Brachytherapy最新文献

{"title":"MRI-based predictors of treatment failure in intermediate-risk prostate cancer treated with high-dose-rate brachytherapy as monotherapy","authors":"Jacob F. Oyeniyi ,&nbsp;Joseph S. Lee ,&nbsp;Chen Shen ,&nbsp;Bailey A. Loving ,&nbsp;Sirisha R. Nandalur ,&nbsp;Andrew B. Thompson ,&nbsp;Kiran R. Nandalur ,&nbsp;Zachary A. Seymour ,&nbsp;Evelyn L. Sebastian ,&nbsp;Amy Limbacher ,&nbsp;Alvaro Martinez ,&nbsp;Daniel J. Krauss","doi":"10.1016/j.brachy.2025.10.012","DOIUrl":"10.1016/j.brachy.2025.10.012","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To identify MRI features associated with treatment failure in intermediate-risk prostate cancer patients treated with HDR brachytherapy monotherapy.</div></div><div><h3>METHODS</h3><div>We analyzed 115 men with intermediate-risk prostate cancer who underwent definitive HDR brachytherapy as monotherapy and had pretreatment MRI within 6 months. MRI features assessed included lesion size, focality, location, capsular contact (yes vs. no, with no gross extracapsular extension), length of capsular contact, and PIRADS score. Univariable and multivariate logistic regression analyses were performed to identify MRI features associated with treatment failure, defined as biochemical recurrence and/or local recurrence.</div></div><div><h3>RESULTS</h3><div>The median age was 64 years, and median pretreatment PSA 5.95 ng/mL; 49 patients had favorable and 66 had unfavorable intermediate-risk disease. At 47 months median follow-up, 19 patients (16.5%) experienced treatment failure. MRI features associated with treatment failure on UVA included lesion size (OR: 3.9, CI: 1.8–8.8, <em>p</em> &lt; 0.001), multifocality (OR: 2.9, CI: 1.0–7.9, <em>p</em> = 0.043), capsular contact (OR: 64.3, CI: 8.1–510.0, <em>p</em> &lt; 0.001), capsular contact length ≥1 cm (OR: 5.0, CI: 1.6–15.7, <em>p</em> = 0.006), and PIRADS 5 (OR: 16.7, CI: 2.7–324.8, <em>p</em> = 0.011). On MVA, only capsular contact remained significant (OR: 57.2, CI: 9.5–106.2, <em>p</em> &lt; 0.001). In patients with capsular contact (<em>n</em> = 39), ADT significantly reduced treatment failure (OR: 0.101, CI: 0.002–0.912, <em>p</em> = 0.023).</div></div><div><h3>CONCLUSION</h3><div>Capsular contact on MRI is a strong independent predictor of treatment failure in intermediate-risk prostate cancer patients undergoing HDR brachytherapy as monotherapy. The addition of ADT significantly decreased the odds of treatment failure in these patients. These findings highlight the value of MRI-based risk stratification and suggest that treatment intensification options such as ADT could be considered to optimize treatment outcomes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 15-23"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of single-click, AI-based brachytherapy auto-planning for cervical cancer within a treatment planning system","authors":"Ryan Truong ,&nbsp;Lance C. Moore ,&nbsp;Aranyo Mitra ,&nbsp;Karoline Kallis ,&nbsp;Kelly Kisling ,&nbsp;Nuno Vasconcelos ,&nbsp;Sandra M. Meyers","doi":"10.1016/j.brachy.2025.08.004","DOIUrl":"10.1016/j.brachy.2025.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Previous work developed an automated cervical brachytherapy treatment planning pipeline consisting of a U-Net dose prediction model and dwell time optimizer. While this method can produce clinically acceptable plans, it relies on time-consuming, manual export and import of DICOM data. This study proposes to increase efficiency by combining scripts into an all-in-one tool that can be used directly within the BrachyVision treatment planning system, producing automated plans in a single click.</div></div><div><h3>Materials and Methods</h3><div>We developed an AI-based planning tool through four main tasks; data retrieval, model inference, dwell time optimization, and auto-plan import. First, a C# plug-in interacts with the currently open patient in BrachyVision. Next, for data retrieval, model inference, and dwell time optimization, a Python executable operates on the data before the optimized dwell times are copied back into the open plan in BrachyVision. The script was tested on 28 brachytherapy plans spanning 7 applicator types, and auto-plans were compared to clinical plans using mean absolute error (MAE) in voxel-based 3D dose and dwell times.