Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.025
Vratislav Strnad Prof. MD , Csaba Polgar Prof. MD , Tibor Major PhD , Jose Luis Guinot MD , Cristina Gutierrez Miguelez MD , Kristina Lössl PD, MD , Bülent Polat PD, MD , Peter Niehoff Prof. MD , Christine Gall PhD , Wolfgang Uter Prof. MD
Purpose
To evaluate efficacy results of the GEC-ESTRO phase 3 non-inferiority trial in subgroups of patients defined by the GEC-ESTRO and ASTRO patient selection criteria for APBI.
Methods
Patients aged ≥ 40 years with low risk invasive breast cancer or ductal carcinoma in-situ after breast conserving surgery were randomized to receive either 50 Gy WBI with tumor bed boost of 10 Gy or APBI using multicatheter brachytherapy. 633/1184 patients were randomized to APBI using multicatheter brachytherapy. In the context of the current available complete results after 10 years follow-up, we report results of a supplementary sub-analysis of these latter 633 patients regarding 10-year local control rates, disease-free and overall survival results comparing subgroups categorized according to the GEC-ESTRO and ASTRO patient selection criteria for APBI. Of note, some of these criteria qualifying patients as more than low risk or as cautionary, respectively, did not occur in our patient cohort by design (c.f. in-/exclusion criteria). The trial is registered with ClinicalTrials.gov, NCT00402519.
Results
The 10-year local recurrence rate in the APBI arm was 3.5% (95% CI: 2.0-5.0%). Among 633 patients treated with multicatheter brachytherapy for APBI, according to ASTRO criteria altogether 423 patients (66.8%) were classified as “suitable”, 195 (30.8%) as “cautionary” and 11 (1.7%) as “unsuitable”; in 4 cases no ASTRO categorization was possible. In the “suitable” and “cautionary” groups, the cumulative incidence (95% CI) of local recurrence at 10 years was 3.3% and 5.0% (p=0.61), respectively; difference 1.7% (95% CI: -2.0 to 5.5%). 10-year disease-free survival was 81.9% and 83.6% (p=0.63), respectively. According to GEC-ESTRO criteria, 430 patients (68%) were classified as good candidates for APBI - “low risk group”, 203 (32%) as possible candidates for APBI - “intermediate risk group”, with no patients being in the “high risk group”. Using ESTRO criteria for subgrouping of patients, the cumulative incidence of local recurrence at 10 years was 3.5% versus 4.4% (p = 0.55) in the “low risk group” and “intermediate risk group”, respectively; difference 0.9% (95%CI: -2.6 to 4.5%). Furthermore, 10-year disease-free survival was 81.0% versus 86.4% (p = 0.11) in the “low” and “intermediate” risk group, respectively.
Conclusion
The 10-year results in patients treated with breast conserving surgery followed by APBI using multicatheter brachytherapy are comparable as well between “low risk” and “intermediate risk” groups according to GEC-ESTRO criteria as between “suitable” and “cautionary” risk groups according to ASTRO criteria. Based on the present long-term results of APBI, refinement of available recommendations for APBI patient selection criteria should be discussed to allow more patients to be treated with APBI after breast conserving surgery.
{"title":"Thursday, July 11, 20244:00 PM - 5:30 PM BP01 Presentation Time: 4:00 PM","authors":"Vratislav Strnad Prof. MD , Csaba Polgar Prof. MD , Tibor Major PhD , Jose Luis Guinot MD , Cristina Gutierrez Miguelez MD , Kristina Lössl PD, MD , Bülent Polat PD, MD , Peter Niehoff Prof. MD , Christine Gall PhD , Wolfgang Uter Prof. MD","doi":"10.1016/j.brachy.2024.08.025","DOIUrl":"10.1016/j.brachy.2024.08.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate efficacy results of the GEC-ESTRO phase 3 non-inferiority trial in subgroups of patients defined by the GEC-ESTRO and ASTRO patient selection criteria for APBI.</div></div><div><h3>Methods</h3><div>Patients aged ≥ 40 years with low risk invasive breast cancer or ductal carcinoma in-situ after breast conserving surgery were randomized to receive either 50 Gy WBI with tumor bed boost of 10 Gy or APBI using multicatheter brachytherapy. 633/1184 patients were randomized to APBI using multicatheter brachytherapy. In the context of the current available complete results after 10 years follow-up, we report results of a supplementary sub-analysis of these latter 633 patients regarding 10-year local control rates, disease-free and overall survival results comparing subgroups categorized according to the GEC-ESTRO and ASTRO patient selection criteria for APBI. Of note, some of these criteria qualifying patients as more than low risk or as cautionary, respectively, did not occur in our patient cohort by design (c.f. in-/exclusion criteria). The trial is registered with ClinicalTrials.gov, NCT00402519.</div></div><div><h3>Results</h3><div>The 10-year local recurrence rate in the APBI arm was 3.5% (95% CI: 2.0-5.0%). Among 633 patients treated with multicatheter brachytherapy for APBI, according to ASTRO criteria altogether 423 patients (66.8%) were classified as “suitable”, 195 (30.8%) as “cautionary” and 11 (1.7%) as “unsuitable”; in 4 cases no ASTRO categorization was possible. In the “suitable” and “cautionary” groups, the cumulative incidence (95% CI) of local recurrence at 10 years was 3.3% and 5.0% (p=0.61), respectively; difference 1.7% (95% CI: -2.0 to 5.5%). 10-year disease-free survival was 81.9% and 83.6% (p=0.63), respectively. According to GEC-ESTRO criteria, 430 patients (68%) were classified as good candidates for APBI - “low risk group”, 203 (32%) as possible candidates for APBI - “intermediate risk group”, with no patients being in the “high risk group”. Using ESTRO criteria for subgrouping of patients, the cumulative incidence of local recurrence at 10 years was 3.5% versus 4.4% (p = 0.55) in the “low risk group” and “intermediate risk group”, respectively; difference 0.9% (95%CI: -2.6 to 4.5%). Furthermore, 10-year disease-free survival was 81.0% versus 86.4% (p = 0.11) in the “low” and “intermediate” risk group, respectively.</div></div><div><h3>Conclusion</h3><div>The 10-year results in patients treated with breast conserving surgery followed by APBI using multicatheter brachytherapy are comparable as well between “low risk” and “intermediate risk” groups according to GEC-ESTRO criteria as between “suitable” and “cautionary” risk groups according to ASTRO criteria. Based on the present long-term results of APBI, refinement of available recommendations for APBI patient selection criteria should be discussed to allow more patients to be treated with APBI after breast conserving surgery.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S29-S30"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526711","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.031
Robert Herrera BA , Usha Abraham MSc , Cristina Lopez-Penalver MD , Alonso La Rosa MD , Dustin Epstein BASc , Marc Morcos PhD , Jessika Contreras MD , Vibha Chaswal PhD , Maria-Amelia Rodrigues MD
