Brachytherapy最新文献_第3页

Feasibility of balloon rectal spacer implantation in HDR and LDR brachytherapy for prostate cancer treatment 在前列腺癌的 HDR 和 LDR 近距离放射治疗中植入球囊直肠垫片的可行性。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.10.003

Tomer Charas, Salem Billan

PURPOSE

This study evaluates the use of a biodegradable balloon rectal spacer in two prostate cancer patients undergoing low dose radiation (LDR) and salvage high dose radiation (HDR) brachytherapy. The spacer aims to reduce radiation dose to adjacent organs, particularly the rectum, in patients previously treated with radiation.

METHODS

The balloon spacer was implanted transperineally under transrectal ultrasonography (TRUS) guidance in two patients. For the LDR case (73-year-old, intermediate-risk), the balloon was placed postimplant with 55 iodine-125 seeds delivering 145 Gy. For the HDR case (66-year-old, high-risk), the balloon was placed one week before treatment, which delivered 23 Gy in two weekly fractions using 16 channels.

RESULTS

The balloon provided a 14-15mm separation between rectum and prostate. In the LDR case, prostate D90 was 149.1Gy (102.83%), V100 was 91.95%, and rectum D30 was 23.93Gy (16.50%). For the HDR case, prostate D90 was 11.63Gy (105.79%), V100 was 93.63%, and rectum D0.5cc was 8.04Gy (73.15%). Both patients tolerated the treatment well, with no observed postoperative complications at 6-month follow-up.

CONCLUSIONS

The use of a rectal balloon spacer in both salvage HDR and LDR brachytherapy is feasible and safe, allowing for controlled placement and providing rectal protection from high radiation doses.

目的：本研究评估了生物可降解球囊直肠垫片在两名接受低剂量放射治疗（LDR）和挽救性高剂量放射治疗（HDR）近距离放射治疗的前列腺癌患者中的应用情况。该垫片旨在减少曾接受过放射治疗的患者邻近器官（尤其是直肠）的放射剂量：方法：在经直肠超声（TRUS）引导下，经会阴部为两名患者植入了球囊垫片。在 LDR 病例（73 岁，中危）中，球囊植入后放置了 55 颗碘-125 粒子，放射剂量为 145 Gy。对于 HDR 病例（66 岁，高风险），球囊在治疗前一周放置，使用 16 个通道，每周分两次释放 23 Gy：球囊在直肠和前列腺之间提供了 14-15 毫米的间隔。在 LDR 病例中，前列腺 D90 为 149.1Gy（102.83%），V100 为 91.95%，直肠 D30 为 23.93Gy（16.50%）。在 HDR 病例中，前列腺 D90 为 11.63Gy（105.79%），V100 为 93.63%，直肠 D0.5cc 为 8.04Gy（73.15%）。两名患者对治疗的耐受性良好，术后 6 个月随访时未观察到并发症：在抢救性 HDR 和 LDR 近距离放射治疗中使用直肠球囊垫片既可行又安全，既能控制放置位置，又能保护直肠免受高辐射剂量的伤害。

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引用次数: 0

Image guided cervical brachytherapy practice patterns: 2023/2024 survey of the American brachytherapy society 影像引导宫颈近距离放疗实践模式：2023/2024年美国近距离放疗学会调查

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.10.013

Elizabeth A. Kidd , Santino S. Butler , Ulysses Gardner Jr , Akila N. Viswanathan

BACKGROUND

An update of the 2007 and 2014 surveys of the American Brachytherapy Society (ABS) will elucidate current practice patterns of cervical cancer brachytherapy.

METHODS

A 40-question survey was sent to all ABS members in June-July 2023 and February 2024; 167 responses were received, with 140 used for analysis. Results were compared to the 2014 survey using chi-squared testing. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI) for outcomes of interest.

RESULTS

Compared to 2014, MRI use for treatment planning of the first brachytherapy fraction increased from 34% to 63% (p < 0.001), prescription to the high-risk clinical target volume (HR-CTV) increased from 52% to 94% (p < 0.001), while Point A prescription decreased from 42% to 16% (p < 0.001). Additionally, procedural guidance with ultrasound significantly increased (79% vs. 32%, p < 0.001) along with the use of interstitial needles (always or nearly always, >80%) (29% vs. 4%, p < 0.001). MRI availability around the time of procedure was the largest challenge to incorporating MRI into brachytherapy treatment planning. Compared to those with MRI access reserved specifically for Radiation Oncology, respondents with shared-access or out-of-department MRI were less likely to obtain treatment planning MRIs for each brachytherapy fraction (22% vs. 75%; aOR 0.10 [95% CI, 0.03–0.30], p < 0.001).

CONCLUSION

For cervix cancer brachytherapy there has been significant increase in the use of MRI-based volumetric brachytherapy treatment planning, ultrasound guidance during procedures and the addition of interstitial needles. These advancements in practice patterns are congruent with published consensus guidelines and ongoing training initiatives. However, MRI access and lack of easy availability continue to be significant challenges for optimizing cervix brachytherapy.

