Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.07.006
Taylor Dear , Jodi Chiu , Harley Meirovich , Amie Malkin , Razan Amjad , David D'Souza , Jeannie Callum , Eric Leung , Kate Kelly , Alejandro Lazo-Langner , Ziad Solh
BACKGROUND AND PURPOSE
Anemia is common in locally advanced cervical cancer. Clinical practice varies greatly for management of anemia during brachytherapy, with some centres providing red cell transfusion to increase hemoglobin levels above 100 g/L.
MATERIALS AND METHODS
This is a retrospective observational cohort study of adult patients with cervical cancer treated with brachytherapy at two academic hospitals. One hospital (H1) uses a liberal transfusion strategy with hemoglobin threshold of 100 g/L during brachytherapy and the other uses a restrictive target of 70 g/L (H2).
RESULTS
Overall, 336 patients met inclusion criteria (H1: 150 patients, H2: 186 patients). 11 patients were excluded (2 at H1, 9 at H2). Demographics at both sites were comparable, except for cancer stage and smoking history. External beam radiation and chemotherapy provided was similar. Hemoglobin values were compared at baseline (within 4 weeks of oncology consult), and prior to the first and second brachytherapy treatments. In total, 101red blood cell (RBC) units were transfused to patients at H1 and 19 units to patients at H2. Patients were followed for a median of 37.0 months (0.6-80.5) at H1, and 33.3 months (1.6-82.0) at H2. There was no significant difference in progression-free or overall survival. Multivariable logistic regression analysis showed that FIGO stage was a predictor for both overall survival and cancer progression. Age, tumor size, chemotherapy, and hemoglobin levels were not predictors of disease progression or mortality.
CONCLUSIONS
The practice of liberal transfusion should be re-evaluated in the absence of robust data to support its use.
{"title":"Are outcomes of locally advanced cervical cancer associated with prebrachytherapy hemoglobin values and transfusion practice? An observational study comparing two large academic centres with divergent clinical guidelines","authors":"Taylor Dear , Jodi Chiu , Harley Meirovich , Amie Malkin , Razan Amjad , David D'Souza , Jeannie Callum , Eric Leung , Kate Kelly , Alejandro Lazo-Langner , Ziad Solh","doi":"10.1016/j.brachy.2024.07.006","DOIUrl":"10.1016/j.brachy.2024.07.006","url":null,"abstract":"<div><h3>BACKGROUND AND PURPOSE</h3><div>Anemia is common in locally advanced cervical cancer. Clinical practice varies greatly for management of anemia during brachytherapy, with some centres providing red cell transfusion to increase hemoglobin levels above 100 g/L.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This is a retrospective observational cohort study of adult patients with cervical cancer treated with brachytherapy at two academic hospitals. One hospital (H1) uses a liberal transfusion strategy with hemoglobin threshold of 100 g/L during brachytherapy and the other uses a restrictive target of 70 g/L (H2).</div></div><div><h3>RESULTS</h3><div>Overall, 336 patients met inclusion criteria (H1: 150 patients, H2: 186 patients). 11 patients were excluded (2 at H1, 9 at H2). Demographics at both sites were comparable, except for cancer stage and smoking history. External beam radiation and chemotherapy provided was similar. Hemoglobin values were compared at baseline (within 4 weeks of oncology consult), and prior to the first and second brachytherapy treatments. In total, 101red blood cell (RBC) units were transfused to patients at H1 and 19 units to patients at H2. Patients were followed for a median of 37.0 months (0.6-80.5) at H1, and 33.3 months (1.6-82.0) at H2. There was no significant difference in progression-free or overall survival. Multivariable logistic regression analysis showed that FIGO stage was a predictor for both overall survival and cancer progression. Age, tumor size, chemotherapy, and hemoglobin levels were not predictors of disease progression or mortality.</div></div><div><h3>CONCLUSIONS</h3><div>The practice of liberal transfusion should be re-evaluated in the absence of robust data to support its use.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 660-667"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094331","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 : 2024-11-01DOI: 10.1016/j.brachy.2024.07.003
Genevieve Loos , James P Buteau , Justin Oh , Sylvia Van Dyk , David Chang , Declan G Murphy , Michael S Hofman , Scott Williams , Sarat Chander
PURPOSE
Brachytherapy as monotherapy is a recommended treatment option for men with low to intermediate risk prostate cancer. Local recurrence is difficult to identify. This study investigated PSMA PET/CT for recurrence after brachytherapy, as well as their subsequent management when recurrence occurred only within the prostate.
METHODS
We performed a retrospective single-center analysis for patients who were treated with brachytherapy as monotherapy for prostate cancer from May 2002 to May 2021 and who underwent a PSMA PET/CT for BCR. We report the findings on PSMA PET/CT, quantitative parameters, as well as the later management of the patients.
RESULTS
Forty patients were identified, who underwent PSMA PET/CT to investigate a rising PSA at a median (IQR) of 7 years (3.0–10.8) after initial therapy. Median (IQR) PSA at time of PSMA PET/CT was 6.54 ng/mL (3.9–15.5). On PSMA PET/CT, 20/40 (50%) men had prostate-only recurrence. Of the 20 patients with prostate-only recurrence, 8/20 (40%) had recurrence in a high-dose radiation zone, versus 7/20 (35%) in an under-covered zone. On PSMA PET/CT, recurrence within the prostate had median (IQR) SUVmax 10.4 (5.1–15.7) and volume 2.9 mL (2.0–11.2). Subsequent management of these patients with local recurrence included surveillance followed by ADT (9/20, 45%). For those with surveillance followed by ADT, the mean time before introduction of ADT was 4.1 years (range 1–8 years).