<div><h3>Purpose</h3><div>As an alternative to the standard 4 to 6 weeks of breast-conserving surgery with whole breast irradiation, a two-day short course accelerated partial breast irradiation (APBI) is available proposed in Triumph-T trial. We present the 2-year follow-up results from a single institution of a 3-fraction APBI delivered using the Strut-Adjusted Volume Implant (SAVI) brachytherapy.</div></div><div><h3>Materials and Methods</h3><div>Retrospective analysis was conducted to evaluate the efficacy of an ultra-hypofractionated 2-day APBI schedule [22.5 Gy in 3 fractions, Bi-daily, ∼6 hours apart]. Women aged 40 years or older with early-stage breast cancer with diagnosis pTis or pT1-2 underwent breast-conserving surgery and received APBI using high-dose-rate Ir-192 SAVI-brachytherapy. The SAVI applicator is offered in four sizes, each designed to accommodate different cavity volumes: 6-1 mini, 6-1, 8-1, and 10-1. During follow-up (2019-2021), data was gathered on patient and tumor characteristics, treatment summary, oncologic outcomes, and both acute and late treatment-related toxicities, using the Common Terminology Criteria for Adverse Events (CTCAE) v5. Adverse events occurring within 90 days following the completion of APBI were defined as acute, whereas those thereafter were considered late.</div></div><div><h3>Results</h3><div>A total of 103 female patients (median age, 67 years [range (R), 40-92 years] mainly with pT1 tumors (77.7%) underwent APBI using SAVI-brachytherapy. Seventy-seven percent of the patient had invasive carcinoma histology and 22.3% were Ductal carcinoma in situ (DCIS). Median tumor size was 10 mm [R, 1.0-30.0 mm]. There were 91.3% estrogen positive and 84.5% progesterone receptors positive tumors, while Her2neu was positive in 1.9% of cases. Post-APBI, 88.3% of patients received adjuvant hormonal therapy and 7.8% received adjuvant chemotherapy. With a median follow-up of 36.4 months [R, 2.3-53.0 months], the most commonly reported toxicities were hyperpigmentation (47.6%) followed by skin induration (32.0%). Acute grade 1 toxicities were seen in 35.0% of cases, including 27.2% hyperpigmentation, 7.8% skin induration, 6.8% breast pain, 2.9% fatigue, 1.9% moist desquamation, and 1.0% erythema. Late grade 1 toxicities were seen in 53.4% of cases, including 28.2% skin induration, 24.3% hyperpigmentation, 17.5% breast pain, 4.9% fatigue, 1.9% telangiectasia, and 1.0% moist desquamation. No acute or late grade 2+ toxicities were observed. Fifteen patients developed late grade 1 fat necrosis within a median 17.3 months [R, 4.2-38.2 months], 12 were asymptomatic and 3 were symptomatic. Six patients developed breast tissue fibrosis. There were 2 (1.9%) local recurrences. Two-year overall survival following APBI was 98.1%.</div></div><div><h3>Conclusions</h3><div>Retrospective analysis of 2-year follow-up of 103 patients treated at our center using 3-fraction APBI with SAVI- brachytherapy, after breast-conserving surg
{"title":"BP07 Presentation Time: 4:54 PM","authors":"Robert Herrera BA , Usha Abraham MSc , Cristina Lopez-Penalver MD , Alonso La Rosa MD , Dustin Epstein BASc , Marc Morcos PhD , Jessika Contreras MD , Vibha Chaswal PhD , Maria-Amelia Rodrigues MD","doi":"10.1016/j.brachy.2024.08.031","DOIUrl":"10.1016/j.brachy.2024.08.031","url":null,"abstract":"<div><h3>Purpose</h3><div>As an alternative to the standard 4 to 6 weeks of breast-conserving surgery with whole breast irradiation, a two-day short course accelerated partial breast irradiation (APBI) is available proposed in Triumph-T trial. We present the 2-year follow-up results from a single institution of a 3-fraction APBI delivered using the Strut-Adjusted Volume Implant (SAVI) brachytherapy.</div></div><div><h3>Materials and Methods</h3><div>Retrospective analysis was conducted to evaluate the efficacy of an ultra-hypofractionated 2-day APBI schedule [22.5 Gy in 3 fractions, Bi-daily, ∼6 hours apart]. Women aged 40 years or older with early-stage breast cancer with diagnosis pTis or pT1-2 underwent breast-conserving surgery and received APBI using high-dose-rate Ir-192 SAVI-brachytherapy. The SAVI applicator is offered in four sizes, each designed to accommodate different cavity volumes: 6-1 mini, 6-1, 8-1, and 10-1. During follow-up (2019-2021), data was gathered on patient and tumor characteristics, treatment summary, oncologic outcomes, and both acute and late treatment-related toxicities, using the Common Terminology Criteria for Adverse Events (CTCAE) v5. Adverse events occurring within 90 days following the completion of APBI were defined as acute, whereas those thereafter were considered late.</div></div><div><h3>Results</h3><div>A total of 103 female patients (median age, 67 years [range (R), 40-92 years] mainly with pT1 tumors (77.7%) underwent APBI using SAVI-brachytherapy. Seventy-seven percent of the patient had invasive carcinoma histology and 22.3% were Ductal carcinoma in situ (DCIS). Median tumor size was 10 mm [R, 1.0-30.0 mm]. There were 91.3% estrogen positive and 84.5% progesterone receptors positive tumors, while Her2neu was positive in 1.9% of cases. Post-APBI, 88.3% of patients received adjuvant hormonal therapy and 7.8% received adjuvant chemotherapy. With a median follow-up of 36.4 months [R, 2.3-53.0 months], the most commonly reported toxicities were hyperpigmentation (47.6%) followed by skin induration (32.0%). Acute grade 1 toxicities were seen in 35.0% of cases, including 27.2% hyperpigmentation, 7.8% skin induration, 6.8% breast pain, 2.9% fatigue, 1.9% moist desquamation, and 1.0% erythema. Late grade 1 toxicities were seen in 53.4% of cases, including 28.2% skin induration, 24.3% hyperpigmentation, 17.5% breast pain, 4.9% fatigue, 1.9% telangiectasia, and 1.0% moist desquamation. No acute or late grade 2+ toxicities were observed. Fifteen patients developed late grade 1 fat necrosis within a median 17.3 months [R, 4.2-38.2 months], 12 were asymptomatic and 3 were symptomatic. Six patients developed breast tissue fibrosis. There were 2 (1.9%) local recurrences. Two-year overall survival following APBI was 98.1%.</div></div><div><h3>Conclusions</h3><div>Retrospective analysis of 2-year follow-up of 103 patients treated at our center using 3-fraction APBI with SAVI- brachytherapy, after breast-conserving surg","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S33"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527275","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.033
Adam Kluska MD PhD, Adam Chicheł MD PhD, Artur Chyrek MD PhD, Wojciech Burchardt MD PhD
Purpose
Our prospective mono-institutional non-randomized open-label study (NTC05142202) evaluates the impact of adjuvant accelerated partial breast irradiation with HDR brachytherapy on health-related quality of life (QOL) of patients with low-risk early-stage breast cancer after breast-conserving surgery. It is to report an interim analysis of a novel fractionation scheme's influence on patients' QOL.
