Pub Date : 2026-01-01DOI: 10.1016/j.brachy.2025.08.007
Prashant Nayak , Supriya Chopra , Yashna Gupta , Washim Saahil , Prachi Mittal , Ankita Gupta , Subhojit Panda , Palak Popat , Sudeep Gupta , Jai Prakash Agarwal , Jayant S. Goda
PURPOSE
We investigated baseline magnetic resonance imaging (MRI) radiomic features for predicting tumor response in patients with locally advanced cervical cancer (LACC) at brachytherapy (BT).
METHODS
Seventy-four patients underwent baseline T2W MRI. Gross tumor volume at diagnosis (GTV-T initial) was delineated. Tumor radiomic features were extracted using TexRAD software. Feature enrichment using parameters indicative of response was done using least absolute shrinkage and selection operator (LASSO) regression. The support vector machine (SVM) algorithm was used to generate the model. Response to chemo-radiotherapy was based on the criteria GTV-BT/GTV-T initial ratio < or >0.20 was used for classifying good versus poor responders.
RESULTS
Fifty-six radiomic features were extracted. LASSO enriched the number of features to 11 for the GTV-BT/GTV-T initial ratio. The SVM classifier with a 10-fold internal cross-validation demonstrated an AUC of 0.82 and 76.8% accuracy when the response was assessed using the GTV-BT/GTV-T initial ratio for response evaluation. When SVM was modeled using clinical features, the AUC was 0.55, and the accuracy was 62.6% for the GTV-BT/GTV-T initial ratio,
CONCLUSION
Machine learning model employing radiomic features extracted from pre-treatment MRI reliably predicted treatment response in patients with LACC.
{"title":"Radiomics-based machine-learning approach to predict response at brachytherapy using pretreatment magnetic resonance imaging in locally advanced cervical cancer","authors":"Prashant Nayak , Supriya Chopra , Yashna Gupta , Washim Saahil , Prachi Mittal , Ankita Gupta , Subhojit Panda , Palak Popat , Sudeep Gupta , Jai Prakash Agarwal , Jayant S. Goda","doi":"10.1016/j.brachy.2025.08.007","DOIUrl":"10.1016/j.brachy.2025.08.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>We investigated baseline magnetic resonance imaging (MRI) radiomic features for predicting tumor response in patients with locally advanced cervical cancer (LACC) at brachytherapy (BT).</div></div><div><h3>METHODS</h3><div>Seventy-four patients underwent baseline T2W MRI. Gross tumor volume at diagnosis (GTV-T initial) was delineated. Tumor radiomic features were extracted using TexRAD software. Feature enrichment using parameters indicative of response was done using least absolute shrinkage and selection operator (LASSO) regression. The support vector machine (SVM) algorithm was used to generate the model. Response to chemo-radiotherapy was based on the criteria GTV-BT/GTV-T initial ratio < or >0.20 was used for classifying good versus poor responders.</div></div><div><h3>RESULTS</h3><div>Fifty-six radiomic features were extracted. LASSO enriched the number of features to 11 for the GTV-BT/GTV-T initial ratio. The SVM classifier with a 10-fold internal cross-validation demonstrated an AUC of 0.82 and 76.8% accuracy when the response was assessed using the GTV-BT/GTV-T initial ratio for response evaluation. When SVM was modeled using clinical features, the AUC was 0.55, and the accuracy was 62.6% for the GTV-BT/GTV-T initial ratio,</div></div><div><h3>CONCLUSION</h3><div>Machine learning model employing radiomic features extracted from pre-treatment MRI reliably predicted treatment response in patients with LACC.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 74-84"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423536","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 : 2026-01-01DOI: 10.1016/j.brachy.2025.10.013
Gil’ad N. Cohen, Jason Gurewitz, Jennifer Johnson, Jeffrey Cooney, Yuhao Shi, Harry Adler, Matthew Long, David J. Byun , Michael J. Zelefsky
Purpose
Optimizing radiotherapy delivery for higher-risk prostate cancer often requires dose escalation while minimizing dose to surrounding normal tissues. We report on the feasibility of combining high-dose-rate (HDR) brachytherapy with dose intensification to the dominant intra-prostatic lesion (DIL) followed by magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT).
