Brachytherapy最新文献_第6页

American Brachytherapy Society (ABS) rectoprostatic gel spacer consensus statement 美国近距离治疗学会（ABS）直肠前列腺凝胶间隔器共识声明。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-09-21 DOI: 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.

目的：本共识声明提供了基于专家意见和现有最佳证据的建议，用于前列腺癌（PC）患者的明确放射治疗（RT）以及相关不良事件的预防和管理。材料和方法：美国近距离放射治疗学会（ABS）召集了一个由11名医生组成的专家小组，审查RPS在RT治疗PC的决定性治疗中的关键方面。经过小组多次迭代，以完善关于RPS在PC RT中的应用的关键问题和陈述，采用德尔菲共识法产生共识陈述。为了补充专家小组的建议，对外束放射治疗（EBRT）、近距离放射治疗（BT，包括低剂量率（LDR）和高剂量率（HDR））以及EBRT和BT联合治疗PC的前瞻性和回顾性RPS研究进行了回顾，重点关注适应症、预期获益、已知风险和不良事件管理的见解。结果：小组讨论了关于RPS适应症和不良事件的8个关键问题，共27个小节。经过包括小组讨论会议在内的三次匿名调查迭代，对27个审查项目中的24个达成了共识。虽然专家组一致支持RPS用于外束光子放疗、质子放疗和LDR BT单药治疗，但专家组未就RPS用于HDR单药治疗或BT联合EBRT达成共识。除了涉及神经血管束（NVB）肿瘤基台的情况外，大多数情况下对RPS放置的禁忌症达成了共识。就成像指征、知情同意要素和直肠壁浸润（RWI）的处理达成共识。结论：本共识声明总结了目前RPS放置的适应症以及在PC进行最终RT治疗之前潜在不良事件的处理。

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引用次数: 0

Cancer control and toxicity results of chemoradiation for cervical cancer using a three-fraction HDR brachytherapy boost 三段式HDR近距离放射治疗宫颈癌的癌症控制和毒性结果。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-09-16 DOI: 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.

目的：近距离放射治疗是治疗局部晚期宫颈癌的必要手段，但由于治疗资源密集，许多患者没有接受近距离放射治疗。本研究评估了加速三段式近距离治疗方案后的癌症控制和毒性。方法：我们确定了2012-2020年在Kaiser Permanente北加州接受三次高剂量率（HDR）近距离放疗的宫颈癌患者，作为放化疗的一部分。利用现有的医疗记录回顾性地确定治疗细节、肿瘤预后和毒性。主要预后指标为局部复发（LR）。次要结局包括无病生存期（DFS）、总生存期（OS）和≥3级胃肠道（GI）、泌尿和妇科毒性。结果：199例患者（中位年龄52岁）中，46.2%为I-II期，53.8%为III-IV期。总放疗时间中位数为50天，接受≥5个周期顺铂治疗的患者占86.9%。HDR近距离治疗（中位剂量2400 cGy/3）联合EBRT， 92.6%的患者达到D90%≥8000 cGy （EQD2）的高危临床靶体积。2年时，LR为5.6%，DFS为66.2%，OS为80.2%，60岁以上或III-IV期患者的DFS和OS较低（p < 0.001）。9.0%的患者发生≥3级毒性反应，主要是胃肠道（3级6.5%，4-5级1.0%）。泌尿和妇科三级毒性分别为1.5%和1.0%，无4-5级事件。结论：三段式近距离治疗方案显示局部控制，DFS和OS与历史对照组相当，同时保持高级别毒性率

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引用次数: 0

“Reply to letter to the editor” “回复给编辑的信”。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-08-29 DOI: 10.1016/j.brachy.2025.07.005

Christopher L. Deufel

引用次数: 0

Novel low dose rate brachytherapy with focal sparing of neurovascular bundle: Report on the primary outcome from the PRIAPUS trial 新颖的低剂量率近距离神经血管束局部保留治疗：PRIAPUS试验的主要结果报告。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-09-19 DOI: 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.