Material and Methods
147 patients were enrolled in a prospective study during recruitment between October 2021 and December 2023. Treatment was performed using postoperative interstitial HDR brachytherapy and was given for three days in 5 fractions of 5,4 Gy up to a total dose of 27,0 Gy. Health-related QOL was assessed using the QLQ-C30 questionnaire and breast cancer-specific HRQL module (EORTC QLQ-BR23) before APBI, one month, three months, six months after treatment, and every six months after that. Both questionnaires contain functional scales (a higher score represents better functioning) and symptom scales (a higher score represents a higher level of symptoms). This analysis presents a preliminary report of the short-term (6 months) QOL of 111 patients who completed six months of follow-up (FU). Repeated measures ANOVA was used to compare HRQL scores between time points. A p-value below 0.05 was considered statistically significant.
Results
There was a statistically significant increase in the mean of social functioning scale (SF, Fig. 1A; p=0.019) and an increase in the constipation symptoms scale (CO, Fig. 1B; p=0.004) assessed in EORTC QLQ-C30 scale. The analysis of EORTC QLQ-BR23 module scales showed an increase in body image functional scale (BRBI, Fig. 1C, p=0.004) and future perspective functional scale (BRFU, Fig.1D; p<0.001). In symptoms scales, there was an increase in the systemic therapy side effects scale (BRST, Fig. 1E; p=0.001) and a decrease in breast symptoms (BRBS, Fig. 1F; p=0.006). There were no other statistically significant changes in the functional or symptom scales of the QLQ-C30 and BR23 questionnaires.
Conclusions
There is no deterioration of short-time health-related quality of life of patients treated with 5 × 5,4 Gy HDR APBI. We observed increased symptoms only in scales linked with adjuvant systemic therapy. After six months of FU, an increase in body image functional scale and a decrease in breast symptoms after the treatment are worth noticing the most promising observations.
{"title":"BP09 Presentation Time: 5:12 PM","authors":"Adam Kluska MD PhD, Adam Chicheł MD PhD, Artur Chyrek MD PhD, Wojciech Burchardt MD PhD","doi":"10.1016/j.brachy.2024.08.033","DOIUrl":"10.1016/j.brachy.2024.08.033","url":null,"abstract":"<div><h3>Purpose</h3><div>Our prospective mono-institutional non-randomized open-label study (NTC05142202) evaluates the impact of adjuvant accelerated partial breast irradiation with HDR brachytherapy on health-related quality of life (QOL) of patients with low-risk early-stage breast cancer after breast-conserving surgery. It is to report an interim analysis of a novel fractionation scheme's influence on patients' QOL.</div></div><div><h3>Material and Methods</h3><div>147 patients were enrolled in a prospective study during recruitment between October 2021 and December 2023. Treatment was performed using postoperative interstitial HDR brachytherapy and was given for three days in 5 fractions of 5,4 Gy up to a total dose of 27,0 Gy. Health-related QOL was assessed using the QLQ-C30 questionnaire and breast cancer-specific HRQL module (EORTC QLQ-BR23) before APBI, one month, three months, six months after treatment, and every six months after that. Both questionnaires contain functional scales (a higher score represents better functioning) and symptom scales (a higher score represents a higher level of symptoms). This analysis presents a preliminary report of the short-term (6 months) QOL of 111 patients who completed six months of follow-up (FU). Repeated measures ANOVA was used to compare HRQL scores between time points. A p-value below 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>There was a statistically significant increase in the mean of social functioning scale (SF, Fig. 1A; <em>p=0.019</em>) and an increase in the constipation symptoms scale (CO, Fig. 1B; <em>p=0.004</em>) assessed in EORTC QLQ-C30 scale. The analysis of EORTC QLQ-BR23 module scales showed an increase in body image functional scale (BRBI, Fig. 1C, <em>p=0.004</em>) and future perspective functional scale (BRFU, Fig.1D; <em>p<0.001</em>). In symptoms scales, there was an increase in the systemic therapy side effects scale (BRST, Fig. 1E; <em>p=0.001</em>) and a decrease in breast symptoms (BRBS, Fig. 1F; <em>p=0.006</em>). There were no other statistically significant changes in the functional or symptom scales of the QLQ-C30 and BR23 questionnaires.</div></div><div><h3>Conclusions</h3><div>There is no deterioration of short-time health-related quality of life of patients treated with 5 × 5,4 Gy HDR APBI. We observed increased symptoms only in scales linked with adjuvant systemic therapy. After six months of FU, an increase in body image functional scale and a decrease in breast symptoms after the treatment are worth noticing the most promising observations.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S34"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527277","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.083
Brian Hrycushko Ph.D., Aurelie Garant MD, Zohaib Iqbal PhD, Yesenia Gonzalez PhD, Tiylar Cotton BS, David Sher MD, MPH, Kevin Albuquerque MD, Tsuicheng Chiu PhD
Purpose
Plesio-brachytherapy offers a favorable option for treating skin cancer or keloids post-surgical excision, particularly on curved body surfaces. By closely conforming body contours, plesio-brachytherapy can provide a more uniform surface dose compared to suboptimal external beam techniques. Current HDR flap-based brachytherapy methods, although flexible in design, can be a challenge to shape to irregular surfaces where maintaining a consistent distance for the radioactive sources is paramount to treatment goals. To address these issues, this work proposes a customized flexible silicone applicator to achieve a better fit to the patient's body with minimal air gaps.
Materials and Methods
Our plesiotherapy workflow begins with thin-cut (1mm slice) CT simulation of the treatment area for patient setup and applicator fabrication. Depending on the site, immobilization methods may be used for patient comfort and position reproducibility. A 10 mm thick bolus structure is created from the simulation image set in treatment planning system software. Applicator channel paths are designed in Autodesk Inventor (Autodesk, Inc. San Francisco, CA). Two molds are then 3D printed for surface applicator casting: an external mold is printed with PLA on an Ultimaker S7 printer (Utrecht, Netherlands) to maintain the applicator shape; and internal molds are printed with regular resin using a FormLab Form 3 printer (Somerville, MA) to house the applicator channels. Once assembled, silicone (ECO-Flex 00-30, Smooth-on) was cast into the molds. After curing, single leader flexible implant tubes are inserted into the channels and fixed in place with standard plastic buttons. The patient undergoes a second CT simulation scan for treatment planning, during which the applicator location is marked on the patient for reproducibility on treatment days. Figure 1 illustrates a 3D rendering of a silicone applicator for a vulvar and perineal surface region treatment.