背景：美国近距离放射治疗协会（ABS） 2007年和2014年调查的更新将阐明当前宫颈癌近距离放射治疗的实践模式。方法：于2023年6 - 7月和2024年2月向所有ABS会员发送40个问题的调查问卷；收到167份回复，其中140份用于分析。使用卡方检验将结果与2014年的调查结果进行比较。采用多变量logistic回归计算相关结果的校正优势比（aOR）， 95%置信区间（CI）。结果：与2014年相比，MRI用于近距离治疗第一段的治疗计划从34%增加到63% (p < 0.001)，处方到高危临床靶体积（HR-CTV）从52%增加到94% (p < 0.001)，而A点处方从42%减少到16% （p < 0.001）。此外，超声的手术指导显著增加（79%对32%，p < 0.001），同时使用间质针（总是或几乎总是，bbb80 %）（29%对4%，p < 0.001）。手术前后MRI的可用性是将MRI纳入近距离治疗计划的最大挑战。与那些专门为放射肿瘤学保留MRI通道的患者相比，共享通道或科室外MRI的受访者更不可能获得每个近距离治疗部分的治疗计划MRI (22% vs. 75%；aOR 0.10 [95% CI, 0.03-0.30], p < 0.001)。结论：在宫颈癌近距离放射治疗中，基于mri的体积近距离放射治疗计划、术中超声引导和添加间质针的使用显著增加。这些实践模式的进步与已发表的一致指导方针和正在进行的培训计划是一致的。然而，MRI访问和缺乏容易获得仍然是优化宫颈近距离治疗的重大挑战。

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引用次数: 0

Definitive treatment for primary urethral cancer: A single institution's experience with organ-preserving brachytherapy 原发性尿道癌的确定性治疗：一家医疗机构使用保留器官近距离放射治疗的经验。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.09.001

R. Merten , V. Strnad , A. Karius , M. Lotter , S. Kreppner , C. Schweizer , R. Fietkau , P. Schubert

BACKGROUND

Radical urethectomy ± cystectomy has long represented the standard of care for rare primary urethral cancer (PUC). With our analysis, we want to demonstrate the efficacy and safety of brachytherapy (BT) of urethra for organ preservation.

MATERIALS AND METHODS

We analyzed treatment procedures and results of 3 patients with PUC, which have been treated in our department between 2011 and 2020 with brachytherapy. One male patient underwent brachytherapy with chemoradiotherapy after transurethral resection (TUR). Brachytherapy has been performed as high-dose-rate (HDR) boost with a cumulative dose of 8 Gy (9.3 Gy _{EQD2-α/β = 10 Gy}). The 2 further female patients have been treated with sole pulsed-dose-rate (PDR) brachytherapy with a total dose of 49.9 Gy (50.3 Gy _{EQD2-α/β = 10 Gy}) and 62.2 Gy (64.6 Gy _{EQD2-α/β = 10 Gy}).

RESULTS

Median follow-up was 103 months (41–153). No local recurrence occurred and all patients are still alive. For the male patient we documented Grade 3 cystitis. As late side effects the pre-existing Grade 2 incontinence worsened to Grade 3. Among female patients one developed Grade 3 vaginal synechiae. There was no Grade ≥4 toxicity.

CONCLUSION

Brachytherapy in PUC is a feasible and promising option with high local control rate and tolerable toxicity. It provides a good alternative to surgery for organ preservation in selected patients.

背景：长期以来，根治性尿道切除术和膀胱切除术一直是罕见原发性尿道癌（PUC）的标准治疗方法。通过分析，我们希望证明尿道近距离放射治疗（BT）在保留器官方面的有效性和安全性：我们分析了 2011 年至 2020 年期间在我科接受近距离放射治疗的 3 例 PUC 患者的治疗过程和结果。其中一名男性患者在经尿道切除术（TUR）后接受了近距离放射治疗和化疗。近距离放射治疗采用高剂量率（HDR）增强疗法，累积剂量为 8 Gy（9.3 Gy EQD2-α/β = 10 Gy）。另外两名女性患者接受了单脉冲剂量率（PDR）近距离放射治疗，总剂量分别为49.9 Gy（50.3 Gy EQD2-α/β = 10 Gy）和62.2 Gy（64.6 Gy EQD2-α/β = 10 Gy）：中位随访时间为 103 个月（41-153 个月）。没有发生局部复发，所有患者均健在。男性患者的膀胱炎达到了 3 级。作为晚期副作用，原有的 2 级尿失禁恶化为 3 级。女性患者中有一人出现了 3 级阴道挛缩。没有≥4级的毒性反应：结论：近距离放射治疗 PUC 是一种可行且前景广阔的选择，具有较高的局部控制率和可耐受的毒性。结论：近距离放射治疗 PUC 是一种可行且有前途的选择，局部控制率高，毒性可耐受，是经选择的患者保留器官手术的良好替代方案。

