Brachytherapy最新文献_第3页

MRI-guided neurovascular bundle avoidance in high dose rate prostate brachytherapy mri引导下高剂量率前列腺近距离治疗中的神经血管束回避

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.08.001

Drew G. Gerber, Sean Dresser, Xiaofeng Yang, Richard L.J. Qiu, Xiaojun Jiang, Sona Desai, Joseph Harms, Sagar A. Patel, Bruce Hershatter, Nikhil Sebastian, Vishal Dhere, Tian Liu, Ashesh B. Jani, Pretesh R. Patel

Purpose

The neurovascular bundles (NVBs) play a role in erectile function and are not well visualized on ultrasound or computed tomography (CT). In this study we hypothesize that treatment planning MRI will allow avoidance of the NVB during HDR prostate brachytherapy.

Materials and Methods

This was a retrospective review of patients who had HDR prostate brachytherapy as monotherapy (two implants 1-2 weeks apart each delivering 13.5 Gy). All patients underwent TRUS-guided HDR catheter placement followed by CT and MRI simulation. The left and right NVB were contoured on the treatment planning MRI. Standard clinical plans were optimized for prostate coverage and avoidance of organs at risk (OARs). Experimental NVB-sparing plans were generated to add avoidance of the NVBs. Differences between target and OAR doses in the original and NVB-sparing plans were assessed pairwise using a 2-tailed t-test.

Results

34 patients were included and segmentation of the left and right NVB was feasible for all cases. Compared to their paired original plans, NVB-sparing plans reduced left and right NVB D0.01cc (130% vs. 102% and 130% vs. 108%, p < 0.01, respectively). There was no difference in prostate D90 (108% vs 108%, p = 0.19) and V100 (96.1 vs 95.9%, p = 0.17) between plans; prostate V150% (35.8% vs. 34.7%, p < 0.01) and V200% (14.0% vs 13.4%, p < 0.01) slightly decreased in the NVB-sparing plans. Mean bladder V75 (0.3 cc), rectum V75 (0.2 cc), and urethra V125 (0.03 cc) were similar between plans.

Conclusions

Using MRI-based treatment planning, NVB-sparing prostate HDR brachytherapy is feasible and merits further study.

目的神经血管束（NVBs）在勃起功能中起着重要作用，但在超声或计算机断层扫描（CT）上不能很好地显示。在本研究中，我们假设治疗计划MRI将允许在HDR前列腺近距离治疗期间避免NVB。材料和方法本研究是对接受HDR前列腺近距离放射治疗作为单药治疗的患者的回顾性研究（两次植入间隔1-2周，每次13.5 Gy）。所有患者均行trus引导下的HDR导管置入，然后进行CT和MRI模拟。在治疗计划MRI上绘制左右NVB轮廓。标准临床计划优化前列腺覆盖和避免危险器官（OARs）。生成了避免nvb的实验NVB-sparing计划。使用双尾t检验两两评估原始和nvb保留计划中靶剂量和OAR剂量的差异。结果共纳入34例患者，所有病例均可进行左右NVB分割。与原始方案相比，NVB保留方案减少了左NVB和右NVB D0.01cc（分别为130%对102%和130%对108%，p < 0.01）。两组间前列腺D90 （108% vs 108%, p = 0.19）和V100 （96.1 vs 95.9%, p = 0.17）无差异；前列腺V150% （35.8% vs. 34.7%, p < 0.01）和V150% （14.0% vs. 13.4%, p < 0.01）在nvb保留计划中略有下降。膀胱V75 （0.3 cc）、直肠V75 （0.2 cc）和尿道V125 （0.03 cc）的平均值在两组间相似。结论采用基于mri的治疗方案，保留nvb的前列腺HDR近距离治疗是可行的，值得进一步研究。

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引用次数: 0

Image guided brachytherapy quality assurance on NRG GY017 investigating immunotherapy in addition to chemoradiation for locally advanced cervical cancer 影像引导下NRG GY017近距离治疗质量保证研究局部晚期宫颈癌在放化疗的基础上进行免疫治疗。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.09.011

Hayeon Kim , Wei Deng , Dimitriy Zamarin , Ying Xiao , Junzo Chino , Stanley Benedict , Hannah Nguyen , Jessica Lowenstein , Susan McNulty , Sharad Ghamande , Catherine Ferguson , Loren Mell , Laura L. Holman , Cara Mathews , Allison Quick , Alexander Olawaiye , Elizabeth Hopp , Robert Mannel , Charles A. Leath-III , Roisin-E. O’Cearbhaill , Jyoti Mayadev

INTRODUCTION

Brachytherapy is a critical component of curative treatment in locally advanced cervical cancer. NRG GY-017 is a randomized Phase I trial of the anti-PD-L1 antibody atezolizumab administered neoadjuvantly and concurrently with chemoradiation (Arm A) or only concurrently with chemoradiation (Arm B) in patients with node positive locally advanced cervical cancer. Image guided brachytherapy (IGBT) was mandated in the protocol with a quality assurance (QA) workflow. Herein, we report the BT quality data on NRG GY-017 trial and practice patterns from the participating centers in this trial as a guide for future protocol brachytherapy QA.