Methods and Materials
Eighty-eight patients were treated with a single fraction of 15-Gy HDR brachytherapy boost followed by MRgSBRT to prostate, or prostate and pelvic lymph nodes, to a dose of 25 Gy in five fractions. The DIL noted on multi-parametric MR imaging was defined as a PIRADS-4/-5 lesion with an associated diffusion-weighted abnormality(s), and was intraoperatively boosted during brachytherapy to 120% of the prescription dose. Dosimetric objectives included D99% >120% to the DIL, D1% <120% for the urethra and D1cc <80% for the rectum. Real-time adaptive SBRT was delivered with a 1.5-T Unity MR Linac.
Results
For the HDR procedure, the mean prostate and DIL D90% were 108.3% ± 2.7% and 135.9% ± 12.2%, respectively. Mean urethra Dmax and D20% were 116.5% ± 4.5% and 108.2% ± 3.8%, respectively. Mean rectal V100 and D1cc were 0.0 ± 0.0cc and 73.6% ± 7.0%, respectively. DIL objective was not met in two lesions owing to proximity of the urethra and bladder neck. At a median follow-up of 6.8 months, Grade 2 genitourinary acute toxicity was observed in 33% of patients and Grade 2 acute gastrointestinal toxicity was observed in 1%.
Conclusions
HDR boost with dose escalation to the DIL in combination with MRgSBRT is a feasible and effective treatment protocol. No significant genitourinary or gastrointestinal acute toxicity was observed.
{"title":"Feasibility of combining high-dose-rate prostate brachytherapy with dose intensification to the MRI dominant lesion followed by real-time adaptive MR-guided pelvic radiotherapy for high-risk prostate cancer","authors":"Gil’ad N. Cohen, Jason Gurewitz, Jennifer Johnson, Jeffrey Cooney, Yuhao Shi, Harry Adler, Matthew Long, David J. Byun , Michael J. Zelefsky","doi":"10.1016/j.brachy.2025.10.013","DOIUrl":"10.1016/j.brachy.2025.10.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Optimizing radiotherapy delivery for higher-risk prostate cancer often requires dose escalation while minimizing dose to surrounding normal tissues. We report on the feasibility of combining high-dose-rate (HDR) brachytherapy with dose intensification to the dominant intra-prostatic lesion (DIL) followed by magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT).</div></div><div><h3>Methods and Materials</h3><div>Eighty-eight patients were treated with a single fraction of 15-Gy HDR brachytherapy boost followed by MRgSBRT to prostate, or prostate and pelvic lymph nodes, to a dose of 25 Gy in five fractions. The DIL noted on multi-parametric MR imaging was defined as a PIRADS-4/-5 lesion with an associated diffusion-weighted abnormality(s), and was intraoperatively boosted during brachytherapy to 120% of the prescription dose. Dosimetric objectives included D99% >120% to the DIL, D1% <120% for the urethra and D1cc <80% for the rectum. Real-time adaptive SBRT was delivered with a 1.5-T Unity MR Linac.</div></div><div><h3>Results</h3><div>For the HDR procedure, the mean prostate and DIL D90% were 108.3% ± 2.7% and 135.9% ± 12.2%, respectively. Mean urethra Dmax and D20% were 116.5% ± 4.5% and 108.2% ± 3.8%, respectively. Mean rectal V100 and D1cc were 0.0 ± 0.0cc and 73.6% ± 7.0%, respectively. DIL objective was not met in two lesions owing to proximity of the urethra and bladder neck. At a median follow-up of 6.8 months, Grade 2 genitourinary acute toxicity was observed in 33% of patients and Grade 2 acute gastrointestinal toxicity was observed in 1%.</div></div><div><h3>Conclusions</h3><div>HDR boost with dose escalation to the DIL in combination with MRgSBRT is a feasible and effective treatment protocol. No significant genitourinary or gastrointestinal acute toxicity was observed.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"25 1","pages":"Pages 235-240"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535195","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 : 2025-09-27DOI: 10.1016/j.brachy.2025.08.003
Matthias Grobien , Laurent Quero , Marc Chaouat , Guillaume Mulier , Gabriel Thiriez , Kevin Serror , David Boccara
BACKGROUND
Between 2009 and 2022, a homogenous cohort of patients at Saint-Louis hospital affected by keloid scars undergone excision surgery followed by HDR brachytherapy on the same day.