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引用次数: 0

Development and implementation of a brachytherapy procedure scoring system to optimize clinic and physics staffing schedule: A retrospective study of a single institution with a busy brachytherapy program 开发并实施近距离放射治疗程序评分系统，以优化门诊和物理科的人员安排：对一家近距离放射治疗项目繁忙的医疗机构的回顾性研究。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.10.007

Arjit Baghwala, Chengfeng Li, Devin Olek, Forrest Ivey, Ramiro Pino, Andrew Farach

PURPOSE

Brachytherapy (BT) is a time and resource intensive treatment modality. Constraints to efficiency and throughput include resource, staff and physician availability. Herein, we introduce a daily BT procedure scorecard, designed to ensure adequate resource allocation based on the type of procedure(s) being performed.

METHODS

Data on BT procedures, number of fractions, number of patients, and the average daily caseload from 2021 to 2024 in our clinic were collected. Each BT procedure was assigned a score from 1 to 3 based on complexity and labor intensity, with 1 representing the least and 3 the most complex procedures. This data was then used to evaluate the efficiency of the BT scoring system.

RESULTS

Implementing the BT scorecard improved scheduling efficiency without compromising patient throughput. Despite the growth in case complexity, we demonstrated that the scoring system effectively prevents understaffing in our clinics. The goal is to limit the daily BT score to 10 per day when creating the schedule, ensuring balanced resource allocation.

CONCLUSION

The strategies presented can enhance scheduling by ensuring an equitable workload distribution based on the BT schedule. These approaches should be considered in all high-volume BT clinics to optimize patient scheduling and throughput. Additionally, the scoring system allows clinics to develop full-time equivalent (FTE) staffing models that account for patient volume and case types, ensuring optimal resource utilization.

目的：近距离放射治疗（BT）是一种时间和资源密集型治疗方式。影响效率和吞吐量的因素包括资源、人员和医生的可用性。在此，我们介绍一种每日近距离放射治疗程序记分卡，旨在确保根据正在进行的程序类型分配足够的资源：方法：我们收集了本诊所 2021 年至 2024 年期间的 BT 手术数据、碎石数量、患者数量和日均工作量。根据复杂程度和劳动强度，对每项 BT 手术进行 1 到 3 分的评分，1 分代表最不复杂的手术，3 分代表最复杂的手术。然后利用这些数据来评估 BT 评分系统的效率：结果：实施 BT 评分卡提高了排班效率，同时也不影响病人的吞吐量。尽管病例复杂程度有所提高，但我们仍证明了评分系统能有效防止诊所人手不足。我们的目标是在制定排班计划时将每天的 BT 分数限制在 10 分以内，以确保资源分配的平衡：结论：所提出的策略可以根据 BT 计划表确保工作量的公平分配，从而加强排班工作。所有工作量大的 BT 诊所都应考虑采用这些方法，以优化患者排班和吞吐量。此外，评分系统允许诊所根据患者数量和病例类型制定全职等效 (FTE) 人员配备模式，确保资源得到最佳利用。

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引用次数: 0

Establishment of an absolute measurement of the reference air kerma rate for HDR 192Ir brachytherapy sources 为 HDR 192Ir 近距离放射源建立参考空气热玛率的绝对测量方法。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.09.006

Jinpeng Han , Shijie Zhi , Peiwei Wang , Ji Wang , Zhijun Yang , Kun Wang , Xingtao An

PURPOSE

Before this study, no institution in China had undertaken the calculation and official establishment of reference values for the reference air kerma rate associated with high-dose rate ¹⁹²Ir sources used in brachytherapy. This research, carried out at the National Institute of Metrology (NIM) in China, has successfully established an ¹⁹²Ir reference radiation facility. Consequently, it has achieved the absolute measurement of the reference air kerma rate for high-dose rate brachytherapy using ¹⁹²Ir sources.

METHODS AND MATERIALS

For this study, a medical afterloader machine was acquired. The radiation source employed was a high-dose rate ¹⁹²Ir source for brachytherapy, produced by HTA Co., Ltd. A reference graphite cavity ionization chamber with a volume of 100 cm³ was designed to serve as the ionization chamber for absolute measurements. The determination of various correction factors and physical constants was achieved through a method that combines Monte Carlo simulations with experimental techniques.

RESULTS

The study successfully accomplished the absolute measurement of the reference air kerma rate for the high-dose rate brachytherapy ¹⁹²Ir radiation source. The expanded uncertainty of the measurement results was 0.72% (k = 2). The relative standard deviation for the RAKR of the same ¹⁹²Ir radiation source was 0.073%.