METHODS

The participating sites were to submit brachytherapy plans online after BT was completed. IROC QA center compiled the BT fractions for each patient using the trial specific dosimetry evaluation template. An expert physician reviewer scored the contours and plans as per protocol, variation acceptable or major deviation as prespecified in the protocol dose metrics.

RESULTS

The BT dosimetry results were available for 32 patients. Seventeen patients (53%) had intracavitary applicator, and 15 patients (47%) had hybrid or interstitial applicators. Point A directed planning was performed for 4 patients (12.5%) and 28 patients had volume directed plans (87.5%). For imaging use, 2 patients had MRI based plans, and 30 had CT based planning (94%). For the dose constraints compliance per protocol, 7 patients had 9 events scored as major deviations (22%).

CONCLUSION

BT trial specific QA has the potential to enhance BT quality for clinical trials. This report will help guide future gynecologic BT trial data collection and QA process.

简介：近距离放射治疗是局部晚期宫颈癌根治性治疗的重要组成部分。NRG GY-017是一项随机I期试验，抗pd - l1抗体atezolizumab在淋巴结阳性的局部晚期宫颈癌患者中新辅助并同时进行放化疗（Arm a）或仅同时进行放化疗（Arm B）。图像引导近距离放射治疗（IGBT）在协议中具有质量保证（QA）工作流程。在此，我们报告NRG GY-017试验的BT质量数据和参与试验中心的实践模式，作为未来近距离治疗方案质量保证的指导。方法：参与单位在BT完成后在线提交近距离治疗方案。IROC质量保证中心使用试验特异性剂量评估模板编制每位患者的BT分数。专家医师审稿人根据方案、可接受的变化或方案剂量指标中预先规定的主要偏差对轮廓和计划进行评分。结果：获得32例患者的BT剂量测定结果。17例（53%）采用腔内涂抹器，15例（47%）采用混合型或间质涂抹器。A点定向计划4例（12.5%），体积定向计划28例（87.5%）。影像学方面，2例患者有基于MRI的计划，30例患者有基于CT的计划（94%）。对于每个方案的剂量限制依从性，7例患者有9个事件被评为主要偏差（22%）。结论：BT试验特异性QA具有提高BT临床试验质量的潜力。本报告将有助于指导今后妇科BT试验数据的收集和质量保证过程。

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引用次数: 0

Quantifying geometric and dosimetric advantage from the use of rectal spacing in HDR prostate brachytherapy 在HDR前列腺近距离放射治疗中使用直肠间距的几何和剂量优势的量化。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.08.009

Joel Beaudry , Tonghe Wang , David Aramburu Núñez , Marisa Kollmeier , Daniel Gorovets , Shirin A. Enger , Antonio L. Damato

INTRODUCTION

Rectal spacers are used during prostate external beam radiation therapy to increase rectal-prostate separation, thereby reducing rectal dose and toxicity. However, their role in high-dose-rate (HDR) brachytherapy remains less understood. This paper presents (i) a cohort study evaluating the dosimetric impact of rectal spacers in HDR prostate brachytherapy and (ii) a simulation study assessing how rectal-prostate separation affects dosimetry.

METHODS

We retrospectively analyzed 157 patients treated with 15 Gy HDR prostate boost brachytherapy. Patients were divided into preimplant spacer (n = 49) and nonspacer (n = 108) cohorts. Prostate and rectal dose-volume histogram (DVH) metrics were compared, and rectal-prostate separation was measured on intraoperative transrectal ultrasound. A custom linear programming optimizer simulated plans with separations of 0.5–12 mm in 30 nonspacer cases to evaluate resulting dose metrics.

RESULTS

Mean (± standard deviation) rectal-prostate separation was 7.8 ± 1.4 mm with spacer versus 4.0 ± 1.4 mm without spacer. Rectal dose was significantly reduced with spacer (mean D_2cc 7.4 ± 1.0 Gy vs. 9.2 ± 1.0 Gy; p < 0.001), while prostate coverage remained similar (mean D₉₀ 16.4 ± 0.3 Gy vs. 16.3 ± 0.3 Gy; p = 0.071). Simulations showed that separations > 3 mm consistently achieved prostate D₉₀ > 16 Gy and V₁₀₀ > 95%, and separations > 4 mm produced a marked reduction in rectal dose.

CONCLUSION

Rectal spacers significantly reduce rectal dose in HDR prostate brachytherapy. Patients with rectal-prostate separations of at least 4 mm are most likely to benefit.

