Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.046
Felipe Castro Canovas MD, DRCPSC, Carlos Herrera Castillo MSc, Eduardo Carrasco Solis MSc, Yesenia Miranda Tunque MD, Luis Gamarra Delgado MD, Indranit Revilla Coz MD, Gustavo Lasteros Ayma MD, Juan Manuel Trejo Mena MD, Herbert Cardenas Del Carpio MD, Paola Fuentes-Rivera Carmelo MD, Alberto Lachos Davila MD, Adela Heredia Zelaya MD, Karinthia Ballon Cervantes MD
Purpose
This single-institution proof of concept and early experience on an innovative workflow for the creation of custom applicators for high dose rate (HDR) skin brachytherapy and skin bolus in low to middle-income countries, where access to CT simulation or dedicated surface scanners is sparse, we utilized geometry mapping technology found in many readily available smartphones as an alternative to other design methods, reducing the number of CT-simulations needed from two to one, improving access to custom applicators for more patients. We now report our skin brachytherapy early experience.
Materials and Methods
In selected consenting patients with indication for skin brachytherapy or EBRT, a smartphone front camera system (e.g. Apple iPhone X or newer with TrueDepth camera) was used to capture the skin surface with capturing software (Apple iOS - Heges 3D Scanner by Marek Simonik), then exported to a computer-aided design software to blueprint the applicator (Meshmixer and Fusion 360 Autodesk on Apple MacOS or Microsoft Windows). The applicator was then 3D printed in-house using a fused deposition modeling printer (Flashforge Adventure 3) with polylactic Acid (PLA) material. The applicator completed a quality assurance examination and then fitted to the patient for a single CT simulation for planning (SagiPlan®), quality assurance and treatment delivery with a Cobalt - 60 after loader (SagiNova®). Follow-up was conducted per standard institutional protocol, and Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE) was used to report toxicities.
Results
From July 2023 to January 2024, 05 patients were scanned, 4 patients received a 3D printed custom bolus for EBRT, and 1 patient received a custom HDR skin brachytherapy custom applicator, the one patient treated with HDR brachytherapy is reported, had basal cell carcinoma of the nose, the prescription dose was 40Gy in 10 fractions delivered daily, 100% isodose line encapsulated the PTV, limiting surface dose <150%. Acute grade 1 skin toxicity was observed at the end of treatment, it completely resolved at 3 months. No late toxicity or recurrence was observed at 6 months.
Conclusions
This small, early-reported experience with a novel workflow seems faceable and safe, potentially allowing less congestion at the CT Sim, improving access for more patients in low to middle-income countries to custom 3D printed accessories. A larger number of patients and longer follow-ups are needed, report on 3D EBRT bolus results to follow.
目的在中低收入国家，CT 模拟或专用表面扫描仪非常稀缺，我们利用许多现成的智能手机中的几何图形映射技术替代其他设计方法，将所需的 CT 模拟次数从两次减少到一次，让更多患者获得了定制涂抹器。材料与方法在选定的有皮肤近距离放射治疗或 EBRT 适应症的同意患者中，使用智能手机前置摄像头系统（如配备 TrueDepth 摄像头的苹果 iPhone X 或更新机型），通过捕捉软件（苹果 iOS - Marek Simonik 的 Heges 3D 扫描仪）捕捉皮肤表面，然后导出到计算机辅助设计软件，绘制涂抹器蓝图（苹果 MacOS 或微软 Windows 上的 Meshmixer 和 Fusion 360 Autodesk）。然后使用内部的熔融沉积建模打印机（Flashforge Adventure 3）和聚乳酸（PLA）材料对涂抹器进行三维打印。敷贴器完成了质量保证检查，然后安装到患者身上，进行单次 CT 模拟规划 (SagiPlan®)、质量保证和使用 Cobalt - 60 后装载器 (SagiNova®) 进行治疗。按照标准机构协议进行随访，并使用《不良事件通用术语标准 5.0 版》（CTCAE）报告毒性。结果从2023年7月到2024年1月，共扫描了05名患者，4名患者接受了3D打印定制的EBRT栓剂，1名患者接受了定制的HDR皮肤近距离放射治疗定制涂抹器，报告的1名接受HDR近距离放射治疗的患者患有鼻基底细胞癌，处方剂量为40Gy，每天分10次给药，100%等剂量线包裹PTV，限制表面剂量<150%。治疗结束时出现急性 1 级皮肤毒性，3 个月后完全消退。结论这种新型工作流程的早期小规模经验似乎是可面对的、安全的，有可能减少 CT Sim 的拥堵，让更多中低收入国家的患者获得定制的 3D 打印配件。还需要更多患者和更长时间的随访，有关 3D EBRT 栓剂结果的报告将在随后公布。
{"title":"MSOR12 Presentation Time: 5:55 PM","authors":"Felipe Castro Canovas MD, DRCPSC, Carlos Herrera Castillo MSc, Eduardo Carrasco Solis MSc, Yesenia Miranda Tunque MD, Luis Gamarra Delgado MD, Indranit Revilla Coz MD, Gustavo Lasteros Ayma MD, Juan Manuel Trejo Mena MD, Herbert Cardenas Del Carpio MD, Paola Fuentes-Rivera Carmelo MD, Alberto Lachos Davila MD, Adela Heredia Zelaya MD, Karinthia Ballon Cervantes MD","doi":"10.1016/j.brachy.2024.08.046","DOIUrl":"10.1016/j.brachy.2024.08.046","url":null,"abstract":"<div><h3>Purpose</h3><div>This single-institution proof of concept and early experience on an innovative workflow for the creation of custom applicators for high dose rate (HDR) skin brachytherapy and skin bolus in low to middle-income countries, where access to CT simulation or dedicated surface scanners is sparse, we utilized geometry mapping technology found in many readily available smartphones as an alternative to other design methods, reducing the number of CT-simulations needed from two to one, improving access to custom applicators for more patients. We now report our skin brachytherapy early experience.</div></div><div><h3>Materials and Methods</h3><div>In selected consenting patients with indication for skin brachytherapy or EBRT, a smartphone front camera system (e.g. Apple iPhone X or newer with TrueDepth camera) was used to capture the skin surface with capturing software (Apple iOS - Heges 3D Scanner by Marek Simonik), then exported to a computer-aided design software to blueprint the applicator (Meshmixer and Fusion 360 Autodesk on Apple MacOS or Microsoft Windows). The applicator was then 3D printed in-house using a fused deposition modeling printer (Flashforge Adventure 3) with polylactic Acid (PLA) material. The applicator completed a quality assurance examination and then fitted to the patient for a single CT simulation for planning (SagiPlan®), quality assurance and treatment delivery with a Cobalt - 60 after loader (SagiNova®). Follow-up was conducted per standard institutional protocol, and Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE) was used to report toxicities.</div></div><div><h3>Results</h3><div>From July 2023 to January 2024, 05 patients were scanned, 4 patients received a 3D printed custom bolus for EBRT, and 1 patient received a custom HDR skin brachytherapy custom applicator, the one patient treated with HDR brachytherapy is reported, had basal cell carcinoma of the nose, the prescription dose was 40Gy in 10 fractions delivered daily, 100% isodose line encapsulated the PTV, limiting surface dose <150%. Acute grade 1 skin toxicity was observed at the end of treatment, it completely resolved at 3 months. No late toxicity or recurrence was observed at 6 months.</div></div><div><h3>Conclusions</h3><div>This small, early-reported experience with a novel workflow seems faceable and safe, potentially allowing less congestion at the CT Sim, improving access for more patients in low to middle-income countries to custom 3D printed accessories. A larger number of patients and longer follow-ups are needed, report on 3D EBRT bolus results to follow.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S41"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526540","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.2024.08.017
Tamer Soror MD, PhD , Pierre-Alexander Justenhoven MD , Anke Leichtle MD, PhD , Karl-Ludwig Bruchhage MD, PhD , György Kovács MD, PhD , Dirk Rades MD, PhD