目的：勃起功能障碍（ED）是任何前列腺癌治疗的常见副作用，而血管保留低剂量率近距离放射治疗（LDR-BT）技术的作用尚未被报道。材料和方法：PRIAPUS （NCT04718987）是一项前瞻性单臂临床试验，旨在评估一种新型LDR BT技术的可行性，该技术旨在避免前列腺神经血管束（NVB）对侧病变。纳入了具有临床意义的前列腺单叶病变的中危前列腺癌患者。主要目标是70%的患者获得可接受的CTV剂量，同时充分保留ed相关结构。在植入后1个月的ct扫描中评估剂量学。结果：15例患者获得同意，14例患者接受临床治疗。术后1个月扫描，平均CTV D90%为152 Gy （SD±10.7 Gy）。除2例患者外，其余患者CTV均为D90% >140 Gy。平均尿道D30%为129% （SD±9%）。平均对侧NVB D50%为60.8 Gy (SD±12.1 Gy)， 14个种植体中有11个未能达到预定目标。未幸免的同侧NVB的平均D50%为128 Gy （SD±32 Gy）。平均阴茎球D10%为31 Gy （SD±13 Gy）。只有2例患者的植入后剂量测定符合所有预先规定的标准。结论：一种新的LDR BT技术能够大幅降低cNVB的剂量，尽管这种减少不符合本试验规定的严格剂量限制。

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引用次数: 0

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” 评论“HDR妇科近距离放疗中应用器重建的准确性如何？”电磁跟踪系统设计用于在辐射输送前拦截错误，从而为患者提供特定结果。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-09-18 DOI: 10.1016/j.brachy.2025.07.006

Rachana Mehta , Ranjana Sah

引用次数: 0

Source position evaluation using X-ray fluoroscopy of the Geneva and Venezia applicators for brachytherapy: An assessment of inter-applicator differences 近距离放射治疗中使用日内瓦和威尼斯涂抹器的x线透视评估源位置：涂抹器间差异的评估。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-08-28 DOI: 10.1016/j.brachy.2025.07.004

Sayaka Kihara , Yoshihiro Ueda , Masahiro Morimoto , Setsuo Tamenaga , Shoki Inui , Akira Masaoka , Yuya Nitta , Masaru Isono , Teiji Nishio , Koji Konishi

PURPOSE

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.

目的：本研究旨在通过x射线透视直接测量铱-192 （192Ir）源位置，评估日内瓦和威尼斯涂抹器间源位置的差异。材料和方法：进行了2至6套Geneva串联和卵形涂抹器和Venezia串联涂抹器的偏移测量。每个涂抹器在最远端位置用192Ir照射，并获得x线透视图像。偏移值测量为从涂抹器尖端到192Ir光源中心的距离。对于两套Venezia卵形涂药器（set 1和set 2）， x线透视图像从最远端位置2毫米处获取。使用涂抹器建模模块将192Ir源位置与预期源位置进行比较。结果：相同类型的施药器中，Geneva串联施药器和卵形施药器的偏移值差异可达0.6 mm， Venezia串联施药器的偏移值差异可达0.3 mm。在所有涂布器中，相同涂布器类型的平均标准差为0.1 mm。对于Venezia卵形涂抹器，第1组涂抹器的192Ir源位置与预期源位置之间的平均差异为0.1 mm（最大值：0.6 mm），第2组涂抹器的-0.2 mm（最大值：0.6 mm）。结论：本研究证明了x线透视直接测量源位置的可行性。这些结果强调需要调试所有涂抹器，但在临床实践中，如果差异在容忍范围内，则无需进行个体表征。

{"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":"2025-11-01","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}

引用次数: 0

Treatment of refractory keloid by postoperative HDR brachytherapy: An 89-month median follow-up retrospective study 术后HDR近距离治疗难治性瘢痕疙瘩：一项中位随访89个月的回顾性研究。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-09-27 DOI: 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.

