Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.053
Alexandra Timea Kirsch Mangu (Medical Doctor)
<div><h3>Purpose</h3><div>There are no international guidelines for optimal needle insertion method during interstitial intracavitary brachytherapy (IS-ICBT) for cervical cancer. We aimed to investigate the clinical feasibility and added value of Three-dimensional computed tomography angiography (3D-CTA) reconstruction of the origin of the uterine artery and its clinical significance guidance to optimize needle insertion in IS-ICBT using the interstitial cylinder applicator and Aarhus ring and Vienna Ring and to evaluate acute complications after needle insertion.</div></div><div><h3>Materials and Methods</h3><div>We enrolled 85 patients with locally advanced cervical cancer (stage II to IIIC2) which were evaluated for in IS-BT at the Oncology Institute Ion Chiricuță Cluj-Napoca, Romania Department of Radiation Oncology. We performed for every patient a 3D-CTA before the needle implantation, in order to visualise uterine artery and its ascending/descending branches . Using 3D-CTA and reconstructed images of adaptive iterative dose resolution 3D (AIDR 3D) with display field of view (D-FOV), which are suitable for arteries with large and small diameters, and created the fusion images. Created images allowed the visual observation of vessel branch and by this technique we could determine optimal needle locations and insertion lengths based on the vessels position in order to avoid needle penetration of the artery or the proximity organs. The needle-channel axis was used as a reference to determine needle insertion. After the needle insertion based on the 3D-CTA another CT was performed for the contouring of the needles. Postinsertion adverse events were recorded during inpatient stay and at 6-week followup.</div></div><div><h3>Results</h3><div>Median followup time was at least 3 months. All patients were initially treated with external beam radiation therapy, median dose of 45 Gy. A total of 170 insertions were performed. No patient presented massive hemorrage because due to the 3D-CTA we were able to know exactly where the uterine artery or the branches are positioned and we avoided the penetration.When we performed the planning CT, there were no radiological evidence of needle intrusion(s) into the pelvic organs and no gastrointestinal complications were found. In this study, only 5 patients with grade 1 thrombocytopenia had minor vaginal bleeding after needle removal which was autolimited. The insertion of the needles was made under general anesteshia. Our results indicated that dizziness, nausea, and vomiting happened to be a constant side effect in this patients because of the general anestesia, but the side effects were acceptable. According to our findings, the most frequent acute adverse impact experienced by patients upon awakening from anaesthesia was pain. Patients experienced varying degrees of discomfort during the brachytherapy procedure. This could lead patients to reposition and alter the position of the applicator and needles, poten
{"title":"GSOR07 Presentation Time: 5:30 PM","authors":"Alexandra Timea Kirsch Mangu (Medical Doctor)","doi":"10.1016/j.brachy.2024.08.053","DOIUrl":"10.1016/j.brachy.2024.08.053","url":null,"abstract":"<div><h3>Purpose</h3><div>There are no international guidelines for optimal needle insertion method during interstitial intracavitary brachytherapy (IS-ICBT) for cervical cancer. We aimed to investigate the clinical feasibility and added value of Three-dimensional computed tomography angiography (3D-CTA) reconstruction of the origin of the uterine artery and its clinical significance guidance to optimize needle insertion in IS-ICBT using the interstitial cylinder applicator and Aarhus ring and Vienna Ring and to evaluate acute complications after needle insertion.