<div><h3>Purpose</h3><div>Periorificial facial cancer (PFC), characterized by cancer originating from the eyelids, nasal vestibule, lips, and ear lobules, exhibits significantly high global incidence rates. Radical surgery have both functional and aesthetic complications. This retrospective analysis explores the effectiveness of high-dose-rate interventional radiotherapy (HDR-IRT, brachytherapy) combined with organ-preserving surgery for managing PFC.</div></div><div><h3>Material and Methods</h3><div>We conducted a retrospective assessment of patients with PFC and treated with HDR-IRT at our center between 2008 and 2022. Patients underwent a physical examination, tumor biopsy, and head-and-neck CT and/or MRI for locoregional staging. The decision of organ-preserving surgery with HDR-IRT was made by a specialized multidisciplinary tumor board. Organ-preserving surgery ranged from tumor debulking to complete local resection. HDR-IRT catheters were immediately implanted in the operating room, in a parallel arrangement with 8-12 mm spacing. The clinical target volume included the estimated tumor volume and a safety margin (5-15 mm) based on anatomical considerations and nearby critical structures. The prescribed radiation dose was administered twice daily with a minimum six-hour gap between fractions. The median HDR-IRT dose was 40Gy (30-50), the median fraction dose was 4Gy (2.5-5), and the median number of fractions was 10 (8-16). Treatment-related toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.</div></div><div><h3>Results</h3><div>A total of 123 patients were identified, with primary sites as follows: 24 (19.5%) eyelids, 58 (47.2%) nasal vestibule, 25 (20.3%) lips, and 16 (13%) ear lobules. The median age was 76 years (37-99), with 60.2% (74/123) males and 39.2% (49/123) females. Sixty-four percent (64.2%) had primary tumors, and 35.8% had recurrent tumors. Among patients with recurrent tumors, 40 had previous surgery, and four were primarily treated with EBRT. Debulking surgery was performed in 16 patients (13%), and neck dissection in 14 patients (11.4%). Among 107 patients undergoing local resection, eight had close surgical margins, 40 had positive margins, and four had macroscopic residuals. T-status included T1 (53.7%), T2 (28.5%), T3 (10.5%), and T4 (7.3%). Six patients had positive neck lymph nodes. Squamous cell carcinoma constituted 61.8%, basal cell carcinoma 30.9%, and other histologies 7.3%. The median follow-up time was 38 months (4-147). During follow-up, 15 local recurrences (12.2%) were documented, with a median time to recurrence of 13 months (5-71). Local recurrence rates by tumor site were as follows: Nose 10/58 (17.2%), eyelid 3/24 (12.5%), lip 1/25 (4%), and ear lobule 1/16 (6.3%). The 5-year local control (LC) rate was 85.3%, with 10-year and 12-year LC rates of 80.8%. Five-year, 10-year, and 12-year disease-free survival (DFS) rates were 87.8%. Five-year distant
{"title":"MPP03 Presentation Time: 4:18 PM","authors":"Tamer Soror MD, PhD , Pierre-Alexander Justenhoven MD , Anke Leichtle MD, PhD , Karl-Ludwig Bruchhage MD, PhD , György Kovács MD, PhD , Dirk Rades MD, PhD","doi":"10.1016/j.brachy.2024.08.017","DOIUrl":"10.1016/j.brachy.2024.08.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Periorificial facial cancer (PFC), characterized by cancer originating from the eyelids, nasal vestibule, lips, and ear lobules, exhibits significantly high global incidence rates. Radical surgery have both functional and aesthetic complications. This retrospective analysis explores the effectiveness of high-dose-rate interventional radiotherapy (HDR-IRT, brachytherapy) combined with organ-preserving surgery for managing PFC.</div></div><div><h3>Material and Methods</h3><div>We conducted a retrospective assessment of patients with PFC and treated with HDR-IRT at our center between 2008 and 2022. Patients underwent a physical examination, tumor biopsy, and head-and-neck CT and/or MRI for locoregional staging. The decision of organ-preserving surgery with HDR-IRT was made by a specialized multidisciplinary tumor board. Organ-preserving surgery ranged from tumor debulking to complete local resection. HDR-IRT catheters were immediately implanted in the operating room, in a parallel arrangement with 8-12 mm spacing. The clinical target volume included the estimated tumor volume and a safety margin (5-15 mm) based on anatomical considerations and nearby critical structures. The prescribed radiation dose was administered twice daily with a minimum six-hour gap between fractions. The median HDR-IRT dose was 40Gy (30-50), the median fraction dose was 4Gy (2.5-5), and the median number of fractions was 10 (8-16). Treatment-related toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.</div></div><div><h3>Results</h3><div>A total of 123 patients were identified, with primary sites as follows: 24 (19.5%) eyelids, 58 (47.2%) nasal vestibule, 25 (20.3%) lips, and 16 (13%) ear lobules. The median age was 76 years (37-99), with 60.2% (74/123) males and 39.2% (49/123) females. Sixty-four percent (64.2%) had primary tumors, and 35.8% had recurrent tumors. Among patients with recurrent tumors, 40 had previous surgery, and four were primarily treated with EBRT. Debulking surgery was performed in 16 patients (13%), and neck dissection in 14 patients (11.4%). Among 107 patients undergoing local resection, eight had close surgical margins, 40 had positive margins, and four had macroscopic residuals. T-status included T1 (53.7%), T2 (28.5%), T3 (10.5%), and T4 (7.3%). Six patients had positive neck lymph nodes. Squamous cell carcinoma constituted 61.8%, basal cell carcinoma 30.9%, and other histologies 7.3%. The median follow-up time was 38 months (4-147). During follow-up, 15 local recurrences (12.2%) were documented, with a median time to recurrence of 13 months (5-71). Local recurrence rates by tumor site were as follows: Nose 10/58 (17.2%), eyelid 3/24 (12.5%), lip 1/25 (4%), and ear lobule 1/16 (6.3%). The 5-year local control (LC) rate was 85.3%, with 10-year and 12-year LC rates of 80.8%. Five-year, 10-year, and 12-year disease-free survival (DFS) rates were 87.8%. Five-year distant ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S24-S25"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Purpose</h3><div>Consensus recommendations for CT based contouring in Image Guided Adaptive Brachytherapy (CT-IGABT) for cervical cancer were published by IBS-GEC ESTRO-ABS. However, real world outcome data of patients treated based on these recommendations is sparse. The purpose of this study is to present early outcomes of cervical cancer patients treated with CT-IGABT using the IBS-GEC ESTRO-ABS recommendations.</div></div><div><h3>Material and Methods</h3><div>Retro-LACER is a mono-institutional database of cervical cancer patients treated with CT-IGABT using uniform target delineation protocols between August 2020 and July 2023. All consecutive patients with biopsy proven locally advanced cervical cancer (FIGO Stage IB3 to IVA) who received curative (chemo) radiation at our institution were screened. While the dosimetric details were maintained prospectively, outcome and treatment related morbidity data is collected retrospectively from the electronic medical records.