<div><h3>Purpose</h3><div>To elucidate systematic approach towards commissioning, implementing and establishing a high dose rate (HDR) interstitial brachytherapy (ISBT) program for head and neck cancers in a new tertiary cancer centre in India.</div></div><div><h3>Materials and Methods</h3><div>We present the systematic approach and challenges encountered during the implementation of ISBT for head and neck cancers and early outcome of patients treated between September 2020 and September 2022 at our Institution.</div></div><div><h3>Results</h3><div>In an established infrastructure for high Dose rate Brachytherapy, we explored implementing H & N BT. Joint tumor board discussions, reviewing of existing treatment guidelines and shared decision making with patients helped to start the program. A comprehensive disease mapping was done using clinical drawings (figure 1) & clinical pictures taken before EBRT and BT. Appropriate check list for performing BT procedure, discussions for anaesthesia requirements, dedicated team of Nurse, RTT & Medical physicist, BT planning and dose parameters were reviewed. A successful collaboration with dental surgeon to work on prosthesis especially to spare mandible for high dose regions was established which evolved from using simple rubber catheters, wax to customized acrylic spacers. All suitable patients were either offered radical BT or BT boost after completion of EBRT.A total of 18 patients diagnosed with early-stage oral cancer underwent treatment with ISBT, either as a boost following VMAT (n=13) or 3DCRT (n=2), or as BT Alone (n=3). The primary tumour sites were lateral border of the tongue (n=13), lip (n=3), and buccal mucosa (n=2). The median tumour size was 2 cm, with 13 cases classified as T1 and 5 as T2 with infiltrative lesion in 13 pts and proliferative lesion in remaining 5 pts.Three patients received ISBT alone (1 with buccal mucosa cancer, 2 with lip cancer), while 15 underwent concurrent neck irradiation alongside primary tumour treatment, with a median dose of 50 Gy in 25 fractions over 5 weeks, followed by HDR ISBT after a median gap of 31 days (IQR, 18-34 days). Most patients (n=9,50%) required implantation in two planes, with a median of 11 catheters (range 9-15). The median dose for ISBT boost cases was 22.5Gy in 5 fractions @ 4.5Gy/fraction, while for radical ISBT, it ranged from 40 Gy in 10 fr to 49.5 Gy in 11 fr. The EQD2 was 74 Gy (range: 69-77.5 Gy EQD2), and the median overall treatment time for combined EBRT and ISBT boost was 67 days (range: 47 - 88 days). Mandibular ISBT doses were limited to a median of 4.3 Gy (D 0.1 cc) and 3.15 Gy (D 1cc) per fraction with cumulative dose(Dmax) in EQD2 of 53Gy. The prescribed dose for radical ISBT ranged from 40 to 48 Gy in 10-15 fr.At the last follow-up, grade 1 xerostomia was reported in 38.9% of patients, with none experiencing grade 2 or higher xerostomia. One patient developed osteoradionecrosis of the mandible with minimal exposure
{"title":"MSOR8 Presentation Time: 5:35 PM","authors":"Kiriti Chiriki DNB, Umesh Mahantshetty MD, DNB, DMRT, Rohit Vadgoankar MD, Pankaj Chauhan MDS, PhD, Sasi Krishna Kavutarapu Mch, Rao N Nageswara Mch, KK Sree Lakshmi MSC, DRP, Raghavendra Hajare MSc, DRP, Sneha Nachu BDS, Raviteja Miriyala MD","doi":"10.1016/j.brachy.2024.08.042","DOIUrl":"10.1016/j.brachy.2024.08.042","url":null,"abstract":"<div><h3>Purpose</h3><div>To elucidate systematic approach towards commissioning, implementing and establishing a high dose rate (HDR) interstitial brachytherapy (ISBT) program for head and neck cancers in a new tertiary cancer centre in India.</div></div><div><h3>Materials and Methods</h3><div>We present the systematic approach and challenges encountered during the implementation of ISBT for head and neck cancers and early outcome of patients treated between September 2020 and September 2022 at our Institution.</div></div><div><h3>Results</h3><div>In an established infrastructure for high Dose rate Brachytherapy, we explored implementing H & N BT. Joint tumor board discussions, reviewing of existing treatment guidelines and shared decision making with patients helped to start the program. A comprehensive disease mapping was done using clinical drawings (figure 1) & clinical pictures taken before EBRT and BT. Appropriate check list for performing BT procedure, discussions for anaesthesia requirements, dedicated team of Nurse, RTT & Medical physicist, BT planning and dose parameters were reviewed. A successful collaboration with dental surgeon to work on prosthesis especially to spare mandible for high dose regions was established which evolved from using simple rubber catheters, wax to customized acrylic spacers. All suitable patients were either offered radical BT or BT boost after completion of EBRT.A total of 18 patients diagnosed with early-stage oral cancer underwent treatment with ISBT, either as a boost following VMAT (n=13) or 3DCRT (n=2), or as BT Alone (n=3). The primary tumour sites were lateral border of the tongue (n=13), lip (n=3), and buccal mucosa (n=2). The median tumour size was 2 cm, with 13 cases classified as T1 and 5 as T2 with infiltrative lesion in 13 pts and proliferative lesion in remaining 5 pts.Three patients received ISBT alone (1 with buccal mucosa cancer, 2 with lip cancer), while 15 underwent concurrent neck irradiation alongside primary tumour treatment, with a median dose of 50 Gy in 25 fractions over 5 weeks, followed by HDR ISBT after a median gap of 31 days (IQR, 18-34 days). Most patients (n=9,50%) required implantation in two planes, with a median of 11 catheters (range 9-15). The median dose for ISBT boost cases was 22.5Gy in 5 fractions @ 4.5Gy/fraction, while for radical ISBT, it ranged from 40 Gy in 10 fr to 49.5 Gy in 11 fr. The EQD2 was 74 Gy (range: 69-77.5 Gy EQD2), and the median overall treatment time for combined EBRT and ISBT boost was 67 days (range: 47 - 88 days). Mandibular ISBT doses were limited to a median of 4.3 Gy (D 0.1 cc) and 3.15 Gy (D 1cc) per fraction with cumulative dose(Dmax) in EQD2 of 53Gy. The prescribed dose for radical ISBT ranged from 40 to 48 Gy in 10-15 fr.At the last follow-up, grade 1 xerostomia was reported in 38.9% of patients, with none experiencing grade 2 or higher xerostomia. One patient developed osteoradionecrosis of the mandible with minimal exposure","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S39"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526755","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.2024.08.039
Christopher P. Cifarelli MD, PhD, MMM , Kevin Petrecca MD , Henning Kahl MD , Oliver Ganslandt MD, PhD , Tamer Abdelrhman MD, PhD , Stephanie Combs MD , Gustavo Sarria MD , Frank A. Giordano MD
Purpose
While the use of 5-ALA has been used to increase the extent of surgical resection in glioblastoma (GBM), its potential to act as a radiosensitizer has not been widely studied in the CNS. Whereas typical external beam radiotherapy (EBRT) treatments occur weeks after surgery and 5-ALA administration, intraoperative radiotherapy (IORT) delivers radiation while protoporphyrin IX is still present in residual tumor. This current study examines the potential for radiation necrosis (RN) development following IORT and subsequent fractionated radiotherapy.