简介：直肠间隔剂用于前列腺外束放射治疗，以增加直肠-前列腺分离，从而减少直肠剂量和毒性。然而，它们在高剂量率（HDR）近距离治疗中的作用仍然知之甚少。本文提出(i)一项队列研究，评估直肠间隔剂在HDR前列腺近距离治疗中的剂量学影响；（ii）一项模拟研究，评估直肠-前列腺分离如何影响剂量学。方法：回顾性分析157例接受 Gy HDR前列腺增强近距离治疗的患者。患者分为种植前间隔剂组（n = 49）和非间隔剂组（n = 108）。比较前列腺和直肠剂量-体积直方图（DVH）指标，术中经直肠超声测量直肠-前列腺分离。一个定制的线性规划优化器模拟了30个非间隔剂情况下0.5-12 mm的分离计划，以评估所得剂量指标。结果：有间隔的直肠-前列腺间隔平均（±标准差）为7.8 ± 1.4 mm，无间隔的为4.0 ± 1.4 mm。直肠剂量显著降低了垫片(平均7.4 D2cc ±1.0  Gy vs 9.2 ±1.0  Gy; p 90 16.4±0.3  Gy vs 16.3 ±0.3  Gy; p = 0.071)。模拟结果表明，分离> mm连续达到前列腺D90 > 16 Gy和V100 > 95%，分离> mm显著降低直肠剂量。结论：直肠间隔剂可显著降低HDR前列腺近距离治疗的直肠剂量。直肠-前列腺分离至少4 mm的患者最有可能受益。

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引用次数: 0

CT-guided high-dose-rate interstitial brachytherapy for malignant lung lesions in a resource-limited setting 在资源有限的情况下，ct引导下高剂量间质近距离治疗恶性肺病变。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.09.015

Simit Sapkota , Subhas Pandit , Sundar Suwal , Jeebana Bhandari , Abish Adhikari , Rajan Prajapati , Gerim Prasai , Sunil Shrestha , Anjani Kumar Jha

PURPOSE

Several nonsurgical techniques are available for the management of inoperable primary and metastatic lung diseases. While Stereotactic body radiotherapy is a well-established technique, its access in low and middle-income countries (LMICs) is restricted. This study aims to present our experience on the feasibility of the high-dose-rate interstitial brachytherapy (IBT) in inoperable lung lesions, including technique and outcomes in LMICs.

MATERIALS AND METHODS

Eleven patients/12 primary and metastatic lung lesions were treated with the IBT at a single cancer center between June 2022 and June 2024. The patients were treated by a multidisciplinary team comprising intervention radiologists, radiation oncologists, and medical oncologists. Treatment response was assessed using RECIST version 1.1.

RESULTS

The study cohort included 6 males and 5 females with a median age of 55 years (range, 39–75). The median volume of the lesions treated was 8.1 cc (range, 1.7–30.8). All the lesions were treated with a 20 Gy dose. The best response included complete responses in 6, partial responses in 1, stable disease in 4 and progressive disease in 1 lesion treated. The local control was 75 % for a median follow-up of 18.7 months (range, 8.3-35.9). Patients experienced no major procedural complications except self-limiting minor pneumothorax (27.3%), hemoptysis (27.3%) and fever (18.2%).

CONCLUSIONS

Our findings present the CT-guided IBT as an effective, safe, and minimally invasive treatment approach for patients with primary or metastatic lung lesions who pose challenges for surgery, with a good local control rate.

目的：几种非手术技术可用于治疗不能手术的原发性和转移性肺部疾病。虽然立体定向体放射治疗是一项成熟的技术，但其在低收入和中等收入国家（LMICs）的可及性受到限制。本研究旨在介绍我们在高剂量间质近距离放射治疗（IBT）治疗不能手术肺病变的可行性方面的经验，包括技术和低收入国家的结果。材料和方法：在2022年6月至2024年6月期间，在一个癌症中心接受IBT治疗的11例患者/12例原发性和转移性肺病变。患者由介入放射科医生、放射肿瘤学家和医学肿瘤学家组成的多学科团队进行治疗。使用RECIST 1.1版评估治疗效果。结果：研究队列包括6名男性和5名女性，中位年龄为55岁（范围39-75岁）。所治疗病变的中位体积为8.1 cc（范围为1.7-30.8）。所有病变均以20gy剂量治疗。最佳反应包括6例完全缓解，1例部分缓解，4例病情稳定，1例病变进展。局部控制率75%，中位随访18.7个月（范围8.3-35.9）。除自限性轻微气胸（27.3%）、咯血（27.3%）和发热（18.2%）外，患者无重大手术并发症。结论：我们的研究结果表明，对于原发性或转移性肺病变患者，ct引导下的IBT是一种有效、安全、微创的治疗方法，具有良好的局部控制率。