</div></div><div><h3>Results</h3><div>Out of 318 patients screened, 73 were excluded as per the eligibility criteria (2, stage ≤ IB2; 3 stage IVB; 19, received EBRT elsewhere; 17 defaulted / received BT elsewhere; 21, participants in other interventional studies; 11, did not come for at least one post treatment follow up). Disease and treatment characteristics of the 245 patients included in this analysis are presented in Table 1. Hybrid IC+IS BT was used in 51.4% of patients. About 64.5% of patients were treated in a basic CT environment (CT alone at BT), while 35.5% were treated in an advanced CT environment (pre-BT MRI, in 3.6% and Trans-Rectal ultrasonography in 31.8%). Median volume of CTV_HR was 31cc, while median D90 and D98 to CTV_HR (in EQD2<sub>10Gy</sub>) were 88 and 79, respectively. Median D2cc for bladder, rectum and sigmoid (in EQD2<sub>3Gy</sub>) were 89, 68 and 67, respectively. Dosimetric details of patients treated in basic and advanced CT environments are also presented in Table 1. At a median follow up of 17 months (IQR, 9 to 26), 12 patients (4.9%) died due to disease and 3 (1.2%) were lost to follow up. Treatment failure was observed in 27 patients (11%), with isolated local, regional (pelvic), regional (para-aortic), regional (pelvic + para-aortic) and distant failures in 3 (1.2%), 0 (0%), 5 (2%), 1 (0.4 %) and 12 (5.2%) respectively. Combination of [local + regional], [regional + distant] and [local + regional + distant] failures was observed in 2 (0.8%), 3 (1.2%) and 1 (0.4%) respectively. Estimated survival probability (Kaplan-Meier) at 6 months and 1 year were 99.5% and 93% for local control, 99.1% and 92% for loco-regional relapse free survival and 100% and 95% for overall survival, respectively. Severe late GI and GU morbidity (CTCAEv5 ≥ Grade 3) was observed in 18 (7.3%) and 1 (0.4%), respectively. Among the patients who developed severe late GU and GI morbidity, median D2cc doses to bladder, rectum and sigmoid (in EQD2<sub>3Gy</sub>) were
{"title":"GPP06 Presentation Time: 9:45 AM","authors":"Raviteja Miriyala M.D , KK Sreelakshmi M.Sc.,D.R.P , Kiriti Chiriki D.N.B , Raghavendra Hajare M.Sc., D.R.P , Rohit Vadgaonkar M.D , Sneha Nachu B.D.S , Surbhi Grover M.D , Umesh Mahantshetty M.D, D.N.B","doi":"10.1016/j.brachy.2024.08.008","DOIUrl":"10.1016/j.brachy.2024.08.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Consensus recommendations for CT based contouring in Image Guided Adaptive Brachytherapy (CT-IGABT) for cervical cancer were published by IBS-GEC ESTRO-ABS. However, real world outcome data of patients treated based on these recommendations is sparse. The purpose of this study is to present early outcomes of cervical cancer patients treated with CT-IGABT using the IBS-GEC ESTRO-ABS recommendations.</div></div><div><h3>Material and Methods</h3><div>Retro-LACER is a mono-institutional database of cervical cancer patients treated with CT-IGABT using uniform target delineation protocols between August 2020 and July 2023. All consecutive patients with biopsy proven locally advanced cervical cancer (FIGO Stage IB3 to IVA) who received curative (chemo) radiation at our institution were screened. While the dosimetric details were maintained prospectively, outcome and treatment related morbidity data is collected retrospectively from the electronic medical records.</div></div><div><h3>Results</h3><div>Out of 318 patients screened, 73 were excluded as per the eligibility criteria (2, stage ≤ IB2; 3 stage IVB; 19, received EBRT elsewhere; 17 defaulted / received BT elsewhere; 21, participants in other interventional studies; 11, did not come for at least one post treatment follow up). Disease and treatment characteristics of the 245 patients included in this analysis are presented in Table 1. Hybrid IC+IS BT was used in 51.4% of patients. About 64.5% of patients were treated in a basic CT environment (CT alone at BT), while 35.5% were treated in an advanced CT environment (pre-BT MRI, in 3.6% and Trans-Rectal ultrasonography in 31.8%). Median volume of CTV_HR was 31cc, while median D90 and D98 to CTV_HR (in EQD2<sub>10Gy</sub>) were 88 and 79, respectively. Median D2cc for bladder, rectum and sigmoid (in EQD2<sub>3Gy</sub>) were 89, 68 and 67, respectively. Dosimetric details of patients treated in basic and advanced CT environments are also presented in Table 1. At a median follow up of 17 months (IQR, 9 to 26), 12 patients (4.9%) died due to disease and 3 (1.2%) were lost to follow up. Treatment failure was observed in 27 patients (11%), with isolated local, regional (pelvic), regional (para-aortic), regional (pelvic + para-aortic) and distant failures in 3 (1.2%), 0 (0%), 5 (2%), 1 (0.4 %) and 12 (5.2%) respectively. Combination of [local + regional], [regional + distant] and [local + regional + distant] failures was observed in 2 (0.8%), 3 (1.2%) and 1 (0.4%) respectively. Estimated survival probability (Kaplan-Meier) at 6 months and 1 year were 99.5% and 93% for local control, 99.1% and 92% for loco-regional relapse free survival and 100% and 95% for overall survival, respectively. Severe late GI and GU morbidity (CTCAEv5 ≥ Grade 3) was observed in 18 (7.3%) and 1 (0.4%), respectively. Among the patients who developed severe late GU and GI morbidity, median D2cc doses to bladder, rectum and sigmoid (in EQD2<sub>3Gy</sub>) were","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S19"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526544","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.2024.08.085
Juanjuan Fu MS, Zhaobin Li MS, Zhen Li MS, Jie Fu MD
Purpose
This study focuses on determining the optimal MRI scanning parameters for precise localization of MR-line markers, and to investigate their apical reconstruction error.
Materials and Methods
In the study, it was assumed that the front seal of each MR-line marker was identical. Three MR-line markers were individually placed at the tips inside the tubes of plastic sharp needles. The position of the plastic-tipped sharp needles was marked with three additional MR-line markers. These needles, along with the markers, were then fixed into the same L-shaped (rectangular) mold to ensure that the plastic sharp needles and their corresponding MR-line markers maintained a stable, horizontal alignment and were immobilized during the process. The physical distance measured between the tips of the two MR line markers, one located inside and the other outside the plastic sharp needle, was approximately 2.30mm. To evaluate the apical reconstruction error of the MR-line marker,10 sets of MR images were acquired with varying slice thicknesses, including T1-weighted images with thicknesses of 3 mm, 2 mm, and 1.4 mm, and T2 -weighted images with thicknesses of 3 mm, 2 mm, and 1 mm.
Results
The analysis of the image distance between the MR-line marker tips, both inside and outside plastic sharp needle, revealed that the probability of the measurement of the MR-line marker being within 1 mm accuracy was 92.59%. It was observed that the thickness of the MR images positively correlated with both the mean and standard deviation of the image measurement value in T1-weighted scans. Additionally, the standard deviation of MR-line marker image measurements in T2-weighted scans showed a slight increase as the layer thickness was reduced to 2mm. Upon comparing the results from the three sets of MR-line marker image measurements, it was found that the overall results of T2-weighted scans at 3 mm and T1-weighted scans at 1.4 mm were similar. However, it is important to note that the thinner slice parameter not only restricts the length of the scan, but also leads to increased scanning time and additional time required for contouring before brachytherapy treatment, resulting in increased discomfort for the patient. Therefore, a scanning parameter of T2-weighted scans at 3 mm is recommended for the reconstruction of the MR-line marker.
Conclusions
The study demonstrated that the MR-line marker possesses significant potential for clinical application, particularly in the precise localization of plastic sharp needles. This finding is pivotal as it provides a crucial experimental foundation for the implementation of an MR-only workflow in interstitial gynecologic brachytherapy.