CONCLUSIONS

This study marks a significant advancement in the field of radiation therapy in China, particularly in the accurate dosimetry for brachytherapy using high-dose rate ¹⁹²Ir sources. The study will contribute to the BIPM.RI(I)-K8 international comparison, organized by the Bureau International des Poids et Mesures (BIPM), thus facilitating the international recognition of the measurement values.

目的：在这项研究之前，中国还没有任何机构对近距离放射治疗中使用的高剂量率 192Ir 放射源相关的参考空气热玛率进行计算并正式确定参考值。中国计量科学研究院（NIM）开展的这项研究成功建立了 192Ir 参考辐射设施。因此，它实现了对使用 192Ir 放射源的高剂量率近距离放射治疗的参考空气开玛率的绝对测量：在这项研究中，购置了一台医用后装机。使用的放射源是 HTA 有限公司生产的高剂量率 192Ir 近距离放射源。设计了一个容积为 100 立方厘米的参考石墨腔电离室，作为绝对测量的电离室。通过蒙特卡罗模拟与实验技术相结合的方法，确定了各种校正因子和物理常数：研究成功地完成了对高剂量率近距离放射源 192Ir 的参考空气开玛率的绝对测量。测量结果的扩展不确定度为 0.72%（k = 2）。同一 192Ir 放射源的 RAKR 的相对标准偏差为 0.073%：这项研究标志着中国在放射治疗领域取得了重大进展，尤其是在使用高剂量率 192Ir 放射源进行近距离放射治疗的精确剂量测定方面。该研究将为国际计量局（BIPM）组织的BIPM.RI(I)-K8国际比对做出贡献，从而促进测量值的国际认可。

{"title":"Establishment of an absolute measurement of the reference air kerma rate for HDR 192Ir brachytherapy sources","authors":"Jinpeng Han , Shijie Zhi , Peiwei Wang , Ji Wang , Zhijun Yang , Kun Wang , Xingtao An","doi":"10.1016/j.brachy.2024.09.006","DOIUrl":"10.1016/j.brachy.2024.09.006","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Before this study, no institution in China had undertaken the calculation and official establishment of reference values for the reference air kerma rate associated with high-dose rate <sup>192</sup>Ir sources used in brachytherapy. This research, carried out at the National Institute of Metrology (NIM) in China, has successfully established an <sup>192</sup>Ir reference radiation facility. Consequently, it has achieved the absolute measurement of the reference air kerma rate for high-dose rate brachytherapy using <sup>192</sup>Ir sources.</div></div><div><h3>METHODS AND MATERIALS</h3><div>For this study, a medical afterloader machine was acquired. The radiation source employed was a high-dose rate <sup>192</sup>Ir source for brachytherapy, produced by HTA Co., Ltd. A reference graphite cavity ionization chamber with a volume of 100 cm<sup>3</sup> was designed to serve as the ionization chamber for absolute measurements. The determination of various correction factors and physical constants was achieved through a method that combines Monte Carlo simulations with experimental techniques.</div></div><div><h3>RESULTS</h3><div>The study successfully accomplished the absolute measurement of the reference air kerma rate for the high-dose rate brachytherapy <sup>192</sup>Ir radiation source. The expanded uncertainty of the measurement results was 0.72% (k = 2). The relative standard deviation for the RAKR of the same <sup>192</sup>Ir radiation source was 0.073%.</div></div><div><h3>CONCLUSIONS</h3><div>This study marks a significant advancement in the field of radiation therapy in China, particularly in the accurate dosimetry for brachytherapy using high-dose rate <sup>192</sup>Ir sources. The study will contribute to the BIPM.RI(I)-K8 international comparison, organized by the Bureau International des Poids et Mesures (BIPM), thus facilitating the international recognition of the measurement values.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 110-121"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634387","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}

引用次数: 0

Instant plan quality prediction on transrectal ultrasound for high-dose-rate prostate brachytherapy 通过经直肠超声预测高剂量率前列腺近距离放射治疗的即时计划质量。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.10.009

Tonghe Wang, Yining Feng, Joel Beaudry, David Aramburu Nunez, Daniel Gorovets, Marisa Kollmeier, Antonio L. Damato

PURPOSE

We investigated the feasibility of AI to provide an instant feedback of the potential plan quality based on live needle placement, and before planning is initiated.

MATERIALS AND METHODS

We utilized YOLOv8 to perform automatic organ segmentation and needle detection on 2D transrectal ultrasound images. The segmentation and detection results for each patient were then fed into a plan quality prediction model based on ResNet101. Its outputs are values of selected dose volume metrics. Imaging and plan data from 504 prostate HDR boost patients (456 for training, 24 for validation, and 24 for testing) treated in our clinic were included in this study. The segmentation, needle detection, and prediction results were compared to the clinical results (ground truth).

RESULTS

For prediction model, the p-values of t-test between the predicted values and ground truth for either rectum D2cc or urethra D20% were larger than 0.8. The sensitivity of prediction model in finding implant geometries resulting in below-median rectum D2cc and urethra D20% were 83% and 87%.