</div></div><div><h3>Materials and Methods</h3><div>We enrolled 85 patients with locally advanced cervical cancer (stage II to IIIC2) which were evaluated for in IS-BT at the Oncology Institute Ion Chiricuță Cluj-Napoca, Romania Department of Radiation Oncology. We performed for every patient a 3D-CTA before the needle implantation, in order to visualise uterine artery and its ascending/descending branches . Using 3D-CTA and reconstructed images of adaptive iterative dose resolution 3D (AIDR 3D) with display field of view (D-FOV), which are suitable for arteries with large and small diameters, and created the fusion images. Created images allowed the visual observation of vessel branch and by this technique we could determine optimal needle locations and insertion lengths based on the vessels position in order to avoid needle penetration of the artery or the proximity organs. The needle-channel axis was used as a reference to determine needle insertion. After the needle insertion based on the 3D-CTA another CT was performed for the contouring of the needles. Postinsertion adverse events were recorded during inpatient stay and at 6-week followup.</div></div><div><h3>Results</h3><div>Median followup time was at least 3 months. All patients were initially treated with external beam radiation therapy, median dose of 45 Gy. A total of 170 insertions were performed. No patient presented massive hemorrage because due to the 3D-CTA we were able to know exactly where the uterine artery or the branches are positioned and we avoided the penetration.When we performed the planning CT, there were no radiological evidence of needle intrusion(s) into the pelvic organs and no gastrointestinal complications were found. In this study, only 5 patients with grade 1 thrombocytopenia had minor vaginal bleeding after needle removal which was autolimited. The insertion of the needles was made under general anesteshia. Our results indicated that dizziness, nausea, and vomiting happened to be a constant side effect in this patients because of the general anestesia, but the side effects were acceptable. According to our findings, the most frequent acute adverse impact experienced by patients upon awakening from anaesthesia was pain. Patients experienced varying degrees of discomfort during the brachytherapy procedure. This could lead patients to reposition and alter the position of the applicator and needles, poten","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S45"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.067
Mélodie Cyr Ph.D. Biological and Biomedical Engineering , Behnaz Behmand Ph.D. , Naim Chabaytah M.Sc. , Joud Babik B.Sc. , Mirta Dumancic Ph.D. , Joanna Li M.Sc. , Guillaume St-Jean D.M.V, Ph.D., DACVP , Shirin A. Enger Ph.D.
<div><h3>Purpose</h3><div>Diffusing alpha-emitter radiation therapy (Alpha-DaRT) is a brachytherapy modality using implantable seeds impregnated with ∼2µCi of <sup>224</sup>Ra to treat solid tumors. Short-lived alpha-particle emitting atoms are released in the decay chain of <sup>224</sup>Ra. From this decay, <sup>220</sup>Rn and <sup>212</sup>Pb atoms are of interest due to their ability to diffuse among the tumor cells undergoing alpha decay and transforming into alpha-emitting daughters. The diffusion will contribute to a high-dose region up to a few mm around the source, overcoming the short-range of alpha-particles in tissue. The diffusion lengths (L<sub>diff</sub>) of these alpha-emitting atoms vary across different tumor types, leading to a non-uniform dose distribution. This study investigates the L<sub>diff</sub> in an orthotopic intra-rectal animal model designed for colorectal adenocarcinoma.</div></div><div><h3>Materials and Methods</h3><div>HT-29 colorectal adenocarcinoma cells were injected into the submucosal layer of the intestinal wall of 28 NSG mice. The tumors growth and position were monitored using a 7T MRI scanner, until reaching 5-7 mm in diameter, then separated into control (n=9), inert (n=9) and active groups. The active group was further divided into two, whether Alpha-DaRT source was injected in rectal muscle (n=4) or in the tumor (n=6). The placement of the sources was confirmed by MRI. After four days of exposure, the tumors, and organs at risk (OARs) (ie. kidneys, bladder, and liver) were collected and measured using gamma spectroscopy, measuring the activity from <sup>212</sup>Pb. Autoradiographs were acquired from the tumors and OARs histological slides using a Typhoon 9500. Slides were stained with H&E, CD-31 and cleaved-caspase 3 (CC-3) for tissue damage, vascularity, and apoptosis, respectively. The autoradiography responses were fit with a diffusion model and the photostimulated luminescence (PSL) was converted into measured activities. A pathologist measured each groups’ necrotic areas, and the CD-31 and CC-3 tumor sections were scored for positively stained cells between each group.