Pub Date : 2025-01-01DOI: 10.1016/j.brachy.2024.11.003
Karen Cheng , Samuel To , Zichen Liu , Hye Ri Han , Derrick Lock , Priya Mitra , Omar Ragab , Andrew Lim , Fahad Momin , Shelly Bian
PURPOSE
To report outcomes of a 3-fraction HDR brachytherapy boost for the treatment of locally advanced cervical cancer (LACC) at a large safety net hospital.
METHODS AND MATERIALS
A retrospective review of 93 patients with FIGO 2018 Stage IA2 to IVB cervical cancer treated with HDR brachytherapy boost in 3 fractions between 2017 and 2022 was conducted. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) was estimated using Kaplan-Meier estimators. Hazard ratios of covariates for local failure (LF) were determined using univariate Cox proportional hazard models.
RESULTS
Median follow-up time was 31 months. Mean cumulative EQD2 of HR-CTV D90 was 85.3 Gy (95% CI 84.2, 86.4). Mean cumulative EQD2 of the D2cc for bladder, rectum, sigmoid, and small bowel was 74.7 Gy (95% CI 72.4, 77.0), 58.2 Gy (95% CI 56.7, 59.6), 60.9 Gy (95% CI 59.4, 62.3), and 58.9 Gy (95% CI 56.7, 61.1) respectively. Two-year LC, PFS, and OS were 80.9% (95% CI 73.1%, 89.5%), 63.2% (95% CI 54.0%, 74.1%), and 85.2% (95% CI 78.1%, 93.0%) respectively. The hazard ratio for LF for incomplete concurrent chemotherapy regimen was 3.07 (95% CI 1.17, 8.09; p = 0.02). Three percent of patients experienced late grade 3+ toxicities after radiation therapy.
CONCLUSIONS
Three-fraction HDR brachytherapy boost was generally well-tolerated by patients and may be a viable alternative in the treatment of LACC.
目的：报道在一家大型安全网医院，三段式HDR近距离放疗促进局部晚期宫颈癌（LACC）治疗的结果。方法与材料：回顾性分析2017 - 2022年分3期接受HDR近距离放疗增强治疗的93例FIGO 2018 IA2 ~ IVB期宫颈癌患者。2年局部对照（LC）、无进展生存期（PFS）和总生存期（OS）使用Kaplan-Meier估计器进行估计。局部失效（LF）的协变量风险比采用单变量Cox比例风险模型确定。结果：中位随访时间31个月。HR-CTV D90的平均累积EQD2为85.3 Gy （95% CI 84.2, 86.4）。膀胱、直肠、乙状结肠和小肠D2cc的平均累积EQD2分别为74.7 Gy （95% CI 72.4, 77.0）、58.2 Gy （95% CI 56.7, 59.6）、60.9 Gy （95% CI 59.4, 62.3）和58.9 Gy （95% CI 56.7, 61.1）。两年LC、PFS和OS分别为80.9% （95% CI 73.1%, 89.5%）、63.2% （95% CI 54.0%, 74.1%）和85.2% （95% CI 78.1%, 93.0%）。不完全同步化疗方案发生LF的风险比为3.07 (95% CI 1.17, 8.09； = 0.02页)。3%的患者在放射治疗后出现晚期3+级毒性。结论：三段式HDR近距离强化治疗通常被患者耐受良好，可能是治疗LACC的可行替代方案。
{"title":"Clinical and dosimetric outcomes of a 3-fraction high-dose-rate brachytherapy boost for the treatment of locally advanced cervical cancer in a safety net hospital","authors":"Karen Cheng , Samuel To , Zichen Liu , Hye Ri Han , Derrick Lock , Priya Mitra , Omar Ragab , Andrew Lim , Fahad Momin , Shelly Bian","doi":"10.1016/j.brachy.2024.11.003","DOIUrl":"10.1016/j.brachy.2024.11.003","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To report outcomes of a 3-fraction HDR brachytherapy boost for the treatment of locally advanced cervical cancer (LACC) at a large safety net hospital.</div></div><div><h3>METHODS AND MATERIALS</h3><div>A retrospective review of 93 patients with FIGO 2018 Stage IA2 to IVB cervical cancer treated with HDR brachytherapy boost in 3 fractions between 2017 and 2022 was conducted. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) was estimated using Kaplan-Meier estimators. Hazard ratios of covariates for local failure (LF) were determined using univariate Cox proportional hazard models.</div></div><div><h3>RESULTS</h3><div>Median follow-up time was 31 months. Mean cumulative EQD2 of HR-CTV D90 was 85.3 Gy (95% CI 84.2, 86.4). Mean cumulative EQD2 of the D2cc for bladder, rectum, sigmoid, and small bowel was 74.7 Gy (95% CI 72.4, 77.0), 58.2 Gy (95% CI 56.7, 59.6), 60.9 Gy (95% CI 59.4, 62.3), and 58.9 Gy (95% CI 56.7, 61.1) respectively. Two-year LC, PFS, and OS were 80.9% (95% CI 73.1%, 89.5%), 63.2% (95% CI 54.0%, 74.1%), and 85.2% (95% CI 78.1%, 93.0%) respectively. The hazard ratio for LF for incomplete concurrent chemotherapy regimen was 3.07 (95% CI 1.17, 8.09; <em>p</em> = 0.02). Three percent of patients experienced late grade 3+ toxicities after radiation therapy.</div></div><div><h3>CONCLUSIONS</h3><div>Three-fraction HDR brachytherapy boost was generally well-tolerated by patients and may be a viable alternative in the treatment of LACC.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 162-170"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793036","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 : 2025-01-01DOI: 10.1016/j.brachy.2024.08.254
Evelien B. van Well , Timothy N. Showalter , Stavroula Giannouli , Elena Nioutsikou , Maroeska M. Rovers , Tim M. Govers
Purpose
Brachytherapy is associated with improved overall survival in cervical cancer patients, but the utilization seems hindered by high costs and relatively low reimbursement, particularly in the US. A one-room brachytherapy suite with CT (ORBT) could optimize the treatment workflow. By eliminating transport and waiting times, limiting applicator movement, and providing real-time applicator placement feedback, treatment time and costs could potentially be reduced. This study assesses the potential value of implementing ORBT in cervical cancer treatment.