Results
HDR plesiotherapy using a patient-specific flexible applicator has been successfully implemented clinically. Several patient-specific applicators have been made to treat sites (e.g. vulvar, face, buttock) with surface contours that would be difficult to treat with external beam or standard flap-based HDR brachytherapy.
Conclusions
This approach demonstrates the feasibility and effectiveness of using a silicone surface applicator in delivering targeted radiation therapy for skin cancer treatment, offering a promising option for patients with lesions in challenging anatomical locations. Future work will evaluate the use of surface-guided imaging technologies to reduce the number of CT simulations. Also, optimization strategies for catheter trajectories will also be investigated.
{"title":"PHSOR09 Presentation Time: 9:40 AM","authors":"Brian Hrycushko Ph.D., Aurelie Garant MD, Zohaib Iqbal PhD, Yesenia Gonzalez PhD, Tiylar Cotton BS, David Sher MD, MPH, Kevin Albuquerque MD, Tsuicheng Chiu PhD","doi":"10.1016/j.brachy.2024.08.083","DOIUrl":"10.1016/j.brachy.2024.08.083","url":null,"abstract":"<div><h3>Purpose</h3><div>Plesio-brachytherapy offers a favorable option for treating skin cancer or keloids post-surgical excision, particularly on curved body surfaces. By closely conforming body contours, plesio-brachytherapy can provide a more uniform surface dose compared to suboptimal external beam techniques. Current HDR flap-based brachytherapy methods, although flexible in design, can be a challenge to shape to irregular surfaces where maintaining a consistent distance for the radioactive sources is paramount to treatment goals. To address these issues, this work proposes a customized flexible silicone applicator to achieve a better fit to the patient's body with minimal air gaps.</div></div><div><h3>Materials and Methods</h3><div>Our plesiotherapy workflow begins with thin-cut (1mm slice) CT simulation of the treatment area for patient setup and applicator fabrication. Depending on the site, immobilization methods may be used for patient comfort and position reproducibility. A 10 mm thick bolus structure is created from the simulation image set in treatment planning system software. Applicator channel paths are designed in Autodesk Inventor (Autodesk, Inc. San Francisco, CA). Two molds are then 3D printed for surface applicator casting: an external mold is printed with PLA on an Ultimaker S7 printer (Utrecht, Netherlands) to maintain the applicator shape; and internal molds are printed with regular resin using a FormLab Form 3 printer (Somerville, MA) to house the applicator channels. Once assembled, silicone (ECO-Flex 00-30, Smooth-on) was cast into the molds. After curing, single leader flexible implant tubes are inserted into the channels and fixed in place with standard plastic buttons. The patient undergoes a second CT simulation scan for treatment planning, during which the applicator location is marked on the patient for reproducibility on treatment days. Figure 1 illustrates a 3D rendering of a silicone applicator for a vulvar and perineal surface region treatment.</div></div><div><h3>Results</h3><div>HDR plesiotherapy using a patient-specific flexible applicator has been successfully implemented clinically. Several patient-specific applicators have been made to treat sites (e.g. vulvar, face, buttock) with surface contours that would be difficult to treat with external beam or standard flap-based HDR brachytherapy.</div></div><div><h3>Conclusions</h3><div>This approach demonstrates the feasibility and effectiveness of using a silicone surface applicator in delivering targeted radiation therapy for skin cancer treatment, offering a promising option for patients with lesions in challenging anatomical locations. Future work will evaluate the use of surface-guided imaging technologies to reduce the number of CT simulations. Also, optimization strategies for catheter trajectories will also be investigated.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S62"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527202","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.096
Noelia Sanmamed Salgado MD, PhD , Peter Chung MD , Alejandro Berlin MD, MSc , Robert Weersink PhD , Rachel Glicksman MD , Alex Rink PhD , Jette Borge MD , Bernadeth Lao BS , Anna Simeonov MRT , Cynthia Menard MD , Joelle Helou MD, MSc
<div><h3>Purpose</h3><div>High dose-rate brachytherapy (HDR-BT) combined with external beam radiotherapy (EBRT) is a widely accepted treatment for patients with clinically localized prostate cancer. A significant impact on sexual health related quality of life (sHRQoL) is reported in published series. The etiology is probably multifactorial, including baseline factors, trauma and dose to the neurovascular bundles (NVB). Magnetic resonance imaging (MRI) enables the visualization and proper localization of the NVB. Herein we aim to analyze the long-term sHRQoL after MRI-guided whole gland HDR-BT boost for prostate cancer and to assess the impact of the dose to the NVB and other factors on sHRQoL.</div></div><div><h3>Materials and Methods</h3><div>Sixty-one patients were treated with a single 15 Gy MRI-guided HDR-BT followed by EBRT as part of a prospective phase II trial approved by the local Research Ethic Board (09-0026-C). For this analysis, patients who received over 12 months of androgen deprivation therapy (ADT) and / or patients with a baseline erectile dysfunction were excluded. The left and right NVB were delineated in retrospect on T2-weighted images. Sexual HRQoL was prospectively collected using the expanded prostate index composite (EPIC) questionnaire at baseline, 1month, 3 months, 6 months, 12 months and Q12 monthly thereafter until 60 months. A minimally important difference (MID) was defined as a deterioration of sHRQoL scores at 3 months ≥ 0.5 standard deviation of baseline score. Linear and logistic regression models were used.</div></div><div><h3>Results</h3><div>Twenty-eight patients met the criteria to be included in this analysis. A short course of ADT was given to 15 patients. the mean baseline sexual HRQOL score was 48.1 (SD=27.1): 41.9 (SD=28.5) for sexual function and 63.8 (SD=37.9) for sexual bother (37.9). At 12, 24, 36 and 60 months the mean sexual score was 37.5 (SD=26.3), 47(SD=24.3), 45.1 (SD=20.4) and 36.8 (SD=29.1), <em>p>0.05</em>. A MID was reported by 50% of patients at 60 months. The mean sHRQoL score at 60 months of patients who had a short course of ADT was 44.1 (SD=27.1) versus 32.2 (SD=31.1), <em>p</em>>0.05.The mean delineated volume of the NVB was 0.35 cc ± 0.12 on the right and 0.36 cc ± 0.13 on the left. The median number of needles used was 18 [interquartile range(IQR):17-19]. The median dose max to the left NVB is 20.9 Gy (17.4-22.8) and to the right NVB is 21.1 Gy (19.0-24.0). the median dose to the penile bulb was 5.4 Gy (4.2-7.8).There was no association found between any of the baseline or dosimetric parameters with the deterioration sHRQoL.</div></div><div><h3>Conclusions</h3><div>Fifty percent of prostate cancer patients treated with MRI-guided HDR-BT followed by EBRT reported a MID in their sHRQoL at 5 years after . The dose received by the NVB bilaterally was consistently higher than 120% of the prescription dose. A short course of ADT was not associated with a worse sHRQoL score at 5 y