PURPOSE
To assess the percentage of long-term recurrence and look for the presence of influencing factors.
MATERIALS AND METHODS
Inclusion criteria included the presence of one or more keloid scars and histological confirmation of the diagnosis. Exclusion criteria comprised a history of keloid surgery other than simple excision, and the absence of intraoperative direct suturing of the scar.
RESULTS
A total of 87 keloids scare were eligible for the analysis. Median follow-up was 89,7 months (IQR: 60.2–120.2). 34 recurrences (39%) were observed. Of these recurrences, 41% (14 of 34) showed a significant reduction in keloid volume, 29% (10 of 34) returned to the original keloid volume, and 29% (10 of 34) demonstrated an increase in volume. The recurrence-free survival for all cheloid was 0.89 [0.45;0.98] at one year and 0.67 [0.28;0.89] at 5 years. Keloid of the ear compared to other sites (HR = 0.38, 95% CI: 0.17–0.85, p = 0.02) was significantly associated with a lower recurrence risk. Male sex (HR = 2.13, 95% CI: 0.88–5.14, p = 0.09) and prior treatment (HR = 3.44, 95% CI: 0.85–13.89, p = 0.08) were associated with an increased recurrence risk.
CONCLUSION
With a prolonged follow-up and a rigorous methodology compared to previous studies, our results lead us to preferentially recommend postoperative brachytherapy for keloid located in the ears, especially for women without any previous treatment.
{"title":"Treatment of refractory keloid by postoperative HDR brachytherapy: An 89-month median follow-up retrospective study","authors":"Matthias Grobien , Laurent Quero , Marc Chaouat , Guillaume Mulier , Gabriel Thiriez , Kevin Serror , David Boccara","doi":"10.1016/j.brachy.2025.08.003","DOIUrl":"10.1016/j.brachy.2025.08.003","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Between 2009 and 2022, a homogenous cohort of patients at Saint-Louis hospital affected by keloid scars undergone excision surgery followed by HDR brachytherapy on the same day.</div></div><div><h3>PURPOSE</h3><div>To assess the percentage of long-term recurrence and look for the presence of influencing factors.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Inclusion criteria included the presence of one or more keloid scars and histological confirmation of the diagnosis. Exclusion criteria comprised a history of keloid surgery other than simple excision, and the absence of intraoperative direct suturing of the scar.</div></div><div><h3>RESULTS</h3><div>A total of 87 keloids scare were eligible for the analysis. Median follow-up was 89,7 months (IQR: 60.2–120.2). 34 recurrences (39%) were observed. Of these recurrences, 41% (14 of 34) showed a significant reduction in keloid volume, 29% (10 of 34) returned to the original keloid volume, and 29% (10 of 34) demonstrated an increase in volume. The recurrence-free survival for all cheloid was 0.89 [0.45;0.98] at one year and 0.67 [0.28;0.89] at 5 years. Keloid of the ear compared to other sites (HR = 0.38, 95% CI: 0.17–0.85, <em>p</em> = 0.02) was significantly associated with a lower recurrence risk. Male sex (HR = 2.13, 95% CI: 0.88–5.14, <em>p</em> = 0.09) and prior treatment (HR = 3.44, 95% CI: 0.85–13.89, <em>p</em> = 0.08) were associated with an increased recurrence risk.</div></div><div><h3>CONCLUSION</h3><div>With a prolonged follow-up and a rigorous methodology compared to previous studies, our results lead us to preferentially recommend postoperative brachytherapy for keloid located in the ears, especially for women without any previous treatment.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 940-948"},"PeriodicalIF":1.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182354","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 : 2025-09-21DOI: 10.1016/j.brachy.2025.07.013
Aurelie Garant , Craig E. Grossman , Martin T. King , Arun Goel , Emily S. Weg , Daniel N. Costa , Hong Zhang , Jeffrey C. Gahan , Khush Aujla , Lara Hathout , Michael R. Folkert
PURPOSE
This consensus statement provides recommendations based on expert opinion and best available evidence for the use of rectoprostatic gel spacers (RPS) in the setting of definitive radiation therapy (RT) for men with prostate cancer (PC) and the prevention and management of associated adverse events.