{"title":"CT-guided high-dose-rate interstitial brachytherapy for malignant lung lesions in a resource-limited setting","authors":"Simit Sapkota , Subhas Pandit , Sundar Suwal , Jeebana Bhandari , Abish Adhikari , Rajan Prajapati , Gerim Prasai , Sunil Shrestha , Anjani Kumar Jha","doi":"10.1016/j.brachy.2025.09.015","DOIUrl":"10.1016/j.brachy.2025.09.015","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Several nonsurgical techniques are available for the management of inoperable primary and metastatic lung diseases. While Stereotactic body radiotherapy is a well-established technique, its access in low and middle-income countries (LMICs) is restricted. This study aims to present our experience on the feasibility of the high-dose-rate interstitial brachytherapy (IBT) in inoperable lung lesions, including technique and outcomes in LMICs.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Eleven patients/12 primary and metastatic lung lesions were treated with the IBT at a single cancer center between June 2022 and June 2024. The patients were treated by a multidisciplinary team comprising intervention radiologists, radiation oncologists, and medical oncologists. Treatment response was assessed using RECIST version 1.1.</div></div><div><h3>RESULTS</h3><div>The study cohort included 6 males and 5 females with a median age of 55 years (range, 39–75). The median volume of the lesions treated was 8.1 cc (range, 1.7–30.8). All the lesions were treated with a 20 Gy dose. The best response included complete responses in 6, partial responses in 1, stable disease in 4 and progressive disease in 1 lesion treated. The local control was 75 % for a median follow-up of 18.7 months (range, 8.3-35.9). Patients experienced no major procedural complications except self-limiting minor pneumothorax (27.3%), hemoptysis (27.3%) and fever (18.2%).</div></div><div><h3>CONCLUSIONS</h3><div>Our findings present the CT-guided IBT as an effective, safe, and minimally invasive treatment approach for patients with primary or metastatic lung lesions who pose challenges for surgery, with a good local control rate.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 182-190"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403217","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

A review of NRC medical event reports related to brachytherapy, 2005-2024 2005-2024年NRC近距离放射治疗相关医疗事件报告综述

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.09.012

Jussi Sillanpaa , Joseph Santoro

Methods

We analyzed the Nuclear Regulatory Commission event notifications related to brachytherapy events that occurred between January 1, 2005, and December 31, 2024.

The events were categorized and their distribution and time evolution analyzed.

Results

A total of 818 events (227 LDR, 203 HDR, 21 intravascular, 367 microsphere) were identified, excluding events that related purely to shipping. We analyzed the events for the whole period and in consecutive 5-year intervals. The total number of events rose by 27% from the first to the last interval (2005–09:179, 2020–24:227), with the LDR events decreasing by 81% (2005–2009:98, 2020–24: 19) and microsphere events increasing by 588% (2005–09:25, 2020–24:172). HDR events decreased by 15% (2005-09:53, 2020–24:45), while intravascular events increased (2005-09:3, 2020–2024:7) but stayed very rare. . For HDR, the three most frequent categories were treatment planning error (26%), transfer tube issues (13%) and other/unknown issues (13%); the frequency of treatment planning events decreased with time (2005-09: 38%, 2020-24: 18%). For LDR, the three most frequent categories were lost or leaking source (39%), other/unknown issues (24%) and permanent implant sources implanted into wrong tissue (18%). For microspheres, most events were related to the sphere remaining in the delivery apparatus and for intravascular brachytherapy, to the source not retracting. The radioisotopes of LDR events were I-125 (72%), Pd-103 (11%), Cs-137 (8%), Ir-192 (4%), Cs-131 (3%) and Sr-90 (2%); no events relating to Ir-192 or Cs-137 occurred in 2020-24.

Conclusion

The reduction in the LDR events is probably explained by the decreased frequency of prostate implants and LDR gynecological procedures. Microspheres now account for most event reports.

方法：我们分析了2005年1月1日至2024年12月31日期间发生的与近距离放射治疗事件相关的核管理委员会事件通报。对这些事件进行了分类，并分析了它们的分布和时间演化。结果：除单纯与运输相关的事件外，共鉴定出818例事件（LDR 227例，HDR 203例，血管内21例，微球367例）。我们分析了整个时期和连续5年的事件。从第一个时间段到最后一个时间段（2005-09:179,2020- 24:27），事件总数增加了27%，LDR事件减少了81%(2005-2009:98,2020- 24:19)，微球事件增加了588%（2005-09:25,2020- 24:20 2）。HDR事件减少了15%(2005-09:53,2020-24:45)，而血管内事件增加（2005-09:3,2020- 24:7），但仍然非常罕见。对于HDR，三个最常见的类别是治疗计划错误（26%），转移管问题（13%）和其他/未知问题（13%）；治疗计划事件的频率随着时间的推移而下降（2005-09年：38%，2020-24年：18%）。对于LDR，三个最常见的类别是源丢失或泄漏（39%），其他/未知问题（24%）和永久植入源植入错误组织（18%）。对于微球，大多数事件与球体留在输送装置中有关，对于血管内近距离治疗，与未收缩的源有关。LDR事件的放射性同位素为I-125（72%）、Pd-103（11%）、Cs-137（8%）、Ir-192（4%）、Cs-131（3%）和Sr-90 (2%)；2020-24年没有发生与Ir-192或Cs-137有关的事件。结论：LDR事件的减少可能与前列腺植入和LDR妇科手术次数的减少有关。微球现在占据了大多数事件报告。