</div></div><div><h3>Results</h3><div>The average (± standard deviation) MAE in 3D dose and dwell times were 3.8 ± 0.7% (normalized to the prescribed dose) and 10.3 ± 7.4 s (2.1 ± 0.9% of the total plan dwell time), respectively. The average runtime of the script was 3.5 ± 1.2 minutes.</div></div><div><h3>Conclusions</h3><div>We developed a script that enables efficient, streamlined auto-planning directly within BrachyVision. After contouring and digitization are performed, the script can be run to produce high-quality, customized plans with a single button-click in a few minutes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 206-213"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-source cone-beam CT for HDR brachytherapy in-suite imaging: Simulation studies of limited angle image reconstruction based on deep image prior","authors":"Xin Qian ,&nbsp;Ziyu Shu ,&nbsp;Salar Souri ,&nbsp;Yizhou Zhao ,&nbsp;Zhaozheng Yin ,&nbsp;Renee F. Farrell ,&nbsp;Jinkoo Kim ,&nbsp;Jieying Wu ,&nbsp;Sam Ryu ,&nbsp;Tiezhi Zhang","doi":"10.1016/j.brachy.2025.09.001","DOIUrl":"10.1016/j.brachy.2025.09.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>C-arm cone-beam computed tomography (CBCT) in-suite imaging is often used in a brachytherapy suite. However, due to the limited rotation angle of the C-arm gantry and the dimension of the flat panel imager (FPI), CBCT images are often truncated and not suitable for treatment planning. In this simulation study, we present the design of a novel ultra-compact mobile dual-source CBCT (dCBCT) that can scan large field of view with half system rotation. Enabled by deep learning image reconstruction, it can perform ultra-short scans and stereoscopic imaging before and during high dose rate (HDR) treatments.</div></div><div><h3>MATERIAL AND METHODS</h3><div>The dCBCT comprises two x-ray sources and a flat panel imager mounted on a C-arm gantry. The dual-sources configuration enables real-time stereoscopic imaging, also avoids data truncation problem of conventional C-arm CBCT. Simulation studies were performed to prove the concept of ultra-short scan of dCBCT. Deep Image Prior (DIP) image reconstruction without and with a <em>Prior</em> was also developed to reduce the scan angle.</div></div><div><h3>RESULTS</h3><div>The simulation studies of dCBCT show that it can achieve a sufficient reconstruction field of view with 180° rotation. DIP reconstruction reduces scanning angle to 135° without sacrificing image quality. With body profile as constraint, ultra-short scan with merely 90° system rotation can be achieved.</div></div><div><h3>CONCLUSIONS</h3><div>Powered by deep-learning based limited-angle image reconstruction, dCBCT can scan full body with a short scan, allowing rapid 3D and real-time planar imaging in brachytherapy suite.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 214-220"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review on the transition from PDR to HDR brachytherapy (interventional radiotherapy) for treatment of head and neck cancer: Clinical and practical aspects","authors":"Renske van Noortwijk ,&nbsp;Petra Kroon ,&nbsp;Maarten Kastelijns ,&nbsp;Ina Jürgenliemk-Schulz ,&nbsp;Gerda Verduijn ,&nbsp;Inger-Karine Kolkman-Deurloo ,&nbsp;Luca Tagliaferri ,&nbsp;Bruno Fionda ,&nbsp;Elisa Placidi ,&nbsp;Abrahim Al-Mamgani ,&nbsp;Martijn Ketelaars ,&nbsp;Ellen Zwijnenburg ,&nbsp;Ruud van Leeuwen ,&nbsp;Milena Smolic ,&nbsp;Mischa de Ridder","doi":"10.1016/j.brachy.2025.09.007","DOIUrl":"10.1016/j.brachy.2025.09.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To increase knowledge on clinical outcomes of pulsed-dose-rate (PDR) and high-dose-rate (HDR) brachytherapy (BT) (also referred to as Interventional Radiotherapy (IRT)) treatments for superficial head and neck cancer subsites (i.e., lip and nasal vestibule carcinoma) and to provide insight in the practical aspects of a transition from PDR to HDR BT.