Methods
Interim data from the INTRAGO II study for newly diagnosed GBM (NCT02685605) were analyzed for the incidence of radiation necrosis (RN) based on 5-ALA use, IORT treatment vs SOC control (60Gy EBRT), and extent of resection. Statistical analysis was performed via univariate (ANOVA), multivariate (Cox regression), and K-M estimations with significance of p<0.05.
Results
234 patients were enrolled in INTRAGO II between 2016 and 2022. Of these, 185 (79%) had a surgical resection performed with the use of 5-ALA tumor fluorescence visualization. Following surgical resection with 5-ALA, 94 (51%) received IORT (30Gy to the margin) and an additional 60Gy EBRT (ARM A). Imaging confirmed RN occurred in 11 (12%) of ARM A patients who had 5-ALA assisted resection, compared to 3 (3.3%) of ARM B patients who received only 60Gy EBRT. In the 49 patients not receiving 5-ALA, the imaging confirmed the RN rate in ARM A patients was 21% (5/24) compared to 12% in ARM B (3/25). The median time to development of RN was 236 days post-IORT and 158 days post completion of EBRT. ANOVA demonstrated a significantly (p=0.025) higher rate of RN in ARM A patients overall, but not with the addition of 5-ALA. Cox regression analysis confirmed that only significant predictor of RN on multivariate analysis was IORT plus EBRT (p=0.033) and KM estimations-Log Rank test of RN incidence were greater in Arm A/IORT patients than SOC/Arm B (p=0.029).
Conclusions
While patients receiving IORT at the time of surgical resection had a higher rate of RN after SOC 60Gy EBRT, the use of 5-ALA in conjunction with surgical resection did not increase RN incidence. Further analysis will need to consider local PFS rates and the impact of 5-ALA use with IORT.
目的虽然 5-ALA 已被用于增加胶质母细胞瘤（GBM）的手术切除范围，但其在中枢神经系统中作为放射增敏剂的潜力尚未得到广泛研究。典型的体外放射治疗（EBRT）是在手术和给药 5-ALA 数周后进行的，而术中放射治疗（IORT）则是在原卟啉 IX 仍存在于残留肿瘤中时进行放射治疗。方法分析了 INTRAGO II 新诊断 GBM 研究（NCT02685605）的中期数据，根据 5-ALA 的使用、IORT 治疗与 SOC 对照（60Gy EBRT）以及切除范围，分析辐射坏死（RN）的发生率。统计分析通过单变量（方差分析）、多变量（Cox 回归）和 K-M 估计进行，显著性为 p<0.05。其中 185 人（79%）在 5-ALA 肿瘤荧光显像下进行了手术切除。使用 5-ALA 进行手术切除后，94 人（51%）接受了 IORT（30Gy 至边缘）和额外的 60Gy EBRT（ARM A）。在接受了 5-ALA 辅助切除术的 ARM A 患者中，有 11 人（12%）经影像学证实出现了 RN，而在仅接受 60Gy EBRT 的 ARM B 患者中，有 3 人（3.3%）经影像学证实出现了 RN。在未接受 5-ALA 的 49 例患者中，ARM A 患者的成像证实 RN 发生率为 21% (5/24)，而 ARM B 患者为 12% (3/25)。RN发生的中位时间为IORT后236天，EBRT结束后158天。方差分析显示，ARM A 患者的 RN 发生率总体上明显较高（P=0.025），但在添加 5-ALA 后并不明显。Cox回归分析证实，多变量分析中唯一显著的RN预测因子是IORT加EBRT（p=0.033），Arm/IORT患者的RN发生率的KM估计-对数秩检验大于SOC/Arm B（p=0.029）。进一步的分析需要考虑局部PFS率以及在IORT同时使用5-ALA的影响。
{"title":"MSOR5 Presentation Time: 5:20 PM","authors":"Christopher P. Cifarelli MD, PhD, MMM , Kevin Petrecca MD , Henning Kahl MD , Oliver Ganslandt MD, PhD , Tamer Abdelrhman MD, PhD , Stephanie Combs MD , Gustavo Sarria MD , Frank A. Giordano MD","doi":"10.1016/j.brachy.2024.08.039","DOIUrl":"10.1016/j.brachy.2024.08.039","url":null,"abstract":"<div><h3>Purpose</h3><div>While the use of 5-ALA has been used to increase the extent of surgical resection in glioblastoma (GBM), its potential to act as a radiosensitizer has not been widely studied in the CNS. Whereas typical external beam radiotherapy (EBRT) treatments occur weeks after surgery and 5-ALA administration, intraoperative radiotherapy (IORT) delivers radiation while protoporphyrin IX is still present in residual tumor. This current study examines the potential for radiation necrosis (RN) development following IORT and subsequent fractionated radiotherapy.</div></div><div><h3>Methods</h3><div>Interim data from the INTRAGO II study for newly diagnosed GBM (NCT02685605) were analyzed for the incidence of radiation necrosis (RN) based on 5-ALA use, IORT treatment vs SOC control (60Gy EBRT), and extent of resection. Statistical analysis was performed via univariate (ANOVA), multivariate (Cox regression), and K-M estimations with significance of p<0.05.</div></div><div><h3>Results</h3><div>234 patients were enrolled in INTRAGO II between 2016 and 2022. Of these, 185 (79%) had a surgical resection performed with the use of 5-ALA tumor fluorescence visualization. Following surgical resection with 5-ALA, 94 (51%) received IORT (30Gy to the margin) and an additional 60Gy EBRT (ARM A). Imaging confirmed RN occurred in 11 (12%) of ARM A patients who had 5-ALA assisted resection, compared to 3 (3.3%) of ARM B patients who received only 60Gy EBRT. In the 49 patients not receiving 5-ALA, the imaging confirmed the RN rate in ARM A patients was 21% (5/24) compared to 12% in ARM B (3/25). The median time to development of RN was 236 days post-IORT and 158 days post completion of EBRT. ANOVA demonstrated a significantly (p=0.025) higher rate of RN in ARM A patients overall, but not with the addition of 5-ALA. Cox regression analysis confirmed that only significant predictor of RN on multivariate analysis was IORT plus EBRT (p=0.033) and KM estimations-Log Rank test of RN incidence were greater in Arm A/IORT patients than SOC/Arm B (p=0.029).</div></div><div><h3>Conclusions</h3><div>While patients receiving IORT at the time of surgical resection had a higher rate of RN after SOC 60Gy EBRT, the use of 5-ALA in conjunction with surgical resection did not increase RN incidence. Further analysis will need to consider local PFS rates and the impact of 5-ALA use with IORT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S37-S38"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526610","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.2024.08.048
Jasmine Zhang BA , Erin Herbert BS , Teresa M. Meier MD , Thomas L. Minges DNP, CRNA , Jordan Kharofa MD , Sarah M.C. Sittenfeld MD
<div><h3>Purpose</h3><div>In 2015, we transitioned from performing gynecologic brachytherapy procedures in an operating room in the hospital under general anesthesia, to a departmental procedure room with preference for spinal anesthesia. MRI was in the main hospital and generally obtained with fraction 1 and fused to CT scans for subsequent fractions. We sought to review the feasibility and tolerability of this workflow utilizing spinal anesthesia and extra-departmental MRI.</div></div><div><h3>Materials and Methods</h3><div>This was an IRB-approved, retrospective review of gynecologic brachytherapy procedures performed in a departmental procedure room at a single center from 4/2015-3/2023. Demographic information and treatment-related data including procedure details, imaging used for treatment planning, type of anesthesia, total time in the department, and highest pain score were obtained. OR procedures that required admission with implant in place were excluded from analysis.