背景：2009年至2022年期间，圣路易斯医院一组同质队列的瘢痕疙瘩疤痕患者在同一天接受了切除手术，随后接受了HDR近距离放疗。目的：评估长期复发率，寻找影响因素的存在。材料和方法：纳入标准包括一个或多个瘢痕疙瘩的存在和组织学诊断的证实。排除标准包括除单纯切除外的瘢痕疙瘩手术史，以及术中没有直接缝合疤痕。结果：87例瘢痕疙瘩符合分析条件。中位随访89.7个月（IQR: 60.2 ~ 120.2）。34例复发（39%）。在这些复发病例中，41%（14 / 34）瘢痕疙瘩体积明显减小，29%（10 / 34）瘢痕疙瘩体积恢复到原来的大小，29%（10 / 34）瘢痕疙瘩体积增大。1年无复发生存率为0.89[0.45;0.98]，5年无复发生存率为0.67[0.28;0.89]。耳部瘢痕瘤与其他部位相比（HR = 0.38,95% CI: 0.17-0.85, p = 0.02）与较低的复发风险显著相关。男性（HR = 2.13,95% CI: 0.88-5.14, p = 0.09）和既往治疗（HR = 3.44,95% CI: 0.85-13.89, p = 0.08）与复发风险增加相关。结论：与以往的研究相比，我们的研究结果延长了随访时间，并采用了严格的方法，因此我们优先推荐耳内瘢痕瘤的术后近距离治疗，特别是对于之前没有接受过任何治疗的女性。

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引用次数: 0

A novel dose-based intra-preplan method for high-dose-rate brachytherapy in cervical cancer using modeling and optimization algorithms 基于建模和优化算法的宫颈癌高剂量率近距离放疗新剂量内预计划方法。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-09-07 DOI: 10.1016/j.brachy.2025.07.007

Shinya Komori , Yoshiaki Takagawa , Hiroki Sato , Masanori Machida , Masato Kato , Hisao Ouchi , Hiromitsu Endo , Wataru Itano , Takahiro Kato

PURPOSE

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 (CTV_HR) 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 CTV_HR and OARs with significantly fewer catheters (p < 0.01). The addition of catheters did not significantly alter DVH parameters, while their reduction significantly compromised CTV_HR 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.

目的：研究基于剂量的宫颈癌腔内/间质近距离放射治疗（IC/ISBT）方法，根据剂量分布优化导管配置。本研究旨在探讨DIP方法的临床可行性及疗效。方法和材料：DIP方法结合了Oncentra Brachy中的种植体建模功能和混合逆规划优化算法。创建虚拟涂布器和导管模型，并与患者特定的计算机断层图像合并。随后，使用优化算法自动确定最佳导管配置-包括数量，位置和插入深度。回顾性验证了14例使用Geneva涂抹器治疗的IC/ISBT患者的工作流程。在导管数量和高危临床靶体积（CTVHR）和危险器官（OARs）的剂量-体积直方图（DVH）参数方面，比较DIP和传统的intra-preplan （IP）方法的导管配置。为了评估基于dip的配置的最佳性，在改变导管数量后评估DVH参数。结果：成功建立了DIP工作流程。与IP方法相比，DIP方法在CTVHR和OARs中获得了相似的DVH参数，且导管数量明显减少（p HR覆盖率（p ））。结论：DIP方法可以针对患者优化最小导管配置，并支持更广泛地实施高质量的IC/ISBT。

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引用次数: 0

Dosimetric characterization and experimental validation for a low-kV FPXS electronic brachytherapy system 低千伏FPXS电子近距离治疗系统的剂量学特性和实验验证。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-08-22 DOI: 10.1016/j.brachy.2025.07.008

Mengke Qi , Sifu Luo , Jing Kang , Song Kang , Xingyu Lu , Ting He , Liang Cui , Jun Chen , Linghong Zhou , Yuan Xu

PURPOSE

This study aims to evaluate the feasibility of using flat-panel X-ray source (FPXS) for brachytherapy through preclinical animal irradiation experiments.

MATERIAL AND METHODS

A low-kV FPXS electronic brachytherapy (EB) system was constructed for dosimetry measurements and experimental validation. The surface and depth dose characteristics of FPXS were measured employing a 34013 chamber. An FPXS-based EB workflow was established, enabling the calculation of required exposure times for FPXS at a given prescription dose. The accuracy of the delivered dose and the therapeutic efficacy of FPXS irradiation were validated through brachytherapy experiments conducted on murine models with breast cancer.