</div></div><div><h3>METHODS</h3><div>A systematic literature review following the PRISMA guidelines was performed using PubMed and Embase to examine the clinical outcomes of PDR and HDR BT. Additional information on the practical aspects of a transition from PDR to HDR BT was obtained through interviews by means of a questionnaire, completed by five experienced brachytherapy centers. The topics addressed were “treatment”, “equipment and usage”, and “workflow and logistics”.</div></div><div><h3>RESULTS</h3><div>Of 1095 records identified from two databases, eleven studies (four PDR, seven HDR) were included for the systematic review. Local control (LC) rates ranged from 91% to 100% (median 93%) and 86–100% (median 95%) for PDR and HDR studies, respectively. According to the information provided by the five institutions, significant practical differences between institutions included fractionation schedules, weekly treatment days, and hospitalization choices.</div></div><div><h3>CONCLUSION</h3><div>Both PDR and HDR BT result in excellent LC with median above 93% for lip and nasal vestibule carcinomas. Therefore, a transition from PDR to HDR BT is not expected to influence local control. In terms of practical aspects, questionnaire results show that HDR provides more flexibility than PDR in terms of patient hospitalization and afterloader availability. The choice between PDR or HDR is mostly dependent on institutional resources.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 154-162"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of vaginal stenosis following vault brachytherapy monotherapy between common fractionation schemes in the treatment of endometrial cancer","authors":"H. Byrd ,&nbsp;M. Kessler ,&nbsp;G. Sosa ,&nbsp;G. Emeka-Ibe ,&nbsp;C. Penn ,&nbsp;A. Brown ,&nbsp;L. Prescott ,&nbsp;M. Crispens ,&nbsp;R.D. Alvarez ,&nbsp;A. Shinde","doi":"10.1016/j.brachy.2025.09.004","DOIUrl":"10.1016/j.brachy.2025.09.004","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;Vaginal stenosis is a well-documented toxicity of vaginal brachytherapy (VBT), which can lead to impaired quality of life and difficulty with surveillance pelvic exams. While multiple dosing and fractionation schemes have proven efficacy at preventing local recurrence, the comparative rates and severity of vaginal stenosis is not well-documented. This study aims to evaluate the rate of vaginal stenosis in patients with endometrial cancer treated with 2 common high-dose rate (HDR) adjuvant VBT without external beam radiation (EBRT) using vaginal cylinders.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS AND MATERIALS&lt;/h3&gt;&lt;div&gt;A retrospective review of patients treated at a single institution with adjuvant VBT following hysterectomy for uterine cancer was performed. The 2 regimens evaluated were 21 Gray (Gy) delivered in 3 fractions (fx) prescribed to a depth of 5 mm, delivered once weekly, and 30Gy/5fx prescribed to the vaginal surface, delivered every other day. Patient demographic and treatment information was collected from electronic medical records, including patient age at the time of treatment, BMI, cancer histology, chemotherapy status, common terminology criteria for adverse events (CTCAE) grade of vaginal stenosis, cylinder size, treatment length, sexual activity, and subsequent dilator use. Bivariate analysis was completed using Odds Ratios and χ2 tests with KNIME software version 5.4.0.