MATERIALS AND METHODS
The American Brachytherapy Society (ABS) assembled an expert panel of 11 physicians to review key aspects of RPS in the definitive treatment of PC with RT. After multiple iterations by the panel to refine key questions and statements regarding RPS utilization in PC RT, a Delphi consensus method was employed to generate consensus statements. A review of prospective and retrospective RPS studies in the setting of external beam RT (EBRT), brachytherapy (BT, including low dose rate (LDR) and high dose rate (HDR)), and combinations of EBRT and BT for treatment of PC was performed to complement the expert panel’s recommendations, focused on indications, expected benefits, known risks, and insights on adverse event management.
RESULTS
A total of eight key questions with a total of 27 subsections regarding RPS indications and adverse events were addressed by the panel. Following three anonymized survey iterations which included panel discussion meetings, consensus statements were reached for 24 of the 27 reviewed items. While the panel reached consensus in support of RPS for external beam photon RT, proton RT, and LDR BT monotherapy, the panel did not reach consensus on the use of RPS for HDR monotherapy or combination BT with EBRT. Consensus was reached in most cases for contraindications to RPS placement, except for scenarios involving tumor abutment of the neurovascular bundle (NVB). Consensus was reached for imaging indications, elements of informed consent, and management of rectal wall infiltration (RWI).
CONCLUSIONS
This consensus statement summarizes the current indications for RPS placement and the management of potential adverse events prior to proceeding with definitive RT for PC.
{"title":"American Brachytherapy Society (ABS) rectoprostatic gel spacer consensus statement","authors":"Aurelie Garant , Craig E. Grossman , Martin T. King , Arun Goel , Emily S. Weg , Daniel N. Costa , Hong Zhang , Jeffrey C. Gahan , Khush Aujla , Lara Hathout , Michael R. Folkert","doi":"10.1016/j.brachy.2025.07.013","DOIUrl":"10.1016/j.brachy.2025.07.013","url":null,"abstract":"<div><h3>PURPOSE</h3><div>This consensus statement provides recommendations based on expert opinion and best available evidence for the use of rectoprostatic gel spacers (RPS) in the setting of definitive radiation therapy (RT) for men with prostate cancer (PC) and the prevention and management of associated adverse events.</div></div><div><h3>MATERIALS AND METHODS</h3><div>The American Brachytherapy Society (ABS) assembled an expert panel of 11 physicians to review key aspects of RPS in the definitive treatment of PC with RT. After multiple iterations by the panel to refine key questions and statements regarding RPS utilization in PC RT, a Delphi consensus method was employed to generate consensus statements. A review of prospective and retrospective RPS studies in the setting of external beam RT (EBRT), brachytherapy (BT, including low dose rate (LDR) and high dose rate (HDR)), and combinations of EBRT and BT for treatment of PC was performed to complement the expert panel’s recommendations, focused on indications, expected benefits, known risks, and insights on adverse event management.</div></div><div><h3>RESULTS</h3><div>A total of eight key questions with a total of 27 subsections regarding RPS indications and adverse events were addressed by the panel. Following three anonymized survey iterations which included panel discussion meetings, consensus statements were reached for 24 of the 27 reviewed items. While the panel reached consensus in support of RPS for external beam photon RT, proton RT, and LDR BT monotherapy, the panel did not reach consensus on the use of RPS for HDR monotherapy or combination BT with EBRT. Consensus was reached in most cases for contraindications to RPS placement, except for scenarios involving tumor abutment of the neurovascular bundle (NVB). Consensus was reached for imaging indications, elements of informed consent, and management of rectal wall infiltration (RWI).</div></div><div><h3>CONCLUSIONS</h3><div>This consensus statement summarizes the current indications for RPS placement and the management of potential adverse events prior to proceeding with definitive RT for PC.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 833-843"},"PeriodicalIF":1.8,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115374","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 : 2025-09-19DOI: 10.1016/j.brachy.2025.08.002
Lucas C. Mendez , Douglas A. Hoover , Matt Mulligan , Rohann J.M. Correa , Vikram Velker , Joelle Helou , Samih Mohamed , Aneesh Dhar , Maria Thereza Starling , Aaron Fenster , Gary Brahm , Glenn Bauman , David D’Souza , Jason Vickress
PURPOSE
Erectile dysfunction (ED) is a common side effect of any prostate cancer treatment and the role of vessel-sparing low dose rate brachytherapy (LDR-BT) technique has not been previously described.