{"title":"PSMA PET/CT patterns of recurrence after mono-brachytherapy in men with low and intermediate prostate cancer and subsequent management","authors":"Genevieve Loos , James P Buteau , Justin Oh , Sylvia Van Dyk , David Chang , Declan G Murphy , Michael S Hofman , Scott Williams , Sarat Chander","doi":"10.1016/j.brachy.2024.07.003","DOIUrl":"10.1016/j.brachy.2024.07.003","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Brachytherapy as monotherapy is a recommended treatment option for men with low to intermediate risk prostate cancer. Local recurrence is difficult to identify. This study investigated PSMA PET/CT for recurrence after brachytherapy, as well as their subsequent management when recurrence occurred only within the prostate.</div></div><div><h3>METHODS</h3><div>We performed a retrospective single-center analysis for patients who were treated with brachytherapy as monotherapy for prostate cancer from May 2002 to May 2021 and who underwent a PSMA PET/CT for BCR. We report the findings on PSMA PET/CT, quantitative parameters, as well as the later management of the patients.</div></div><div><h3>RESULTS</h3><div>Forty patients were identified, who underwent PSMA PET/CT to investigate a rising PSA at a median (IQR) of 7 years (3.0–10.8) after initial therapy. Median (IQR) PSA at time of PSMA PET/CT was 6.54 ng/mL (3.9–15.5). On PSMA PET/CT, 20/40 (50%) men had prostate-only recurrence. Of the 20 patients with prostate-only recurrence, 8/20 (40%) had recurrence in a high-dose radiation zone, versus 7/20 (35%) in an under-covered zone. On PSMA PET/CT, recurrence within the prostate had median (IQR) SUVmax 10.4 (5.1–15.7) and volume 2.9 mL (2.0–11.2). Subsequent management of these patients with local recurrence included surveillance followed by ADT (9/20, 45%). For those with surveillance followed by ADT, the mean time before introduction of ADT was 4.1 years (range 1–8 years).</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 719-726"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367860","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 : 2024-11-01DOI: 10.1016/j.brachy.2024.06.006
Christopher L. Deufel, Eric E. Brost, Justine M. Dupere, Ivy A. Petersen, Michael G. Haddock, Allison E. Garda
PURPOSE
To design, construct, and evaluate a system for image-guided placement of brachytherapy applicators using electromagnetic tracking (EMT) technology for improved procedure quality and efficiency. The system, named EMVision, provides a three-dimensional display of planned needle sites, visibility of the anatomy and needle position during placement, and reference tracking to account for generator or target anatomy shifts.
METHODS
The EMVision EMT guidance system registers CT and EMT reference frames using an automated point-based algorithm according to tandem/ovoid locations. Subsequent needle placement and digitization is guided with an intraluminal EMT sensor and user interface that displays the needle's location in axial, coronal, sagittal, and 3D-volumetric CT views. The interface can overlay contours, preplanned needles, and provide 6DOF compensation for tandem movement during needle placement/manipulation. EMVision accuracy was evaluated in phantom and human cadaver by comparing EMVision's DICOM needle positions with a ground-truth, postimplant CT.
RESULTS
Proof of concept was demonstrated for EMT-assisted placement of brachytherapy needles. EMVision accuracy in phantom (mean ± standard deviation) on a brachysuite CT table was 0.76 ± 0.13 mm for needle tips placed up to 75 mm from the tandem/ovoids and 0.52 ± 0.27 mm for needle shafts at distances up to 100 mm from the tandem/ovoids. Performance in human cadaver was similar, with tip and shaft accuracies of 0.77 ± 0.14 mm and 0.40 ± 0.21 mm, respectively.
CONCLUSION
EMVision provides sub-millimeter accuracy for the placement of brachytherapy needles without repeated or continuous imaging. The technology can be used to reduce brachytherapy procedure times, improve the correspondence between intended and actual needle positions, or decrease the trainee learning curve.
{"title":"EMVision: An electromagnetic tracking guidance system for accurate placement of interstitial brachytherapy applicators","authors":"Christopher L. Deufel, Eric E. Brost, Justine M. Dupere, Ivy A. Petersen, Michael G. Haddock, Allison E. Garda","doi":"10.1016/j.brachy.2024.06.006","DOIUrl":"10.1016/j.brachy.2024.06.006","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To design, construct, and evaluate a system for image-guided placement of brachytherapy applicators using electromagnetic tracking (EMT) technology for improved procedure quality and efficiency. The system, named EMVision, provides a three-dimensional display of planned needle sites, visibility of the anatomy and needle position during placement, and reference tracking to account for generator or target anatomy shifts.</div></div><div><h3>METHODS</h3><div>The EMVision EMT guidance system registers CT and EMT reference frames using an automated point-based algorithm according to tandem/ovoid locations. Subsequent needle placement and digitization is guided with an intraluminal EMT sensor and user interface that displays the needle's location in axial, coronal, sagittal, and 3D-volumetric CT views. The interface can overlay contours, preplanned needles, and provide 6DOF compensation for tandem movement during needle placement/manipulation. EMVision accuracy was evaluated in phantom and human cadaver by comparing EMVision's DICOM needle positions with a ground-truth, postimplant CT.</div></div><div><h3>RESULTS</h3><div>Proof of concept was demonstrated for EMT-assisted placement of brachytherapy needles. EMVision accuracy in phantom (mean ± standard deviation) on a brachysuite CT table was 0.76 ± 0.13 mm for needle tips placed up to 75 mm from the tandem/ovoids and 0.52 ± 0.27 mm for needle shafts at distances up to 100 mm from the tandem/ovoids. Performance in human cadaver was similar, with tip and shaft accuracies of 0.77 ± 0.14 mm and 0.40 ± 0.21 mm, respectively.</div></div><div><h3>CONCLUSION</h3><div>EMVision provides sub-millimeter accuracy for the placement of brachytherapy needles without repeated or continuous imaging. The technology can be used to reduce brachytherapy procedure times, improve the correspondence between intended and actual needle positions, or decrease the trainee learning curve.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 676-686"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378712","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 : 2024-11-01DOI: 10.1016/j.brachy.2024.03.004
Dominic Rafie, David Beyer, Kyle Schmanke, Frank Rafie
INTRODUCTION
Accelerated partial breast irradiation with high dose rate brachytherapy treats early-stage carcinoma. Strut-adjusted volume implant applicators are inserted into the cavity post-lumpectomy. For an unstable applicator, changes in distance are seen each day between struts. If an applicator is asymmetrical with no strut movement on subsequent days, then it is stable. If an asymmetrical applicator continues to change strut distances, it is unstable. Waiting for applicator stabilization improves treatment reproducibility but increases infection risk. There is currently no consensus on stability, with ranges from 24 hours (h) to 72 h. Therefore, this study aims to determine when stability is achieved.