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of the 150 patients treated with VBT between 2018 and 2024, 92 received cuff brachytherapy alone with a single-channel cylinder, utilizing either 30Gy/5fx or 21Gy/3fx. Of these patients, 88 were available for at least 3 months of follow-up with median follow-up of 23 months. Median patient age was 66 years. Seventy-two (82%) patients were white and 47 (53%) patients received chemotherapy. Thirty-three patients received 21Gy/3fx (38%) and 55 patients received 30Gy/5fx (62%). Vaginal stenosis was reported in 54% of patients who received 21Gy/3fx, compared to 22% of those who received 30Gy/5fx (OR 4.3 [95% CI: 1.7–11.0, &lt;em&gt;p&lt;/em&gt; = 0.002]). Most patients in each group had common terminology criteria for adverse events (CTCAE) grade 1 stenosis (90% in 21Gy/3fx-group and 67% in 30Gy/5fx-group). The median cylinder size was 30 mm, and the mean treatment length was 5 cm, neither of which appeared to affect risk of developing vaginal stenosis (OR 1 [95% CI: 0.4–2.5, &lt;em&gt;p&lt;/em&gt; = 1] and OR 1.4 [95% CI: 0.5–3.4, &lt;em&gt;p&lt;/em&gt; = 0.6, respectively). Receipt of adjuvant systemic therapy had a numerical, but not statistically significant increase in risk of developing vaginal stenosis (OR 2.3 [95% CI: 0.9–5.7, &lt;em&gt;p&lt;/em&gt; = 0.1]). The risk of developing vaginal stenosis in the absence of sexual activity following completion of therapy was not significant (OR 2 [95% CI: 0.6–7, &lt;em&gt;p&lt;/em&gt; = 0.3]), and this was true also for vaginal dilator utilization (OR 1.2 [95% CI: 0.5–3, &lt;em&gt;p&lt;/em&gt; = 0.8]). Diagnosis with a high-risk histolog","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 229-234"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Dedeepya et al. comment on “High-dose-rate (HDR) brachytherapy boost in combination with external beam radiotherapy for localized prostate cancer”","authors":"Sagar A. Patel ,&nbsp;Mitchell R. Kamrava","doi":"10.1016/j.brachy.2025.10.006","DOIUrl":"10.1016/j.brachy.2025.10.006","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 253-254"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose-rate brachytherapy for cutaneous T-cell lymphoma involving complex skin sites","authors":"Van Sim ,&nbsp;Regina Gonzalez Vaz ,&nbsp;Emma L Jones ,&nbsp;Irene De Francesco ,&nbsp;Adam Dobson ,&nbsp;Bjorn R Thomas ,&nbsp;Stephen Morris","doi":"10.1016/j.brachy.2025.09.016","DOIUrl":"10.1016/j.brachy.2025.09.016","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Mycosis fungoides (MF) is a highly radiosensitive tumor and low dose palliative radiotherapy is an essential treatment modality with excellent results. However, some skin sites with complex, oblique or very curved shape are difficult to treat with conventional radiotherapy techniques. We report our experience using HDR brachytherapy to treat MF in complex skin sites.</div></div><div><h3>MATERIALS AND METHODS</h3><div>All patients who underwent HDR brachytherapy (HDR BT) for mycosis fungoides from 2014–2023 were included. Superficial brachytherapy molds such as the Freiburg flap applicator and 3D surface mold applicator were used. Following CT acquisition, the Oncentra treatment planning software was used to generate a treatment plan. Clinical response locally was assessed using the Olsen criteria and toxicities were recorded on the skin tumor unit database.</div></div><div><h3>RESULTS</h3><div>Thirty-nine (39) skin lesions within complex, and oblique and/or curved sites in 28 patients were treated with HDR BT. Local complete response rate is 100% with a mean follow up of 33 months. Sites treated were the face (<em>n</em> = 5), arms (<em>n</em> = 5), hands (<em>n</em> = 17), legs (<em>n</em> = 4), and feet (<em>n</em> = 8). Dose and fractionations used were 8 Gy/2F/2 days, 9 Gy/3F/3d, 12 Gy/3F/3d and 20 Gy/10F/2 weeks. Sixty percent were retreatment sites with a prior mean cumulative dose of 34 Gy (EQD2 α/β = 3). The mean D80% for all sites was 96.8% (range 85.6%–99.9%) with D0.1cc and D2cc to the involved skin 112.6% (range 101.5%–130.7%) and 102.5% (range 93.7%–117.3%) respectively. Complete response was achieved in 100%. Rate of G3 toxicity was 2.6% and G2 toxicity was 10.3%.</div></div><div><h3>CONCLUSION</h3><div>HDR BT is a safe and effective technique to treat MF lesions situated in regions of high obliquity and/or curvature with an acceptable toxicity rate.