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引用次数: 0

Evaluation of a commercial deep-learning-based contouring software for CT-based gynecological brachytherapy 基于ct的妇科近距离放射治疗的商用深度学习轮廓软件的评估。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.08.005

Haechan J Yang , John Patrick , Jason Vickress , David D’Souza , Vikram Velker , Lucas Mendez , Maria Mansur Starling , Aaron Fenster , Douglas Hoover

PURPOSE

To evaluate a commercial deep-learning based auto-contouring software specifically trained for high-dose-rate gynecological brachytherapy.

METHODS AND MATERIALS

We collected CT images from 30 patients treated with gynecological brachytherapy (19.5-28 Gy in 3-4 fractions) at our institution from January 2018 to December 2022. Clinical and artificial intelligence (AI) generated contours for bladder, bowel, rectum, and sigmoid were obtained. Five patients were randomly selected from the test set and manually re-contoured by 4 radiation oncologists. Contouring was repeated 2 weeks later using AI contours as the starting point (“AI-assisted” approach). Comparisons amongst clinical, AI, AI-assisted, and manual retrospective contours were made using various metrics, including Dice similarity coefficient (DSC) and unsigned D2cc difference.

RESULTS

Between clinical and AI contours, DSC was 0.92, 0.79, 0.62, 0.66, for bladder, rectum, sigmoid, and bowel, respectively. Rectum and sigmoid had the lowest median unsigned D2cc difference of 0.20 and 0.21 Gy/fraction respectively between clinical and AI contours, while bowel had the largest median difference of 0.38 Gy/fraction. Agreement between fully automated AI and clinical contours was generally not different compared to agreement between AI-assisted and clinical contours. AI-assisted interobserver agreement was better than manual interobserver agreement for all organs and metrics. The median time to contour all organs for manual and AI-assisted approaches was 14.8 and 6.9 minutes/patient (p < 0.001), respectively.

CONCLUSIONS

The agreement between AI or AI-assisted contours against the clinical contours was similar to manual interobserver agreement. Implementation of the AI-assisted contouring approach could enhance clinical workflow by decreasing both contouring time and interobserver variability.

目的：评估一种商业的基于深度学习的自动轮廓软件，该软件专门用于高剂量率妇科近距离治疗。方法与材料：收集2018年1月至2022年12月在我院接受妇科近距离放射治疗（19.5-28 Gy，分3-4组）的30例患者的CT图像。获得临床和人工智能（AI）生成的膀胱、肠、直肠和乙状结肠轮廓。从测试集中随机选择5例患者，由4名放射肿瘤学家手动重新勾画。2周后使用人工智能轮廓作为起点（“人工智能辅助”方法）重复轮廓。临床、人工智能、人工智能辅助和手动回顾性轮廓之间的比较使用各种指标，包括Dice相似系数（DSC）和无符号D2cc差异。结果：膀胱、直肠、乙状结肠和肠道的DSC在临床和AI轮廓之间分别为0.92、0.79、0.62、0.66。直肠和乙状结肠的无征D2cc中位数与临床和AI轮廓的差异最低，分别为0.20和0.21 Gy/fraction，而肠的中位数差异最大，为0.38 Gy/fraction。与人工智能辅助与临床轮廓的一致性相比，全自动人工智能与临床轮廓之间的一致性通常没有什么不同。在所有器官和指标上，人工智能辅助的观察者间协议优于人工观察者间协议。人工和人工智能辅助入路对所有器官轮廓的中位时间分别为14.8分钟和6.9分钟/患者（p ）。结论：人工智能或人工智能辅助轮廓与临床轮廓的一致性与人工观察者间的一致性相似。人工智能辅助轮廓方法的实施可以通过减少轮廓时间和观察者之间的可变性来增强临床工作流程。

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引用次数: 0

Clinical outcome of high-dose-rate interstitial brachytherapy in vulvar cancer: A single institutional experience 外阴癌高剂量间质近距离放射治疗的临床结果：单一机构经验。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.09.008

Henna Kärkkäinen , Ester Jääskeläinen , Jan-Erik Palmgren , Janne Heikkilä , Maarit Anttila

OBJECTIVE

The aim was to evaluate the toxicities and survival of patients with inoperable vulvar cancer treated using brachytherapy (BT).

STUDY Design

Patients treated at Kuopio University Hospital, Finland, during years 2007-2022 were retrospectively analyzed.

RESULTS

Twenty-seven patients with vulvar cancer received high-dose-rate (HDR) interstitial brachytherapy (BT), most of them after external beam radiotherapy (EBRT). Nineteen had primary locally advanced vulvar cancer, and 8 had recurrent cancer. The mean EBRT prescription dose was 48.5 Gy (39-60 Gy) in 13-33 fractions. Eighteen patients (67%) had cisplatin as a radiosensitizer. EBRT was followed by BT (16-36 Gy in 3-8 fractions). The mean HR-CTV (high-risk clinical target volume) D90 EBRT + BT dose was 71.2 Gy (EQD₂).