MATERIALS AND METHODS
PRIAPUS (NCT 04718987) is a prospective, single-arm clinical trial evaluating feasibility of a novel LDR BT technique designed to spare the prostatic neurovascular bundles (NVB) contralateral to the index lesion. Intermediate-risk prostate cancer patients with clinically significant disease contained to one lobe of the prostate were enrolled. Primary objective was for 70% of patients to achieve acceptable dose to CTV while sufficiently sparing ED-related structures. Dosimetry was evaluated on a 1-month postimplant CT-scan.
RESULTS
Fifteen patients have been consented with 14 patients treated on trial. In the 1-month postprocedure scan, the mean CTV D90% was 152 Gy (SD ± 10.7 Gy). All patients but two had a CTV D90% >140 Gy. The mean urethra D30% was 129% (SD ± 9%). The mean contralateral NVB D50% was 60.8 Gy (SD ± 12.1 Gy), with 11 of 14 implants failing to meet the prespecified goal. The ipsilateral NVB which was not spared received a mean D50% of 128 Gy (SD ± 32 Gy). The mean penile bulb D10% was 31 Gy (SD ± 13 Gy). Only 2 patients had a postimplant dosimetry that met all prespecified criteria.
CONCLUSIONS
A novel LDR BT technique is capable of drastically reduce dose to the cNVB, although this reduction did not meet the stringent dose constraints specified in this trial.
{"title":"Novel low dose rate brachytherapy with focal sparing of neurovascular bundle: Report on the primary outcome from the PRIAPUS trial","authors":"Lucas C. Mendez , Douglas A. Hoover , Matt Mulligan , Rohann J.M. Correa , Vikram Velker , Joelle Helou , Samih Mohamed , Aneesh Dhar , Maria Thereza Starling , Aaron Fenster , Gary Brahm , Glenn Bauman , David D’Souza , Jason Vickress","doi":"10.1016/j.brachy.2025.08.002","DOIUrl":"10.1016/j.brachy.2025.08.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Erectile dysfunction (ED) is a common side effect of any prostate cancer treatment and the role of vessel-sparing low dose rate brachytherapy (LDR-BT) technique has not been previously described.</div></div><div><h3>MATERIALS AND METHODS</h3><div>PRIAPUS (NCT 04718987) is a prospective, single-arm clinical trial evaluating feasibility of a novel LDR BT technique designed to spare the prostatic neurovascular bundles (NVB) contralateral to the index lesion. Intermediate-risk prostate cancer patients with clinically significant disease contained to one lobe of the prostate were enrolled. Primary objective was for 70% of patients to achieve acceptable dose to CTV while sufficiently sparing ED-related structures. Dosimetry was evaluated on a 1-month postimplant CT-scan.</div></div><div><h3>RESULTS</h3><div>Fifteen patients have been consented with 14 patients treated on trial. In the 1-month postprocedure scan, the mean CTV D90% was 152 Gy (SD ± 10.7 Gy). All patients but two had a CTV D90% >140 Gy. The mean urethra D30% was 129% (SD ± 9%). The mean contralateral NVB D50% was 60.8 Gy (SD ± 12.1 Gy), with 11 of 14 implants failing to meet the prespecified goal. The ipsilateral NVB which was not spared received a mean D50% of 128 Gy (SD ± 32 Gy). The mean penile bulb D10% was 31 Gy (SD ± 13 Gy). Only 2 patients had a postimplant dosimetry that met all prespecified criteria.</div></div><div><h3>CONCLUSIONS</h3><div>A novel LDR BT technique is capable of drastically reduce dose to the cNVB, although this reduction did not meet the stringent dose constraints specified in this trial.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 924-930"},"PeriodicalIF":1.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103157","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 : 2025-09-18DOI: 10.1016/j.brachy.2025.07.006
Rachana Mehta , Ranjana Sah
{"title":"Comment on “How accurate is applicator reconstruction in HDR gynecological brachytherapy? Patient-specific results from an electromagnetic tracking system designed to intercept errors before radiation delivery”","authors":"Rachana Mehta , Ranjana Sah","doi":"10.1016/j.brachy.2025.07.006","DOIUrl":"10.1016/j.brachy.2025.07.006","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 961-962"},"PeriodicalIF":1.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093012","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 : 2025-09-16DOI: 10.1016/j.brachy.2025.07.014
Chinmayi Aryasomayajula , Melody J. Xu , Cheukkai B. Hui , Michael L. Wong , Rajni Sethi , Subir Nag , L. Matthew Scala , Christopher H. Chapman
OBJECTIVE
Brachytherapy is essential for treating locally advanced cervical cancer, but many patients do not receive it due to the resource-intensive nature of the treatment. This study assessed cancer control and toxicity following an accelerated 3-fraction brachytherapy protocol.