CONCLUSION

The proposed method has great potential to facilitate the current prostate HDR brachytherapy workflows by providing valuable feedback during needle insertion, and facilitating decision making of where and if additional needles are required.

目的：我们研究了人工智能的可行性，它能在计划开始前，根据实时置针情况即时反馈潜在计划的质量：我们利用 YOLOv8 对二维经直肠超声图像进行自动器官分割和针检测。然后将每位患者的分割和检测结果输入基于 ResNet101 的计划质量预测模型。其输出是选定的剂量体积指标值。本研究包括本诊所治疗的 504 名前列腺 HDR 提升患者（456 名用于训练，24 名用于验证，24 名用于测试）的成像和计划数据。将分割、针检测和预测结果与临床结果（地面实况）进行了比较：结果：对于预测模型，直肠 D2cc 或尿道 D20% 的预测值与地面实况之间的 t 检验 p 值均大于 0.8。预测模型在找到导致直肠 D2cc 和尿道 D20% 低于中线的种植体几何形状方面的灵敏度分别为 83% 和 87%：所提出的方法在前列腺 HDR 近距离放射治疗工作流程中大有可为，它能在穿刺针插入过程中提供有价值的反馈，并有助于决定在何处以及是否需要额外的穿刺针。

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引用次数: 0

Complications of intravascular brachytherapy 血管内近距离放射治疗的并发症。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.11.006

Kent Wallner , Kathleen E. Kearney , Lorenzo Azzalini , Edward Y. Kim , Upendra Parvathaneni , George Sandison , William L. Lombardi , Creighton Don , Minsun Kim

INTRODUCTION

There is some evidence of a dose-response relationship for intravascular brachytherapy (IVBT) of native vessel or first-time in-stent restenosis (ISR). It has also been shown that in-field failure predominates following intravascular brachytherapy-treated lesions. Accordingly, it may be advantageous to increase the radiation dose(s) currently used. Given the rationale for escalation from currently doses, a scrutiny of the potential complications that have been reported seems timely.

METHODS

PubMed was searched from 1966 through November 21st, 2023, using the terms coronary and brachytherapy, yielding 1287 references. A 10/16/24 follow-up search of Embase, using the terms “coronary and brachytherapy and complications”, yielding 511 articles. In total, 68 articles were identified as adverse event reports based on their title, or by scrutinizing articles that did not mention adverse events in their titles.

RESULTS

The best documented adverse IVBT-related event is the occurrence of late (> 1 month) thrombosis. Following identification of the risk, longer DAPT regimens were adopted, bringing the incidence to non-IVBT levels. A variety of other adverse events have been reported, including aneurysms, dissections, arterial spasm, “black holes” and vasomotor response inhibition. However, none of which were associated with adverse clinical outcomes.

CONCLUSIONS

Nearly all reports regarding IVBT-related complications are retrospective analyses of a limited number of events, subject to reporting bias. Clinically important IVBT-related complications, at current doses, appear highly unlikely.

有一些证据表明，原生血管近距离放射治疗（IVBT）或首次支架内再狭窄（ISR）存在剂量-反应关系。也有研究表明，在血管内近距离治疗病变后，场内失败占主导地位。因此，增加目前使用的辐射剂量可能是有利的。鉴于目前剂量增加的理由，对已报告的潜在并发症进行审查似乎是及时的。方法：PubMed检索自1966年至2023年11月21日，检索词为冠状动脉和近距离放射治疗，共1287篇文献。24年10月16日对Embase进行后续搜索，使用术语“冠状动脉和近距离治疗及并发症”，获得511篇文章。总共有68篇文章根据标题被确定为不良事件报告，或者通过仔细检查标题中没有提到不良事件的文章。结果：记录最充分的不良ivbt相关事件是发生晚期（bb10 - 1个月）血栓形成。在确定风险后，采用更长时间的DAPT方案，使发病率达到非ivbt水平。各种其他不良事件已被报道，包括动脉瘤、夹层、动脉痉挛、“黑洞”和血管舒缩反应抑制。然而，没有一个与不良临床结果相关。结论：几乎所有关于ivbt相关并发症的报道都是对有限事件的回顾性分析，存在报道偏倚。在目前的剂量下，临床上重要的ivbt相关并发症似乎极不可能发生。

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引用次数: 0

Improving plan quality in cervical cancer brachytherapy using knowledge-based planning for direction modulated brachytherapy tandem applicator 基于知识的方向调制近距离放疗串联应用计划提高宫颈癌近距离放疗计划质量。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.11.001

Suman Gautam , Emily Flower , Dylan Richeson , Ikchit Sangha , Tianjun Ma , William Y. Song

PURPOSE

The bladder and rectal toxicities in cervical cancer brachytherapy are positively correlated with the DVH parameter: D2cc. This study evaluates the feasibility of knowledge-based planning to predict the D2cc, identify suboptimal plans, and improve the plan quality with Direction Modulated Brachytherapy (DMBT) applicators using knowledge-based planning based on linear relationship between overlap distances and D2cc.