{"title":"PPP04 Presentation Time: 10:57 AM","authors":"Noelia Sanmamed Salgado MD, PhD , Peter Chung MD , Alejandro Berlin MD, MSc , Robert Weersink PhD , Rachel Glicksman MD , Alex Rink PhD , Jette Borge MD , Bernadeth Lao BS , Anna Simeonov MRT , Cynthia Menard MD , Joelle Helou MD, MSc","doi":"10.1016/j.brachy.2024.08.096","DOIUrl":"10.1016/j.brachy.2024.08.096","url":null,"abstract":"<div><h3>Purpose</h3><div>High dose-rate brachytherapy (HDR-BT) combined with external beam radiotherapy (EBRT) is a widely accepted treatment for patients with clinically localized prostate cancer. A significant impact on sexual health related quality of life (sHRQoL) is reported in published series. The etiology is probably multifactorial, including baseline factors, trauma and dose to the neurovascular bundles (NVB). Magnetic resonance imaging (MRI) enables the visualization and proper localization of the NVB. Herein we aim to analyze the long-term sHRQoL after MRI-guided whole gland HDR-BT boost for prostate cancer and to assess the impact of the dose to the NVB and other factors on sHRQoL.</div></div><div><h3>Materials and Methods</h3><div>Sixty-one patients were treated with a single 15 Gy MRI-guided HDR-BT followed by EBRT as part of a prospective phase II trial approved by the local Research Ethic Board (09-0026-C). For this analysis, patients who received over 12 months of androgen deprivation therapy (ADT) and / or patients with a baseline erectile dysfunction were excluded. The left and right NVB were delineated in retrospect on T2-weighted images. Sexual HRQoL was prospectively collected using the expanded prostate index composite (EPIC) questionnaire at baseline, 1month, 3 months, 6 months, 12 months and Q12 monthly thereafter until 60 months. A minimally important difference (MID) was defined as a deterioration of sHRQoL scores at 3 months ≥ 0.5 standard deviation of baseline score. Linear and logistic regression models were used.</div></div><div><h3>Results</h3><div>Twenty-eight patients met the criteria to be included in this analysis. A short course of ADT was given to 15 patients. the mean baseline sexual HRQOL score was 48.1 (SD=27.1): 41.9 (SD=28.5) for sexual function and 63.8 (SD=37.9) for sexual bother (37.9). At 12, 24, 36 and 60 months the mean sexual score was 37.5 (SD=26.3), 47(SD=24.3), 45.1 (SD=20.4) and 36.8 (SD=29.1), <em>p>0.05</em>. A MID was reported by 50% of patients at 60 months. The mean sHRQoL score at 60 months of patients who had a short course of ADT was 44.1 (SD=27.1) versus 32.2 (SD=31.1), <em>p</em>>0.05.The mean delineated volume of the NVB was 0.35 cc ± 0.12 on the right and 0.36 cc ± 0.13 on the left. The median number of needles used was 18 [interquartile range(IQR):17-19]. The median dose max to the left NVB is 20.9 Gy (17.4-22.8) and to the right NVB is 21.1 Gy (19.0-24.0). the median dose to the penile bulb was 5.4 Gy (4.2-7.8).There was no association found between any of the baseline or dosimetric parameters with the deterioration sHRQoL.</div></div><div><h3>Conclusions</h3><div>Fifty percent of prostate cancer patients treated with MRI-guided HDR-BT followed by EBRT reported a MID in their sHRQoL at 5 years after . The dose received by the NVB bilaterally was consistently higher than 120% of the prescription dose. A short course of ADT was not associated with a worse sHRQoL score at 5 y","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S70-S71"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526979","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.001
{"title":"Listing of the Abstracts of the 2024 American Brachytherapy Society Annual Meeting","authors":"","doi":"10.1016/j.brachy.2024.08.001","DOIUrl":"10.1016/j.brachy.2024.08.001","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S1-S15"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526707","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.065
Anne Valkenburg MD , Evert van Limbergen MD, PhD , Maaike Berbée MD, PhD , Mark Long MSc , Nikolaos Tselis MD, PhD , Alexandra Stewart MD, PhD
Purpose
Earlier it was demonstrated that lack of standardization in dose reporting is hampering progress in the field of rectal brachytherapy (Verrijssen et al 2019). Standardization of dose reporting and thus treatment data would allow for better comparison of results between patient cohorts of different studies and also allow for NTCP or TCP modelling. A prerequisite for standardized dose reporting is standardization of target volume and organ at risk (OAR) delineation. As there is currently a lack of guidelines for target volume definition and organ at risk delineation in image-guided rectal HDR brachytherapy, this project is aimed at solving this issue. The collaboration involves members of GEC ESTRO and the ABS.
Materials and Methods
The target volume consensus process consists of several steps: Step 1: Selection of an expert group and evaluation group (including radiation oncologists and physicists from Europe/Canada/India). Step 2: Survey regarding target volume delineation in each institution. Step 3: Delineation of 3 rectal cancer (RC) cases with different clinical stages using the FALCON platform. Step 4: First expert group meeting to create a draft guideline. Step 5: Redelineation by the expert group using the draft guideline. Step 6: Second expert group meeting to evaluate the redelineations and optimize the draft guideline. Step 7: Redelineation by the evaluation group and finalization of the guideline.
Results
The current project involves radiation oncologists and physicists from 10 countries in Europe/Canada/India and has currently finalized step 2. Ten out of 17 respondents indicated that they don't have their own delineation guidelines. There is clear variation in the CTV definitions used, for example some use margins and some prescribe to the GTV. Eleven respondents don't use PTV margins. There is no consensus on which OAR need to be delineated and how.
Conclusions
Our survey has shown that target volume delineation and OAR definition varies widely between institutions. Here we describe the methodology to come to international standardization in dose reporting for rectal brachytherapy. The next step is to evaluate the consensus and differences in target and OAR delineation between the different centers using test cases, prior to contouring guideline development.