METHODS
We identified patients with cervical cancer who received high-dose-rate (HDR) brachytherapy in three fractions as part of chemoradiation at Kaiser Permanente Northern California from 2012–2020. Treatment details, oncologic outcomes and toxicity were determined retrospectively using available medical records. The primary outcome was local recurrence (LR). Secondary outcomes included disease-free survival (DFS), overall survival (OS), and grade ≥3 gastrointestinal (GI), urinary, and gynecologic toxicities.
RESULTS
Among 199 patients (median age 52 years), 46.2% had Stage I-II and 53.8% had Stage III-IV disease. The median total radiotherapy duration was 50 days, with ≥5 cycles of cisplatin received by 86.9%. HDR brachytherapy (median dose 2400 cGy/3 fractions) was combined with EBRT, achieving D90% ≥8000 cGy (EQD2) to the high-risk clinical target volume in 92.6% of patients. At 2 years, LR was 5.6%, DFS 66.2%, and OS 80.2%, with lower DFS and OS in patients over 60 or with Stage III-IV disease (p < 0.001). Grade ≥3 toxicities occurred in 9.0% of patients, primarily GI (6.5% grade 3, 1.0% grade 4-5). Urinary and gynecologic grade three toxicities were 1.5% and 1.0%, respectively, with no grade 4–5 events.
CONCLUSIONS
A 3-fraction brachytherapy protocol demonstrated local control, DFS, and OS comparable to historical controls while maintaining high grade toxicity rates <10%. This approach reduces resource use and may improve treatment access for cervical cancer patients.
{"title":"Cancer control and toxicity results of chemoradiation for cervical cancer using a three-fraction HDR brachytherapy boost","authors":"Chinmayi Aryasomayajula , Melody J. Xu , Cheukkai B. Hui , Michael L. Wong , Rajni Sethi , Subir Nag , L. Matthew Scala , Christopher H. Chapman","doi":"10.1016/j.brachy.2025.07.014","DOIUrl":"10.1016/j.brachy.2025.07.014","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Brachytherapy is essential for treating locally advanced cervical cancer, but many patients do not receive it due to the resource-intensive nature of the treatment. This study assessed cancer control and toxicity following an accelerated 3-fraction brachytherapy protocol.</div></div><div><h3>METHODS</h3><div>We identified patients with cervical cancer who received high-dose-rate (HDR) brachytherapy in three fractions as part of chemoradiation at Kaiser Permanente Northern California from 2012–2020. Treatment details, oncologic outcomes and toxicity were determined retrospectively using available medical records. The primary outcome was local recurrence (LR). Secondary outcomes included disease-free survival (DFS), overall survival (OS), and grade ≥3 gastrointestinal (GI), urinary, and gynecologic toxicities.</div></div><div><h3>RESULTS</h3><div>Among 199 patients (median age 52 years), 46.2% had Stage I-II and 53.8% had Stage III-IV disease. The median total radiotherapy duration was 50 days, with ≥5 cycles of cisplatin received by 86.9%. HDR brachytherapy (median dose 2400 cGy/3 fractions) was combined with EBRT, achieving D90% ≥8000 cGy (EQD2) to the high-risk clinical target volume in 92.6% of patients. At 2 years, LR was 5.6%, DFS 66.2%, and OS 80.2%, with lower DFS and OS in patients over 60 or with Stage III-IV disease (<em>p</em> < 0.001). Grade ≥3 toxicities occurred in 9.0% of patients, primarily GI (6.5% grade 3, 1.0% grade 4-5). Urinary and gynecologic grade three toxicities were 1.5% and 1.0%, respectively, with no grade 4–5 events.</div></div><div><h3>CONCLUSIONS</h3><div>A 3-fraction brachytherapy protocol demonstrated local control, DFS, and OS comparable to historical controls while maintaining high grade toxicity rates <10%. This approach reduces resource use and may improve treatment access for cervical cancer patients.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 883-889"},"PeriodicalIF":1.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082660","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}
This study presents the dose-based intra-preplan (DIP) method for intracavitary/interstitial brachytherapy (IC/ISBT) in cervical cancer, optimizing catheter configurations based on dose distribution. This study aimed to assess the DIP method’s clinical feasibility and efficacy.