Methods and Materials
A variable cost model was developed to compare current (multi-room) brachytherapy workflows (MBRT) to ORBT, taking into account staff utilization, staff, equipment and consumables costs and room expenses. Two current care scenarios were simulated; applicator placement performed in the operating room (S1), and applicator placement performed in a brachytherapy suite (S2). For both scenarios literature reported fraction times of MBRT were compared to a range of ORBT times. Sensitivity analyses were performed to determine the influence of input parameters.
Results
In scenario one, the results showed yearly savings of $45,572 up to $339,439 (USD), assuming a 5% and 20% reduction in fraction duration, respectively, in ORBT compared to MRBT. In scenario two, ORBT does not result in costs savings at 5% to 15% improvement. Therefore, only when ORBT results in a >20% improvement of fraction time, cost will be saved.
Conclusions
The results indicate that reducing procedure time (using ORBT) can lead to cost savings, depending on the current workflow. Savings seem to depend mostly on applicator placement location, number of patients per year, and involved personnel.
{"title":"The effect of one-room CT guided brachytherapy on procedure time and cost in the treatment of cervical cancer","authors":"Evelien B. van Well , Timothy N. Showalter , Stavroula Giannouli , Elena Nioutsikou , Maroeska M. Rovers , Tim M. Govers","doi":"10.1016/j.brachy.2024.08.254","DOIUrl":"10.1016/j.brachy.2024.08.254","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy is associated with improved overall survival in cervical cancer patients, but the utilization seems hindered by high costs and relatively low reimbursement, particularly in the US. A one-room brachytherapy suite with CT (ORBT) could optimize the treatment workflow. By eliminating transport and waiting times, limiting applicator movement, and providing real-time applicator placement feedback, treatment time and costs could potentially be reduced. This study assesses the potential value of implementing ORBT in cervical cancer treatment.</div></div><div><h3>Methods and Materials</h3><div>A variable cost model was developed to compare current (multi-room) brachytherapy workflows (MBRT) to ORBT, taking into account staff utilization, staff, equipment and consumables costs and room expenses. Two current care scenarios were simulated; applicator placement performed in the operating room (S1), and applicator placement performed in a brachytherapy suite (S2). For both scenarios literature reported fraction times of MBRT were compared to a range of ORBT times. Sensitivity analyses were performed to determine the influence of input parameters.</div></div><div><h3>Results</h3><div>In scenario one, the results showed yearly savings of $45,572 up to $339,439 (USD), assuming a 5% and 20% reduction in fraction duration, respectively, in ORBT compared to MRBT. In scenario two, ORBT does not result in costs savings at 5% to 15% improvement. Therefore, only when ORBT results in a >20% improvement of fraction time, cost will be saved.</div></div><div><h3>Conclusions</h3><div>The results indicate that reducing procedure time (using ORBT) can lead to cost savings, depending on the current workflow. Savings seem to depend mostly on applicator placement location, number of patients per year, and involved personnel.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 30-35"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate outcomes of cervical cancer patients treated with abbreviated high dose rate brachytherapy (HDR-BT) that used 2-implants and delivered 4–5 fractions over 7–12 days rather than 21–28 days.