</div></div><div><h3>Results</h3><div>A total of 141 patients undergoing 541 procedures were included. The most common diagnosis was cervical cancer (n = 118) followed by endometrial and vaginal cancer. Most patients (98%) underwent external beam radiation therapy ± chemotherapy prior to brachytherapy. The most common brachytherapy regimen was 28 Gy in 4 fractions, delivered twice weekly, and the average overall treatment time was 52.6 days. Tandem and ring was the most frequently used applicator (n = 89), and 38 patients had hybrid or interstitial implants. Eighty-two percent of patients received spinal anesthesia. For those undergoing general anesthesia, the most common reasons were low platelets (52%) or anticoagulation (32%). There were no complications from spinal anesthesia in this cohort. Sixty-seven percent of patients underwent MRI with applicator in place and 22% had pre-brachytherapy MRI. For fractions performed when only a CT scan was obtained for planning, average total time in the department was 346 minutes (min). Patients who received spinal anesthesia spent a longer time in the department than patients who received general anesthesia (average of 353 min vs. 325 min, p=0.00005). Similar trend was seen on fractions when an MRI was obtained, with average time in the department of 371 min for those under spinal anesthesia vs. 346 min for those under general anesthesia (p=0.04). When comparing fractions when an MRI was obtained vs. CT scan only, the MRI added an average of 20 min to the total time (366 min vs. 346 min). Patients receiving spinal anesthesia had a lower average pain score than those receiving general anesthesia (1.63 vs. 2.34, p=0.02). Overall, only 17% of patients required narcotics for post-procedure pain control regardless of type of anesthesia received, and the majority of these (91%) required only 5-10 mg of oxycodone or equivalent for adequate pain control.</div></div><div><h3>Conclusion</h3><div>Spinal anesthesia is feasible and offers goo
{"title":"GSOR02 Presentation Time: 5:05 PM","authors":"Jasmine Zhang BA , Erin Herbert BS , Teresa M. Meier MD , Thomas L. Minges DNP, CRNA , Jordan Kharofa MD , Sarah M.C. Sittenfeld MD","doi":"10.1016/j.brachy.2024.08.048","DOIUrl":"10.1016/j.brachy.2024.08.048","url":null,"abstract":"<div><h3>Purpose</h3><div>In 2015, we transitioned from performing gynecologic brachytherapy procedures in an operating room in the hospital under general anesthesia, to a departmental procedure room with preference for spinal anesthesia. MRI was in the main hospital and generally obtained with fraction 1 and fused to CT scans for subsequent fractions. We sought to review the feasibility and tolerability of this workflow utilizing spinal anesthesia and extra-departmental MRI.</div></div><div><h3>Materials and Methods</h3><div>This was an IRB-approved, retrospective review of gynecologic brachytherapy procedures performed in a departmental procedure room at a single center from 4/2015-3/2023. Demographic information and treatment-related data including procedure details, imaging used for treatment planning, type of anesthesia, total time in the department, and highest pain score were obtained. OR procedures that required admission with implant in place were excluded from analysis.</div></div><div><h3>Results</h3><div>A total of 141 patients undergoing 541 procedures were included. The most common diagnosis was cervical cancer (n = 118) followed by endometrial and vaginal cancer. Most patients (98%) underwent external beam radiation therapy ± chemotherapy prior to brachytherapy. The most common brachytherapy regimen was 28 Gy in 4 fractions, delivered twice weekly, and the average overall treatment time was 52.6 days. Tandem and ring was the most frequently used applicator (n = 89), and 38 patients had hybrid or interstitial implants. Eighty-two percent of patients received spinal anesthesia. For those undergoing general anesthesia, the most common reasons were low platelets (52%) or anticoagulation (32%). There were no complications from spinal anesthesia in this cohort. Sixty-seven percent of patients underwent MRI with applicator in place and 22% had pre-brachytherapy MRI. For fractions performed when only a CT scan was obtained for planning, average total time in the department was 346 minutes (min). Patients who received spinal anesthesia spent a longer time in the department than patients who received general anesthesia (average of 353 min vs. 325 min, p=0.00005). Similar trend was seen on fractions when an MRI was obtained, with average time in the department of 371 min for those under spinal anesthesia vs. 346 min for those under general anesthesia (p=0.04). When comparing fractions when an MRI was obtained vs. CT scan only, the MRI added an average of 20 min to the total time (366 min vs. 346 min). Patients receiving spinal anesthesia had a lower average pain score than those receiving general anesthesia (1.63 vs. 2.34, p=0.02). Overall, only 17% of patients required narcotics for post-procedure pain control regardless of type of anesthesia received, and the majority of these (91%) required only 5-10 mg of oxycodone or equivalent for adequate pain control.</div></div><div><h3>Conclusion</h3><div>Spinal anesthesia is feasible and offers goo","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S42"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526542","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.2024.08.027
Sylwia Kellas-Sleczka PhD , Stankiewicz Magdalena PhD , Wojcieszek Piotr PhD , Szlag Marta PhD , Lelek Piotr MD , Sleczka Maciej PhD , Cholewka Agnieszka MS
Purpose
The study aims to present the long-term results of 508 cases of early breast cancer treated with accelerated partial breast irradiation (APBI) using interstitial multicatheter high-dose-rate brachytherapy (HDR-BT) following breast-conserving surgery (BCS) in a single institution.
Materials and Methods
Between July 2006 and December 2020, a total of 514 cases of low-risk invasive and in situ carcinoma after BCS were treated with APBI using interstitial multicatheter HDR brachytherapy (MIB) at our department and 508 who met the inclusion criteria were analyzed. The inclusion criteria were: ZUBROD 0 or 1, age ≥50 years, pT1-2aN0 cM0, tumor size ≤3 cm, unifocal, invasive carcinoma without neuroinvasion or angioinvasion, with a minimal surgical margin of 2 mm or DCIS with a minimal margin of 5 mm, without extensive intraductal components, positive estrogen receptors. A total dose of 32 Gy in 8 fractions was delivered twice daily with a minimum 6-hour interval. The recommended dose constraints from the Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC ESTRO) were followed. The primary endpoint was local recurrence.