The mean follow-up time was 30 months. The 2-year progression-free survival (PFS) was 41% in the primary cancer group and 38% in the recurrence group. The 2-year overall survival (OS) was 56% and 63%, respectively. There were 12/19 (63%) recurrences in the primary cancer group. In the recurrent cancer group, 4 out of 8 (50%) patients had a subsequent recurrence. 7/27 (26%) patients suffered from grade 3-4 late toxicities.

Before EBRT, the median size of the tumors was 3.8 cm. Patients with a tumor ≥ 3.8 cm had significantly worse OS than patients with tumors <3.8 cm, 45 months and 54 months, respectively (p = 0.022). The use of radiosensitizing chemotherapy also predicted better overall survival (p = 0.037).

CONCLUSIONS

Definitive radiation therapy, including EBRT and BT, is a potential option in the management of inoperable vulvar cancer. To avoid toxicities, the proper radiation doses are to be found.

目的：评价不能手术的外阴癌患者采用近距离放射治疗（BT）的毒副作用和生存率。研究设计：回顾性分析2007-2022年在芬兰库奥皮奥大学医院治疗的患者。结果：27例外阴癌患者均接受了高剂量率间质近距离放射治疗（HDR），大部分患者均在体外束放射治疗（EBRT）后接受。19例为原发性局部晚期外阴癌，8例为复发性癌症。EBRT处方平均剂量为48.5 Gy(39-60 Gy)，分为13-33组。18例患者（67%）使用顺铂作为放射增敏剂。EBRT之后是BT（16-36 Gy，按3-8分）。平均HR-CTV（高风险临床靶体积）D90 EBRT + BT剂量为71.2 Gy （EQD₂）。平均随访时间为30个月。原发癌组的2年无进展生存期（PFS）为41%，复发组为38%。2年总生存率（OS）分别为56%和63%。原发癌组有12/19（63%）的复发率。在复发性癌症组中，8例患者中有4例（50%）随后复发。7/27（26%）患者出现3-4级晚期毒性。EBRT前，肿瘤的中位大小为3.8 cm。肿瘤≥3.8 cm患者的OS明显差于肿瘤患者。结论：明确的放射治疗，包括EBRT和BT，是治疗不能手术外阴癌的潜在选择。为了避免毒性，必须找到适当的辐射剂量。

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引用次数: 0

Long-term oncologic outcomes of high-dose-rate interstitial brachytherapy (interventional radiotherapy) in oral tongue squamous cell carcinoma; 15 years of experience from a tertiary cancer center 高剂量率间质放疗治疗口腔舌鳞癌的长期肿瘤预后在三级癌症中心工作了15年。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.09.009

Mahdi Aghili , Fatemeh Jafari , Kasra Kolahdouzan , Fatemeh Biglar , Ava Yousefi , Mansoureh Nabavi , Ramin Jaberi , Ata Garajei , Alireza Abdshah , Ali Kazemian , Luca Tagliaferri

PURPOSE

High-dose-rate interstitial brachytherapy (HDR-IBT) is commonly used for treating oral tongue squamous cell carcinoma (OTSCC). This study aims to evaluate long-term outcomes, survival predictors, chronic side effects, and failure patterns in patients receiving adjuvant HDR-IBT after surgical resection.

METHODS AND MATERIALS

We analyzed records of 239 early-stage OTSCC patients treated with surgery, and adjuvant HDR-IBT at a tertiary cancer center from October 2010 to February 2024. Follow-up included assessing survival status, disease recurrence, and chronic adverse events.

RESULTS

Among the patients, 142 received HDR-IBT as monotherapy, 73 as a boost to external beam radiotherapy (EBRT), and 24 as salvage therapy. The 5-year overall survival (OS) rates were 78.4%, 56.0%, and 53.5%, while disease-free survival (DFS) rates were 74.7%, 57.7%, and 32.6%, respectively. The monotherapy group demonstrated the best outcomes, whereas the salvage group had the poorest results. Age and T stage were independent predictors of OS, with local recurrence within 5 years linked to initial T stage in monotherapy (p = 0.057) and EBRT boost patients (p = 0.046). Chronic adverse events such as xerostomia, fibrosis, and dysesthesia were more prevalent in the salvage group compared to the other groups.

CONCLUSIONS

HDR-IBT is an effective treatment for early-stage OTSCC, yielding favorable survival rates and manageable acute and chronic side effects, particularly when used in low-risk patients for regional recurrence.

