different schedules of modern image-guided adaptive brachytherapy (IGABT) in patients underwent chemoradiotherapy (CCRT) and high-dose rate (HDR) brachytherapy (BT) for locally advanced cervical cancer treated (LACC)</div></div><div><h3>METHODS AND MATERIALS</h3><div>Data from medical records of all consecutive patients with histologically proven cervical cancer (FIGO 2018 stage IB-IVA) treated by HDR-BT after CCRT at our institution between 2016 and 2021 were reviewed.</div></div><div><h3>RESULTS</h3><div>Two hundred and 8 patients with LACC FIGO 2018 stages (IB 20.7%; II 26.5%, III 51%, IVA 1.9%) underwent brachytherapy at our institution. Depending on initial clinical features of disease and the clinical response to CCRT, HDR-BT was delivered with one implant (BT1i) or two implants (BT2i) in 39% and 61% of patients respectively. FIGO stages (≥IIB) were 63% vs. 78% for BT1i and BT2i patient group respectively. Combined brachytherapy technique [endocavitary/interstitial (IC/IS)] was required in 14.8% vs. 68.5% for BT1i and BT2i respectively. With a median follow-up of 32.5 months (95% confidence interval, [29.7–35.8]), l<em>ocal relapse was observed in sixteen patients: 8 patients (3.8%) had local (exclusive) relapse and 8 patients (3.8%) had locally persistent and progressive disease</em>, without significant difference for each BT modality group (<em>p</em> = 0.27), even if BT2i group had more aggressive initial disease. The estimated 3-year disease free survival and overall survival for the entire population was 69% (95% confidence interval, [62–75%]) and 88% (95% confidence interval, [82–92%]) respectively. There was a significant difference in the incidence of global toxicity grade G≥2 in favour to the BT2i group (<em>p</em> = 0.026).</div></div><div><h3>CONCLUSIONS</h3><div>HDR brachytherapy delivered with a long time interval between fractions, two implants, and combined IC/IS brachytherapy is the best way to ensure local control and to perform IGABT with low toxicity, even in advanced stages of disease.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 248-257"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective study on ruthenium-106 and strontium-90 eye-plaques treatment for retinoblastoma: 16-years clinical experience","authors":"Andrey A. Yarovoy,&nbsp;Denis P. Volodin,&nbsp;Vera A. Yarovaya","doi":"10.1016/j.brachy.2024.11.008","DOIUrl":"10.1016/j.brachy.2024.11.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To retrospectively evaluate the efficacy of plaque brachytherapy for the treatment of retinoblastoma.</div></div><div><h3>METHODS</h3><div>We retrospectively reviewed the clinical records of 163 patients (186 eyes, 333 tumors) treated with brachytherapy (¹⁰⁶Ru or ⁹⁰Sr plaques) for intraocular retinoblastoma between November 2007 and August 2023.</div></div><div><h3>RESULTS</h3><div>Complete tumor control was achieved in 273 tumors (82%). Incomplete tumor control was observed in 44 tumors (13%). Thirteen tumors presented with tumor progression. Three tumors relapsed after brachytherapy. On multivariate statistical analysis apex dose ≤ 85 Gy (for ¹⁰⁶Ru) (<em>p</em> = 0.03), dark fundus pigmentation (<em>p =</em> 0.005) and intraarterial chemotherapy-brachytherapy period &lt; 2 months (<em>p</em> = 0.001) demonstrated significant effect on brachytherapy insufficiency.</div><div>Radiation-induced complications occurred in 62 eyes (33%). The most frequent complications were nonproliferative retinopathy (n = 39, 21%), optic neuropathy (n = 29, 16%) and vitreous hemorrhage (n = 29, 16%). Multivariate statistical analysis showed central localization (<em>p</em> = 0.005), tumor thickness &gt; 2.7 mm (p = 0.04) and larger plaque diameter (&gt;14 mm) (<em>p =</em> 0.035) to be the most significant variables for brachytherapy-associated complications.</div><div>Eye retention was achieved in 91% of the treated eyes (n = 169). 17 eyes (9%) were enucleated. The reasons for enucleation were tumor recurrence or uncontrolled tumor growth (n = 7), anterior chamber involvement (n = 3), recurrent active vitreous seeding (n = 1), inability of adequate tumor monitoring due to opaque media (dense total vitreous hemorrhage or total retinal detachment) (n = 3), subatrophy of the eye with functional blindness (n = 3).</div></div><div><h3>CONCLUSION</h3><div>Overall, Beta-ray brachytherapy proved to be a highly effective method of retinoblastoma treatment with excellent local tumor control, eye preservation rate and acceptable incidence of curable radiation-induced complications.