MATERIALS AND METHODS
Patients with stage IB2–IVA cervical cancer, treated with external beam radiation (EBRT) chemotherapy followed by abbreviated MR/CT-based HDR-BT were included. The planning aim was to achieve > 70Gy equivalent doses in 2Gy (EQD210Gy) at Point A dose in patients undergoing intracavitary BT (ICBT) and > 85Gy EQD210Gy to the HRCTV in intracavitary-interstitial BT (IC-ISBT). The dose constraints to 2 cc of bladder, rectum and sigmoid were restricted to < 90Gy3, < 75Gy3 and < 75Gy EQD23Gy respectively.
RESULTS
From 2020 to 2022, 245 patients were treated with EBRT followed by MR/CT-based HDR-BT. Median OTT was 57 days. The median HRCTV volume was 35.5cc with higher HRCTV in MR than CT-based (42.3cc vs. 32.8cc). The median dose to Point-A, HRCTV-D90, B2cc, R2cc and S2cc for ICBT was 78.1, 86.2, 87, 70.2 and 70.4Gy respectively. For IC-ISBT cohort, the median dose to HRCTV-D90, B2cc, R2cc, and S2cc was 86.1, 88.6, 70 & 66.7Gy respectively. The 3-years local control, pelvic control, locoregional, disease free and overall survival was 90%, 88%, 83.7%, 75.5% and 85% respectively. Late ≥ grade III gastrointestinal and genitourinary toxicities were 7.3% and 1.6% respectively with marginally higher toxicity in CT based cohort.
CONCLUSION
Accelerated HDR-BT schedule of 2-implants 4–5 fractions is radiobiological iso-effective and clinically safe with comparable oncological outcomes and adverse events.
{"title":"Clinical outcomes of abbreviated high dose-rate brachytherapy in locally advanced cervical cancer: lessons from the COVID pandemic for high dose-rate fractionation","authors":"Supriya Chopra , Asesh Samanta , Arunima Nagar , Prachi Mittal , Ankita Gupta , Jaahid Mulani , Jeevanshu Jain , Satish Kohle , Yogesh Ghadi , Sushmita Rath , Seema Gulia , Jaya Ghosh , Sudeep Gupta","doi":"10.1016/j.brachy.2024.10.010","DOIUrl":"10.1016/j.brachy.2024.10.010","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To evaluate outcomes of cervical cancer patients treated with abbreviated high dose rate brachytherapy (HDR-BT) that used 2-implants and delivered 4–5 fractions over 7–12 days rather than 21–28 days.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Patients with stage IB2–IVA cervical cancer, treated with external beam radiation (EBRT) <span><math><mo>±</mo></math></span> chemotherapy followed by abbreviated MR/CT-based HDR-BT were included. The planning aim was to achieve > 70Gy equivalent doses in 2Gy (EQD2<sub>10Gy</sub>) at Point A dose in patients undergoing intracavitary BT (ICBT) and > 85Gy EQD2<sub>10Gy</sub> to the HRCTV in intracavitary-interstitial BT (IC-ISBT). The dose constraints to 2 cc of bladder, rectum and sigmoid were restricted to < 90Gy<sub>3</sub>, < 75Gy<sub>3</sub> and < 75Gy EQD2<sub>3Gy</sub> respectively.</div></div><div><h3>RESULTS</h3><div>From 2020 to 2022, 245 patients were treated with EBRT followed by MR/CT-based HDR-BT. Median OTT was 57 days. The median HRCTV volume was 35.5cc with higher HRCTV in MR than CT-based (42.3cc vs. 32.8cc). The median dose to Point-A, HRCTV-D90, B2cc, R2cc and S2cc for ICBT was 78.1, 86.2, 87, 70.2 and 70.4Gy respectively. For IC-ISBT cohort, the median dose to HRCTV-D90, B2cc, R2cc, and S2cc was 86.1, 88.6, 70 & 66.7Gy respectively. The 3-years local control, pelvic control, locoregional, disease free and overall survival was 90%, 88%, 83.7%, 75.5% and 85% respectively. Late ≥ grade III gastrointestinal and genitourinary toxicities were 7.3% and 1.6% respectively with marginally higher toxicity in CT based cohort.</div></div><div><h3>CONCLUSION</h3><div>Accelerated HDR-BT schedule of 2-implants 4–5 fractions is radiobiological iso-effective and clinically safe with comparable oncological outcomes and adverse events.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 1-10"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793040","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 : 2025-01-01DOI: 10.1016/j.brachy.2024.10.006
Osagie Igiebor , Samuel Lewis Cooper , Brian Orr , Harriet Eldredge-Hindy
PURPOSE
Women on chronic anticoagulation (AC) who require operative brachytherapy for gynecologic malignancies represent a clinical challenge, but no guidelines exist regarding patient selection for brachytherapy or their perioperative management. We aimed to understand the incidence of hemorrhagic and embolic events in our patients on chronic AC and suggest management strategies for this patient population.