目的：高剂量间质近距离放射治疗（HDR-IBT）是口腔舌鳞癌（OTSCC）的常用治疗方法。本研究旨在评估手术切除后接受辅助HDR-IBT患者的长期预后、生存预测因素、慢性副作用和失败模式。方法和材料：我们分析了2010年10月至2024年2月在三级癌症中心接受手术和辅助HDR-IBT治疗的239例早期OTSCC患者的记录。随访包括评估生存状态、疾病复发和慢性不良事件。结果：142例患者接受了HDR-IBT单药治疗，73例接受了外束放疗（EBRT）的强化治疗，24例接受了补救性治疗。5年总生存率（OS）分别为78.4%、56.0%和53.5%，无病生存率（DFS）分别为74.7%、57.7%和32.6%。单一治疗组表现出最好的结果，而挽救组的结果最差。年龄和T分期是OS的独立预测因子，5年内局部复发与单药治疗患者的初始T分期（p = 0.057）和EBRT增强患者（p = 0.046）相关。与其他组相比，抢救组的慢性不良事件如口干、纤维化和感觉不良更为普遍。结论：HDR-IBT是早期OTSCC的有效治疗方法，具有良好的生存率和可控的急性和慢性副作用，特别是用于低风险的局部复发患者。

{"title":"Long-term oncologic outcomes of high-dose-rate interstitial brachytherapy (interventional radiotherapy) in oral tongue squamous cell carcinoma; 15 years of experience from a tertiary cancer center","authors":"Mahdi Aghili , Fatemeh Jafari , Kasra Kolahdouzan , Fatemeh Biglar , Ava Yousefi , Mansoureh Nabavi , Ramin Jaberi , Ata Garajei , Alireza Abdshah , Ali Kazemian , Luca Tagliaferri","doi":"10.1016/j.brachy.2025.09.009","DOIUrl":"10.1016/j.brachy.2025.09.009","url":null,"abstract":"<div><h3>PURPOSE</h3><div>High-dose-rate interstitial brachytherapy (HDR-IBT) is commonly used for treating oral tongue squamous cell carcinoma (OTSCC). This study aims to evaluate long-term outcomes, survival predictors, chronic side effects, and failure patterns in patients receiving adjuvant HDR-IBT after surgical resection.</div></div><div><h3>METHODS AND MATERIALS</h3><div>We analyzed records of 239 early-stage OTSCC patients treated with surgery, and adjuvant HDR-IBT at a tertiary cancer center from October 2010 to February 2024. Follow-up included assessing survival status, disease recurrence, and chronic adverse events.</div></div><div><h3>RESULTS</h3><div>Among the patients, 142 received HDR-IBT as monotherapy, 73 as a boost to external beam radiotherapy (EBRT), and 24 as salvage therapy. The 5-year overall survival (OS) rates were 78.4%, 56.0%, and 53.5%, while disease-free survival (DFS) rates were 74.7%, 57.7%, and 32.6%, respectively. The monotherapy group demonstrated the best outcomes, whereas the salvage group had the poorest results. Age and T stage were independent predictors of OS, with local recurrence within 5 years linked to initial T stage in monotherapy (<em>p</em> = 0.057) and EBRT boost patients (<em>p</em> = 0.046). Chronic adverse events such as xerostomia, fibrosis, and dysesthesia were more prevalent in the salvage group compared to the other groups.</div></div><div><h3>CONCLUSIONS</h3><div>HDR-IBT is an effective treatment for early-stage OTSCC, yielding favorable survival rates and manageable acute and chronic side effects, particularly when used in low-risk patients for regional recurrence.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 163-172"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535202","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

Novel use of 3D printing for preoperative dose estimation in the first case of GammaTile spine implantation 在第一例GammaTile脊柱植入手术中，3D打印在术前剂量估计中的新应用。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.08.006

Jessie Huang , Anthony Doemer , Salim Siddiqui , Mira Shah , Ali Al Asadi , Amanda DiCarlo , Kundan Thind , Alexandra Moceri , Lisa Scarpace , Ian Lee , Adam Robin

PURPOSE

For a patient who had two previous courses of external beam radiation therapy for rectosigmoid adenocarcinoma and presented with painful, recurrent disease in the sacrum, this study describes the first use of Cs-131 LDR GammaTile therapy outside of the brain and demonstrates a novel use of 3D printing for preoperative dose estimation.

MATERIAL AND METHODS

A personalized 3D-printed model of the patient's spine was created using segmented MRI data, differentiating uninvolved bone, tumor, and thecal sac and nerve roots, with a Stratasys J5 MediJet® Printer. This model was used to simulate surgical resection and placement of dummy radioactive sources. A CT scan of the model facilitated preoperative dose calculations, including physical dose using Eclipse planning software and biologically effective dose (BED) using MIM Maestro software. The predicted dose was then compared to the postimplant dosimetry for the actual patient.

RESULTS

For the relevant organ at risk (thecal sac), the max dose (D_0.035cc) was calculated accurately within 8.0% for physical dose and within 10.0% for BED when comparing the dose estimated using our 3D-printed model and the patient’s postimplant dosimetry.