Results
The median age was 65 years (range 46-86 years). The median follow-up was 101 months (range 5-209 months). No serious complications occurred during the procedure and all patients completed the treatment without interruptions. The treatment was well tolerated. In the first 40 cases the 2D treatment planning was used, while in the subsequent cases - 3D treatment planning. The recommended dose-volume limits for the implant, planning target volume (PTV) and organs at risk (OARs) were met. The mean volume of the PTV was 74 cc, with the average coverage with the prescribed dose (PTV ref) of 94%. The mean conformity index (COIN) was 0.69, while the mean dose homogeneity index (DHI) was 0.67. There were no grade ≥ 3 complications. In the whole group, a total of 10 local recurrences (1.96%) were observed. In 3 cases distant metastases (0.6%) and ipsilateral breast tumor recurrence in 8 cases (1.57%) were observed. The 5- and 10-year overall survival (OS) was 97.5% and 96.6%, respectively. The 5- and 10-year disease-free survival (DFS) was 95.6% and 91.3%, respectively.
Conclusions
APBI with interstitial multicatheterhigh-dose-rate brachytherapy is a safe and effective treatment, associated with a good toxicity profile and low relapse rates. We believe that patient selection criteria should be revised and possibly expanded. However, further studies are required to validate this approach.
{"title":"BP03 Presentation Time: 4:18 PM","authors":"Sylwia Kellas-Sleczka PhD , Stankiewicz Magdalena PhD , Wojcieszek Piotr PhD , Szlag Marta PhD , Lelek Piotr MD , Sleczka Maciej PhD , Cholewka Agnieszka MS","doi":"10.1016/j.brachy.2024.08.027","DOIUrl":"10.1016/j.brachy.2024.08.027","url":null,"abstract":"<div><h3>Purpose</h3><div>The study aims to present the long-term results of 508 cases of early breast cancer treated with accelerated partial breast irradiation (APBI) using interstitial multicatheter high-dose-rate brachytherapy (HDR-BT) following breast-conserving surgery (BCS) in a single institution.</div></div><div><h3>Materials and Methods</h3><div>Between July 2006 and December 2020, a total of 514 cases of low-risk invasive and in situ carcinoma after BCS were treated with APBI using interstitial multicatheter HDR brachytherapy (MIB) at our department and 508 who met the inclusion criteria were analyzed. The inclusion criteria were: ZUBROD 0 or 1, age ≥50 years, pT1-2aN0 cM0, tumor size ≤3 cm, unifocal, invasive carcinoma without neuroinvasion or angioinvasion, with a minimal surgical margin of 2 mm or DCIS with a minimal margin of 5 mm, without extensive intraductal components, positive estrogen receptors. A total dose of 32 Gy in 8 fractions was delivered twice daily with a minimum 6-hour interval. The recommended dose constraints from the Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC ESTRO) were followed. The primary endpoint was local recurrence.</div></div><div><h3>Results</h3><div>The median age was 65 years (range 46-86 years). The median follow-up was 101 months (range 5-209 months). No serious complications occurred during the procedure and all patients completed the treatment without interruptions. The treatment was well tolerated. In the first 40 cases the 2D treatment planning was used, while in the subsequent cases - 3D treatment planning. The recommended dose-volume limits for the implant, planning target volume (PTV) and organs at risk (OARs) were met. The mean volume of the PTV was 74 cc, with the average coverage with the prescribed dose (PTV ref) of 94%. The mean conformity index (COIN) was 0.69, while the mean dose homogeneity index (DHI) was 0.67. There were no grade ≥ 3 complications. In the whole group, a total of 10 local recurrences (1.96%) were observed. In 3 cases distant metastases (0.6%) and ipsilateral breast tumor recurrence in 8 cases (1.57%) were observed. The 5- and 10-year overall survival (OS) was 97.5% and 96.6%, respectively. The 5- and 10-year disease-free survival (DFS) was 95.6% and 91.3%, respectively.</div></div><div><h3>Conclusions</h3><div>APBI with interstitial multicatheterhigh-dose-rate brachytherapy is a safe and effective treatment, associated with a good toxicity profile and low relapse rates. We believe that patient selection criteria should be revised and possibly expanded. However, further studies are required to validate this approach.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S31"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527271","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.2024.08.029
Dylan Richeson MS, Robert Hawranko MS, Dorin Todor PhD
<div><h3>Purpose</h3><div>High dose-rate brachytherapy can be plagued by a multitude of user errors that could result in late toxicities for patients. A common one reported to NRC is wrong treatment length. This error will result in a shifted dose distribution between planned and delivered dose. To automate and verify delivery with correct treatment lengths, Varian released its Bravos remote afterloader which uses the device's dummy wire for accurate pre-treatment applicator measurements. Bravos measurements are compared with the planned lengths and if differences are small, treatment length is adjusted automatically. In this process, dwell positions are kept unchanged relative to the tip of the applicator. In breast interstitial implants, from our clinical experience, we noticed, through these automated measurements a significant catheter lengthening that occurs between the first and second fractions. The first fraction is typically delivered within 2h from implantation and the second fraction is more than 12h later. The catheters length does not seem to change much after that. We seek to quantify the dosimetric impact of such automated adjustments, identify cases and treatment parameters particularly sensitive to these effects and describe the best planning and delivery mitigation strategies to ensure accurate dose delivery.</div></div><div><h3>Materials and Methods</h3><div>A retrospective cohort of 14 successively treated breast cancer patients using multi-catheter implants were selected for analysis. Actual length measurements were used to create plans simulating the dosimetric impact of making or not making these adjustments. Daily QA for two years shows positional accuracy of 0.3±0.3mm and for the dummy and source wires. In these simulations, it was hypothesized that the target did not change in volume or position relative to breast. In planning these treatments, two targets are used, expansions of the lumpectomy cavity, a CTV1cm and CTV1.5cm for which we try to achieve V95>95% and V90>90% respectively. The max skin dose is limited to <100% Prescription dose regimens included 7.5Gyx3fx=22.5Gy(8/14 patients) and 4.3Gyx7fx=30.1Gy(6/14 patients). Dose inhomogeneity was evaluated using V150% and V200% for breast tissue. The skin contour encompassed an area 5mm from the surface of the breast and the maximum dose was evaluated using D0. 1cc.The change in catheter lengths, as measured by Bravos, were recorded for each fraction of a patient's treatment.</div></div><div><h3>Results</h3><div>The following results show single fraction changes between the original clinically delivered plan and the re-plan which does not consider catheter lengthening by the amount measured by Bravos prior to the second fraction) averaged over all 14 cases. The average reductions in the V95% of the cavity 1.0 and V90% of the cavity 1.5 structures were -0.49±0.99% and -2.93±2.85%, respectively. Negligible changes in normal tissue dose were observed with an avera