METHODS

The overlap volume histogram (OVH) method was used to determine the distances for 2 cm³ of overlap between the Organs at Risks (OAR) and High-Risk Clinical Target Volume (CTV_HR). Linear plots were utilized to model the OAR D2cc and 2 cm³ overlap distances. Two datasets from 45 patients (125 plans) were used to create 2 independent models: Model 1 from 59 Intracavitary (IC) and Model 2 from 66 Intracavitary-Interstitial (ICIS) plans. Performances were compared using 5-fold cross-validation. The predicted D2cc values were used as the maximum constraints in the inverse planning optimization.

RESULTS

The mean bladder D2cc decreased by 4.3% and 10.3% for conventional applicators, and 4.4% and 3.6% for DMBT applicators for Models 1 and 2, respectively. The rectum D2cc decreased by 3.4% and 10.7% for conventional and 3.0% and 5.0% for DMBT applicators, respectively. The sigmoid D2cc decreased by 3.1% and 6.9% for conventional and 3.2% and 5.9% for DMBT applicators, respectively. There were also significant reductions for the recto-vaginal (RV-RP) point and posterior-inferior border of symphysis (PIBS) reference points: PIBS+2cm, PIBS+1cm, PIBS-1cm, and PIBS-2cm, for both models as well.

CONCLUSIONS

A knowledge-based planning method successfully predicted D2cc and optimized brachytherapy plans for cervical cancer. The proposed model demonstrates the feasibility of predicting D2cc, detecting suboptimal plans, and improving the plan quality especially for DMBT where cumulative clinical experience is limited.

目的：宫颈癌近距离放射治疗的膀胱和直肠毒性与DVH参数D2cc呈正相关。本研究基于重叠距离与D2cc之间的线性关系，评估了基于知识的规划来预测D2cc，识别次优方案，并提高方向调制近距离放射治疗（DMBT）应用程序的计划质量。方法：采用重叠体积直方图（OVH）法确定危险器官（OAR）与高危临床靶体积（CTVHR）之间2 cm3的重叠距离。线性图用于模拟OAR D2cc和2cm3的重叠距离。使用来自45例患者（125个方案）的两个数据集创建2个独立的模型：模型1来自59个腔内（IC）方案，模型2来自66个腔内-间质（ICIS）方案。使用5倍交叉验证对性能进行比较。将预测的D2cc值作为逆向规划优化的最大约束条件。结果：模型1和模型2的膀胱D2cc平均值分别下降了4.3%和10.3%，DMBT分别下降了4.4%和3.6%。常规组直肠D2cc分别下降3.4%和10.7%，DMBT组分别下降3.0%和5.0%。乙状结肠D2cc分别下降3.1%和6.9%，DMBT分别下降3.2%和5.9%。两种模型的直肠-阴道（RV-RP）点和联合后下边界（PIBS）参考点：PIBS+2cm， PIBS+1cm， PIBS-1cm和PIBS-2cm也有显著降低。结论：基于知识的规划方法可成功预测D2cc，优化宫颈癌近距离治疗方案。该模型证明了预测D2cc、检测次优方案和提高方案质量的可行性，特别是对于临床经验有限的DMBT。

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引用次数: 0

Ruthenium-106 (106Ru) plaque brachytherapy as salvage treatment for retinoblastoma following intravenous chemotherapy 将钌-106（106Ru）斑块近距离放射疗法作为静脉化疗后视网膜母细胞瘤的挽救疗法。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.06.008

Vijay Anand Reddy Palkonda , Aiswarya Ramachandran , Bolajoko Abidemi Adewara , Ritesh Verma , Vishal Raval , Swathi Kaliki

PURPOSE

To describe the clinical presentation and treatment outcomes of patients undergoing Ruthenium-106 (¹⁰⁶Ru) plaque brachytherapy as salvage treatment for retinoblastoma (RB) following intravenous chemotherapy (IVC).

METHODS

Retrospective chart review of 44 eyes of 42 patients. The indications for plaque brachytherapy included solid tumor recurrence (n=20; 45%), solid tumor residual (n=16; 36%), new subretinal seeds (n=5; 12%), and new solid tumor (n=3; 7%).