CONCLUSIONS

3D printing can be used preoperatively to estimate dose to critical organs at risk for patients receiving surgical resection followed by Cs-131 LDR implantation in the spine and can be especially valuable in the context of reirradiation.

目的：对于一名曾接受过两次直肠乙状结肠腺癌外部放射治疗并表现为骶骨疼痛和复发性疾病的患者，本研究描述了首次在脑外使用Cs-131 LDR GammaTile治疗，并展示了3D打印在术前剂量估计中的新应用。材料和方法：使用Stratasys J5 MediJet®打印机，使用分段MRI数据创建患者脊柱的个性化3d打印模型，区分未受损伤的骨骼，肿瘤，鞘囊和神经根。该模型用于模拟手术切除和假放射源的放置。模型的CT扫描有助于术前剂量计算，包括使用Eclipse计划软件的物理剂量和使用MIM Maestro软件的生物有效剂量（BED）。然后将预测剂量与实际患者的植入后剂量进行比较。结果：对于相关危险器官（鞘囊），将3d打印模型估算的剂量与患者移植后剂量进行比较，物理剂量的最大剂量（D0.035cc）精确计算在8.0%以内，BED的最大剂量（D0.035cc）精确计算在10.0%以内。结论：3D打印技术可用于预估手术切除后颈椎植入Cs-131 LDR后危及关键器官的剂量，在再照射的情况下尤其有价值。

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引用次数: 0

Automated daily check QA of treatment channel adjustments (TCA), active, and dummy source positioning using bravos after loader 自动每日检查QA处理通道调整（TCA），主动和虚拟源定位使用bravos装载机后。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2026-01-01 DOI: 10.1016/j.brachy.2025.08.008

Joel Beaudry, Antonio L. Damato, David Aramburu Núñez

PURPOSE

As HDR afterloader technology evolves, new treatment delivery capabilities create opportunities to reinforce quality assurance (QA) procedures. We present a novel method of automated log file analysis for daily, longitudinal tracking of channel length offsets, and active and dummy source positional accuracy. Leveraging features of the Bravos afterloader system, the method supplements visual inspections and functional tests, enhancing QA accuracy and reliability.

METHODS/MATERIALS

Our clinic utilizes 3 HDR afterloaders across 4 vaults, delivering over 900 treatments annually. Applicators and transfer guide tubes (TGTs) vary in length and connectors. We collected treatment reports and daily Position Verification Test (PVT) logs over 9 months resulting in 694 and 455 treatment reports and PVT logs, respectively. Each TGT is assigned a unique identifier (UID) to monitor readings over time, including dedicated TGTs used in PVT readings. Statistical analysis was performed per afterloader across 3 CamScales, and later grouped by CamScale to assess deviations from expected distances and identify trends in TGT and PVT measurements.

RESULTS

PVT readings for dummy (and active) sources are within 0.05 cm, for 97% (91%), 90% (97%), and 97% (94%) of readings for Afterloaders A1, A2, and A3, respectively, across all CamScales. Postcalibration distances compared to the precalibration distances result in an average difference of <0.03 cm for active and dummy sources. Across 7421 treatment channels adjustments (TCAs), 74 exceeded the overall threshold of 2 mm, decreasing to 7 when group-specific thresholds were applied.

CONCLUSION

The implementation of an automated QA program of treatment channel adjustments in HDR brachytherapy has benefits in maintaining the accuracy and reliability of TGT measurements and applicators. Daily QA checks provide a comprehensive overview of trends, enabling early detection of potential issues and timely interventions.

目的：随着HDR后装技术的发展，新的处理交付能力为加强质量保证（QA）程序创造了机会。我们提出了一种新的自动日志文件分析方法，用于日常，通道长度偏移的纵向跟踪，以及主动和虚拟源的位置精度。利用Bravos后装药系统的特点，该方法补充了目视检查和功能测试，提高了QA的准确性和可靠性。方法/材料：我们的诊所在4个库中使用3台HDR后载机，每年提供900多例治疗。涂抹器和传输导管（tgt）的长度和连接方式各不相同。我们收集了9个月的处理报告和每日位置验证测试（PVT）日志，分别得到694份和455份处理报告和PVT日志。每个TGT被分配一个唯一标识符（UID）来监控一段时间内的读数，包括用于PVT读数的专用TGT。通过3种CamScale对每个加力器进行统计分析，然后根据CamScale进行分组，以评估与预期距离的偏差，并确定TGT和PVT测量的趋势。结果：在所有CamScales中，假源（和活动源）的PVT读数分别为97%(91%),90%（97%）和97%（94%）的后加载器A1， A2和A3的读数在0.05 cm以内。结论：在HDR近距离放疗中实施治疗通道调整自动化QA程序有利于保持TGT测量和施药器的准确性和可靠性。每日QA检查提供趋势的全面概述，使早期发现潜在问题和及时干预成为可能。

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引用次数: 0