{"title":"BP05 Presentation Time: 4:36 PM","authors":"Dylan Richeson MS, Robert Hawranko MS, Dorin Todor PhD","doi":"10.1016/j.brachy.2024.08.029","DOIUrl":"10.1016/j.brachy.2024.08.029","url":null,"abstract":"<div><h3>Purpose</h3><div>High dose-rate brachytherapy can be plagued by a multitude of user errors that could result in late toxicities for patients. A common one reported to NRC is wrong treatment length. This error will result in a shifted dose distribution between planned and delivered dose. To automate and verify delivery with correct treatment lengths, Varian released its Bravos remote afterloader which uses the device's dummy wire for accurate pre-treatment applicator measurements. Bravos measurements are compared with the planned lengths and if differences are small, treatment length is adjusted automatically. In this process, dwell positions are kept unchanged relative to the tip of the applicator. In breast interstitial implants, from our clinical experience, we noticed, through these automated measurements a significant catheter lengthening that occurs between the first and second fractions. The first fraction is typically delivered within 2h from implantation and the second fraction is more than 12h later. The catheters length does not seem to change much after that. We seek to quantify the dosimetric impact of such automated adjustments, identify cases and treatment parameters particularly sensitive to these effects and describe the best planning and delivery mitigation strategies to ensure accurate dose delivery.</div></div><div><h3>Materials and Methods</h3><div>A retrospective cohort of 14 successively treated breast cancer patients using multi-catheter implants were selected for analysis. Actual length measurements were used to create plans simulating the dosimetric impact of making or not making these adjustments. Daily QA for two years shows positional accuracy of 0.3±0.3mm and for the dummy and source wires. In these simulations, it was hypothesized that the target did not change in volume or position relative to breast. In planning these treatments, two targets are used, expansions of the lumpectomy cavity, a CTV1cm and CTV1.5cm for which we try to achieve V95>95% and V90>90% respectively. The max skin dose is limited to <100% Prescription dose regimens included 7.5Gyx3fx=22.5Gy(8/14 patients) and 4.3Gyx7fx=30.1Gy(6/14 patients). Dose inhomogeneity was evaluated using V150% and V200% for breast tissue. The skin contour encompassed an area 5mm from the surface of the breast and the maximum dose was evaluated using D0. 1cc.The change in catheter lengths, as measured by Bravos, were recorded for each fraction of a patient's treatment.</div></div><div><h3>Results</h3><div>The following results show single fraction changes between the original clinically delivered plan and the re-plan which does not consider catheter lengthening by the amount measured by Bravos prior to the second fraction) averaged over all 14 cases. The average reductions in the V95% of the cavity 1.0 and V90% of the cavity 1.5 structures were -0.49±0.99% and -2.93±2.85%, respectively. Negligible changes in normal tissue dose were observed with an avera","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S32"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527273","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.2024.08.022
Samantha Simiele PhD , Manik Aima PhD , Frank-Andre Siebert PhD , Joel Poder PhD , Luc Beaulieu PhD , Christopher Melhus PhD , Susan Richardson PhD
<div><h3>Purpose</h3><div>The documented decline in brachytherapy (BT) utilization in some parts of the world has caused concern for the impact this may have on resident (or equivalent) training and education. The AAPM established a BT survey subunit (UN72) in 2018 with the goals of (1) assessing the current state of medical physics resident BT education on a global scale and (2) collecting data to allow comparison of BT training challenges and opportunities between different organizational systems.</div></div><div><h3>Materials and Methods</h3><div>UN72 collaborated with representatives from COMP, GEC-ESTRO, and ABG. The team designed a survey consisting of 26 questions of four types, including multiple choice, select all that apply, free response, and five-point scale. Information was collected in six subject areas including: (1) Trainee demographics, (2) Training methods, (3) Caseload and confidence levels, (4) Future plans and interest in performing BT, (5) Interest in additional BT training opportunities, and (6) Trainee practice impressions. The survey was reviewed and approved for distribution by the AAPM as well as the UN72 collaborators. Within the AAPM, the survey was distributed to current residents and recent graduates of CAMPEP-accredited medical physics residency programs. This survey closed in March 2022 and the results are summarized in a manuscript currently under review. The same survey was distributed separately to resident members of COMP, GEC-ESTRO, and ABG and was closed for responses in March 2022. This abstract summarizes the results of the international survey, considering the contributions of GEC-ESTRO, ABG, and COMP.</div></div><div><h3>Results</h3><div>The survey received 183 (AAPM), 41 (ABG), 106 (GEC-ESTRO), and 13 (COMP) responses. The majority of respondents from AAPM (60%), ABG (67%), and GEC-ESTRO (69%) had completed their training whereas 62% of COMP respondents were currently enrolled in their program at the time of survey completion. The results presented are for those who had completed their training program. At least 63% of respondents in each organization expressed interest in performing BT at their first post-residency position and at least 55% in each organization indicated their first position would require them to perform BT. 64% (AAPM), 56% (GEC-ESTRO), 59% (ABG) and 40% (COMP) of respondents wished they had additional BT training opportunities. Of those expressing interest in additional training opportunities, the majority in each organization said they would be ‘very likely’ or ‘likely’ to select BT as an elective rotation if one were offered at their training institute, the majority expressed interest in performing a post-residency fellowship (Figure 1) if one were available, and 76% (AAPM), 83% (GEC-ESTRO), 84% (ABG), and 50% (COMP) expressed interest in completing a BT rotation at an institution with a higher caseload or a greater variety of cases.</div></div><div><h3>Conclusions</h3><div>The majo
{"title":"PP03 Presentation Time: 4:18 PM","authors":"Samantha Simiele PhD , Manik Aima PhD , Frank-Andre Siebert PhD , Joel Poder PhD , Luc Beaulieu PhD , Christopher Melhus PhD , Susan Richardson PhD","doi":"10.1016/j.brachy.2024.08.022","DOIUrl":"10.1016/j.brachy.2024.08.022","url":null,"abstract":"<div><h3>Purpose</h3><div>The documented decline in brachytherapy (BT) utilization in some parts of the world has caused concern for the impact this may have on resident (or equivalent) training and education. The AAPM established a BT survey subunit (UN72) in 2018 with the goals of (1) assessing the current state of medical physics resident BT education on a global scale and (2) collecting data to allow comparison of BT training challenges and opportunities between different organizational systems.</div></div><div><h3>Materials and Methods</h3><div>UN72 collaborated with representatives from COMP, GEC-ESTRO, and ABG. The team designed a survey consisting of 26 questions of four types, including multiple choice, select all that apply, free response, and five-point scale. Information was collected in six subject areas including: (1) Trainee demographics, (2) Training methods, (3) Caseload and confidence levels, (4) Future plans and interest in performing BT, (5) Interest in additional BT training opportunities, and (6) Trainee practice impressions. The survey was reviewed and approved for distribution by the AAPM as well as the UN72 collaborators. Within the AAPM, the survey was distributed to current residents and recent graduates of CAMPEP-accredited medical physics residency programs. This survey closed in March 2022 and the results are summarized in a manuscript currently under review. The same survey was distributed separately to resident members of COMP, GEC-ESTRO, and ABG and was closed for responses in March 2022. This abstract summarizes the results of the international survey, considering the contributions of GEC-ESTRO, ABG, and COMP.