MATERIALS AND METHODS
We retrospectively reviewed 242 female breast cancer patients (2014–2022). CT was performed the same day as applicator insertion (Day 0) and repeated each treatment day. If applicators were initially asymmetrical, the distance between adjacent struts was measured, and the percentage change between the next and previous treatment day was calculated to determine how many applicators stabilized. Less than 5% change indicated stability.
RESULTS
On Day 0, 208 out of 242 patients (86%) had stable and symmetrical applicators that maintained stability each treatment day, and 34 out of 242 patients (14%) had applicators with asymmetrical struts. Within 24 h post-insertion, 229 out of 242 (95%) patients had stabilized applicators that maintained stability on subsequent treatment days.
CONCLUSION
Narrows previously suggested stability (24–72 h) to 24 h, leading to improved treatment efficiency and decreased infection risk as less time is needed to achieve applicator stability.
{"title":"Determination of the optimal time for planning SAVI brachytherapy for APBI","authors":"Dominic Rafie, David Beyer, Kyle Schmanke, Frank Rafie","doi":"10.1016/j.brachy.2024.03.004","DOIUrl":"10.1016/j.brachy.2024.03.004","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Accelerated partial breast irradiation with high dose rate brachytherapy treats early-stage carcinoma. Strut-adjusted volume implant applicators are inserted into the cavity post-lumpectomy. For an unstable applicator, changes in distance are seen each day between struts. If an applicator is asymmetrical with no strut movement on subsequent days, then it is stable. If an asymmetrical applicator continues to change strut distances, it is unstable. Waiting for applicator stabilization improves treatment reproducibility but increases infection risk. There is currently no consensus on stability, with ranges from 24 hours (h) to 72 h. Therefore, this study aims to determine when stability is achieved.</div></div><div><h3>MATERIALS AND METHODS</h3><div>We retrospectively reviewed 242 female breast cancer patients (2014–2022). CT was performed the same day as applicator insertion (Day 0) and repeated each treatment day. If applicators were initially asymmetrical, the distance between adjacent struts was measured, and the percentage change between the next and previous treatment day was calculated to determine how many applicators stabilized. Less than 5% change indicated stability.</div></div><div><h3>RESULTS</h3><div>On Day 0, 208 out of 242 patients (86%) had stable and symmetrical applicators that maintained stability each treatment day, and 34 out of 242 patients (14%) had applicators with asymmetrical struts. Within 24 h post-insertion, 229 out of 242 (95%) patients had stabilized applicators that maintained stability on subsequent treatment days.</div></div><div><h3>CONCLUSION</h3><div>Narrows previously suggested stability (24–72 h) to 24 h, leading to improved treatment efficiency and decreased infection risk as less time is needed to achieve applicator stability.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 737-742"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094332","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 : 2024-11-01DOI: 10.1016/j.brachy.2024.06.004
Chengjun Feng, Xiaomin Wen, Shiting Li, Li Hua, Shaojun Chen
OBJECTIVE
This study was conducted to compare the differences between 3D-printed multichannel non–co-planar vaginal applicators and single-channel vaginal applicators in cervical cancer patients with positive or close surgical margins.
METHODS
Between January 2015 and June 2023, 104 cervical cancer patients who underwent radical surgery with positive or close surgical margins were enrolled to receive concurrent intensity-modulated chemoradiotherapy combined with 3D-printed multichannel non–co-planar vaginal applicators (3D-printed group, 41 patients) or single-channel vaginal applicators (single-channel group, 63 patients) guided brachytherapy. The dosimetric parameters, 5-year local control (LC), progression-free survival (PFS), overall survival (OS) of two groups were retrospectively analyzed.
RESULTS
The high-risk clinical target volume (D90, D100) and high-dose volume fraction (V150) in 3D-printed group were significantly higher than those in single-channel group (p < 0.05), and the homogeneity index (HI) and conformal index (COIN) were equally better in 3D-printed group. In 3D-printed group, the D2cc, D1cc, and D0.1cc of the bladder and rectum were significantly lower than those of the single-channel group (p < 0.05). The 3D-printed group had significantly superior 5-year LC (70.0% vs. 51.3%, p = 0.041) and PFS (63.0% vs. 44.2%, p = 0.045), but OS were not significantly different between treatment groups (75.4% vs. 59.7%, p = 0.112). The incidence of radiation enteritis and cystitis was lower in the 3D-printed group than in the single-channel group, but no statistical difference was noted.
CONCLUSIONS
The 3D-printed multichannel non–co-planar vaginal insertion applicators show the advantage of target dose, improve the LC and PFS in patients with positive or close surgical margins after cervical cancer surgery. Thus, the popularization of this method and its application may be of value.