{"title":"PHSOR11 Presentation Time: 9:50 AM","authors":"Juanjuan Fu MS, Zhaobin Li MS, Zhen Li MS, Jie Fu MD","doi":"10.1016/j.brachy.2024.08.085","DOIUrl":"10.1016/j.brachy.2024.08.085","url":null,"abstract":"<div><h3>Purpose</h3><div>This study focuses on determining the optimal MRI scanning parameters for precise localization of MR-line markers, and to investigate their apical reconstruction error.</div></div><div><h3>Materials and Methods</h3><div>In the study, it was assumed that the front seal of each MR-line marker was identical. Three MR-line markers were individually placed at the tips inside the tubes of plastic sharp needles. The position of the plastic-tipped sharp needles was marked with three additional MR-line markers. These needles, along with the markers, were then fixed into the same L-shaped (rectangular) mold to ensure that the plastic sharp needles and their corresponding MR-line markers maintained a stable, horizontal alignment and were immobilized during the process. The physical distance measured between the tips of the two MR line markers, one located inside and the other outside the plastic sharp needle, was approximately 2.30mm. To evaluate the apical reconstruction error of the MR-line marker,10 sets of MR images were acquired with varying slice thicknesses, including T1-weighted images with thicknesses of 3 mm, 2 mm, and 1.4 mm, and T2 -weighted images with thicknesses of 3 mm, 2 mm, and 1 mm.</div></div><div><h3>Results</h3><div>The analysis of the image distance between the MR-line marker tips, both inside and outside plastic sharp needle, revealed that the probability of the measurement of the MR-line marker being within 1 mm accuracy was 92.59%. It was observed that the thickness of the MR images positively correlated with both the mean and standard deviation of the image measurement value in T1-weighted scans. Additionally, the standard deviation of MR-line marker image measurements in T2-weighted scans showed a slight increase as the layer thickness was reduced to 2mm. Upon comparing the results from the three sets of MR-line marker image measurements, it was found that the overall results of T2-weighted scans at 3 mm and T1-weighted scans at 1.4 mm were similar. However, it is important to note that the thinner slice parameter not only restricts the length of the scan, but also leads to increased scanning time and additional time required for contouring before brachytherapy treatment, resulting in increased discomfort for the patient. Therefore, a scanning parameter of T2-weighted scans at 3 mm is recommended for the reconstruction of the MR-line marker.</div></div><div><h3>Conclusions</h3><div>The study demonstrated that the MR-line marker possesses significant potential for clinical application, particularly in the precise localization of plastic sharp needles. This finding is pivotal as it provides a crucial experimental foundation for the implementation of an MR-only workflow in interstitial gynecologic brachytherapy.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S63-S64"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527289","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.2024.08.047
Dulce M. Barrios MD , Mitchell Kamrava MD , Jenna M. Kahn MD , Vonetta M. Williams MD , Keyur J. Mehta MD , Aaron Wolfson MD , Lorraine Portelance MD , Amanda Rivera MD
<div><h3>Purpose</h3><div>To determine the current practice patterns of analgesia (AG) and anesthesia (AS) use across the U.S. for gynecologic brachytherapy (BT) procedures.</div></div><div><h3>Methods and Materials</h3><div>A 27-item survey was created with expertise from five practicing radiation oncology brachytherapists in the U.S. and distributed electronically to 90 Radiation Oncology residency programs for dissemination. The survey was also publicized on social media via the X (formally Twitter) platform, and at two national meetings (The American Brachytherapy Society Annual Meeting 2023 and The American Society for Radiation Therapy Annual Meeting 2023) during the months of June-October 2023.</div></div><div><h3>Results</h3><div>Forty-one responses were received (46% response rate). Fifty-four percent identified as female, 66% Caucasian race and 85% of non-Hispanic/Latino ethnicity. Ninety-three percent were physician brachytherapists, 5% medical physicists, and 2% did not disclose their profession. Forty nine percent reported typically carrying out procedures in a BT suite ± separate CT simulator alone, 39% in the operating room ± BT suite or CT simulator or other location. Ten percent reported the CT simulation room alone, and 2% in a clinic exam room. The number of cervix BT courses most frequently performed per month was between 0 and 5 at 61%, and 44% reported an average of five applicator placements per course (range 0-5). Thirty four percent reported using general anesthesia alone (GA) for intracavitary BT (n=41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, and 9% spinal or epidural AS alone. The remaining responses were combinations of AG or AS (see table 1). Hybrid intracavitary/interstitial BT applicators are being used by 61% of respondents, 49% of which are vendor made devices (e.g., Elekta/Varian). Among those performing hybrid BT (n=25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, and 4% OA alone. The remaining responses were combinations of AG or AS. For template interstitial BT (n=25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of all respondents report providing AG or AS during applicator placement only, while 32% report offering it during placement, planning, treatment, and removal. The most commonly cited reason for not using CS or GA was lack of anesthesia resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder (PTSD) symptoms after BT. However, 68% reported not using techniques to help alleviate emotional distress related to BT procedures.</div></div><div><h3>Conclusions</h3><div>AG/AS practice patterns for gynecologic BT vary widely across the United States. While many clinicians report using some form of GA, CS or epidural AS, 10% are using only oral analgesia methods, and 22% are offering AG/AS only during applicator placement.
{"title":"Thursday, July 11, 20245:00 PM - 6:00 PM GSOR01 Presentation Time: 5:00 PM","authors":"Dulce M. Barrios MD , Mitchell Kamrava MD , Jenna M. Kahn MD , Vonetta M. Williams MD , Keyur J. Mehta MD , Aaron Wolfson MD , Lorraine Portelance MD , Amanda Rivera MD","doi":"10.1016/j.brachy.2024.08.047","DOIUrl":"10.1016/j.brachy.2024.08.047","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the current practice patterns of analgesia (AG) and anesthesia (AS) use across the U.S. for gynecologic brachytherapy (BT) procedures.</div></div><div><h3>Methods and Materials</h3><div>A 27-item survey was created with expertise from five practicing radiation oncology brachytherapists in the U.S. and distributed electronically to 90 Radiation Oncology residency programs for dissemination. The survey was also publicized on social media via the X (formally Twitter) platform, and at two national meetings (The American Brachytherapy Society Annual Meeting 2023 and The American Society for Radiation Therapy Annual Meeting 2023) during the months of June-October 2023.</div></div><div><h3>Results</h3><div>Forty-one responses were received (46% response rate). Fifty-four percent identified as female, 66% Caucasian race and 85% of non-Hispanic/Latino ethnicity. Ninety-three percent were physician brachytherapists, 5% medical physicists, and 2% did not disclose their profession. Forty nine percent reported typically carrying out procedures in a BT suite ± separate CT simulator alone, 39% in the operating room ± BT suite or CT simulator or other location. Ten percent reported the CT simulation room alone, and 2% in a clinic exam room. The number of cervix BT courses most frequently performed per month was between 0 and 5 at 61%, and 44% reported an average of five applicator placements per course (range 0-5). Thirty four percent reported using general anesthesia alone (GA) for intracavitary BT (n=41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, and 9% spinal or epidural AS alone. The remaining responses were combinations of AG or AS (see table 1). Hybrid intracavitary/interstitial BT applicators are being used by 61% of respondents, 49% of which are vendor made devices (e.g., Elekta/Varian). Among those performing hybrid BT (n=25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, and 4% OA alone. The remaining responses were combinations of AG or AS. For template interstitial BT (n=25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of all respondents report providing AG or AS during applicator placement only, while 32% report offering it during placement, planning, treatment, and removal. The most commonly cited reason for not using CS or GA was lack of anesthesia resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder (PTSD) symptoms after BT. However, 68% reported not using techniques to help alleviate emotional distress related to BT procedures.</div></div><div><h3>Conclusions</h3><div>AG/AS practice patterns for gynecologic BT vary widely across the United States. While many clinicians report using some form of GA, CS or epidural AS, 10% are using only oral analgesia methods, and 22% are offering AG/AS only during applicator placement. ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S41-S42"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526541","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.2024.08.080