MATERIALS AND METHODS
A retrospective, single institutional study of patients treated with operative, gynecologic brachytherapy from 2013 to 2023 was performed to identify patients on chronic AC. We determined indications for AC use, oncologic therapy characteristics, duration of AC interruption, and therapy outcomes. The primary aim was to determine perioperative embolic or hemorrhagic complications as measured by the Common Terminology Criteria for Adverse Events.
Results
Of 304 patients treated with operative implants, 32 (10%) were on chronic AC for venous thromboembolism (n = 25), or atrial fibrillation/flutter (n = 13). The most common malignancies were cervical (n = 15) and inoperable uterine (n = 11). Implants were intracavitary (n = 14), interstitial (n = 6), or hybrid (n = 12) with a median (range) of 2 (1-3) implants, 4 (2-5) fractions, and 2 (1-3) days of bedrest per implant. 63% (n = 20) had an epidural for analgesia. AC was held for a median 3 days in 94% (n = 30) prior to the operative implant, and pharmacologic DVT prophylaxis was used in 78% (n = 25). There were two grade ≥ 2 hemorrhagic events and no new embolic events.
Conclusions
The rate of bleeding and embolic events was acceptable, and women on chronic AC should not be excluded from potentially lifesaving operative brachytherapy, including complex cases that require spinal analgesia and interstitial applicators.
{"title":"Anticoagulation management in gynecologic brachytherapy patients with perioperative or chronic thromboembolic disease: A retrospective analysis","authors":"Osagie Igiebor , Samuel Lewis Cooper , Brian Orr , Harriet Eldredge-Hindy","doi":"10.1016/j.brachy.2024.10.006","DOIUrl":"10.1016/j.brachy.2024.10.006","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Women on chronic anticoagulation (AC) who require operative brachytherapy for gynecologic malignancies represent a clinical challenge, but no guidelines exist regarding patient selection for brachytherapy or their perioperative management. We aimed to understand the incidence of hemorrhagic and embolic events in our patients on chronic AC and suggest management strategies for this patient population.</div></div><div><h3>MATERIALS AND METHODS</h3><div>A retrospective, single institutional study of patients treated with operative, gynecologic brachytherapy from 2013 to 2023 was performed to identify patients on chronic AC. We determined indications for AC use, oncologic therapy characteristics, duration of AC interruption, and therapy outcomes. The primary aim was to determine perioperative embolic or hemorrhagic complications as measured by the Common Terminology Criteria for Adverse Events.</div></div><div><h3>Results</h3><div>Of 304 patients treated with operative implants, 32 (10%) were on chronic AC for venous thromboembolism (n = 25), or atrial fibrillation/flutter (n = 13). The most common malignancies were cervical (n = 15) and inoperable uterine (n = 11). Implants were intracavitary (n = 14), interstitial (n = 6), or hybrid (n = 12) with a median (range) of 2 (1-3) implants, 4 (2-5) fractions, and 2 (1-3) days of bedrest per implant. 63% (n = 20) had an epidural for analgesia. AC was held for a median 3 days in 94% (n = 30) prior to the operative implant, and pharmacologic DVT prophylaxis was used in 78% (n = 25). There were two grade ≥ 2 hemorrhagic events and no new embolic events.</div></div><div><h3>Conclusions</h3><div>The rate of bleeding and embolic events was acceptable, and women on chronic AC should not be excluded from potentially lifesaving operative brachytherapy, including complex cases that require spinal analgesia and interstitial applicators.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 154-161"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634374","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 : 2025-01-01DOI: 10.1016/j.brachy.2024.11.009
Leah R.M. Dickhoff , Renzo J. Scholman , Danique L.J. Barten , Ellen M. Kerkhof , Jelmen J. Roorda , Anton Bouter , Laura A. Velema , Lukas J.A. Stalpers , Bradley R. Pieters , Peter A.N. Bosman , Tanja Alderliesten
{"title":"“Erratum to keeping your best options open with AI-based treatment planning in prostate and cervix brachytherapy” [Brachytherapy Volume 23, ISSUE 2, P188-198, March 2024]","authors":"Leah R.M. Dickhoff , Renzo J. Scholman , Danique L.J. Barten , Ellen M. Kerkhof , Jelmen J. Roorda , Anton Bouter , Laura A. Velema , Lukas J.A. Stalpers , Bradley R. Pieters , Peter A.N. Bosman , Tanja Alderliesten","doi":"10.1016/j.brachy.2024.11.009","DOIUrl":"10.1016/j.brachy.2024.11.009","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Page 197"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017671","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 : 2025-01-01DOI: 10.1016/j.brachy.2024.09.002
Firas Mourtada , Sara Belko , Rachel Monane , Robert Pugliese , Lydia Komarnicky-Kocher , Sara E. Lally , Wentao Wang , Carol L. Shields , Jacqueline Emrich
PURPOSE
Suture preplacement by the ocular oncology surgeon is a critical step before inserting a radioactive plaque for ocular melanoma brachytherapy. We report on a novel 3D-printing method to create a custom “dummy” plaque applicator for the 22 mm notched gold plaque using in-house 3D-printing.