目的本研究旨在比较3D打印多通道非共平面阴道涂抹器与单通道阴道涂抹器在手术边缘阳性或接近手术边缘的宫颈癌患者中的差异：2015年1月至2023年6月期间，104名接受根治术且手术切缘阳性或近距离的宫颈癌患者入组，同时接受强度调节化放疗联合3D打印多通道非共平面阴道涂抹器（3D打印组，41名患者）或单通道阴道涂抹器（单通道组，63名患者）引导的近距离治疗。对两组患者的剂量学参数、5年局部控制率（LC）、无进展生存期（PFS）和总生存期（OS）进行了回顾性分析：结果：三维打印组的高危临床靶体积（D90、D100）和高剂量体积分数（V150）明显高于单通道组（P＜0.05），三维打印组的均匀性指数（HI）和保形指数（COIN）同样优于单通道组。三维打印组膀胱和直肠的 D2cc、D1cc 和 D0.1cc 明显低于单通道组（P < 0.05）。3D 打印组的 5 年 LC（70.0% vs. 51.3%，p = 0.041）和 PFS（63.0% vs. 44.2%，p = 0.045）明显优于单通道组，但 OS 在治疗组间无明显差异（75.4% vs. 59.7%，p = 0.112）。三维打印组放射性肠炎和膀胱炎的发生率低于单通道组，但无统计学差异：3D打印多通道非共平面阴道插入涂抹器在宫颈癌术后手术切缘阳性或接近手术切缘的患者中显示出目标剂量的优势，提高了LC和PFS。因此，这种方法的推广和应用可能具有重要价值。
{"title":"Comparison of 3D-printed multichannel non–co-planar vaginal applicators and single-channel vaginal applicators for brachytherapy with positive or close surgical margins in cervical cancer","authors":"Chengjun Feng, Xiaomin Wen, Shiting Li, Li Hua, Shaojun Chen","doi":"10.1016/j.brachy.2024.06.004","DOIUrl":"10.1016/j.brachy.2024.06.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study was conducted to compare the differences between 3D-printed multichannel non–co-planar vaginal applicators and single-channel vaginal applicators in cervical cancer patients with positive or close surgical margins.</div></div><div><h3>METHODS</h3><div>Between January 2015 and June 2023, 104 cervical cancer patients who underwent radical surgery with positive or close surgical margins were enrolled to receive concurrent intensity-modulated chemoradiotherapy combined with 3D-printed multichannel non–co-planar vaginal applicators (3D-printed group, 41 patients) or single-channel vaginal applicators (single-channel group, 63 patients) guided brachytherapy. The dosimetric parameters, 5-year local control (LC), progression-free survival (PFS), overall survival (OS) of two groups were retrospectively analyzed.</div></div><div><h3>RESULTS</h3><div>The high-risk clinical target volume (D90, D100) and high-dose volume fraction (V150) in 3D-printed group were significantly higher than those in single-channel group (<em>p</em> < 0.05), and the homogeneity index (HI) and conformal index (COIN) were equally better in 3D-printed group. In 3D-printed group, the D2cc, D1cc, and D0.1cc of the bladder and rectum were significantly lower than those of the single-channel group (<em>p</em> < 0.05). The 3D-printed group had significantly superior 5-year LC (70.0% vs. 51.3%, <em>p</em> = 0.041) and PFS (63.0% vs. 44.2%, <em>p</em> = 0.045), but OS were not significantly different between treatment groups (75.4% vs. 59.7%, <em>p</em> = 0.112). The incidence of radiation enteritis and cystitis was lower in the 3D-printed group than in the single-channel group, but no statistical difference was noted.</div></div><div><h3>CONCLUSIONS</h3><div>The 3D-printed multichannel non–co-planar vaginal insertion applicators show the advantage of target dose, improve the LC and PFS in patients with positive or close surgical margins after cervical cancer surgery. Thus, the popularization of this method and its application may be of value.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 641-647"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057580","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}
Pub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.06.005
Alexander Lukez , Brian L. Egleston , Peter L. Lee , Krisha J. Howell , Jeremy G. Price
OBJECTIVE
We utilized the National Cancer Database (NCDB) to evaluate trends and assess outcomes in radiation therapy (RT) boost modality and total dose among medically inoperable endometrial cancer (EC) patients with locoregional disease.
METHODS
Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I – IIIC2 inoperable EC treated with RT ± chemotherapy were analyzed. Practice patterns compared external beam RT (EBRT) versus high-dose-rate brachytherapy (BT) boost and total RT dose (palliative: ≤3000 cGy, definitive low dose [DLD]: 4500 – 6249 cGy, definitive high dose [DHD]: ≥6250 cGy) over time. Kaplan-Meier method evaluated overall survival (OS) and Cox proportional hazard modeling assessed variables associated with OS.
RESULTS
NCDB included 1755 total cases, of which 1209 received a radiotherapy boost. From 2004 to 2019, boost modality rates differed with increasing utilization of BT consolidation and a decreasing rate of palliation. Predictors of a palliative dose were stage III disease, Black race, N2 disease, and poorly or undifferentiated grade. Multivariable analysis found BT boost was associated with lower mortality compared to EBRT (HR: 0.81, CI: 0.68–0.97; p = 0.019). Mortality rates were higher for palliation versus DHD. Additional factors associated with inferior survival were increasing age, worse Charlson-Deyo score, higher T stage, higher N stage, and moderately, poorly, or undifferentiated grade.
CONCLUSIONS
Utilization of BT boost for locoregionally confined, medically inoperable EC has increased since 2004. Brachytherapy consolidation remains an effective RT modality for medically inoperable EC, associated with lower mortality compared to EBRT consolidation.