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 265-272"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D-printed radiopaque episcleral plaques with radioactive collimating cavities for enhanced dose delivery in brachytherapy","authors":"Souheib Zekraoui ,&nbsp;Théophraste Lescot ,&nbsp;Mahdokht Akbari Taemeh ,&nbsp;Marc-André Fortin","doi":"10.1016/j.brachy.2024.12.001","DOIUrl":"10.1016/j.brachy.2024.12.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Episcleral plaque brachytherapy (EPBT) is a well-established treatment. However, the lateral dose to healthy tissues, such as the sclera, retina, and optic nerve is often problematic and results in side effects. This study proposes an innovative approach based on the 3D-printing of radiopaque polymer plaques featuring cylindrical radioactive cavities (CRC) with a potential collimating effect on radiation delivery to tumors.</div></div><div><h3>METHODS AND MATERIALS</h3><div>A CAD model based on the COMS protocol was created and 3D-printed using radiopaque PEEK polymer. Cylindrical cavities (1 mm depth/diameter) were evenly spaced on the plaque's inner surface. Two radioactive layouts (RL₁: uniform loading; RL₂: radial gradient loading) were designed. µCT imaging was used to assess the geometric accuracy of the 3D-printed CRC EPs, and dose distribution was evaluated for the two (2) radioactive layouts using MAGIC-pf gel dosimetry and <em>T₂</em>-weighted MRI. The resulting dose profiles were compared with those generated by both COMS and SEP plaques.</div></div><div><h3>RESULTS</h3><div>Radiopaque CRC EPs showed higher central axis dose deposition while minimizing lateral overexposure compared to COMS and SEP plaques, while also providing robust back-shielding. Dose profiles from RL₁ CRC EPs (uniform layout) extended deeper into the eye, whereas RL₂ CRC EPs (with gradient) exhibited a more rapid dose fall-off, producing a concentrated, spherical dose distribution.</div></div><div><h3>CONCLUSIONS</h3><div>3D-printed radiopaque EPs with radioactivity encapsulated in cylindrical cavities demonstrated the ability to achieve more forward-projected dose profiles in EPBT. This fabrication design and a modulated radioactivity distribution across the EP surface would enable more precise and deeper dose delivery while reducing radiation exposure to lateral healthy tissues.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 354-363"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076719","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}

{"title":"Towards U-Net-based intraoperative 2D dose prediction in high dose rate prostate brachytherapy","authors":"Eric Knull ,&nbsp;Christopher W. Smith ,&nbsp;Aaron D. Ward ,&nbsp;Aaron Fenster ,&nbsp;Douglas A. Hoover","doi":"10.1016/j.brachy.2024.11.007","DOIUrl":"10.1016/j.brachy.2024.11.007","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Poor needle placement in prostate high-dose-rate brachytherapy (HDR-BT) results in sub-optimal dosimetry and mentally predicting these effects during HDR-BT is difficult, creating a barrier to widespread availability of high-quality prostate HDR-BT.</div></div><div><h3>PURPOSE</h3><div>To provide earlier feedback on needle implantation quality, we trained machine learning models to predict 2D dosimetry for prostate HDR-BT on axial TRUS images.</div></div><div><h3>METHODS AND MATERIALS</h3><div>Clinical treatment plans from 248 prostate HDR-BT patients were retrospectively collected and randomly split 80/20 for training/testing. Fifteen U-Net models were implemented to predict the 90%, 100%, 120%, 150%, and 200% isodose levels in the prostate base, midgland, and apex. Predicted isodose lines were compared to delivered dose using Dice similarity coefficient (DSC), precision, recall, average symmetric surface distance, area percent difference, and 95th percentile Hausdorff distance. To benchmark performance, 10 cases were retrospectively replanned and compared against the clinical plans using the same metrics.</div></div><div><h3>RESULTS</h3><div>Models predicting 90% and 100% isodose lines at midgland performed best, with median DSC of 0.97 and 0.96, respectively. Performance declined as isodose level increased, with median DSC of 0.90, 0.79, and 0.65 in the 120%, 150%, and 200% models. In the base, median DSC was 0.94 for 90% and decreased to 0.64 for 200%. In the apex, median DSC was 0.93 for 90% and decreased to 0.63 for 200%. Median prediction time was 25 ms.</div></div><div><h3>CONCLUSION</h3><div>U-Net models accurately predicted HDR-BT isodose lines on 2D TRUS images sufficiently quickly for real-time use. Incorporating auto-segmentation algorithms will allow intra-operative feedback on needle implantation quality.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 328-338"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820425","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}