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 173-181"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring access to brachytherapy for cervical cancer in Texas: Geographic availability and distribution","authors":"Samyukta Jhavar ,&nbsp;Gaurav Gomber ,&nbsp;Mayank Patel ,&nbsp;Ann Klopp ,&nbsp;Andrew Farach ,&nbsp;Anne Hubbard ,&nbsp;Michelle Ludwig","doi":"10.1016/j.brachy.2025.09.010","DOIUrl":"10.1016/j.brachy.2025.09.010","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Cervical cancer remains a leading diagnosis among women in the state of Texas and manifests in a backdrop of health access and care inequities. In our study we aim to examine and highlight the geographic gaps in availability of brachytherapy across the state.</div></div><div><h3>METHODS</h3><div>Using data obtained from the Texas State Department of Health Services and industry records we identified a list of brachytherapy centers with active Ir-192 licenses. Using data obtained from the Texas Cancer Registry, we examined epidemiological rates of cervical cancer between 2010 and 2020, calculated the relative availability of centers across the state, and mapped our findings.</div></div><div><h3>RESULTS/DISCUSSION</h3><div>There are currently 48 active HDR brachytherapy centers/providers for cervical cancer across 28 counties in Texas. The majority of counties across the state had no brachytherapy centers or providers. The highest number of brachytherapy centers were housed in Harris (<em>n</em> = 7) and Tarrant (<em>n</em> = 5) counties which are home to the Houston and Fort Worth metropolitan areas. Mismatches between high incidence and mortality rates and low brachytherapy availability were noted in public health regions and counties near the Texas-Mexico border regions and northern/northeastern regions of Texas. A mapping tool (tinyurl.com/BrachytherapyTX) was developed to visualize active brachytherapy centers offering definitive cervical cancer treatment.</div></div><div><h3>CONCLUSION</h3><div>Our findings suggest that geographic discrepancies in brachytherapy availability for cervical cancer exist across the state of Texas. We hope to not only raise awareness for the inequity but also work towards implementing resources and sustainable solutions to help bridge the statewide gaps.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 221-228"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI-guided brachytherapy for vaginal recurrence of endometrial cancer","authors":"Juliet Maina ,&nbsp;Zhihui Amy Liu ,&nbsp;Michael Milosevic ,&nbsp;Jennifer Croke ,&nbsp;Jelena Lukovic ,&nbsp;Nauman Malik ,&nbsp;Alexandra Rink ,&nbsp;Akbar Beiki-Ardakani ,&nbsp;Robert A. Weersink ,&nbsp;Monica Serban ,&nbsp;Julia Skliarenko ,&nbsp;Sarah Rauth ,&nbsp;Jessica L. Conway ,&nbsp;Kathy Han","doi":"10.1016/j.brachy.2025.10.007","DOIUrl":"10.1016/j.brachy.2025.10.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Vaginal recurrence of endometrial cancer can be salvaged by external beam radiotherapy and vaginal brachytherapy, but data on MRI-guided brachytherapy is limited. This study evaluated disease and toxicity outcomes of patients treated with MRI-guided brachytherapy for vaginal recurrence of endometrial cancer.</div></div><div><h3>METHODS</h3><div>Patients who received salvage MRI-guided interstitial/intracavitary brachytherapy for vaginal recurrence of endometrial cancer between 2015 and 2023 were retrospectively reviewed. Local failure (LF) was estimated using the cumulative incidence function. Disease-free (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Toxicities were assessed using the Common Terminology Criteria for Adverse Events (version 5).</div></div><div><h3>RESULTS</h3><div>Of the 56 patients, 17 (30%) and 39 (70%) were treated with intracavitary (multichannel vaginal applicator) and interstitial (Syed-Neblett template) brachytherapy, respectively. Fifty-three (94%) had endometroid adenocarcinoma histology. The median high-risk clinical target volume D_90% was 82 Gy. With a median follow up of 39.5 months, 11 patients (20%) developed recurrence: four local failures (LFs), three regional failures, and seven distant failures (simultaneous failures at different sites included). The 2-year LF was 5.9% (95% confidence interval [CI] 1.5%–15.9%); 2-year DFS was 83% (95% CI 73%–94%); and 2-year OS was 94% (95% CI 87%–100%). There were few late toxicities, with the highest toxicity grade being grade 2: 0 gastrointestinal, one genitourinary and six vaginal.