{"title":"National Cancer Database analysis of radiation therapy consolidation modality and dose for inoperable endometrial cancer","authors":"Alexander Lukez , Brian L. Egleston , Peter L. Lee , Krisha J. Howell , Jeremy G. Price","doi":"10.1016/j.brachy.2024.06.005","DOIUrl":"10.1016/j.brachy.2024.06.005","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>We utilized the National Cancer Database (NCDB) to evaluate trends and assess outcomes in radiation therapy (RT) boost modality and total dose among medically inoperable endometrial cancer (EC) patients with locoregional disease.</div></div><div><h3>METHODS</h3><div>Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I – IIIC2 inoperable EC treated with RT ± chemotherapy were analyzed. Practice patterns compared external beam RT (EBRT) versus high-dose-rate brachytherapy (BT) boost and total RT dose (palliative: ≤3000 cGy, definitive low dose [DLD]: 4500 – 6249 cGy, definitive high dose [DHD]: ≥6250 cGy) over time. Kaplan-Meier method evaluated overall survival (OS) and Cox proportional hazard modeling assessed variables associated with OS.</div></div><div><h3>RESULTS</h3><div>NCDB included 1755 total cases, of which 1209 received a radiotherapy boost. From 2004 to 2019, boost modality rates differed with increasing utilization of BT consolidation and a decreasing rate of palliation. Predictors of a palliative dose were stage III disease, Black race, N2 disease, and poorly or undifferentiated grade. Multivariable analysis found BT boost was associated with lower mortality compared to EBRT (HR: 0.81, CI: 0.68–0.97; <em>p</em> = 0.019). Mortality rates were higher for palliation versus DHD. Additional factors associated with inferior survival were increasing age, worse Charlson-Deyo score, higher T stage, higher N stage, and moderately, poorly, or undifferentiated grade.</div></div><div><h3>CONCLUSIONS</h3><div>Utilization of BT boost for locoregionally confined, medically inoperable EC has increased since 2004. Brachytherapy consolidation remains an effective RT modality for medically inoperable EC, associated with lower mortality compared to EBRT consolidation.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 623-633"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038007","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}
This study aimed to assess if prostate-specific antigen (PSA) threshold and PSA bounce are associated with oncological control after low-dose-rate brachytherapy (LDR-BT) alone or with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), considering serum testosterone levels.
METHODS
This study enrolled 944 prostate cancer patients treated at a single institution with LDR-BT alone or LDR-BT combined with EBRT, with or without ADT. The Fine-Gray hazard model was used to evaluate factors related to clinical failure, including experience of PSA bounce between baseline and 2, 4, or 7 years after LDR-BT and PSA value (0.1, 0.2, or 0.5 ng/mL) with normal testosterone levels at 2, 4, and 7 years after LDR-BT, respectively.
RESULTS
Patients with normal testosterone levels and a PSA of 0.2 or 0.5 ng/mL at 2, 4, and 7 years after LDR-BT had a significantly better clinical failure free rate (CFFR) than those with PSA levels >0.2 or >0.5 ng/mL or low testosterone levels. Multivariate analysis revealed that PSA <0.1, 0.2, or 0.5 ng/mL with normal testosterone levels at 2, 4, and 7 years and experience of PSA bounce between baseline and 2 or 4 years after LDR-BT were significantly related to better CFFR.
CONCLUSIONS
Patients with normal serum testosterone levels who reached PSA of <0.1, 0.2, or 0.5 ng/mL after LDR-BT, or those who experienced PSA bounce, showed better oncological control.
{"title":"Prostate-specific antigen (PSA) nadir and experience of PSA bounce after low-dose-rate brachytherapy for prostate cancer predicts clinical failure","authors":"Yasushi Nakai , Nobumichi Tanaka , Isao Asakawa , Kenta Onishi , Makito Miyake , Kaori Yamaki , Kiyohide Fujimoto","doi":"10.1016/j.brachy.2024.09.003","DOIUrl":"10.1016/j.brachy.2024.09.003","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to assess if prostate-specific antigen (PSA) threshold and PSA bounce are associated with oncological control after low-dose-rate brachytherapy (LDR-BT) alone or with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), considering serum testosterone levels.</div></div><div><h3>METHODS</h3><div>This study enrolled 944 prostate cancer patients treated at a single institution with LDR-BT alone or LDR-BT combined with EBRT, with or without ADT. The Fine-Gray hazard model was used to evaluate factors related to clinical failure, including experience of PSA bounce between baseline and 2, 4, or 7 years after LDR-BT and PSA value (0.1, 0.2, or 0.5 ng/mL) with normal testosterone levels at 2, 4, and 7 years after LDR-BT, respectively.</div></div><div><h3>RESULTS</h3><div>Patients with normal testosterone levels and a PSA of 0.2 or 0.5 ng/mL at 2, 4, and 7 years after LDR-BT had a significantly better clinical failure free rate (CFFR) than those with PSA levels >0.2 or >0.5 ng/mL or low testosterone levels. Multivariate analysis revealed that PSA <0.1, 0.2, or 0.5 ng/mL with normal testosterone levels at 2, 4, and 7 years and experience of PSA bounce between baseline and 2 or 4 years after LDR-BT were significantly related to better CFFR.</div></div><div><h3>CONCLUSIONS</h3><div>Patients with normal serum testosterone levels who reached PSA of <0.1, 0.2, or 0.5 ng/mL after LDR-BT, or those who experienced PSA bounce, showed better oncological control.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 727-736"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378713","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.2024.08.019
Grzegorz Bielęda PhD , Anna Marach MSc , Adam Chichel MD PhD , Natalia Langner MSc , Artur Chyrek MD PhD , Adam Kluska MD PhD , Wojciech Burchardt MD PhD , Grzegorz Zwierzchowski PhD