METHODS
A computer-aided design (CAD) file was created replicating a heavily used gold plaque that no longer has a satisfactory “dummy” plaque. The file was exported as a 3D file (surface tessellation language, STL) and prepared using Formlabs’ PreForm print software. The 3D-printed dummies were oriented on the printer to have no cups or supports on the surfaces that would come in contact with the patient's external sclera. The dummies were printed in FormLabs BioMed Clear V1 on a Formlabs Form-3 3D printer. Postprinting, the dummies were processed in isopropyl alcohol and cured according to manufacturer instructions. They were polished utilizing a rotary tool to improve transparency. Chemical and sterilization cycle tests were performed to ensure dummy integrity.
RESULTS
Four “dummy” plaques were printed. The 3D-printed “dummy” dimensions were verified to be within 0.5-mm of the notched plaque using digital calipers. The polishing process created acceptable light opacity for the eye plaque procedure in the operating room. No impactful discoloration or material change was observed during the chemical and sterilization cycle tests performed.
CONCLUSIONS
3D printing can produce custom eye plaque dummies using transparent, biocompatible, chemically inert materials suitable for human use. This capability introduces an additional layer of patient-specific hygienics.
{"title":"A novel 3D printing method for a notched eye plaque “dummy” for uveal melanoma brachytherapy","authors":"Firas Mourtada , Sara Belko , Rachel Monane , Robert Pugliese , Lydia Komarnicky-Kocher , Sara E. Lally , Wentao Wang , Carol L. Shields , Jacqueline Emrich","doi":"10.1016/j.brachy.2024.09.002","DOIUrl":"10.1016/j.brachy.2024.09.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Suture preplacement by the ocular oncology surgeon is a critical step before inserting a radioactive plaque for ocular melanoma brachytherapy. We report on a novel 3D-printing method to create a custom “dummy” plaque applicator for the 22 mm notched gold plaque using in-house 3D-printing.</div></div><div><h3>METHODS</h3><div>A computer-aided design (CAD) file was created replicating a heavily used gold plaque that no longer has a satisfactory “dummy” plaque. The file was exported as a 3D file (surface tessellation language, STL) and prepared using Formlabs’ PreForm print software. The 3D-printed dummies were oriented on the printer to have no cups or supports on the surfaces that would come in contact with the patient's external sclera. The dummies were printed in FormLabs BioMed Clear V1 on a Formlabs Form-3 3D printer. Postprinting, the dummies were processed in isopropyl alcohol and cured according to manufacturer instructions. They were polished utilizing a rotary tool to improve transparency. Chemical and sterilization cycle tests were performed to ensure dummy integrity.</div></div><div><h3>RESULTS</h3><div>Four “dummy” plaques were printed. The 3D-printed “dummy” dimensions were verified to be within 0.5-mm of the notched plaque using digital calipers. The polishing process created acceptable light opacity for the eye plaque procedure in the operating room. No impactful discoloration or material change was observed during the chemical and sterilization cycle tests performed.</div></div><div><h3>CONCLUSIONS</h3><div>3D printing can produce custom eye plaque dummies using transparent, biocompatible, chemically inert materials suitable for human use. This capability introduces an additional layer of patient-specific hygienics.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 86-91"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634371","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 : 2025-01-01DOI: 10.1016/j.brachy.2024.10.012
Denisa Pohanková , Igor Sirák , Miroslav Hodek , Linda Kašaová , Petr Paluska , Jakub Grepl , Munachiso Ndukwe , Ivan Práznovec , Jiří Petera , Zdeněk Zoul , Milan Vošmik
PURPOSE
MRI-only adaptive brachytherapy (MRI-ABT) is the state-of-the-art for treating locally advanced cervical cancer (LACC) in combination with concurrent chemoradiotherapy. We aimed to evaluate the pattern of pelvic recurrence after the treatment.
MATERIAL AND METHODS
A total of one hundred LACC patients were treated between January 2017 and December 2023 with concurrent chemoradiotherapy of 45 Gy in 25 fractions ± boost to lymphadenopathy (up to a maximum dose of 60 Gy in 25 fractions) with concurrent weekly cisplatin chemotherapy at the dose of 40 mg/m2/week, and MR-ABT.
RESULTS
At a median follow-up of 30.2 months, there were 2 local recurrences (2%) and 9 regional pelvic recurrences (9%). The median time to local/regional recurrence was 11 months (range 6–21). For all stages, the 3-year local control was 97.66%, and the 3-year pelvic control was 89.45%. Twenty-four patients died during follow-up; the 3-year overall survival was 75.11%, and the 3-year disease-free survival was 70.97%.