METHODS AND MATERIALS
The DIP method incorporates the implant modeling function and the hybrid inverse planning optimization algorithm in Oncentra Brachy. Virtual applicator and catheter models were created and merged with patient-specific computed tomography images. Subsequently, an optimization algorithm was used to automatically determine the optimal catheter configuration—including the number, positions, and insertion depths. The workflow was retrospectively validated in 14 IC/ISBT patients treated with the Geneva applicators. Catheter configurations from the DIP and conventional intra-preplan (IP) methods were compared in terms of catheter number and dose-volume histogram (DVH) parameters for high-risk clinical target volume (CTVHR) and organs at risk (OARs). To evaluate the optimality of the DIP-based configurations, DVH parameters were assessed after changing the number of catheters.
RESULTS
The DIP workflow was successfully established. Compared to the IP method, the DIP method achieved similar DVH parameters for both CTVHR and OARs with significantly fewer catheters (p < 0.01). The addition of catheters did not significantly alter DVH parameters, while their reduction significantly compromised CTVHR coverage (p < 0.01) and increased OAR doses (p < 0.05).
CONCLUSIONS
The DIP method enables patient-specific optimization of minimal catheter configurations and supports the broader implementation of high-quality IC/ISBT.
{"title":"A novel dose-based intra-preplan method for high-dose-rate brachytherapy in cervical cancer using modeling and optimization algorithms","authors":"Shinya Komori , Yoshiaki Takagawa , Hiroki Sato , Masanori Machida , Masato Kato , Hisao Ouchi , Hiromitsu Endo , Wataru Itano , Takahiro Kato","doi":"10.1016/j.brachy.2025.07.007","DOIUrl":"10.1016/j.brachy.2025.07.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>This study presents the dose-based intra-preplan (DIP) method for intracavitary/interstitial brachytherapy (IC/ISBT) in cervical cancer, optimizing catheter configurations based on dose distribution. This study aimed to assess the DIP method’s clinical feasibility and efficacy.</div></div><div><h3>METHODS AND MATERIALS</h3><div>The DIP method incorporates the implant modeling function and the hybrid inverse planning optimization algorithm in Oncentra Brachy. Virtual applicator and catheter models were created and merged with patient-specific computed tomography images. Subsequently, an optimization algorithm was used to automatically determine the optimal catheter configuration—including the number, positions, and insertion depths. The workflow was retrospectively validated in 14 IC/ISBT patients treated with the Geneva applicators. Catheter configurations from the DIP and conventional intra-preplan (IP) methods were compared in terms of catheter number and dose-volume histogram (DVH) parameters for high-risk clinical target volume (CTV<sub>HR</sub>) and organs at risk (OARs). To evaluate the optimality of the DIP-based configurations, DVH parameters were assessed after changing the number of catheters.</div></div><div><h3>RESULTS</h3><div>The DIP workflow was successfully established. Compared to the IP method, the DIP method achieved similar DVH parameters for both CTV<sub>HR</sub> and OARs with significantly fewer catheters (<em>p</em> < 0.01). The addition of catheters did not significantly alter DVH parameters, while their reduction significantly compromised CTV<sub>HR</sub> coverage (<em>p</em> < 0.01) and increased OAR doses (<em>p</em> < 0.05).</div></div><div><h3>CONCLUSIONS</h3><div>The DIP method enables patient-specific optimization of minimal catheter configurations and supports the broader implementation of high-quality IC/ISBT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 911-923"},"PeriodicalIF":1.8,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017003","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 : 2025-08-29DOI: 10.1016/j.brachy.2025.07.005
Christopher L. Deufel
{"title":"“Reply to letter to the editor”","authors":"Christopher L. Deufel","doi":"10.1016/j.brachy.2025.07.005","DOIUrl":"10.1016/j.brachy.2025.07.005","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 963-964"},"PeriodicalIF":1.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982353","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}
This study aimed to evaluate the inter-applicator differences in source positions of the Geneva and Venezia applicators by using X-ray fluoroscopy to perform direct measurements of iridium-192 (192Ir) source positions.