Sharbacha Edward PhD in Medical Physics, Justin Mikell PhD, Jose Garcia-Ramirez MS, Michael B. Altman PhD, Phillip D. Wall PhD, Anamaria Guta MS, Jason LaBrash BS, Jessika A. Contreras MD, Jacqueline E. Zoberi PhD
<div><h3>Purpose</h3><div>Two high dose rate (HDR) remote afterloaders (RALs) were recently accepted and commissioned for use in our clinic. These RALs are unique in that prior to treatment, they measure each connected applicator + transfer guide tube (TGT) channel length with the dummy wire. If this measurement deviation is within some user-specified tolerance, the RAL automatically adjusts the planned channel length (and subsequent dwell positions) used for treatment by the active wire. This work evaluates the positional accuracy of these units and reports their performance over the first few months of gynecologic patient treatments.</div></div><div><h3>Materials and Methods</h3><div>Acceptance testing and commissioning were performed for both units: RAL1 in August 2023, and RAL2 in November 2023. Applicator + TGT channel length verification tests were performed as part of this process. Channel lengths were measured with two independent ruler systems provided by the manufacturer. Manually measured channel lengths were within 0.5 mm of the baseline nominal values provided by the manufacturer. In order to quantify RAL positional accuracy, rigid fixed length applicators - including tandems, ovoids, cylinders, and Simon-Heyman capsules - were affixed to radiochromic film, and double exposure irradiations were performed. First, they were irradiated using a mobile C-Arm fluoroscopy unit. An autoradiograph was then acquired using mock treatment plans designed using nominal channel lengths as the planned lengths, and delivered by the RALs using an ideal applicator setup, i.e. minimizing curvature of TGTs. We configured the RAL to automatically adjust dwell positions when the difference between the RAL-measured and planned channel lengths were within 2 mm. Dwell position deviations measured on film were compared with differences between planned and RAL-measured channel lengths. The record and verify system's treatment summary was queried to extract the RALs’ measured channel lengths. The performance of each RAL was assessed over time by comparing the treatment summary channel lengths for patient treatments with the planned values.</div></div><div><h3>Results</h3><div>Double exposure films indicated that, on average, dwell positions deviated towards the applicator tip by 0.8mm (max=1.5mm). Mean difference between planned and RAL-measured channel lengths was 0.5 mm (max=0.9mm). On both RALs, more curved applicators had larger length deviations during commissioning and patient treatments. This increased curvature resulted in larger overestimates of channel length, up to 1.7mm for ovoids. Ovoid channel length deviations were similar for left and right ovoids on RAL1 at just over 1mm initially, and decreased over a 23 week period to be <1mm. The deviations however remained steady for RAL2 over 10 weeks of treatment, with 90% of all values being >1mm(Fig.1). Left ovoids showed larger deviation than right (1.45 vs 1.18mm respectively) (p<0.01).</div><
{"title":"PHSOR06 Presentation Time: 9:25 AM","authors":"Sharbacha Edward PhD in Medical Physics, Justin Mikell PhD, Jose Garcia-Ramirez MS, Michael B. Altman PhD, Phillip D. Wall PhD, Anamaria Guta MS, Jason LaBrash BS, Jessika A. Contreras MD, Jacqueline E. Zoberi PhD","doi":"10.1016/j.brachy.2024.08.080","DOIUrl":"10.1016/j.brachy.2024.08.080","url":null,"abstract":"<div><h3>Purpose</h3><div>Two high dose rate (HDR) remote afterloaders (RALs) were recently accepted and commissioned for use in our clinic. These RALs are unique in that prior to treatment, they measure each connected applicator + transfer guide tube (TGT) channel length with the dummy wire. If this measurement deviation is within some user-specified tolerance, the RAL automatically adjusts the planned channel length (and subsequent dwell positions) used for treatment by the active wire. This work evaluates the positional accuracy of these units and reports their performance over the first few months of gynecologic patient treatments.</div></div><div><h3>Materials and Methods</h3><div>Acceptance testing and commissioning were performed for both units: RAL1 in August 2023, and RAL2 in November 2023. Applicator + TGT channel length verification tests were performed as part of this process. Channel lengths were measured with two independent ruler systems provided by the manufacturer. Manually measured channel lengths were within 0.5 mm of the baseline nominal values provided by the manufacturer. In order to quantify RAL positional accuracy, rigid fixed length applicators - including tandems, ovoids, cylinders, and Simon-Heyman capsules - were affixed to radiochromic film, and double exposure irradiations were performed. First, they were irradiated using a mobile C-Arm fluoroscopy unit. An autoradiograph was then acquired using mock treatment plans designed using nominal channel lengths as the planned lengths, and delivered by the RALs using an ideal applicator setup, i.e. minimizing curvature of TGTs. We configured the RAL to automatically adjust dwell positions when the difference between the RAL-measured and planned channel lengths were within 2 mm. Dwell position deviations measured on film were compared with differences between planned and RAL-measured channel lengths. The record and verify system's treatment summary was queried to extract the RALs’ measured channel lengths. The performance of each RAL was assessed over time by comparing the treatment summary channel lengths for patient treatments with the planned values.</div></div><div><h3>Results</h3><div>Double exposure films indicated that, on average, dwell positions deviated towards the applicator tip by 0.8mm (max=1.5mm). Mean difference between planned and RAL-measured channel lengths was 0.5 mm (max=0.9mm). On both RALs, more curved applicators had larger length deviations during commissioning and patient treatments. This increased curvature resulted in larger overestimates of channel length, up to 1.7mm for ovoids. Ovoid channel length deviations were similar for left and right ovoids on RAL1 at just over 1mm initially, and decreased over a 23 week period to be <1mm. The deviations however remained steady for RAL2 over 10 weeks of treatment, with 90% of all values being >1mm(Fig.1). Left ovoids showed larger deviation than right (1.45 vs 1.18mm respectively) (p<0.01).</div><","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S60-S61"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527205","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.2024.08.063
Csaba Polgar MD, PhD, MSc, DSc , Vratislav Strnad MD, PhD , Jose Luis Guinot MD , Cristina Gutierrez Miguelez MD , Tibor Major PhD, DSc , Kristina Lössl MD , Bülent Polat MD , Peter Niehoff MD, PhD , Christine Gall PhD , Wolfgang Uter PhD
Purpose
To report the 10-year late side-effects and cosmetic results of the GEC-ESTRO multicentric phase 3 accelerated partial breast irradiation (APBI) trial.
Materials and Methods
Women aged 40 years or older with stage 0-IIA breast cancer who underwent breast-conserving surgery (BCS) with clear resection margins were randomly assigned to receive either whole-breast irradiation (WBI) of 50 Gy with a tumor-bed boost of 10 Gy or APBI with interstitial brachytherapy. The non-inferiority of APBI in terms of local tumor control as primary end-point has been confirmed. Here, we report the secondary endpoints of late side-effects and cosmesis at 7.5 and 10 years of follow-up. This trial is registered with ClinicalTrials.gov number NCT00402519.