</div></div><div><h3>CONCLUSION</h3><div>Patients with vaginal recurrence of endometrial cancer treated with MRI-guided interstitial/intracavitary brachytherapy had favorable local control, DFS, OS and toxicity rates.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 107-114"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-assisted 3D-printed transvaginal template guidance for interstitial brachytherapy in patients with cervical cancer with parametrial invasion","authors":"Huiling Li ,&nbsp;Xiuhua Li ,&nbsp;Jianqiu Zhang ,&nbsp;Yitao Dai ,&nbsp;Huijuan Lin ,&nbsp;Xingyun Xie ,&nbsp;Meichun Yang","doi":"10.1016/j.brachy.2025.10.011","DOIUrl":"10.1016/j.brachy.2025.10.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Three-dimensional (3D) interstitial brachytherapy (BT) can improve bulky cervical cancer treatment efficacy. BT technology guided by 3D-printed templates can assist radiation oncologists in accurately inserting needles and ensuring optimal dose coverage. Artificial intelligence (AI) holds promise for enhancing the accuracy, precision, efficiency, and overall quality of radiotherapy (RT) for cancer patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This retrospective study aimed to evaluate the safety and efficacy of using AI-assisted transvaginal 3D-printed (AI/3D-printed) templates for guiding interstitial BT as a part of definitive RT for patients with cervical cancer with parametrial invasion.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Localization data from computed tomography scans of 17 patients were gathered and imported into the software. Using AI-assisted technology, individualized 3D-printed templates were automatically configured based on the specific anatomical morphology and volume of the target. To ensure the precision and consistency of the AI/3D-printed template, the patient's clitoris and anus were used as localization markers. Needle positions in the template were adjusted to maintain a designated distance from the insertion needles to the tip of the tailbone. The difference in the distance between the actual interstitial needle and the designed needle to the tailbone was aimed to be less than 2 mm. The target dose dosimetric parameters were evaluated and compared between AI/3D-printed applicator guidance and free-hand (FH) insertion methods, with one fraction of AI/3D-printed BT paired with one fraction of FH BT per patient for direct comparison.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;No instances of severe bleeding or infection associated with puncture were observed. Compared with FH BT, the AI/3D-printed approach required no intraoperative needle adjustment. The mean (with standard deviation) values of the dose-volume histogram (DVH) parameters of AI/3D-printed BT showed significantly higher high-risk clinical target volume (HR-CTV) V100 (90.19 ± 0.72% vs. 88.89 ± 0.11%, &lt;em&gt;p&lt;/em&gt; = 0.011) and HR-CTV D98 (5.67 ± 0.14 Gy vs. 5.55 ± 0.13 Gy, &lt;em&gt;p&lt;/em&gt; = 0.044), but no significant difference in D90 (6.80 ± 0.10 Gy vs. 6.79 ± 0.10 Gy, &lt;em&gt;p&lt;/em&gt; = 0.163). For organs at risk (OARs), the AI/3D-printed approach resulted in lower doses to the bladder (4.92 ± 0.06 Gy vs. 5.10 ± 0.06 Gy, &lt;em&gt;p&lt;/em&gt; = 0.004) and rectum (3.95 ± 0.10 Gy vs. 4.24 ± 0.05 Gy, &lt;em&gt;p&lt;/em&gt; = 0.01), but no significant difference for the sigmoid (2.99 ± 0.13 Gy vs. 3.23 ± 0.14 Gy, &lt;em&gt;p&lt;/em&gt; = 0.125). The AI/3D-printed approach exhibited significantly superior conformal index(CI), dose homogeneity index (HI), and overdose volume index (OI) compared with the FH approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;AI/3D-printed applicator-guided BT for cervical cancer with parametrial invasion demonstrated successful implementation, significant d","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 95-106"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535068","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}