RESULTS

The FPXS operates with a maximum voltage of up to 50 kV and a maximum surface dose rate exceeding 2.30 Gy/min. The surface dose rate and current demonstrate an exponential increase with voltage, and the dose rate exhibits a linear correlation with the current. The calculated cumulative dose delivered to mice in the experimental group was slightly higher than the average in-field dose measured by film (21.88±0.61 Gy vs. 20.83 ± 1.03 Gy). Following FPXS irradiation, the increase in tumor volume of mice in the experimental group was markedly less pronounced than that observed in the control group, and the survival rate of mice in the experimental group over time was significantly higher than that of the control group (66.67% vs 12.50%).

CONCLUSION

The intensity of FPXS is comparable to current EB systems, and its surface dose rate is adequate for therapeutic applications. Animal irradiation experiments confirm the accuracy of FPXS-delivered doses and demonstrate its efficacy in tumor irradiation.

目的：本研究旨在通过临床前动物辐照实验，评价平板x射线源（FPXS）用于近距离放射治疗的可行性。材料与方法：构建低kv FPXS电子近距离放射治疗（EB）系统，进行剂量学测量和实验验证。采用34013腔室测量了FPXS的表面和深度剂量特性。建立了基于FPXS的EB工作流程，可以计算给定处方剂量下FPXS所需的暴露时间。通过对乳腺癌小鼠模型的近距离放疗实验，验证了FPXS照射剂量的准确性和治疗效果。结果：FPXS的最大工作电压可达50 kV，最大表面剂量率超过2.30 Gy/min。表面剂量率和电流随电压呈指数增长，剂量率与电流呈线性相关。实验组小鼠的计算累积剂量略高于膜法测得的平均场内剂量（21.88±0.61 Gy vs. 20.83 ± 1.03 Gy）。FPXS照射后，实验组小鼠肿瘤体积的增加明显小于对照组，且实验组小鼠随时间的存活率明显高于对照组（66.67% vs 12.50%）。结论：FPXS的强度与现有的EB系统相当，其表面剂量率足以用于治疗。动物辐照实验证实了fpxs给药剂量的准确性，证明了其在肿瘤辐照中的有效性。

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引用次数: 0

A machine learning-based decision support tool for standardizing intracavitary versus interstitial brachytherapy technique selection in high-dose-rate cervical cancer 一种基于机器学习的决策支持工具，用于标准化高剂量率宫颈癌腔内与间质近距离治疗技术选择。

IF 1.8 4区医学 Q4 ONCOLOGY

Brachytherapy

Pub Date : 2025-11-01 Epub Date: 2025-08-20 DOI: 10.1016/j.brachy.2025.07.011

Tomohiro Kajikawa , Koji Masui , Koji Sakai , Tadashi Takenaka , Gen Suzuki , Yuki Yoshino , Hikaru Nemoto , Hideya Yamazaki , Kei Yamada

PURPOSE

To develop and evaluate a machine-learning (ML) decision-support tool that standardizes selection of intracavitary brachytherapy (ICBT) versus hybrid intracavitary/interstitial brachytherapy (IC/ISBT) in high-dose-rate (HDR) cervical cancer.

METHODS AND MATERIALS

We retrospectively analyzed 159 HDR brachytherapy plans from 50 consecutive patients treated between April 2022 and June 2024. Brachytherapy techniques (ICBT or IC/ISBT) were determined by an experienced radiation oncologist using CT/MRI-based 3-D image-guided brachytherapy. For each plan, 144 shape- and distance-based geometric features describing the high-risk clinical target volume (HR-CTV), bladder, rectum, and applicator were extracted. Nested five-fold cross-validation combined minimum-redundancy–maximum-relevance feature selection with five classifiers (k-nearest neighbors, logistic regression, naïve Bayes, random forest, support-vector classifier) and two voting ensembles (hard and soft voting). Model performance was benchmarked against single-factor rules (HR-CTV > 30 cm³; maximum lateral HR-CTV–tandem distance > 25 mm).

RESULTS

Logistic regression achieved the highest test accuracy 0.849 ± 0.023 and a mean area-under-the-curve (AUC) 0.903 ± 0.033, outperforming the volume rule and matching the distance rule’s AUC 0.907 ± 0.057 while providing greater accuracy 0.805 ± 0.114. These differences were not statistically significant. Feature-importance analysis showed that the maximum HR-CTV–tandem lateral distance and the bladder’s minimal short-axis length consistently dominated model decisions.