CONCLUSION
MRI-ABT combined with external beam radiotherapy and concurrent chemotherapy for LACC demonstrates excellent local and regional pelvic control. Most local/regional recurrences occur inside or at the edge of the external-beam irradiated field. Recurrences inside the field of brachytherapy are rare. Distant recurrences are the predominant cause of death in LACC patients treated with definitive CRT and MRI-ABT.
{"title":"Pattern of pelvic recurrence in MRI-only adaptive brachytherapy for locally advanced cervical cancer","authors":"Denisa Pohanková , Igor Sirák , Miroslav Hodek , Linda Kašaová , Petr Paluska , Jakub Grepl , Munachiso Ndukwe , Ivan Práznovec , Jiří Petera , Zdeněk Zoul , Milan Vošmik","doi":"10.1016/j.brachy.2024.10.012","DOIUrl":"10.1016/j.brachy.2024.10.012","url":null,"abstract":"<div><h3>PURPOSE</h3><div>MRI-only adaptive brachytherapy (MRI-ABT) is the state-of-the-art for treating locally advanced cervical cancer (LACC) in combination with concurrent chemoradiotherapy. We aimed to evaluate the pattern of pelvic recurrence after the treatment.</div></div><div><h3>MATERIAL AND METHODS</h3><div>A total of one hundred LACC patients were treated between January 2017 and December 2023 with concurrent chemoradiotherapy of 45 Gy in 25 fractions ± boost to lymphadenopathy (up to a maximum dose of 60 Gy in 25 fractions) with concurrent weekly cisplatin chemotherapy at the dose of 40 mg/m<sup>2</sup>/week, and MR-ABT.</div></div><div><h3>RESULTS</h3><div>At a median follow-up of 30.2 months, there were 2 local recurrences (2%) and 9 regional pelvic recurrences (9%). The median time to local/regional recurrence was 11 months (range 6–21). For all stages, the 3-year local control was 97.66%, and the 3-year pelvic control was 89.45%. Twenty-four patients died during follow-up; the 3-year overall survival was 75.11%, and the 3-year disease-free survival was 70.97%.</div></div><div><h3>CONCLUSION</h3><div>MRI-ABT combined with external beam radiotherapy and concurrent chemotherapy for LACC demonstrates excellent local and regional pelvic control. Most local/regional recurrences occur inside or at the edge of the external-beam irradiated field. Recurrences inside the field of brachytherapy are rare. Distant recurrences are the predominant cause of death in LACC patients treated with definitive CRT and MRI-ABT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 11-17"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756048","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}
High-dose-rate brachytherapy (HDR-BT) is now becoming more common than low-dose-rate and pulsed-dose-rate BT in the treatment of lip cancer. However, due to the limited history of HDR-BT, relatively few studies have been published. Two institutions (in Ukraine and the USA) reviewed their clinical outcomes of lip cancer patients treated with HDR-BT as monotherapy or in combination with external beam radiotherapy (EBRT).
METHODS AND MATERIALS
An interstitial (IS), surface custom mold (SC), or a combination of IS and SC (IS+SC) was used for treatments based on the depth of tumor invasion. Prescription doses were 24 Gy in 6 BID fractions when combined with 46–50 Gy of EBRT, 45–55 Gy in 9–10 BID fractions for IS and IS+SC monotherapy or 3 Gy × 16 daily fractions for SC monotherapy.
RESULTS
A total of 33 cases of lip cancer were treated from 2015 to 2021. By using TNM staging classification, there were 14 stage I (42.4%), 15 stage II (45.5%), and 4 stage III (12.1%) lip cancers. Thirty-one patients (93.9%) had a complete response to the treatment. Only 2 patients (6.1%) displayed local recurrence. Grade 1, 2, and 3 acute toxicities were observed in 30.3%, 51.5%, and 18.2% of patients, respectively. Grade 1, 2, and 3 late toxicities were observed in 39.4%, 21.2%, and 0.0% of cases. Cosmetic results were excellent in 21.2%, good in 54.5%, fair in 18.2%, and poor in 6.1% of patients.
CONCLUSIONS
HDR-BT is an effective and safe treatment for lip carcinomas with excellent local control, functional, and cosmetic outcomes and should be considered as a standard treatment.