</div></div><div><h3>Results</h3><div>The survey received 183 (AAPM), 41 (ABG), 106 (GEC-ESTRO), and 13 (COMP) responses. The majority of respondents from AAPM (60%), ABG (67%), and GEC-ESTRO (69%) had completed their training whereas 62% of COMP respondents were currently enrolled in their program at the time of survey completion. The results presented are for those who had completed their training program. At least 63% of respondents in each organization expressed interest in performing BT at their first post-residency position and at least 55% in each organization indicated their first position would require them to perform BT. 64% (AAPM), 56% (GEC-ESTRO), 59% (ABG) and 40% (COMP) of respondents wished they had additional BT training opportunities. Of those expressing interest in additional training opportunities, the majority in each organization said they would be ‘very likely’ or ‘likely’ to select BT as an elective rotation if one were offered at their training institute, the majority expressed interest in performing a post-residency fellowship (Figure 1) if one were available, and 76% (AAPM), 83% (GEC-ESTRO), 84% (ABG), and 50% (COMP) expressed interest in completing a BT rotation at an institution with a higher caseload or a greater variety of cases.</div></div><div><h3>Conclusions</h3><div>The majo","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S28"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527067","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.2024.08.073
Sung-Woo Lee PhD
<div><h3>Purpose</h3><div>Lu-177 (Pluvicto) and Ra-223 (Xofigo) have recently been adopted as targeted radiopharmaceutical therapies for castration-resistant prostate cancer patients. Both of these radiopharmaceutical therapies increase life expectancy and improve the prognosis of patients with a relatively simple procedure involving injection. The treatment procedures for Ra-223 and Lu-177 are similar, with Ra-223 administered in up to 6 fractions every 4 weeks, while Lu-177 is administered in the same number of fractions every 6 weeks. Although these treatments could be considered routine procedures in a nuclear medicine department, their implementation poses challenges in a small radiation oncology center due to a lack of staff experience. The purpose of this work is to provide guidance and share experiences for an independent small radiation oncology center preparing to launch such a program.</div></div><div><h3>Materials and Methods</h3><div>Physicians, physicists, and nurses collaborated as a team in the process, led by a physicist who served as a Radiation Safety Officer (RSO). Effective communication among staff is critical for successful workflow. We followed the Maryland regulations specific to radioactive material licenses consistent with the Federal Nuclear Regulatory Commission. The program build-up involved three phases: obtaining the license, conducting emergency planning and safety training for staff, and equipment acceptance and quality assurance (QA), source logistics, and workflow development. As an example, overall procedures from beginning to the first treatment of Ra-223 are depicted in Figure 1.</div></div><div><h3>Results</h3><div>Documentation of radiation safety procedures, staff training, acceptance and initial calibration of dose calibrators and well chambers, and workflow development using ARIA® Electronic Medical Record (EMR) were completed for the first treatment. Some steps, such as acceptance and QA of a dose calibrator and a well chamber for calibration contamination checks, may not be familiar to therapy physicists. Therefore, gaining knowledge through site visits and frequent contact with nuclear medicine personnel is essential. As of now, our institution has treated 8 patients with Ra-223, with a total of 29 injections. Among these patients, 3 have completed a total of 6 rounds of injections, all successfully treated without incident. Quality assurance for the injection program included recording prescribed versus actual injection activities, with an average discrepancy of 2.43%, well below the 10% tolerance level. Radiation surveys were conducted after injection to ensure patient safety, with an average maximum radiation exposure rate of 0.32 R/hr on the patient's surface, indicating safe release immediately after injection. We anticipate treating patients with Lu-177 in the near future, with preparations already in place.</div></div><div><h3>Conclusion</h3><div>Implementation of these therapies requires a te
{"title":"MSOR11 Presentation Time: 8:50 AM","authors":"Sung-Woo Lee PhD","doi":"10.1016/j.brachy.2024.08.073","DOIUrl":"10.1016/j.brachy.2024.08.073","url":null,"abstract":"<div><h3>Purpose</h3><div>Lu-177 (Pluvicto) and Ra-223 (Xofigo) have recently been adopted as targeted radiopharmaceutical therapies for castration-resistant prostate cancer patients. Both of these radiopharmaceutical therapies increase life expectancy and improve the prognosis of patients with a relatively simple procedure involving injection. The treatment procedures for Ra-223 and Lu-177 are similar, with Ra-223 administered in up to 6 fractions every 4 weeks, while Lu-177 is administered in the same number of fractions every 6 weeks. Although these treatments could be considered routine procedures in a nuclear medicine department, their implementation poses challenges in a small radiation oncology center due to a lack of staff experience. The purpose of this work is to provide guidance and share experiences for an independent small radiation oncology center preparing to launch such a program.</div></div><div><h3>Materials and Methods</h3><div>Physicians, physicists, and nurses collaborated as a team in the process, led by a physicist who served as a Radiation Safety Officer (RSO). Effective communication among staff is critical for successful workflow. We followed the Maryland regulations specific to radioactive material licenses consistent with the Federal Nuclear Regulatory Commission. The program build-up involved three phases: obtaining the license, conducting emergency planning and safety training for staff, and equipment acceptance and quality assurance (QA), source logistics, and workflow development. As an example, overall procedures from beginning to the first treatment of Ra-223 are depicted in Figure 1.</div></div><div><h3>Results</h3><div>Documentation of radiation safety procedures, staff training, acceptance and initial calibration of dose calibrators and well chambers, and workflow development using ARIA® Electronic Medical Record (EMR) were completed for the first treatment. Some steps, such as acceptance and QA of a dose calibrator and a well chamber for calibration contamination checks, may not be familiar to therapy physicists. Therefore, gaining knowledge through site visits and frequent contact with nuclear medicine personnel is essential. As of now, our institution has treated 8 patients with Ra-223, with a total of 29 injections. Among these patients, 3 have completed a total of 6 rounds of injections, all successfully treated without incident. Quality assurance for the injection program included recording prescribed versus actual injection activities, with an average discrepancy of 2.43%, well below the 10% tolerance level. Radiation surveys were conducted after injection to ensure patient safety, with an average maximum radiation exposure rate of 0.32 R/hr on the patient's surface, indicating safe release immediately after injection. We anticipate treating patients with Lu-177 in the near future, with preparations already in place.</div></div><div><h3>Conclusion</h3><div>Implementation of these therapies requires a te","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S56"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527132","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.2024.08.052