Results
Between 2004, and 2009, we randomly assigned 1328 women to receive either WBI (n=673) or APBI with interstitial brachytherapy (n=655); 1184 patients comprised the as-treated population and among these 10-year data on late side-effects and cosmetic results were available in 688 patients (313 in the WBI group and 375 in the APBI group). At 7.5 and 10 years 10 (2.7%) and 4 (1.3%) patients in the WBI group and 2 (0.4%) and 1 (0.3%) patients in the APBI group had grade 3 skin teleangiectasia (p=0.02 at 7.5 years and p=0.18 at 10 years). At 7.5 and 10 years 2 (0.5%) and 5 patients (1.6%) in the WBI group and 2 (0.4%) and 3 (0.8%) in the APBI group developed grade 3 late subcutaneous tissue toxicity (p=0.62 at 7.5 years and p=0.53 at 10 years). The incidence of grade 2-3 breast pain at 7.5 and 10 years was 1.6% and 1.0% after WBI versus 1.1% and 0.8% after APBI (p=0.39 at 7.5 years and p=0.93 at 10 years). At 7.5 years brachial lymphoedema occurred more frequently after WBI compared to APBI (5.4% vs 2.2%; p=0.03). At 7.5 and 10 years’ follow-up, according to the patients’ view, 31.9% and 33.8% of patients had excellent cosmetic results in the WBI group versus 44.3% and 45.0% of patients in the APBI group (p=0.001 at 7.5 years and p=0.002 at 10 years); when judged by the physicians, 31.7% and 33.2% of patients in the WBI group versus 40.0% and 40.0% of patients in the APBI group, had excellent cosmetic results, respectively (p=0.05 at 7.5 years and p=0.2 at 10 years).
Conclusions
Long-term toxicity profiles and cosmetic results were similar in patients treated with BCS followed by either APBI with interstitial brachytherapy or conventional WBI, with significantly fewer skin teleangiectasia and brachial lymphoedema accompanied with a slightly better cosmetic results after APBI with interstitial brachytherapy. These findings provide further clinical evidence for the routine use of sole interstitial multicatheter brachytherapy after BCS.
{"title":"PL05 Presentation Time: 2:30 PM","authors":"Csaba Polgar MD, PhD, MSc, DSc , Vratislav Strnad MD, PhD , Jose Luis Guinot MD , Cristina Gutierrez Miguelez MD , Tibor Major PhD, DSc , Kristina Lössl MD , Bülent Polat MD , Peter Niehoff MD, PhD , Christine Gall PhD , Wolfgang Uter PhD","doi":"10.1016/j.brachy.2024.08.063","DOIUrl":"10.1016/j.brachy.2024.08.063","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the 10-year late side-effects and cosmetic results of the GEC-ESTRO multicentric phase 3 accelerated partial breast irradiation (APBI) trial.</div></div><div><h3>Materials and Methods</h3><div>Women aged 40 years or older with stage 0-IIA breast cancer who underwent breast-conserving surgery (BCS) with clear resection margins were randomly assigned to receive either whole-breast irradiation (WBI) of 50 Gy with a tumor-bed boost of 10 Gy or APBI with interstitial brachytherapy. The non-inferiority of APBI in terms of local tumor control as primary end-point has been confirmed. Here, we report the secondary endpoints of late side-effects and cosmesis at 7.5 and 10 years of follow-up. This trial is registered with ClinicalTrials.gov number NCT00402519.</div></div><div><h3>Results</h3><div>Between 2004, and 2009, we randomly assigned 1328 women to receive either WBI (n=673) or APBI with interstitial brachytherapy (n=655); 1184 patients comprised the as-treated population and among these 10-year data on late side-effects and cosmetic results were available in 688 patients (313 in the WBI group and 375 in the APBI group). At 7.5 and 10 years 10 (2.7%) and 4 (1.3%) patients in the WBI group and 2 (0.4%) and 1 (0.3%) patients in the APBI group had grade 3 skin teleangiectasia (p=0.02 at 7.5 years and p=0.18 at 10 years). At 7.5 and 10 years 2 (0.5%) and 5 patients (1.6%) in the WBI group and 2 (0.4%) and 3 (0.8%) in the APBI group developed grade 3 late subcutaneous tissue toxicity (p=0.62 at 7.5 years and p=0.53 at 10 years). The incidence of grade 2-3 breast pain at 7.5 and 10 years was 1.6% and 1.0% after WBI versus 1.1% and 0.8% after APBI (p=0.39 at 7.5 years and p=0.93 at 10 years). At 7.5 years brachial lymphoedema occurred more frequently after WBI compared to APBI (5.4% vs 2.2%; p=0.03). At 7.5 and 10 years’ follow-up, according to the patients’ view, 31.9% and 33.8% of patients had excellent cosmetic results in the WBI group versus 44.3% and 45.0% of patients in the APBI group (p=0.001 at 7.5 years and p=0.002 at 10 years); when judged by the physicians, 31.7% and 33.2% of patients in the WBI group versus 40.0% and 40.0% of patients in the APBI group, had excellent cosmetic results, respectively (p=0.05 at 7.5 years and p=0.2 at 10 years).</div></div><div><h3>Conclusions</h3><div>Long-term toxicity profiles and cosmetic results were similar in patients treated with BCS followed by either APBI with interstitial brachytherapy or conventional WBI, with significantly fewer skin teleangiectasia and brachial lymphoedema accompanied with a slightly better cosmetic results after APBI with interstitial brachytherapy. These findings provide further clinical evidence for the routine use of sole interstitial multicatheter brachytherapy after BCS.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S50"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527029","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.2024.08.020
Christopher Jason Tien Ph.D. , Sean Mullane M.S. , Emily Draeger Ph.D. , Mark J. Rivard Ph.D. , Zhe (Jay) Chen Ph.D.
<div><h3>Purpose</h3><div>In Ir-192-based high dose rate (HDR) brachytherapy, the dose delivered at the central axis of single-channel vaginal cylinder (SCVC) is inherently lower than the surrounding areas due to the anisotropic dose distribution of the Ir-192 seed. In principle, this situation could be addressed by introducing custom shielding into the dome of SCVC to shape the dose distribution near the central axis. Aided by advanced dose calculation methods, including both Monte Carlo (MC) simulations and Model-Based Dose Calculation Algorithms (MBDCAs), the shape and density of the shielding materials could provide additional degrees of freedom for inverse dose optimization. In this work, we investigate the potential benefits of this approach by investigating the efficacy of an SCVC with custom shielding (SCVC+S) design to flatten the distal dose profile.</div></div><div><h3>Materials and Methods</h3><div>A standard SCVC with 140 mm cylinder height (h) and 30 mm outer diameter (OD) with an air channel of 1.6 mm along the central axis for the source transit was used in the initial investigation. The cylinder is capped by a half-spherical dome with a matching diameter (d) of 30 mm. While the existing SCVC is composed entirely of water-equivalent material, the SCVC+S design includes a cavity within the dome which will be injected with stainless steel (mass density of 8.0 g/cc, 6.49 electron density, 13415 HU) shielding material. Three distinct SCVC+S dome designs were explored: A) dome composed of entirely stainless steel except an air channel of d=5 mm along the central axis; B) dome containing one disk “washer” (OD=27 mm, inner diameter (ID)=20 mm, h=1 mm); C) dome containing one disk “washer” (OD=13 mm, ID=3 mm, h=2.5 mm) stacked on a short cylinder (d=13 mm, h=2.5 mm). The SCVC/SCVC+S geometries were independently modeled, with the GammaMed Plus 232 HDR <sup>192</sup>Ir (dosimetrically identical to Bravos 232A HDR192) radioactive source model for 1) AcurosBV v1.8.0.867816 (Varian Medical Systems, Palo Alto, CA) MBDCA, with dose reported to medium for a 1 × 1 × 1 mm<sup>3</sup> grid; and 2) Geant4 MC with TOPAS v3.8 toolkit, with tracklength estimator (TLE) dose for 1 × 1 × 1 mm<sup>3</sup> grid, with n=1 × 10<sup>8</sup> histories.