CONCLUSIONS

A compact ML tool using two readily measurable geometric features can reliably assist clinicians in choosing between ICBT and IC/ISBT, thereby reducing inter-physician variability and promoting standardized HDR cervical brachytherapy technique selection.

目的：开发和评估一种机器学习（ML）决策支持工具，用于标准化高剂量率（HDR）宫颈癌腔内近距离放疗（ICBT）与腔内/间质混合近距离放疗（IC/ISBT）的选择。方法和材料：我们回顾性分析了2022年4月至2024年6月期间连续治疗的50例患者的159个HDR近距离治疗方案。近距离治疗技术（ICBT或IC/ISBT）由经验丰富的放射肿瘤学家使用基于CT/ mri的三维图像引导近距离治疗确定。对于每个方案，提取144个基于形状和距离的几何特征，描述高危临床靶体积（HR-CTV）、膀胱、直肠和涂抹器。嵌套五重交叉验证结合了最小冗余最大相关性特征选择与五个分类器（k近邻，逻辑回归，naïve贝叶斯，随机森林，支持向量分类器）和两个投票集成（硬投票和软投票）。模型性能以单因素规则为基准（HR-CTV > 30 cm³；HR-CTV-tandem最大横向距离> 25 mm）。结果：Logistic回归的最高检验精度为0.849±0.023，平均曲线下面积（AUC）为0.903±0.033，优于体积规则，与距离规则的AUC（0.907±0.057）相匹配，准确度为0.805±0.114。这些差异没有统计学意义。特征重要性分析表明，最大hr - ctv串联侧向距离和膀胱最小短轴长度始终主导着模型决策。结论：使用两个易于测量的几何特征的紧凑ML工具可以可靠地帮助临床医生在ICBT和IC/ISBT之间进行选择，从而减少医生之间的差异，促进标准化的HDR颈椎近距离治疗技术选择。

{"title":"A machine learning-based decision support tool for standardizing intracavitary versus interstitial brachytherapy technique selection in high-dose-rate cervical cancer","authors":"Tomohiro Kajikawa , Koji Masui , Koji Sakai , Tadashi Takenaka , Gen Suzuki , Yuki Yoshino , Hikaru Nemoto , Hideya Yamazaki , Kei Yamada","doi":"10.1016/j.brachy.2025.07.011","DOIUrl":"10.1016/j.brachy.2025.07.011","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To develop and evaluate a machine-learning (ML) decision-support tool that standardizes selection of intracavitary brachytherapy (ICBT) versus hybrid intracavitary/interstitial brachytherapy (IC/ISBT) in high-dose-rate (HDR) cervical cancer.</div></div><div><h3>METHODS AND MATERIALS</h3><div>We retrospectively analyzed 159 HDR brachytherapy plans from 50 consecutive patients treated between April 2022 and June 2024. Brachytherapy techniques (ICBT or IC/ISBT) were determined by an experienced radiation oncologist using CT/MRI-based 3-D image-guided brachytherapy. For each plan, 144 shape- and distance-based geometric features describing the high-risk clinical target volume (HR-CTV), bladder, rectum, and applicator were extracted. Nested five-fold cross-validation combined minimum-redundancy–maximum-relevance feature selection with five classifiers (k-nearest neighbors, logistic regression, naïve Bayes, random forest, support-vector classifier) and two voting ensembles (hard and soft voting). Model performance was benchmarked against single-factor rules (HR-CTV > 30 cm³; maximum lateral HR-CTV–tandem distance > 25 mm).</div></div><div><h3>RESULTS</h3><div>Logistic regression achieved the highest test accuracy 0.849 ± 0.023 and a mean area-under-the-curve (AUC) 0.903 ± 0.033, outperforming the volume rule and matching the distance rule’s AUC 0.907 ± 0.057 while providing greater accuracy 0.805 ± 0.114. These differences were not statistically significant. Feature-importance analysis showed that the maximum HR-CTV–tandem lateral distance and the bladder’s minimal short-axis length consistently dominated model decisions.<!--> </div></div><div><h3>CONCLUSIONS</h3><div>A compact ML tool using two readily measurable geometric features can reliably assist clinicians in choosing between ICBT and IC/ISBT, thereby reducing inter-physician variability and promoting standardized HDR cervical brachytherapy technique selection.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 6","pages":"Pages 863-871"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982382","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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