{"title":"MSOR02 Presentation Time: 8:05 AM","authors":"Anne Valkenburg MD , Evert van Limbergen MD, PhD , Maaike Berbée MD, PhD , Mark Long MSc , Nikolaos Tselis MD, PhD , Alexandra Stewart MD, PhD","doi":"10.1016/j.brachy.2024.08.065","DOIUrl":"10.1016/j.brachy.2024.08.065","url":null,"abstract":"<div><h3>Purpose</h3><div>Earlier it was demonstrated that lack of standardization in dose reporting is hampering progress in the field of rectal brachytherapy (Verrijssen et al 2019). Standardization of dose reporting and thus treatment data would allow for better comparison of results between patient cohorts of different studies and also allow for NTCP or TCP modelling. A prerequisite for standardized dose reporting is standardization of target volume and organ at risk (OAR) delineation. As there is currently a lack of guidelines for target volume definition and organ at risk delineation in image-guided rectal HDR brachytherapy, this project is aimed at solving this issue. The collaboration involves members of GEC ESTRO and the ABS.</div></div><div><h3>Materials and Methods</h3><div>The target volume consensus process consists of several steps: Step 1: Selection of an expert group and evaluation group (including radiation oncologists and physicists from Europe/Canada/India). Step 2: Survey regarding target volume delineation in each institution. Step 3: Delineation of 3 rectal cancer (RC) cases with different clinical stages using the FALCON platform. Step 4: First expert group meeting to create a draft guideline. Step 5: Redelineation by the expert group using the draft guideline. Step 6: Second expert group meeting to evaluate the redelineations and optimize the draft guideline. Step 7: Redelineation by the evaluation group and finalization of the guideline.</div></div><div><h3>Results</h3><div>The current project involves radiation oncologists and physicists from 10 countries in Europe/Canada/India and has currently finalized step 2. Ten out of 17 respondents indicated that they don't have their own delineation guidelines. There is clear variation in the CTV definitions used, for example some use margins and some prescribe to the GTV. Eleven respondents don't use PTV margins. There is no consensus on which OAR need to be delineated and how.</div></div><div><h3>Conclusions</h3><div>Our survey has shown that target volume delineation and OAR definition varies widely between institutions. Here we describe the methodology to come to international standardization in dose reporting for rectal brachytherapy. The next step is to evaluate the consensus and differences in target and OAR delineation between the different centers using test cases, prior to contouring guideline development.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S51"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526894","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.009
M Christianen MD, PhD , B.R. Pieters MD, PhD , L.P. Bokhorst MD, PhD , M. Peters MD, PhD , B. Vanneste MD, PhD , P. Gradowska PhD , I.K.K. Kolkman-Deurloo PhD , J.L. Boormans MD, PhD , R.A. Nout MD, PhD , S. Aluwini MD, PhD
<div><h3>Purpose</h3><div>A high radiation dose (≥ 75 Gy EQD2) is required to achieve tumor control in intermediate / high-risk prostate cancer (PCa). Brachytherapy (BT) provides a steep dose gradient, resulting in a higher dose to the tumor while minimizing dose to surrounding organs. Therefore, a combination of external beam radiotherapy (EBRT) and a BT boost may potentially result in less gastrointestinal (GI) and genitourinary (GU) toxicity. This multicenter, randomized trial was designed to compare the toxicity of EBRT alone with that of EBRT plus a BT boost. Here we present the primary endpoint: the 3 years late GI and GU toxicity. Overall survival (OS), biochemical disease-free survival (bDFS) and relapse-free survival (RFS) were analyzed as secondary endpoints.</div></div><div><h3>Materials and Methods</h3><div>Patients with PCa, stage T1c-T3a, N0, M0, PSA ≤ 60 ug/l and Gleason ≤ 8, were randomized to: EBRT alone (35 × 2.2 Gy) or EBRT (20 × 2.2 Gy) + BT boost (HDR: 1 × 13 Gy or PDR: 24 × 1.27 Gy, 2.2 hour interval). Both arms received an EQD2 of 79 Gy. EBRT was given using intensity modulated radiotherapy. The toxicity was assessed with the RTOG Late Radiation Morbidity Scoring criteria from both physicians’ records (clinical record form) and patients’ self-assessment questionnaires, at baseline, every 6 months for the first 3 years, and at 4 and 5 years post treatment. For both GI and GU toxicity, the highest score and the earliest date corresponding to the occurrence of grade ≥2 toxicity was registered for analysis. For the cumulative incidence of grade ≥ 2 late GI / GU toxicity, a competing risk regression analysis was performed considering death without toxicity as the competing event. First a univariate regression analysis was performed, followed by a multivariate regression analysis with adjustment for significant univariable prognostic factors. With age, PSA, Gleason, T-stage, risk classification, smoking, urinary flow, hormonal therapy, diabetes, abdominal surgery, GI comorbidity, prostate volume and overall GI/GU at baseline considered as candidate prognostic factors. OS, bDFS and RFS were assessed from randomization using the Kaplan-Meier method and univariate / multivariate Cox regression.</div></div><div><h3>Results</h3><div>From March 2013 to March 2019, 196 evaluable patients were enrolled. Baseline patient and tumor characteristics as well as baseline toxicity were well balanced between arms. The 3-year cumulative incidence of grade ≥ 2 GI toxicity (Fig. 1a) was 22% (EBRT+BT) vs 31% (EBRT), not statistically different in univariate (HR 0.67; 95% CI 0.41 - 1.12; p=0.129). Since no factor seem to have prognostic value for grade ≥ 2 GI toxicity based on the univariate analysis, no multivariate analysis was conducted. The 3-year cumulative incidence of grade ≥ 2 GU toxicity (Fig. 1b) was 43% (EBRT+BT) vs 29% (EBRT), not statistically different in univariate (HR 1.49; 95% CI 0.98 - 2.27; p=0.064) nor multivariate analysis adjust
{"title":"Thursday, July 11, 202410:30 AM - 11:30 AMPPP01 Presentation Time: 10:30 AM","authors":"M Christianen MD, PhD , B.R. Pieters MD, PhD , L.P. Bokhorst MD, PhD , M. Peters MD, PhD , B. Vanneste MD, PhD , P. Gradowska PhD , I.K.K. Kolkman-Deurloo PhD , J.L. Boormans MD, PhD , R.A. Nout MD, PhD , S. Aluwini MD, PhD","doi":"10.1016/j.brachy.2024.08.009","DOIUrl":"10.1016/j.brachy.2024.08.009","url":null,"abstract":"<div><h3>Purpose</h3><div>A high radiation dose (≥ 75 Gy EQD2) is required to achieve tumor control in intermediate / high-risk prostate cancer (PCa). Brachytherapy (BT) provides a steep dose gradient, resulting in a higher dose to the tumor while minimizing dose to surrounding organs. Therefore, a combination of external beam radiotherapy (EBRT) and a BT boost may potentially result in less gastrointestinal (GI) and genitourinary (GU) toxicity. This multicenter, randomized trial was designed to compare the toxicity of EBRT alone with that of EBRT plus a BT boost. Here we present the primary endpoint: the 3 years late GI and GU toxicity. Overall survival (OS), biochemical disease-free survival (bDFS) and relapse-free survival (RFS) were analyzed as secondary endpoints.