<div><h3>Purpose</h3><div>Contact brachytherapy for non-melanoma skin cancers demonstrates very good treatment results. The main problem is to fit properly a standard applicator to a heavily pleated surface, such as the nasal or orbital region. In order to improve the reproducibility and quality of dose distributions, we have introduced individual custom-designed applicators manufactured on a 3D printer. The purpose of this study was to verify the effect of changing the contoured CTV volume between the pre-plan and the therapeutic plan.</div></div><div><h3>Materials and Methods</h3><div>For the study, 95 consecutive treatment plans were qualified for patients treated between 2021 and 2023 with individual contact applicators for skin brachytherapy. After the qualification, on the first visit in brachytherapy department, the patient had fiducial radiological markers surrounding the skin lesion placed and the CT scan performed. On the images, the physician contoured the volume of the CTV and critical organs. Based on the CT images and contours, medical physicist prepared the body of the applicator, the position of the catheters and the optimal source dwell positions in treatment planning system. The proposed dose distribution was consulted with the physician for verification. After approval, the DICOM files were exported to software converting DICOM files to printable stl files and the applicator was printed. At the next visit, the patient was CT scanned with the applicator in place and a treatment plan was prepared, based on the recontoured CTV and critical organs. We compared CTV volume values and dose distribution values in reconstructed critical organs and CTV for the pre-plan and approved treatment plan. We considered CTV volume, V100, V150 and D90. For OARs we compared doses in 0.1, 1 and 2 ccm.</div></div><div><h3>Results</h3><div>Since the parameters studied did not show conformity to the normal distribution (the Shapiro-Wilk test was used) we applied the Wilcoxon signed-rank test. The compared parameters for the evaluation of the treatment plan appeared to be consistent with each other within the limits assumed for the tests performed (α=0.05), except for the maximum doses in the lenses. The doses in 0.1 cc of lens in the realized plans were found to be statistically significantly lower than in the plans created at the time of applicator design. Left lens pre-plan D0.1 = 12.86% vs 11.48% (p=0,005441) in treatment plan, right lens pre-plan D.01 = 9.67% vs 8.02% (p=0,005694) in treatment plan. During the preparation of the final treatment plans, physicists suspected physicians to contour larger CTV volumes than during the pre-plan and the applicator design. A surprising result of this study was that although not statistically significant but the mean CTV volume in the pre-plan was higher than in the contour made for the final treatment plan (1.69 ccm vs. 1.61 ccm). The main investigator thought before performing the statistics that the relati
{"title":"MPP05 Presentation Time: 4:45 PM","authors":"Grzegorz Bielęda PhD , Anna Marach MSc , Adam Chichel MD PhD , Natalia Langner MSc , Artur Chyrek MD PhD , Adam Kluska MD PhD , Wojciech Burchardt MD PhD , Grzegorz Zwierzchowski PhD","doi":"10.1016/j.brachy.2024.08.019","DOIUrl":"10.1016/j.brachy.2024.08.019","url":null,"abstract":"<div><h3>Purpose</h3><div>Contact brachytherapy for non-melanoma skin cancers demonstrates very good treatment results. The main problem is to fit properly a standard applicator to a heavily pleated surface, such as the nasal or orbital region. In order to improve the reproducibility and quality of dose distributions, we have introduced individual custom-designed applicators manufactured on a 3D printer. The purpose of this study was to verify the effect of changing the contoured CTV volume between the pre-plan and the therapeutic plan.</div></div><div><h3>Materials and Methods</h3><div>For the study, 95 consecutive treatment plans were qualified for patients treated between 2021 and 2023 with individual contact applicators for skin brachytherapy. After the qualification, on the first visit in brachytherapy department, the patient had fiducial radiological markers surrounding the skin lesion placed and the CT scan performed. On the images, the physician contoured the volume of the CTV and critical organs. Based on the CT images and contours, medical physicist prepared the body of the applicator, the position of the catheters and the optimal source dwell positions in treatment planning system. The proposed dose distribution was consulted with the physician for verification. After approval, the DICOM files were exported to software converting DICOM files to printable stl files and the applicator was printed. At the next visit, the patient was CT scanned with the applicator in place and a treatment plan was prepared, based on the recontoured CTV and critical organs. We compared CTV volume values and dose distribution values in reconstructed critical organs and CTV for the pre-plan and approved treatment plan. We considered CTV volume, V100, V150 and D90. For OARs we compared doses in 0.1, 1 and 2 ccm.</div></div><div><h3>Results</h3><div>Since the parameters studied did not show conformity to the normal distribution (the Shapiro-Wilk test was used) we applied the Wilcoxon signed-rank test. The compared parameters for the evaluation of the treatment plan appeared to be consistent with each other within the limits assumed for the tests performed (α=0.05), except for the maximum doses in the lenses. The doses in 0.1 cc of lens in the realized plans were found to be statistically significantly lower than in the plans created at the time of applicator design. Left lens pre-plan D0.1 = 12.86% vs 11.48% (p=0,005441) in treatment plan, right lens pre-plan D.01 = 9.67% vs 8.02% (p=0,005694) in treatment plan. During the preparation of the final treatment plans, physicists suspected physicians to contour larger CTV volumes than during the pre-plan and the applicator design. A surprising result of this study was that although not statistically significant but the mean CTV volume in the pre-plan was higher than in the contour made for the final treatment plan (1.69 ccm vs. 1.61 ccm). The main investigator thought before performing the statistics that the relati","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S26"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527065","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.2024.08.054
Mayank Patel MD MBA , Samyukta Jhavar BS , Gaurav Gomber BS , Anne Hubbard MBA , Ann Klopp MD PhD , Andrew Farach MD , Michelle Ludwig MD MPH PhD
Purpose
Brachytherapy is a critical component of definitive cervical cancer treatment. Timely access to treatment has shown an improved survival benefit. Texas is the second largest state by size and population in the US. Here we explore the geographic availability of brachytherapy (BT) centers in the state.