</div></div><div><h3>Results</h3><div>After modeling the 4 (one SCVC and three SCVC+S) applicator designs in EclipseBV and TOPAS, the dose grids were obtained. PORTEC A3 (3.5 mm lateral, 5 mm superior) reference point and lateral dose profiles up to lateral radius (r) of 15 mm were extracted from a plane 5 mm superior to the SCVC tip (normalized to 100% dose at the central axis). The traditional SCVC has region of lowest dose at central axis, with large shoulders, 109% dose at A3, 116% dose at r=10 mm. Design A of SCVC+S has its highest relative dose at central axis, with no shoulders, 92% dose at A3, 61% dose at r=10 mm. Design B of SCVC+S has a wide flat region with shoulders, 100% dose at A3, 104% dose at r=10
{"title":"Thursday, July 11, 20244:00 PM - 5:00 PM PP01 Presentation Time: 4:00 PM","authors":"Christopher Jason Tien Ph.D. , Sean Mullane M.S. , Emily Draeger Ph.D. , Mark J. Rivard Ph.D. , Zhe (Jay) Chen Ph.D.","doi":"10.1016/j.brachy.2024.08.020","DOIUrl":"10.1016/j.brachy.2024.08.020","url":null,"abstract":"<div><h3>Purpose</h3><div>In Ir-192-based high dose rate (HDR) brachytherapy, the dose delivered at the central axis of single-channel vaginal cylinder (SCVC) is inherently lower than the surrounding areas due to the anisotropic dose distribution of the Ir-192 seed. In principle, this situation could be addressed by introducing custom shielding into the dome of SCVC to shape the dose distribution near the central axis. Aided by advanced dose calculation methods, including both Monte Carlo (MC) simulations and Model-Based Dose Calculation Algorithms (MBDCAs), the shape and density of the shielding materials could provide additional degrees of freedom for inverse dose optimization. In this work, we investigate the potential benefits of this approach by investigating the efficacy of an SCVC with custom shielding (SCVC+S) design to flatten the distal dose profile.</div></div><div><h3>Materials and Methods</h3><div>A standard SCVC with 140 mm cylinder height (h) and 30 mm outer diameter (OD) with an air channel of 1.6 mm along the central axis for the source transit was used in the initial investigation. The cylinder is capped by a half-spherical dome with a matching diameter (d) of 30 mm. While the existing SCVC is composed entirely of water-equivalent material, the SCVC+S design includes a cavity within the dome which will be injected with stainless steel (mass density of 8.0 g/cc, 6.49 electron density, 13415 HU) shielding material. Three distinct SCVC+S dome designs were explored: A) dome composed of entirely stainless steel except an air channel of d=5 mm along the central axis; B) dome containing one disk “washer” (OD=27 mm, inner diameter (ID)=20 mm, h=1 mm); C) dome containing one disk “washer” (OD=13 mm, ID=3 mm, h=2.5 mm) stacked on a short cylinder (d=13 mm, h=2.5 mm). The SCVC/SCVC+S geometries were independently modeled, with the GammaMed Plus 232 HDR <sup>192</sup>Ir (dosimetrically identical to Bravos 232A HDR192) radioactive source model for 1) AcurosBV v1.8.0.867816 (Varian Medical Systems, Palo Alto, CA) MBDCA, with dose reported to medium for a 1 × 1 × 1 mm<sup>3</sup> grid; and 2) Geant4 MC with TOPAS v3.8 toolkit, with tracklength estimator (TLE) dose for 1 × 1 × 1 mm<sup>3</sup> grid, with n=1 × 10<sup>8</sup> histories.</div></div><div><h3>Results</h3><div>After modeling the 4 (one SCVC and three SCVC+S) applicator designs in EclipseBV and TOPAS, the dose grids were obtained. PORTEC A3 (3.5 mm lateral, 5 mm superior) reference point and lateral dose profiles up to lateral radius (r) of 15 mm were extracted from a plane 5 mm superior to the SCVC tip (normalized to 100% dose at the central axis). The traditional SCVC has region of lowest dose at central axis, with large shoulders, 109% dose at A3, 116% dose at r=10 mm. Design A of SCVC+S has its highest relative dose at central axis, with no shoulders, 92% dose at A3, 61% dose at r=10 mm. Design B of SCVC+S has a wide flat region with shoulders, 100% dose at A3, 104% dose at r=10 ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S26-S27"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142525875","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.2024.08.062
Gregory Merrick MD , Martin King MD, PhD , Kent Wallner MD , Robert W. Gallbreath PhD , Ryan Fiano PhD , Wayne M. Butler PhD , Peter F. Orio DO, MS
Purpose
To evaluate the necessity and/or dose of supplemental external beam radiotherapy (EBRT) in predicting biochemical failure (BF) and prostate cancer specific mortality (PCSM) in higher-risk prostate cancer patients implanted with Pd-103.
Materials and Methods
Eligibility criteria included clinically organ-confined disease with Gleason scores 7-9 and/or a pre-treatment prostate-specific antigen (PSA) of 10-20ng/mL. Trial 44/20 randomized 247 patients to 44Gy + 90Gy Pd-103 vs. 20Gy with 115Gy Pd-103. The subsequent 20/0 trial randomized 383 patients to the 20Gy arm vs. monotherapeutic 125Gy Pd-103. The brachytherapy prescription dose was prescribed to the prostate gland with generous periprostatic margins using extracapsular seeds and implantation of the proximal 10-12mm of the seminal vesicles. Post-implant computerized tomography (CT) based dosimetry was performed on day 0. Biochemical failure (BF) was defined as a PSA > 0.40ng/mL after nadir. Multiple clinical, pathologic and treatment parameters were evaluated for impact on BF, PCSM, and overall mortality(OM).
Results
For all 630 patients, the median follow up was 11.8 years with a day 0 D90 of 121.9% of prescription and a V100 of 98.3%. The 13-year BF, PCSM and OM were 5.8%, 1.0%, 30.4%, respectively. For the 44/20 patients (median follow up 13.7 years) BF, PCSM &OM were 8.9%, 2.4% and 39.7% while BF, PCSM & OM for 20/0 (median follow-up 10.4 years) were 3.6%, 0.0% and 21.5%. In part, the difference in outcome between the two groups was due to a significant difference in the number of accrued Gleason score (GS) 8-9 patients (15.8% versus 1.6%). BF and PCSM for FIR, UIR and HR were 3.5% and 0.0%, 7.5% and 1.9%, and 15.2%, and 4.3%, respectively. The median time to BF was 5.1 (range 0.7-10.7), 4.6 (range 0.7-12.3), & 2.9 (range 0.2-7.8) years for FIR, UIR & HR. Neither the addition of EBRT or dose impacted BF (Figure) or PCSM. In multivariate analysis, BF was most closely related to pre-implant PSA (p=0.019, HR=1.154), GS (p=0.008, HR=1.748) & percent positive biopsies (p=0.015, HR=1.020). PCSM was most closely related to pre-implant PSA (p= 0.02, HR=1.218) & GS (p< 0.001, HR=4.178). For all biochemically-controlled patients, the median PSA was< 0.02 ng/ml.
Conclusions
In this study, consistent, high-quality Pd-103 dose distributions with aggressive extra-capsular and proximal seminal vesicle coverage resulted in durable biochemical control rates in patients with higher-risk features. The addition of supplemental EBRT did not impact BF or PCSM.