Osagie Igiebor MD, Lewis Cooper MD, Harriet Eldredge-Hindy MD
<div><h3>Purpose</h3><div>Patients on chronic anticoagulation (AC) represent a challenge for operative, gynecologic (gyn), intracavitary (IC) and interstitial (IS) brachytherapy (brachy). Frequently, AC is temporarily held to permit use of epidural catheters for anesthesia and pain control, and to minimize the risk of bleeding during applicator insertion and removal. This is complicated by significant risks of thromboembolism during brachy related to patient immobilization, surgery, cancer diagnosis, and comorbidities. There are currently no guidelines for AC management in patients undergoing operative gyn brachy. Thus, the aim of this study is to evaluate the safety and efficacy of our practice approach to patients with thromboembolic disease on chronic AC, undergoing operative brachy for gyn malignancies.</div></div><div><h3>Materials and Methods</h3><div>After IRB approval, we reviewed the records of 277 patients consecutively treated from 2013 to 2022 with operative brachy for gyn malignancies to identify 30 patients who had perioperative or chronic thromboembolic disease requiring AC therapy. We determined indications for AC use, operative metrics, oncologic and brachy characteristics, duration of AC interruption, as well as operative or postoperative complications. The primary aim was to determine operative or postoperative (within 90 days) embolic or hemorrhagic complications as measured by the Common Terminology Criteria for Adverse Events (CTCAE).</div></div><div><h3>Results</h3><div>The median age was 66 (range 35-80) years and patients were treated for cervical (n=14), inoperable uterine (n=11), recurrent uterine (n=2), and vaginal (n=3) cancers. Median follow up was 9 (range, 0-70) months after brachy. Indications for AC therapy were DVT (n=13), pulmonary embolism (n=8), and atrial fibrillation/flutter (n=11). AC medications used were apixaban (n=17), enoxaparin (n=5), rivaroxaban (n=3), warfarin (n=2), and intravenous heparin (n=3). Implants were IC (n=14), IS (n=7) and combined IC/IS (n=9), with a median number of 2 (range, 1-3) implants per patient and 4 (range, 2-9) brachy fractions. 16 patients received epidurals prior to the operative procedure. 26 patients were on AC prior to brachy and 4 started in the perioperative period. Therapeutic AC was held in 24 patients prior to operative brachy. The median total duration of AC Interruption was 2 (range, 0-16) days before and 1 (range, 0-4) days after the operative procedure, with median total duration of AC interruption 4 days. DVT prophylaxis was used after applicator placement in most patients, which included: IVC filter (n=3), subcutaneous heparin (n=15), intravenous heparin (n=1), prophylactic dose enoxaparin (n= 5), therapeutic dose enoxaparin (n=2). The median days of bedrest immobilization was 1 (range, 1-8) per implant. Only 3 patients (10%) experienced CTCAE grade≥ 2 operative or postoperative complications with no grade 4 or 5 events. One patient developed postoperative gra
{"title":"GSOR06 Presentation Time: 5:25 PM","authors":"Osagie Igiebor MD, Lewis Cooper MD, Harriet Eldredge-Hindy MD","doi":"10.1016/j.brachy.2024.08.052","DOIUrl":"10.1016/j.brachy.2024.08.052","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients on chronic anticoagulation (AC) represent a challenge for operative, gynecologic (gyn), intracavitary (IC) and interstitial (IS) brachytherapy (brachy). Frequently, AC is temporarily held to permit use of epidural catheters for anesthesia and pain control, and to minimize the risk of bleeding during applicator insertion and removal. This is complicated by significant risks of thromboembolism during brachy related to patient immobilization, surgery, cancer diagnosis, and comorbidities. There are currently no guidelines for AC management in patients undergoing operative gyn brachy. Thus, the aim of this study is to evaluate the safety and efficacy of our practice approach to patients with thromboembolic disease on chronic AC, undergoing operative brachy for gyn malignancies.</div></div><div><h3>Materials and Methods</h3><div>After IRB approval, we reviewed the records of 277 patients consecutively treated from 2013 to 2022 with operative brachy for gyn malignancies to identify 30 patients who had perioperative or chronic thromboembolic disease requiring AC therapy. We determined indications for AC use, operative metrics, oncologic and brachy characteristics, duration of AC interruption, as well as operative or postoperative complications. The primary aim was to determine operative or postoperative (within 90 days) embolic or hemorrhagic complications as measured by the Common Terminology Criteria for Adverse Events (CTCAE).</div></div><div><h3>Results</h3><div>The median age was 66 (range 35-80) years and patients were treated for cervical (n=14), inoperable uterine (n=11), recurrent uterine (n=2), and vaginal (n=3) cancers. Median follow up was 9 (range, 0-70) months after brachy. Indications for AC therapy were DVT (n=13), pulmonary embolism (n=8), and atrial fibrillation/flutter (n=11). AC medications used were apixaban (n=17), enoxaparin (n=5), rivaroxaban (n=3), warfarin (n=2), and intravenous heparin (n=3). Implants were IC (n=14), IS (n=7) and combined IC/IS (n=9), with a median number of 2 (range, 1-3) implants per patient and 4 (range, 2-9) brachy fractions. 16 patients received epidurals prior to the operative procedure. 26 patients were on AC prior to brachy and 4 started in the perioperative period. Therapeutic AC was held in 24 patients prior to operative brachy. The median total duration of AC Interruption was 2 (range, 0-16) days before and 1 (range, 0-4) days after the operative procedure, with median total duration of AC interruption 4 days. DVT prophylaxis was used after applicator placement in most patients, which included: IVC filter (n=3), subcutaneous heparin (n=15), intravenous heparin (n=1), prophylactic dose enoxaparin (n= 5), therapeutic dose enoxaparin (n=2). The median days of bedrest immobilization was 1 (range, 1-8) per implant. Only 3 patients (10%) experienced CTCAE grade≥ 2 operative or postoperative complications with no grade 4 or 5 events. One patient developed postoperative gra","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S44"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527136","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.2024.08.069
Ema Yoshioka BSN, MSc, Puja S Venkat MD, Ermina Cavcic NP, Maylene Choy Gutierrez BSN, Gabriel Dimalanta BSN