{"title":"High dose rate brachytherapy for lip cancer with interstitial, surface, or a combination of interstitial and surface mold technique","authors":"Serhii Brovchuk , Zoia Shepil , Puja Venkat , Oleg Vaskevych , Sang-June Park","doi":"10.1016/j.brachy.2024.09.004","DOIUrl":"10.1016/j.brachy.2024.09.004","url":null,"abstract":"<div><h3>PURPOSE</h3><div>High-dose-rate brachytherapy (HDR-BT) is now becoming more common than low-dose-rate and pulsed-dose-rate BT in the treatment of lip cancer. However, due to the limited history of HDR-BT, relatively few studies have been published. Two institutions (in Ukraine and the USA) reviewed their clinical outcomes of lip cancer patients treated with HDR-BT as monotherapy or in combination with external beam radiotherapy (EBRT).</div></div><div><h3>METHODS AND MATERIALS</h3><div>An interstitial (IS), surface custom mold (SC), or a combination of IS and SC (IS+SC) was used for treatments based on the depth of tumor invasion. Prescription doses were 24 Gy in 6 BID fractions when combined with 46–50 Gy of EBRT, 45–55 Gy in 9–10 BID fractions for IS and IS+SC monotherapy or 3 Gy × 16 daily fractions for SC monotherapy.</div></div><div><h3>RESULTS</h3><div>A total of 33 cases of lip cancer were treated from 2015 to 2021. By using TNM staging classification, there were 14 stage I (42.4%), 15 stage II (45.5%), and 4 stage III (12.1%) lip cancers. Thirty-one patients (93.9%) had a complete response to the treatment. Only 2 patients (6.1%) displayed local recurrence. Grade 1, 2, and 3 acute toxicities were observed in 30.3%, 51.5%, and 18.2% of patients, respectively. Grade 1, 2, and 3 late toxicities were observed in 39.4%, 21.2%, and 0.0% of cases. Cosmetic results were excellent in 21.2%, good in 54.5%, fair in 18.2%, and poor in 6.1% of patients.</div></div><div><h3>CONCLUSIONS</h3><div>HDR-BT is an effective and safe treatment for lip carcinomas with excellent local control, functional, and cosmetic outcomes and should be considered as a standard treatment.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 68-75"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483035","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 : 2025-01-01DOI: 10.1016/j.brachy.2024.09.005
Meng-hua xia , Kai-cai Liu , Wei Zhao , Yi-zhuang Cheng , Liang-ping Shi , Li-qin Bi , Xue-ran Guo , Meng-xia Zhang , Wei-Fu Lv
PURPOSE
To compare the effectiveness and safety of CT-guided iodine-125 seed brachytherapy in conjunction with chemotherapy against chemotherapy alone for the management of intermediate and advanced non-small cell lung cancer (NSCLC) lacking oncogenic driving genes.
METHODS AND MATERIALS
Retrospective analysis was conducted on clinical data from 128 patients diagnosed with intermediate and advanced non-small cell lung cancer who received iodine-125 combined with chemotherapy or chemotherapy alone due to the absence of oncogenic driver gene mutations. The patients in two groups were compared at 6-month follow-up for objective remission rate (ORR), Disease control rate (DCR), local progression−free survival (LPFS), overall survival (OS), clinical symptom improvement, and adverse events.
RESULTS
A median of 47 (range, 16–100) iodine-125 seeds were implanted. The median D90 was 139.4 Gy. In patients with stage III NSCLC, the 6-month ORR were 40.0% and 8.0% in two groups, while those with stage IV NSCLC had rates of 20.9% and 4.0%. No significant issues arose during the 5–58 months follow-up period. OS did not significantly differ between stage III and IV NSCLC patients. The LPFS for stage III patients was 14 months and 9 months, compared to 8 months and 7 months for stage IV patients. Symptom improvement rates, including cough, chest discomfort, hemoptysis, and chest constriction, were 87.2% versus 20.4%, 77.8% versus 33.3%, and 77.8% versus 26.1%, respectively.
CONCLUSIONS
CT-guided iodine-125 seed implantation with chemotherapy failed to improve OS in stages III and IV NSCLC. However, it did extend the LPFS of stage III NSCLC. Furthermore, the ORR was much higher than that of the chemotherapy-only group, and lung cancer clinical symptoms were significantly reduced, improving patient quality of life.