RESULTS

The median age at the presentation was 12 months (range, 3–72 months). Based on ICRB classification, 8 (18%), 8 (18%), 16 (36%), and 5 (12%) tumors belonged to Groups B, C, D, and E, respectively. A median interval of 5 months (range 3–21 months) was noted between the last IVC cycle and plaque brachytherapy. The mean tumor height was four mm (range, 1.5–6 mm). All patients were treated with ¹⁰⁶Ru plaque (round or notch) with a median total dose of 45 Gy (range, 40–55 Gy) delivered to the tumor apex. At a mean post plaque follow-up period of 28 months (median, 23 months; range, 3–132 months), tumor completely regressed in 25 eyes (56%). Tumor recurrence within the plaque site was noted in eight eyes (18%) associated with a type 2 regression pattern (75%). At the last follow-up, the globe salvage rate was 24 eyes (55%), while 2 patients (5%) died due to metastasis.

CONCLUSION

¹⁰⁶RU plaque brachytherapy can be a useful salvage treatment for focal tumors (new or recurrent) following systemic IVC.

目的：描述静脉化疗（IVC）后接受钌-106（106Ru）斑块近距离放射治疗作为视网膜母细胞瘤（RB）挽救治疗的患者的临床表现和治疗结果：方法：对42名患者的44只眼睛进行回顾性病历审查。斑块近距离治疗的适应症包括实体瘤复发（20 例；45%）、实体瘤残留（16 例；36%）、新的视网膜下种子（5 例；12%）和新的实体瘤（3 例；7%）：患者发病时的中位年龄为12个月（3-72个月）。根据ICRB分类，分别有8例（18%）、8例（18%）、16例（36%）和5例（12%）肿瘤属于B、C、D和E组。最后一次IVC周期与斑块近距离治疗之间的中位间隔为5个月（3-21个月）。肿瘤平均高度为 4 毫米（范围为 1.5-6 毫米）。所有患者都接受了106Ru斑块（圆形或凹槽形）治疗，肿瘤顶点的中位总剂量为45 Gy（范围为40-55 Gy）。斑块术后平均随访 28 个月（中位数为 23 个月；范围为 3-132 个月），25 只眼睛（56%）的肿瘤完全消退。8只眼睛（18%）的肿瘤在斑块部位复发，并伴有2型消退模式（75%）。结论：106RU斑块近距离放射治疗是治疗全身性IVC术后局灶性肿瘤（新发或复发）的有效救治方法。

{"title":"Ruthenium-106 (106Ru) plaque brachytherapy as salvage treatment for retinoblastoma following intravenous chemotherapy","authors":"Vijay Anand Reddy Palkonda , Aiswarya Ramachandran , Bolajoko Abidemi Adewara , Ritesh Verma , Vishal Raval , Swathi Kaliki","doi":"10.1016/j.brachy.2024.06.008","DOIUrl":"10.1016/j.brachy.2024.06.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To describe the clinical presentation and treatment outcomes of patients undergoing Ruthenium-106 (<sup>106</sup>Ru) plaque brachytherapy as salvage treatment for retinoblastoma (RB) following intravenous chemotherapy (IVC).</div></div><div><h3>METHODS</h3><div>Retrospective chart review of 44 eyes of 42 patients. The indications for plaque brachytherapy included solid tumor recurrence (n=20; 45%), solid tumor residual (n=16; 36%), new subretinal seeds (n=5; 12%), and new solid tumor (n=3; 7%).</div></div><div><h3>RESULTS</h3><div>The median age at the presentation was 12 months (range, 3–72 months). Based on ICRB classification, 8 (18%), 8 (18%), 16 (36%), and 5 (12%) tumors belonged to Groups B, C, D, and E, respectively. A median interval of 5 months (range 3–21 months) was noted between the last IVC cycle and plaque brachytherapy. The mean tumor height was four mm (range, 1.5–6 mm). All patients were treated with <sup>106</sup>Ru plaque (round or notch) with a median total dose of 45 Gy (range, 40–55 Gy) delivered to the tumor apex. At a mean post plaque follow-up period of 28 months (median, 23 months; range, 3–132 months), tumor completely regressed in 25 eyes (56%). Tumor recurrence within the plaque site was noted in eight eyes (18%) associated with a type 2 regression pattern (75%). At the last follow-up, the globe salvage rate was 24 eyes (55%), while 2 patients (5%) died due to metastasis.</div></div><div><h3>CONCLUSION</h3><div><sup>106</sup>RU plaque brachytherapy can be a useful salvage treatment for focal tumors (new or recurrent) following systemic IVC.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 76-85"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696090","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}

引用次数: 0

Reconstruction errors in clinical intraoperative TRUS–based prostate HDR-BT detected using electromagnetic tracking 应用电磁跟踪检测临床术中基于tri的前列腺HDR-BT重建错误。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-01-01 DOI: 10.1016/j.brachy.2024.11.004

Ioannis Androulakis , Jérémy Godart , Lorne Luthart , Miranda E.M.C. Christianen , Henrike Westerveld , Remi A. Nout , Mischa Hoogeman , Inger-Karine K. Kolkman-Deurloo

PURPOSE

To investigate the occurrence of errors in transrectal ultrasound (TRUS)-based implant reconstructions for high-dose-rate brachytherapy (HDR-BT) in prostate cancer using an afterloader-integrated electromagnetic tracking (EMT) system.