Materials and Methods
We queried publicly available data on cervical cancer incidence and mortality between 2010-2020 from the Texas Cancer Registry. Available BT centers were compiled from the Texas Department of State Health Services (DSHS) Radiation Control Program and verified by direct contact with each treating institution. Number of BT units per 1,000 new cases was calculated as an index of BT availability.
Results
The state currently has 48 institutions actively treating cervical cancer with definitive tandem & ring/ovoid intracavitary BT. Texas DSHS geographically divided the state into 11 public health regions (PHR) to support and coordinate the local health needs of the entire state. PHR 8 located in the south-central region has the lowest availability of centers (1.23 centers/1,000 new cases), while PHR 1 in the north region has the highest availability (8.73 centers/1,000 new cases). The overall Texas incidence rate, mortality rate, and BT availability is 9.4 per 100,000 (US rate 7.7), 2.8 per 100,000 (US rate 2.6), and 3.43 per 1,000 new cases, respectively. In Texas, it is estimated that 45% of cases are diagnosed with locally advanced disease. The overall state locally advanced incidence rate is 4.2 cases per 100,000 population, which is 55% higher than the national locally advanced incidence rate of 2.7. Annually, 31% of all cervical cancer patients diagnosed in Texas die from the disease, as compared to only 10% nationally. On the county level, Henderson County has the highest mortality rate (5.8 deaths per 100,000 population) and no BT availability. Hidalgo County located on the southern border has the highest incidence (500) and deaths (157) of rural counties. Fort Bend County has the highest absolute incidence (263) and deaths (90) for a county without any BT centers. Angelina County has the highest incidence rate (15.9 per 100,000) with a non-zero death rate (3.9 per 100,000).
Conclusions
Compared to national rates, Texas has a higher overall incidence rate of cervical cancer overall and locally advanced cervical cancer highlighting the need for widespread access to BT services across the state. Herein, we review cervical cancer incidence rates, mortality rates, and access to intracavitary BT centers by county and PHR to identify BT deserts across the state. This analysis identifies the highest at-risk populations and opportunities for improved BT access. There is an existing need for expanded geographic access to high-quality BT centers and well-trained brachytherapists across Texas.
{"title":"GSOR08 Presentation Time: 5:35 PM","authors":"Mayank Patel MD MBA , Samyukta Jhavar BS , Gaurav Gomber BS , Anne Hubbard MBA , Ann Klopp MD PhD , Andrew Farach MD , Michelle Ludwig MD MPH PhD","doi":"10.1016/j.brachy.2024.08.054","DOIUrl":"10.1016/j.brachy.2024.08.054","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy is a critical component of definitive cervical cancer treatment. Timely access to treatment has shown an improved survival benefit. Texas is the second largest state by size and population in the US. Here we explore the geographic availability of brachytherapy (BT) centers in the state.</div></div><div><h3>Materials and Methods</h3><div>We queried publicly available data on cervical cancer incidence and mortality between 2010-2020 from the Texas Cancer Registry. Available BT centers were compiled from the Texas Department of State Health Services (DSHS) Radiation Control Program and verified by direct contact with each treating institution. Number of BT units per 1,000 new cases was calculated as an index of BT availability.</div></div><div><h3>Results</h3><div>The state currently has 48 institutions actively treating cervical cancer with definitive tandem & ring/ovoid intracavitary BT. Texas DSHS geographically divided the state into 11 public health regions (PHR) to support and coordinate the local health needs of the entire state. PHR 8 located in the south-central region has the lowest availability of centers (1.23 centers/1,000 new cases), while PHR 1 in the north region has the highest availability (8.73 centers/1,000 new cases). The overall Texas incidence rate, mortality rate, and BT availability is 9.4 per 100,000 (US rate 7.7), 2.8 per 100,000 (US rate 2.6), and 3.43 per 1,000 new cases, respectively. In Texas, it is estimated that 45% of cases are diagnosed with locally advanced disease. The overall state locally advanced incidence rate is 4.2 cases per 100,000 population, which is 55% higher than the national locally advanced incidence rate of 2.7. Annually, 31% of all cervical cancer patients diagnosed in Texas die from the disease, as compared to only 10% nationally. On the county level, Henderson County has the highest mortality rate (5.8 deaths per 100,000 population) and no BT availability. Hidalgo County located on the southern border has the highest incidence (500) and deaths (157) of rural counties. Fort Bend County has the highest absolute incidence (263) and deaths (90) for a county without any BT centers. Angelina County has the highest incidence rate (15.9 per 100,000) with a non-zero death rate (3.9 per 100,000).</div></div><div><h3>Conclusions</h3><div>Compared to national rates, Texas has a higher overall incidence rate of cervical cancer overall and locally advanced cervical cancer highlighting the need for widespread access to BT services across the state. Herein, we review cervical cancer incidence rates, mortality rates, and access to intracavitary BT centers by county and PHR to identify BT deserts across the state. This analysis identifies the highest at-risk populations and opportunities for improved BT access. There is an existing need for expanded geographic access to high-quality BT centers and well-trained brachytherapists across Texas.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S45-S46"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527138","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.2024.08.072
Yhana Chavis DO, Kristin Walker MD MBA, Allen Luk MD, Daniel Leach MD, Kara Romano MD, Einsley Janowski MD PhD