</div></div><div><h3>Materials and Methods</h3><div>Patients with PCa, stage T1c-T3a, N0, M0, PSA ≤ 60 ug/l and Gleason ≤ 8, were randomized to: EBRT alone (35 × 2.2 Gy) or EBRT (20 × 2.2 Gy) + BT boost (HDR: 1 × 13 Gy or PDR: 24 × 1.27 Gy, 2.2 hour interval). Both arms received an EQD2 of 79 Gy. EBRT was given using intensity modulated radiotherapy. The toxicity was assessed with the RTOG Late Radiation Morbidity Scoring criteria from both physicians’ records (clinical record form) and patients’ self-assessment questionnaires, at baseline, every 6 months for the first 3 years, and at 4 and 5 years post treatment. For both GI and GU toxicity, the highest score and the earliest date corresponding to the occurrence of grade ≥2 toxicity was registered for analysis. For the cumulative incidence of grade ≥ 2 late GI / GU toxicity, a competing risk regression analysis was performed considering death without toxicity as the competing event. First a univariate regression analysis was performed, followed by a multivariate regression analysis with adjustment for significant univariable prognostic factors. With age, PSA, Gleason, T-stage, risk classification, smoking, urinary flow, hormonal therapy, diabetes, abdominal surgery, GI comorbidity, prostate volume and overall GI/GU at baseline considered as candidate prognostic factors. OS, bDFS and RFS were assessed from randomization using the Kaplan-Meier method and univariate / multivariate Cox regression.</div></div><div><h3>Results</h3><div>From March 2013 to March 2019, 196 evaluable patients were enrolled. Baseline patient and tumor characteristics as well as baseline toxicity were well balanced between arms. The 3-year cumulative incidence of grade ≥ 2 GI toxicity (Fig. 1a) was 22% (EBRT+BT) vs 31% (EBRT), not statistically different in univariate (HR 0.67; 95% CI 0.41 - 1.12; p=0.129). Since no factor seem to have prognostic value for grade ≥ 2 GI toxicity based on the univariate analysis, no multivariate analysis was conducted. The 3-year cumulative incidence of grade ≥ 2 GU toxicity (Fig. 1b) was 43% (EBRT+BT) vs 29% (EBRT), not statistically different in univariate (HR 1.49; 95% CI 0.98 - 2.27; p=0.064) nor multivariate analysis adjust","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S19-S20"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526545","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}
<div><h3>Purpose</h3><div>The adoption of IGABT is limited in LMIC. This could be from lack of training in contouring, evaluation of volumetric plan and access to MRI. In most of the centres CT scan was routinely done for at least one fraction with applicator in situ but dose to target and OAR was still reported and optimized to points. MRI was seldom done at any point during course of radiation and brachytherapy schedule was 3-4 fractions performed weekly prolonging total treatment duration to be more than 55 days.</div></div><div><h3>Methods</h3><div>Live and virtual workshop was performed over 1.5 days for hands on training with both physicians and physicists from all sites in December 2022. Workshop focused on use of sonogram for placement of applicator, CT scan-based contouring and planning with volumetric dose constraints, 3D MRI with T2 sequence whenever feasible, and use of hybrid applicator when available. First day was discussion on guidelines, contouring and data followed by hands on contouring of 3 cases on CT scan by all physicians. On second day entire workflow was demonstrated with live case with use of ultrasound, placement of hybrid applicator, contouring on CT scan and MRI and planning with clinical goals. Later most of the physicians were asked to perform IGBT procedure in the presence of an expert or a fellow physician practicing IGBT at their centre in this network. All participants were asked to share anonymized data for analyses of practice pattern after the workshop. The data was collected after 13 months from the initial workshop.</div></div><div><h3>Results</h3><div>Eleven out of 15 physicians from 6 sites agreed to share their dosimetry and early outcome data. All 11 physicians transitioned from point A to volume-based planning and treated 257 consecutive patients with IGBT (CT based 85% and MRI based 15%). 76% had MRI pelvis done before brachytherapy as part of workup. The commonest EBRT dose schedule was 45 in 25 fraction (60%) and HDR schedule was 21-28 Gy in 3-4 fraction (95%). For those who had EBRT in the network 97.2% received EBRT dose of 45 Gy in 25 fractions and HDR Schedule of 28 Gy in 4 fractions. Majority had intracavitary alone (86%) while 14% used hybrid applicator. Median D90 for HRCTV and D2cc for rectum, bladder, sigmoid and small bowel were 80.8Gy (79.28-85.05 Gy), 62.18Gy (57.5-66.8Gy), 63.87Gy (582-72Gy), 61.2 Gy (55.5-68.6Gy) and 55.1 Gy (45-63.6Gy) respectively. Overall treatment time was ≤ 50 days and ≤55 days for 64.9 % and 78.9% respectively for all patients and 72.2% and 88.9% for patients who received EBRT plus brachy at same location. The first follow up between 3-6 months was available for 148 patients and 138 (93.9%) had clinical and/or metabolic complete response.</div></div><div><h3>Conclusion</h3><div>This workshop model of Identifying baseline practice pattern with education and training focused on specific quality aspect of RT delivery showed significant changes with adoption of IGBT,
{"title":"GPP02 Presentation Time: 9:09 AM","authors":"Manikumar Singamsetty MD , Mohan Lal MD , Manjinder Singh Sidhu MD , Sumeet Agarwal MD , Ritu Agarwal DNB , Harjot Kaur Bajwa DNB , KS Dhanya MD , Midhun Murali MD , Parisa Shamsesfandabadi MD , Suresh Chaudhari Msc, Dip RP , Vibhor Gupta MD , Sushil Beriwal MD, FASTRO, FABS, FICRO, FACRO","doi":"10.1016/j.brachy.2024.08.004","DOIUrl":"10.1016/j.brachy.2024.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>The adoption of IGABT is limited in LMIC. This could be from lack of training in contouring, evaluation of volumetric plan and access to MRI. In most of the centres CT scan was routinely done for at least one fraction with applicator in situ but dose to target and OAR was still reported and optimized to points. MRI was seldom done at any point during course of radiation and brachytherapy schedule was 3-4 fractions performed weekly prolonging total treatment duration to be more than 55 days.</div></div><div><h3>Methods</h3><div>Live and virtual workshop was performed over 1.5 days for hands on training with both physicians and physicists from all sites in December 2022. Workshop focused on use of sonogram for placement of applicator, CT scan-based contouring and planning with volumetric dose constraints, 3D MRI with T2 sequence whenever feasible, and use of hybrid applicator when available. First day was discussion on guidelines, contouring and data followed by hands on contouring of 3 cases on CT scan by all physicians. On second day entire workflow was demonstrated with live case with use of ultrasound, placement of hybrid applicator, contouring on CT scan and MRI and planning with clinical goals. Later most of the physicians were asked to perform IGBT procedure in the presence of an expert or a fellow physician practicing IGBT at their centre in this network. All participants were asked to share anonymized data for analyses of practice pattern after the workshop. The data was collected after 13 months from the initial workshop.