<div><h3>Purpose</h3><div>Radiation is an effective therapy for non-melanomatous cutaneous malignancies, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). One of the side effects of radiation for skin cancer is radiation-induced dermatitis (RID), which can negatively affect patients emotionally and physically. This can occur in patients undergoing brachytherapy (BT) or external beam radiation therapy (EBRT). Despite significant advances in radiation treatments, there are gaps in nursing care such as lack of standardized nursing guidelines for managing RID skin care during BT or EBRT. Therefore, establishing a proper nursing guideline is essential as nurses have a key role in monitoring and managing RID. The purpose of this study is to identify the gaps in nursing care, assessment and intervention for RID during BT or EBRT, and assess the effect of a comprehensive guideline to assist nurses in providing efficient skin care.</div></div><div><h3>Materials and Methods</h3><div>Electronic databases such as PubMed, CINAHL and Embase were used to identify studies from the last decade (2012-2023) related to nursing care regarding RID. A comprehensive skin care guideline was then developed based on peer-reviewed literature and given to nurses working in the radiation oncology department of a large teaching institution with a high volume of both BT and EBRT (N=20). A survey was conducted among these nurses to identify the gaps in nursing care and knowledge before and after the introduction of the skin care guideline. The survey consisted of questions to assess nursing comfort level with skin care, proper documentation of stages of RID and familiarity with wound care products and supplies. The goal of the survey was to compare the nursing team's comfort and competency level before and after the implementation of the nursing guideline.</div></div><div><h3>Results</h3><div>The review of the literature revealed inconsistency in assessment practices, intervention strategies, and a lack of standardized guidelines. While some nursing recommendations exist through various oncology societies, the guidelines are generalized and do not directly address RID during BT. Furthermore, subjective data from the survey highlighted gaps in nursing care management of RID, such as lack of confidence, lack of standardized training, lack of consistency in products used, and ultimately wide variation in patient care delivery. Nursing staff reported that the guidelines for RID provided to them enhanced the quality of nursing care through multiple methods including the implementation of a standardization framework, utilization of evidence-based practice, risk reduction, optimized patient care, and empowerment of nurses. It also helps to foster interdisciplinary collaboration in the management of RID and improve patient satisfaction in both BT and EBRT.</div></div><div><h3>Conclusions</h3><div>By implementing standardized guidelines, nurses can follow the same p
{"title":"MSOR07 Presentation Time: 8:30 AM","authors":"Ema Yoshioka BSN, MSc, Puja S Venkat MD, Ermina Cavcic NP, Maylene Choy Gutierrez BSN, Gabriel Dimalanta BSN","doi":"10.1016/j.brachy.2024.08.069","DOIUrl":"10.1016/j.brachy.2024.08.069","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation is an effective therapy for non-melanomatous cutaneous malignancies, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). One of the side effects of radiation for skin cancer is radiation-induced dermatitis (RID), which can negatively affect patients emotionally and physically. This can occur in patients undergoing brachytherapy (BT) or external beam radiation therapy (EBRT). Despite significant advances in radiation treatments, there are gaps in nursing care such as lack of standardized nursing guidelines for managing RID skin care during BT or EBRT. Therefore, establishing a proper nursing guideline is essential as nurses have a key role in monitoring and managing RID. The purpose of this study is to identify the gaps in nursing care, assessment and intervention for RID during BT or EBRT, and assess the effect of a comprehensive guideline to assist nurses in providing efficient skin care.</div></div><div><h3>Materials and Methods</h3><div>Electronic databases such as PubMed, CINAHL and Embase were used to identify studies from the last decade (2012-2023) related to nursing care regarding RID. A comprehensive skin care guideline was then developed based on peer-reviewed literature and given to nurses working in the radiation oncology department of a large teaching institution with a high volume of both BT and EBRT (N=20). A survey was conducted among these nurses to identify the gaps in nursing care and knowledge before and after the introduction of the skin care guideline. The survey consisted of questions to assess nursing comfort level with skin care, proper documentation of stages of RID and familiarity with wound care products and supplies. The goal of the survey was to compare the nursing team's comfort and competency level before and after the implementation of the nursing guideline.</div></div><div><h3>Results</h3><div>The review of the literature revealed inconsistency in assessment practices, intervention strategies, and a lack of standardized guidelines. While some nursing recommendations exist through various oncology societies, the guidelines are generalized and do not directly address RID during BT. Furthermore, subjective data from the survey highlighted gaps in nursing care management of RID, such as lack of confidence, lack of standardized training, lack of consistency in products used, and ultimately wide variation in patient care delivery. Nursing staff reported that the guidelines for RID provided to them enhanced the quality of nursing care through multiple methods including the implementation of a standardization framework, utilization of evidence-based practice, risk reduction, optimized patient care, and empowerment of nurses. It also helps to foster interdisciplinary collaboration in the management of RID and improve patient satisfaction in both BT and EBRT.</div></div><div><h3>Conclusions</h3><div>By implementing standardized guidelines, nurses can follow the same p","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S53-S54"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526898","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.2024.08.011
Vitaly A. Biryukov MD, PhD , Kseniia S. Makarova MD , Alexey V. Troyanov MD , Yulia V. Gumenetskaya MD, PhD , Tatyana A. Rodina MD , Elizaveta O. Shchukina MD , Oleg B. Karyakin (Prof) , Sergey A. Ivanov (Prof) , Andrey D. Kaprin (Prof)
Very-high risk [VHR] prostate cancer [PC] is an aggressive subgroup with high risk of distant disease progression. According to a number of studies systemic treatment intensification with docetaxel reduces PC-specific mortality in men receiving external beam radiation therapy [EBRT] with androgen deprivation therapy [ADT]. Whether the addition of chemotherapy to combined modality of radiotherapy (EBRT + brachytherapy [BT] boost) with ADT improves outcomes in this group is unclear.
Purpose
A comparative analysis of the efficacy of EBRT, BT boost and ADT with or without neoadjuvant docetaxel chemotherapy in VHR PC patients.
Materials and Methods
A total of 86 men diagnosed between 2016 and 2020 with VHR prostate cancer were stratified into 2 groups: EBRT plus BT boost and ADT (n = 66) or EBRT plus BT boost, ADT and neoadjuvant docetaxel chemotherapy (n = 20). Conformal EBRT was delivered with conventional fractionation to a total dose of 44-46 Gy to the prostate gland and seminal vesicles and the Ir-192 high-dose rate BT was delivered with one single fraction of 15 Gy. Neoadjuvant docetaxel was administered at 75 mg/m2 every 3 weeks for 4 cycles. A median duration of ADT, consisting of a gonadotropin-releasing hormone agonist, was 24 months. Median age was 66 years (range: 46-81 years). Median follow-up was 65 months (range: 21,5 - 108,7 months). The characteristics of the patient groups are presented in table 1.
Results
Six-years progression free survival [PFS] was 80,1% for the group with chemotherapy vs. 77,2% for no-chemotherapy group (p = 0,499). The presence of Gleason score 9-10 was associated with a statistically significant increase in the risk of PC recurrence (p = 0.013). Six-years overall survival [OS] was 100% and 82,8% for groups with and without chemotherapy respectively (p = 0,075). Six-years PC-specific survival [PCSS] was 100% and 93,4% for groups with and without chemotherapy respectively (p = 0,306).
Conclusion
There was no statistically-significant difference in PFS, OS and PCSS in VHR prostate cancer patients received EBRT+BT+ADT with or without chemotherapy.
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