<div><h3>Purpose</h3><div>Brachytherapy (BT) boost is the standard of care technique for locally advanced cervical cancer (LACC) and a critical component of curative treatment. Overall treatment time strongly correlates with local control, with evidence indicating that completion of chemoradiation within 8 weeks is important for clinical outcomes. Socioeconomic and racial factors are also known to contribute to disparities in BT access and have been linked to worsened survival. The aim of our study is to explore factors impacting timely completion of BT treatment amongst LACC patients treated at a single academic institution that serves a large catchment area in the state of Virginia.</div></div><div><h3>Methods</h3><div>Patients diagnosed with LACC receiving their BT at the University of Virginia (UVA) between 2004 and 2021 were identified. Patient demographics and additional characteristics were recorded, including: insurance and employment status, alcohol and/or drug use disorder, and distance from UVA Cancer Center. Based on proven prognostic factors for local control of LACC, the cut off of 56 days to complete treatment was used for stratification, looking at demographic differences between those groups who received timely or prolonged therapy completion. The means for each demographic were compared using standard error and simple unpaired t-tests.</div></div><div><h3>Results</h3><div>124 patients with LACC, FIGO stage IB2 to IV were included Median age of our cohort at time of treatment was 49.8 years. 50% of patients were employed, 42% were unemployed, and 8% had unknown employment status. 79% of patients had listed insurance, 11% had no insurance, and 10% had unknown insurance information. Racial demographics were 74% white, 15% black, 9% Hispanic, 2% Asian, and <1% unidentified. 4% of patients had a history of incarceration, 3% of patients had a known history of or current drug abuse, and 2 of the above patients had both factors. Out of the 124 patients, 24 patients completed concurrent chemoradiation and BT beyond 56 days. The statistically significant social barriers identified in this group included employment, insurance status, and drug use. Employed patients completed treatment on an average of 49.7 ± 1.1 days (range 36-79), compared to 51.44 days ± 1.5 days (range 34-87) for unemployed patients <em>(p</em> = 0.0135). Insured patients completed their treatment within 50.6 ± 0.9 days (range 43-71), compared to 59.14 ± 1.9 days (range 34-87) for uninsured, (<em>p</em> = 0.035). On average, white, Hispanic, and black women completed treatment in 50.9 ± 1.02 days, 48.9 ± 1.58 days, and 54.0 ± 2.5 days, respectively (<em>p</em>=0.20 for white versus black cohorts). Average completion time was 50.6 ± 0.9 (range 34-87) in the non-incarcerated group compared to 55 ± 5 days (range 47-70) in the incarcerated group, <em>p</em> =0.32, and average completion time was 50.3 ± 0.9 days (range 34-87) in the non-drug use compared to 65.5 ± 2.1 day
{"title":"MSOR10 Presentation Time: 8:45 AM","authors":"Yhana Chavis DO, Kristin Walker MD MBA, Allen Luk MD, Daniel Leach MD, Kara Romano MD, Einsley Janowski MD PhD","doi":"10.1016/j.brachy.2024.08.072","DOIUrl":"10.1016/j.brachy.2024.08.072","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy (BT) boost is the standard of care technique for locally advanced cervical cancer (LACC) and a critical component of curative treatment. Overall treatment time strongly correlates with local control, with evidence indicating that completion of chemoradiation within 8 weeks is important for clinical outcomes. Socioeconomic and racial factors are also known to contribute to disparities in BT access and have been linked to worsened survival. The aim of our study is to explore factors impacting timely completion of BT treatment amongst LACC patients treated at a single academic institution that serves a large catchment area in the state of Virginia.</div></div><div><h3>Methods</h3><div>Patients diagnosed with LACC receiving their BT at the University of Virginia (UVA) between 2004 and 2021 were identified. Patient demographics and additional characteristics were recorded, including: insurance and employment status, alcohol and/or drug use disorder, and distance from UVA Cancer Center. Based on proven prognostic factors for local control of LACC, the cut off of 56 days to complete treatment was used for stratification, looking at demographic differences between those groups who received timely or prolonged therapy completion. The means for each demographic were compared using standard error and simple unpaired t-tests.</div></div><div><h3>Results</h3><div>124 patients with LACC, FIGO stage IB2 to IV were included Median age of our cohort at time of treatment was 49.8 years. 50% of patients were employed, 42% were unemployed, and 8% had unknown employment status. 79% of patients had listed insurance, 11% had no insurance, and 10% had unknown insurance information. Racial demographics were 74% white, 15% black, 9% Hispanic, 2% Asian, and <1% unidentified. 4% of patients had a history of incarceration, 3% of patients had a known history of or current drug abuse, and 2 of the above patients had both factors. Out of the 124 patients, 24 patients completed concurrent chemoradiation and BT beyond 56 days. The statistically significant social barriers identified in this group included employment, insurance status, and drug use. Employed patients completed treatment on an average of 49.7 ± 1.1 days (range 36-79), compared to 51.44 days ± 1.5 days (range 34-87) for unemployed patients <em>(p</em> = 0.0135). Insured patients completed their treatment within 50.6 ± 0.9 days (range 43-71), compared to 59.14 ± 1.9 days (range 34-87) for uninsured, (<em>p</em> = 0.035). On average, white, Hispanic, and black women completed treatment in 50.9 ± 1.02 days, 48.9 ± 1.58 days, and 54.0 ± 2.5 days, respectively (<em>p</em>=0.20 for white versus black cohorts). Average completion time was 50.6 ± 0.9 (range 34-87) in the non-incarcerated group compared to 55 ± 5 days (range 47-70) in the incarcerated group, <em>p</em> =0.32, and average completion time was 50.3 ± 0.9 days (range 34-87) in the non-drug use compared to 65.5 ± 2.1 day","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S55-S56"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526902","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号