{"title":"PL04 Presentation Time: 2:15 PM","authors":"Gregory Merrick MD , Martin King MD, PhD , Kent Wallner MD , Robert W. Gallbreath PhD , Ryan Fiano PhD , Wayne M. Butler PhD , Peter F. Orio DO, MS","doi":"10.1016/j.brachy.2024.08.062","DOIUrl":"10.1016/j.brachy.2024.08.062","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the necessity and/or dose of supplemental external beam radiotherapy (EBRT) in predicting biochemical failure (BF) and prostate cancer specific mortality (PCSM) in higher-risk prostate cancer patients implanted with Pd-103.</div></div><div><h3>Materials and Methods</h3><div>Eligibility criteria included clinically organ-confined disease with Gleason scores 7-9 and/or a pre-treatment prostate-specific antigen (PSA) of 10-20ng/mL. Trial 44/20 randomized 247 patients to 44Gy + 90Gy Pd-103 vs. 20Gy with 115Gy Pd-103. The subsequent 20/0 trial randomized 383 patients to the 20Gy arm vs. monotherapeutic 125Gy Pd-103. The brachytherapy prescription dose was prescribed to the prostate gland with generous periprostatic margins using extracapsular seeds and implantation of the proximal 10-12mm of the seminal vesicles. Post-implant computerized tomography (CT) based dosimetry was performed on day 0. Biochemical failure (BF) was defined as a PSA > 0.40ng/mL after nadir. Multiple clinical, pathologic and treatment parameters were evaluated for impact on BF, PCSM, and overall mortality(OM).</div></div><div><h3>Results</h3><div>For all 630 patients, the median follow up was 11.8 years with a day 0 D90 of 121.9% of prescription and a V100 of 98.3%. The 13-year BF, PCSM and OM were 5.8%, 1.0%, 30.4%, respectively. For the 44/20 patients (median follow up 13.7 years) BF, PCSM &OM were 8.9%, 2.4% and 39.7% while BF, PCSM & OM for 20/0 (median follow-up 10.4 years) were 3.6%, 0.0% and 21.5%. In part, the difference in outcome between the two groups was due to a significant difference in the number of accrued Gleason score (GS) 8-9 patients (15.8% versus 1.6%). BF and PCSM for FIR, UIR and HR were 3.5% and 0.0%, 7.5% and 1.9%, and 15.2%, and 4.3%, respectively. The median time to BF was 5.1 (range 0.7-10.7), 4.6 (range 0.7-12.3), & 2.9 (range 0.2-7.8) years for FIR, UIR & HR. Neither the addition of EBRT or dose impacted BF (Figure) or PCSM. In multivariate analysis, BF was most closely related to pre-implant PSA (p=0.019, HR=1.154), GS (p=0.008, HR=1.748) & percent positive biopsies (p=0.015, HR=1.020). PCSM was most closely related to pre-implant PSA (p= 0.02, HR=1.218) & GS (p< 0.001, HR=4.178). For all biochemically-controlled patients, the median PSA was< 0.02 ng/ml.</div></div><div><h3>Conclusions</h3><div>In this study, consistent, high-quality Pd-103 dose distributions with aggressive extra-capsular and proximal seminal vesicle coverage resulted in durable biochemical control rates in patients with higher-risk features. The addition of supplemental EBRT did not impact BF or PCSM.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S49-S50"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526753","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.2024.08.077
Birjoo Vaishnav PhD, DABR
<div><h3>Purpose</h3><div>Clinical experience or nomograms guide day to day clinical decisions for HDR prostate brachytherapy such as whether there ought to be one more catheter to ensure coverage or whether a given catheter would be unusable as it is too close to urethra. AI or machine learning offers the possibility to mimic this with backing from clinical data. The purpose of this study utilizing simulated data was to explore feasibility of using AI/Machine Learning in answering routine questions during the HDR prostate planning process, such as the number of catheters needed to ensure optimal coverage while ensuring urethral sparing.</div></div><div><h3>Materials and Methods</h3><div>Data from the catheter insertion and planning during HDR prostate cases such as volume of prostate in the ultrasound and CT, number of catheters are available during insertion and after digitization and optimization the D10% for the Urethra, V150 and V200 for the prostate for a V100 ∼ 95% is obtained. To separate the characteristics of the AI modeling from the peculiarities of the clinical data, a simulated dataset with a gaussian distribution with similar bounds as the typical clinical data was created. AutoML is a subset of machine learning which automates the model validation and evaluation. Using various preset criteria, models are trained on data using fivefold cross validation and a portion of data is held for future testing as a holdout. The scoring metric from this is then used for automatically evaluating the performance of models and choosing the optimal model. Various software solutions were explored for deploying AutoML with low or no code and ability to evaluate the underlying machine learning model predictions being the criterion. The user interface for two of the vendors datarobot and symon.ai were intuitive and easily deployable in comparison to the bigger vendors in the field, of the two, free trial online version of datarobot was used for this study. AutoML was trained and deployed on a set of 51 rows with four of the predictive features - TRUS volume of prostate, number of slices, CT volume and the Dose to 10% of the urethra were used as the training data set for machine learning, with the number of catheters as the target. After completion of the run, the output of top five of the algorithms (elastic net, extreme gradient boosted trees, ridge regressor, light gradient and random forest) were calculated just to evaluate how far off they were from each other and ground truth, using another set of 48 rows of data with some overlap with the training data.</div></div><div><h3>Results</h3><div>While it was easy to deploy and create a model with this platform, several other platforms such from leaders in the field were much harder to set up and troubleshoot. The outputs for the test data were evaluated relative to the ground truth and the elastic net had the least deviation from the ground truth both in terms of the overall data spread and the deviat
{"title":"PHSOR03 Presentation Time: 9:10 AM","authors":"Birjoo Vaishnav PhD, DABR","doi":"10.1016/j.brachy.2024.08.077","DOIUrl":"10.1016/j.brachy.2024.08.077","url":null,"abstract":"<div><h3>Purpose</h3><div>Clinical experience or nomograms guide day to day clinical decisions for HDR prostate brachytherapy such as whether there ought to be one more catheter to ensure coverage or whether a given catheter would be unusable as it is too close to urethra. AI or machine learning offers the possibility to mimic this with backing from clinical data. The purpose of this study utilizing simulated data was to explore feasibility of using AI/Machine Learning in answering routine questions during the HDR prostate planning process, such as the number of catheters needed to ensure optimal coverage while ensuring urethral sparing.</div></div><div><h3>Materials and Methods</h3><div>Data from the catheter insertion and planning during HDR prostate cases such as volume of prostate in the ultrasound and CT, number of catheters are available during insertion and after digitization and optimization the D10% for the Urethra, V150 and V200 for the prostate for a V100 ∼ 95% is obtained. To separate the characteristics of the AI modeling from the peculiarities of the clinical data, a simulated dataset with a gaussian distribution with similar bounds as the typical clinical data was created. AutoML is a subset of machine learning which automates the model validation and evaluation. Using various preset criteria, models are trained on data using fivefold cross validation and a portion of data is held for future testing as a holdout. The scoring metric from this is then used for automatically evaluating the performance of models and choosing the optimal model. Various software solutions were explored for deploying AutoML with low or no code and ability to evaluate the underlying machine learning model predictions being the criterion. The user interface for two of the vendors datarobot and symon.ai were intuitive and easily deployable in comparison to the bigger vendors in the field, of the two, free trial online version of datarobot was used for this study. AutoML was trained and deployed on a set of 51 rows with four of the predictive features - TRUS volume of prostate, number of slices, CT volume and the Dose to 10% of the urethra were used as the training data set for machine learning, with the number of catheters as the target. After completion of the run, the output of top five of the algorithms (elastic net, extreme gradient boosted trees, ridge regressor, light gradient and random forest) were calculated just to evaluate how far off they were from each other and ground truth, using another set of 48 rows of data with some overlap with the training data.</div></div><div><h3>Results</h3><div>While it was easy to deploy and create a model with this platform, several other platforms such from leaders in the field were much harder to set up and troubleshoot. The outputs for the test data were evaluated relative to the ground truth and the elastic net had the least deviation from the ground truth both in terms of the overall data spread and the deviat","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S58-S59"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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