{"title":"Efficacy and safety of chemotherapy combined with iodine-125 seed brachytherapy for intermediate and advanced oncogenic driver gene-negative non-small cell lung cancer","authors":"Meng-hua xia , Kai-cai Liu , Wei Zhao , Yi-zhuang Cheng , Liang-ping Shi , Li-qin Bi , Xue-ran Guo , Meng-xia Zhang , Wei-Fu Lv","doi":"10.1016/j.brachy.2024.09.005","DOIUrl":"10.1016/j.brachy.2024.09.005","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To compare the effectiveness and safety of CT-guided iodine-125 seed brachytherapy in conjunction with chemotherapy against chemotherapy alone for the management of intermediate and advanced non-small cell lung cancer (NSCLC) lacking oncogenic driving genes.</div></div><div><h3>METHODS AND MATERIALS</h3><div>Retrospective analysis was conducted on clinical data from 128 patients diagnosed with intermediate and advanced non-small cell lung cancer who received iodine-125 combined with chemotherapy or chemotherapy alone due to the absence of oncogenic driver gene mutations. The patients in two groups were compared at 6-month follow-up for objective remission rate (ORR), Disease control rate (DCR), local progression−free survival (LPFS), overall survival (OS), clinical symptom improvement, and adverse events.</div></div><div><h3>RESULTS</h3><div>A median of 47 (range, 16–100) iodine-125 seeds were implanted. The median D90 was 139.4 Gy. In patients with stage III NSCLC, the 6-month ORR were 40.0% and 8.0% in two groups, while those with stage IV NSCLC had rates of 20.9% and 4.0%. No significant issues arose during the 5–58 months follow-up period. OS did not significantly differ between stage III and IV NSCLC patients. The LPFS for stage III patients was 14 months and 9 months, compared to 8 months and 7 months for stage IV patients. Symptom improvement rates, including cough, chest discomfort, hemoptysis, and chest constriction, were 87.2% versus 20.4%, 77.8% versus 33.3%, and 77.8% versus 26.1%, respectively.</div></div><div><h3>CONCLUSIONS</h3><div>CT-guided iodine-125 seed implantation with chemotherapy failed to improve OS in stages III and IV NSCLC. However, it did extend the LPFS of stage III NSCLC. Furthermore, the ORR was much higher than that of the chemotherapy-only group, and lung cancer clinical symptoms were significantly reduced, improving patient quality of life.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 92-102"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017938","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 : 2025-01-01DOI: 10.1016/j.brachy.2024.07.005
Johan Staby Olsén , Antonios Valachis , Leif Karlsson PhLic , Bengt Johansson
INTRODUCTION
Treating localized high-risk prostate cancer with a combination of external beam radiation therapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) is a common approach. Moderately hypofractionated EBRT and a single HDR-BT boost simplifies the treatment. We aim to present our five-year results.
METHODS
In this study, 355 patients treated with moderately hypofractionated EBRT (42 Gy in 14 fractions) and a single HDR-BT boost (14.5 Gy) at Örebro University Hospital between 2008 and 2018 were included. They were followed with regular PSA tests.
RESULTS
The median age of the cohort was 70 years (range: 51–81) and the median follow-up duration was 56 months (range: 6–150). Among them, 45% were classified as very high-risk, 38% as high-risk and 17% as intermediate-risk. Adjuvant androgen deprivation therapy (ADT) with a median duration of 24 months was given to 75% of the patient cohort. The estimated 5-year failure free survival rates were 79% (whole cohort), 66% (very high-risk), 90% (high-risk) and 85% (intermediate-risk), respectively. Initial PSA > 10 ng/mL, Gleason score 9–10 and tumor stage T3 were significantly associated with biochemical failure (BF). A PSA bounce occurred in 53 (15%) cases and was inversely associated with BF (p = 0.001) for patients receiving ADT.
CONCLUSIONS
Moderately hypofractionated EBRT and a single HDR-BT boost seems to be an effective treatment against intermediate- and high-risk localized prostate cancer. Treatment escalation strategies should be investigated for very high-risk patients where the risk of recurrence remains high.
{"title":"Biochemical outcome of prostate cancer patients treated with hypofractionated external radiation and a single high-dose-rate brachytherapy boost","authors":"Johan Staby Olsén , Antonios Valachis , Leif Karlsson PhLic , Bengt Johansson","doi":"10.1016/j.brachy.2024.07.005","DOIUrl":"10.1016/j.brachy.2024.07.005","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Treating localized high-risk prostate cancer with a combination of external beam radiation therapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) is a common approach. Moderately hypofractionated EBRT and a single HDR-BT boost simplifies the treatment. We aim to present our five-year results.</div></div><div><h3>METHODS</h3><div>In this study, 355 patients treated with moderately hypofractionated EBRT (42 Gy in 14 fractions) and a single HDR-BT boost (14.5 Gy) at Örebro University Hospital between 2008 and 2018 were included. They were followed with regular PSA tests.</div></div><div><h3>RESULTS</h3><div>The median age of the cohort was 70 years (range: 51–81) and the median follow-up duration was 56 months (range: 6–150). Among them, 45% were classified as very high-risk, 38% as high-risk and 17% as intermediate-risk. Adjuvant androgen deprivation therapy (ADT) with a median duration of 24 months was given to 75% of the patient cohort. The estimated 5-year failure free survival rates were 79% (whole cohort), 66% (very high-risk), 90% (high-risk) and 85% (intermediate-risk), respectively. Initial PSA > 10 ng/mL, Gleason score 9–10 and tumor stage T3 were significantly associated with biochemical failure (BF). A PSA bounce occurred in 53 (15%) cases and was inversely associated with BF (<em>p</em> = 0.001) for patients receiving ADT.</div></div><div><h3>CONCLUSIONS</h3><div>Moderately hypofractionated EBRT and a single HDR-BT boost seems to be an effective treatment against intermediate- and high-risk localized prostate cancer. Treatment escalation strategies should be investigated for very high-risk patients where the risk of recurrence remains high.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"Pages 45-53"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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