MATERIALS AND METHODS

Fourteen patients were treated with one TRUS-based treatment fraction in an intraoperative setting while under general anesthesia, as part of their prostate HDR-BT (2×13.5 Gy) treatment. EMT measurements were performed before the start of the treatment in all implanted needles at dwell positions (DPs) with an interval of 5 mm. The Euclidean distances (EDs) between clinically reconstructed and EMT-measured DPs after registration were calculated. Errors were evaluated per needle (minimum ED of 2mm) and stratified into 4 severity levels (minor, moderate, major and severe). Error causes were investigated through retrospective inspection of TRUS imaging.

RESULTS

The median (range) ED between EMT-measured and clinically reconstructed DPs was 1.0 (0.1–9.4) mm. Higher EDs were observed in the anterior and lateral regions of the prostate. From 265 evaluated needle reconstructions, 23% (61/265) had minor errors or higher, while 9% (24/265) had major or severe errors. Severe errors were mostly caused by incorrect needle or depth selection. Major, moderate and minor errors were mostly caused by artifact, shadowing, and user errors, respectively.

CONCLUSIONS

This study found that a quarter of needle reconstructions contained errors >2mm, and that high and severe errors were not uncommon. EMT can play an important role in detecting and preventing these reconstruction errors without disrupting the clinical workflow.

目的：探讨基于经直肠超声（TRUS）的高剂量率近距离前列腺癌治疗（HDR-BT）植入物重建中应用后装载机集成电磁跟踪（EMT）系统的错误发生情况。材料和方法：14例患者在全麻下术中接受一种基于trus的治疗分数，作为前列腺HDR-BT （2×13.5 Gy）治疗的一部分。在治疗开始前，在所有植入针头停留位置（dp）进行EMT测量，间隔5mm。计算配准后临床重建与emt测量dp之间的欧氏距离（EDs）。评估每根针的错误（最小ED为2mm），并将其分为4个严重程度（轻微、中度、严重和严重）。通过回顾性检查TRUS成像来调查错误原因。结果：emt测量的ED与临床重建的dp之间的中位（范围）ED为1.0 (0.1-9.4)mm，在前列腺前部和外侧区域观察到较高的ED。在265个评估的针重建中，23%（61/265）有轻微或以上的错误，9%（24/265）有严重或严重的错误。严重的错误大多是由于不正确的针头或深度选择。主要错误、中等错误和次要错误主要分别由工件、阴影和用户错误引起。结论：本研究发现，1 / 4的针头重建误差约为0.5 mm，高、重度误差并不少见。EMT可以在不中断临床工作流程的情况下，在检测和预防这些重建错误方面发挥重要作用。

{"title":"Reconstruction errors in clinical intraoperative TRUS–based prostate HDR-BT detected using electromagnetic tracking","authors":"Ioannis Androulakis , Jérémy Godart , Lorne Luthart , Miranda E.M.C. Christianen , Henrike Westerveld , Remi A. Nout , Mischa Hoogeman , Inger-Karine K. Kolkman-Deurloo","doi":"10.1016/j.brachy.2024.11.004","DOIUrl":"10.1016/j.brachy.2024.11.004","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To investigate the occurrence of errors in transrectal ultrasound (TRUS)-based implant reconstructions for high-dose-rate brachytherapy (HDR-BT) in prostate cancer using an afterloader-integrated electromagnetic tracking (EMT) system.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Fourteen patients were treated with one TRUS-based treatment fraction in an intraoperative setting while under general anesthesia, as part of their prostate HDR-BT (2×13.5 Gy) treatment. EMT measurements were performed before the start of the treatment in all implanted needles at dwell positions (DPs) with an interval of 5 mm. The Euclidean distances (EDs) between clinically reconstructed and EMT-measured DPs after registration were calculated. Errors were evaluated per needle (minimum ED of 2mm) and stratified into 4 severity levels (minor, moderate, major and severe). Error causes were investigated through retrospective inspection of TRUS imaging.</div></div><div><h3>RESULTS</h3><div>The median (range) ED between EMT-measured and clinically reconstructed DPs was 1.0 (0.1–9.4) mm. Higher EDs were observed in the anterior and lateral regions of the prostate. From 265 evaluated needle reconstructions, 23% (61/265) had minor errors or higher, while 9% (24/265) had major or severe errors. Severe errors were mostly caused by incorrect needle or depth selection. Major, moderate and minor errors were mostly caused by artifact, shadowing, and user errors, respectively.</div></div><div><h3>CONCLUSIONS</h3><div>This study found that a quarter of needle reconstructions contained errors >2mm, and that high and severe errors were not uncommon. EMT can play an important role in detecting and preventing these reconstruction errors without disrupting the clinical workflow.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 177-185"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775661","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}

引用次数: 0