{"title":"Postoperative high-dose-rate brachytherapy alone in stage T1-3N0M0 oral cancer with negative prognostic factors: A retrospective study","authors":"Luboš Tuček ,&nbsp;Igor Sirák ,&nbsp;Denisa Pohanková ,&nbsp;Linda Kašaová ,&nbsp;Jakub Grepl ,&nbsp;Petr Paluska ,&nbsp;Miroslav Hodek ,&nbsp;Milan Vošmik ,&nbsp;Banni Aml Mustafa ,&nbsp;Eva Čermánková ,&nbsp;Jiří Petera","doi":"10.1016/j.brachy.2024.03.001","DOIUrl":"10.1016/j.brachy.2024.03.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate treatment outcomes and toxicity in patients with stage T1-3N0M0 oral cancer treated with surgery followed by high-dose-rate brachytherapy (HDR-BT).</div></div><div><h3>Methods and materials</h3><div>Retrospective study of 50 patients with stage T1-T3N0 tongue and floor-of-mouth cancer who underwent tumour excision (+ elective neck dissection) followed by postoperative HDR-BT due to the presence of negative prognostic factors (close or positive resection margins, lymphovascular and/or perineural invasion, deep invasion). The plastic tube technique (dose: 18 x 3 Gy b.i.d.) was used. Survival outcomes, toxicity, and prognostic factors were evaluated.</div></div><div><h3>Results</h3><div>At a median follow-up of 81 months (range, 4-121), actuarial 5-year local control (LC), nodal control (NC) and progression-free survival (PFS) rates were 79%, 69%, and 64%. After salvage treatment (surgery + external beam radiotherapy), LC, NC, and PFS increased to 87%, 77%, and 72.3%, respectively. Five-year overall survival and cancer-specific survival (CSS) rates were 73% and 77%. Treatmentrelated toxicity included two cases of mandibular osteoradionecrosis and five cases of small soft tissue necrosis. T stage was significantly correlated with nodal control (p=0.02) and CSS (p=0.04). Tumour grade correlated with DFS (p=0.01).</div></div><div><h3>Conclusion</h3><div>Postoperative HDR-BT 18 x 3 Gy b.i.d. seems to be an effective method in patients with T1-3N0M0 oral cancer with negative prognostic factors after tumour resection.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 273-280"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of dose distribution to the tumor and organs at risk for cervical cancer patients treated using HDR-ICBT without central tandem applicator: A single center based experience","authors":"Jonasi A. Foya ,&nbsp;Mwingereza J. Kumwenda ,&nbsp;Khamis O. Amour ,&nbsp;Jofrey J. Masana","doi":"10.1016/j.brachy.2024.10.016","DOIUrl":"10.1016/j.brachy.2024.10.016","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Cervical cancer is the most prevalent type of cancer among women in numerous low and middle-income countries. Tandem-based applicator is a widely used technique in High Dose Rate Intercavitary Brachytherapy (HDR-ICBT) for treating cervical cancer. For cases where central tandem insertion is not feasible due to patient-specific conditions, a ring-only applicator is used as an alternative. This paper presents an assessment of the impacts of dose distribution on cervical cancer treatment using HDR-ICBT without a central tandem applicator.</div></div><div><h3>Materials and method</h3><div>Total 30 patients with cervical cancer (stage IB to IVA) who received brachytherapy with a ring applicator alone were singled out and used in the study. Orthogonal radiographs were used during dose treatment planning.</div></div><div><h3>Results</h3><div>Results indicate that the dose normalized to the Equivalent dose in 2 Gy fractions (EQD2) at Manchester Dosimetry System (MDS) point A was 60.60 ± 1.08 Gy, which is significantly below the recommended curative dose of 80 Gy. This suggests that relying solely on a ring applicator may not provide enough radiation doses to the tumor. The results also show that the International Commission on Radiation Units (ICRU) dose point underestimated the radiation doses to the bladder and rectum, with the ratios of maximum dose (<em>D_Max</em>) to <em>D_ICRU</em> for both organs being 1.15.</div></div><div><h3>Conclusion</h3><div>The study underscores the importance of not exclusively depending on a ring applicator alone in HDR-ICBT treatment for cervical cancer, as it may lead to suboptimal tumor doses. The ICRU point's results show an underestimation of the rectum and bladder dose during HDR-ICBT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 238-247"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}