</div></div><div><h3>Results</h3><div>Eleven out of 15 physicians from 6 sites agreed to share their dosimetry and early outcome data. All 11 physicians transitioned from point A to volume-based planning and treated 257 consecutive patients with IGBT (CT based 85% and MRI based 15%). 76% had MRI pelvis done before brachytherapy as part of workup. The commonest EBRT dose schedule was 45 in 25 fraction (60%) and HDR schedule was 21-28 Gy in 3-4 fraction (95%). For those who had EBRT in the network 97.2% received EBRT dose of 45 Gy in 25 fractions and HDR Schedule of 28 Gy in 4 fractions. Majority had intracavitary alone (86%) while 14% used hybrid applicator. Median D90 for HRCTV and D2cc for rectum, bladder, sigmoid and small bowel were 80.8Gy (79.28-85.05 Gy), 62.18Gy (57.5-66.8Gy), 63.87Gy (582-72Gy), 61.2 Gy (55.5-68.6Gy) and 55.1 Gy (45-63.6Gy) respectively. Overall treatment time was ≤ 50 days and ≤55 days for 64.9 % and 78.9% respectively for all patients and 72.2% and 88.9% for patients who received EBRT plus brachy at same location. The first follow up between 3-6 months was available for 148 patients and 138 (93.9%) had clinical and/or metabolic complete response.</div></div><div><h3>Conclusion</h3><div>This workshop model of Identifying baseline practice pattern with education and training focused on specific quality aspect of RT delivery showed significant changes with adoption of IGBT,","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S16-S17"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526709","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}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.094
Irini Youssef MD, Rahul Barve MD, Victoria Brennan MD, Daniel Gorovets MD, Daniel Shasha MD, Sankalp Pandya BSc, MRes, Joel Beaudry MS, Antonio Damato PhD, Marisa Kollmeier MD
Purpose
Erectile function is a significant quality of life consideration for patients electing definitive radiation therapy. We compared erectile outcomes following low dose rate (LDR) relative to stereotactic body radiation therapy (SBRT) as monotherapy for patients with localized prostate cancer.
Methods/Materials
Using a prospectively collected institutional database, we retrospectively analyzed the charts of patients who underwent LDR (I-125; 144Gy or Pd-103; 125Gy) brachytherapy or SBRT as monotherapy for prostate cancer and were potent (IIEF-5>20) at baseline. Patient-reported erectile function was measured at baseline at each post-treatment followup using IIEF-5 (International Index of Erectile Function). The use of erectile medications was also collected at each timepoint. Clinical (smoking history (none vs former/current), hypertension(yes/no) diabetes (yes/no) and dosimetric parameters were also collected.
Results
The study cohort included 112 patients undergoing LDR and 171 patients undergoing SBRT with a median followup of 31 months for both cohorts. Mean D90% for brachytherapy patients was 111.4%. Median SBRT dose was 4000 (range 3750-4500). 92% of patients received 4000 cGy. Mean age for SBRT patients is 66.7 years (SD±6.8) and 60.5 (SD±71) for brachytherapy patients (p<.001). There were no significant difference in smoking status (p=0.317), hypertension (p= 43) or diabetes (p= 0.18) between cohorts. There was no difference between cohorts with respect to mean baseline IIEF (27; range (21-30) (p=0.8). Mean IIEF at 12 mo ±3 was 20.6 for SBRT group versus 24.1 for brachytherapy group (P=.007). At 18 mo±3 mo, it was 20.35 for SBRT group versus 23.28 for brachytherapy group (P=.03). At 24 mo±3mo, it was 20.2 for the SBRT group versus 25.9 for the brachytherapy group (P<.001). 63% (N=107) versus 72% (N=79) patients in the SBRT and brachytherapy group, respectively, were on ED medications following treatment (P=.07).
Conclusion
Overall erectile preservation with IIEF >20 is high with both LDR and SBRT monotherapy. Higher mean IIEF scores were noted at multiple timepoints for LDR compared with SBRT. Further analyses are needed to assess whether these differences are clinically meaningful.
{"title":"PPP02 Presentation Time: 10:39 AM","authors":"Irini Youssef MD, Rahul Barve MD, Victoria Brennan MD, Daniel Gorovets MD, Daniel Shasha MD, Sankalp Pandya BSc, MRes, Joel Beaudry MS, Antonio Damato PhD, Marisa Kollmeier MD","doi":"10.1016/j.brachy.2024.08.094","DOIUrl":"10.1016/j.brachy.2024.08.094","url":null,"abstract":"<div><h3>Purpose</h3><div>Erectile function is a significant quality of life consideration for patients electing definitive radiation therapy. We compared erectile outcomes following low dose rate (LDR) relative to stereotactic body radiation therapy (SBRT) as monotherapy for patients with localized prostate cancer.</div></div><div><h3>Methods/Materials</h3><div>Using a prospectively collected institutional database, we retrospectively analyzed the charts of patients who underwent LDR (I-125; 144Gy or Pd-103; 125Gy) brachytherapy or SBRT as monotherapy for prostate cancer and were potent (IIEF-5>20) at baseline. Patient-reported erectile function was measured at baseline at each post-treatment followup using IIEF-5 (International Index of Erectile Function). The use of erectile medications was also collected at each timepoint. Clinical (smoking history (none vs former/current), hypertension(yes/no) diabetes (yes/no) and dosimetric parameters were also collected.</div></div><div><h3>Results</h3><div>The study cohort included 112 patients undergoing LDR and 171 patients undergoing SBRT with a median followup of 31 months for both cohorts. Mean D90% for brachytherapy patients was 111.4%. Median SBRT dose was 4000 (range 3750-4500). 92% of patients received 4000 cGy. Mean age for SBRT patients is 66.7 years (SD±6.8) and 60.5 (SD±71) for brachytherapy patients (p<.001). There were no significant difference in smoking status (p=0.317), hypertension (p= 43) or diabetes (p= 0.18) between cohorts. There was no difference between cohorts with respect to mean baseline IIEF (27; range (21-30) (p=0.8). Mean IIEF at 12 mo ±3 was 20.6 for SBRT group versus 24.1 for brachytherapy group (P=.007). At 18 mo±3 mo, it was 20.35 for SBRT group versus 23.28 for brachytherapy group (P=.03). At 24 mo±3mo, it was 20.2 for the SBRT group versus 25.9 for the brachytherapy group (P<.001). 63% (N=107) versus 72% (N=79) patients in the SBRT and brachytherapy group, respectively, were on ED medications following treatment (P=.07).</div></div><div><h3>Conclusion</h3><div>Overall erectile preservation with IIEF >20 is high with both LDR and SBRT monotherapy. Higher mean IIEF scores were noted at multiple timepoints for LDR compared with SBRT. Further analyses are needed to assess whether these differences are clinically meaningful.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S69"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527281","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}
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