MATERIALS AND METHODS
Offset measurements of two to six sets of Geneva tandem and ovoid applicators and Venezia tandem applicators were performed. Each applicator was irradiated with 192Ir at the most distal position and X-ray fluoroscopy images were acquired. The offset values were measured as the distance from the applicator tip to the center of 192Ir source. For two sets of the Venezia ovoid applicators (set 1 and set 2), X-ray fluoroscopy images were acquired at a 2-mm step from the most distal position. The 192Ir source positions were compared with the expected source positions using an applicator modeling module.
RESULTS
The differences in offset values of the same types of applicators were up to 0.6 mm for Geneva tandem and ovoid applicators and 0.3 mm for Venezia tandem applicators. The mean standard deviation calculated for the same applicator types was 0.1 mm across all applicators. For Venezia ovoid applicators, the mean difference between 192Ir source positions and expected source positions were 0.1 mm for the set 1 applicator (maximum: 0.6 mm) and −0.2 mm for the set 2 applicator (maximum: 0.6 mm).
CONCLUSION
This study demonstrated the feasibility of direct source position measurements using X-ray fluoroscopy. These results emphasize the need for commissioning all applicator, but individual characterization is unnecessary in clinical practice if differences fall within tolerance.
{"title":"Source position evaluation using X-ray fluoroscopy of the Geneva and Venezia applicators for brachytherapy: An assessment of inter-applicator differences","authors":"Sayaka Kihara , Yoshihiro Ueda , Masahiro Morimoto , Setsuo Tamenaga , Shoki Inui , Akira Masaoka , Yuya Nitta , Masaru Isono , Teiji Nishio , Koji Konishi","doi":"10.1016/j.brachy.2025.07.004","DOIUrl":"10.1016/j.brachy.2025.07.004","url":null,"abstract":"<div><h3>PURPOSE</h3><div>This study aimed to evaluate the inter-applicator differences in source positions of the Geneva and Venezia applicators by using X-ray fluoroscopy to perform direct measurements of iridium-192 (<sup>192</sup>Ir) source positions.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Offset measurements of two to six sets of Geneva tandem and ovoid applicators and Venezia tandem applicators were performed. Each applicator was irradiated with <sup>192</sup>Ir at the most distal position and X-ray fluoroscopy images were acquired. The offset values were measured as the distance from the applicator tip to the center of <sup>192</sup>Ir source. For two sets of the Venezia ovoid applicators (set 1 and set 2), X-ray fluoroscopy images were acquired at a 2-mm step from the most distal position. The <sup>192</sup>Ir source positions were compared with the expected source positions using an applicator modeling module.</div></div><div><h3>RESULTS</h3><div>The differences in offset values of the same types of applicators were up to 0.6 mm for Geneva tandem and ovoid applicators and 0.3 mm for Venezia tandem applicators. The mean standard deviation calculated for the same applicator types was 0.1 mm across all applicators. For Venezia ovoid applicators, the mean difference between <sup>192</sup>Ir source positions and expected source positions were 0.1 mm for the set 1 applicator (maximum: 0.6 mm) and −0.2 mm for the set 2 applicator (maximum: 0.6 mm).</div></div><div><h3>CONCLUSION</h3><div>This study demonstrated the feasibility of direct source position measurements using X-ray fluoroscopy. These results emphasize the need for commissioning all applicator, but individual characterization is unnecessary in clinical practice if differences fall within tolerance.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 890-899"},"PeriodicalIF":1.8,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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