</div></div><div><h3>Results</h3><div>The initial findings indicate a measured L<sub>diff</sub> of 0.23±0.09 mm in muscle tissue versus 0.5-1.0 mm in tumor, reflecting the inter-variability of the tumor microenvironment among mice and the placement of radiation sources (Figure 1A). A <sup>212</sup>Pb diffusion leakage probability (<sup>212</sup>Pb<sub>leakage</sub>) was noted due to its ability to bind to proteins and/or red blood cells, leading to the escape of <sup>212</sup>Pb from the tumor to the OARs. The <sup>212</sup>Pb<sub>leakage</sub> measured between 54-93 % for the tumors. A linear relationship between <sup>212</sup>Pb<sub>leakage</sub> and the activity uptake in the kidneys was observed. The kidneys had the highest activity of the OARs, measuring between 0.255±0.0025 kBq and 0.85±0.0046 kBq. The autoradiographs sh
{"title":"MSOR04 Presentation Time: 8:15 AM","authors":"Mélodie Cyr Ph.D. Biological and Biomedical Engineering , Behnaz Behmand Ph.D. , Naim Chabaytah M.Sc. , Joud Babik B.Sc. , Mirta Dumancic Ph.D. , Joanna Li M.Sc. , Guillaume St-Jean D.M.V, Ph.D., DACVP , Shirin A. Enger Ph.D.","doi":"10.1016/j.brachy.2024.08.067","DOIUrl":"10.1016/j.brachy.2024.08.067","url":null,"abstract":"<div><h3>Purpose</h3><div>Diffusing alpha-emitter radiation therapy (Alpha-DaRT) is a brachytherapy modality using implantable seeds impregnated with ∼2µCi of <sup>224</sup>Ra to treat solid tumors. Short-lived alpha-particle emitting atoms are released in the decay chain of <sup>224</sup>Ra. From this decay, <sup>220</sup>Rn and <sup>212</sup>Pb atoms are of interest due to their ability to diffuse among the tumor cells undergoing alpha decay and transforming into alpha-emitting daughters. The diffusion will contribute to a high-dose region up to a few mm around the source, overcoming the short-range of alpha-particles in tissue. The diffusion lengths (L<sub>diff</sub>) of these alpha-emitting atoms vary across different tumor types, leading to a non-uniform dose distribution. This study investigates the L<sub>diff</sub> in an orthotopic intra-rectal animal model designed for colorectal adenocarcinoma.</div></div><div><h3>Materials and Methods</h3><div>HT-29 colorectal adenocarcinoma cells were injected into the submucosal layer of the intestinal wall of 28 NSG mice. The tumors growth and position were monitored using a 7T MRI scanner, until reaching 5-7 mm in diameter, then separated into control (n=9), inert (n=9) and active groups. The active group was further divided into two, whether Alpha-DaRT source was injected in rectal muscle (n=4) or in the tumor (n=6). The placement of the sources was confirmed by MRI. After four days of exposure, the tumors, and organs at risk (OARs) (ie. kidneys, bladder, and liver) were collected and measured using gamma spectroscopy, measuring the activity from <sup>212</sup>Pb. Autoradiographs were acquired from the tumors and OARs histological slides using a Typhoon 9500. Slides were stained with H&E, CD-31 and cleaved-caspase 3 (CC-3) for tissue damage, vascularity, and apoptosis, respectively. The autoradiography responses were fit with a diffusion model and the photostimulated luminescence (PSL) was converted into measured activities. A pathologist measured each groups’ necrotic areas, and the CD-31 and CC-3 tumor sections were scored for positively stained cells between each group.</div></div><div><h3>Results</h3><div>The initial findings indicate a measured L<sub>diff</sub> of 0.23±0.09 mm in muscle tissue versus 0.5-1.0 mm in tumor, reflecting the inter-variability of the tumor microenvironment among mice and the placement of radiation sources (Figure 1A). A <sup>212</sup>Pb diffusion leakage probability (<sup>212</sup>Pb<sub>leakage</sub>) was noted due to its ability to bind to proteins and/or red blood cells, leading to the escape of <sup>212</sup>Pb from the tumor to the OARs. The <sup>212</sup>Pb<sub>leakage</sub> measured between 54-93 % for the tumors. A linear relationship between <sup>212</sup>Pb<sub>leakage</sub> and the activity uptake in the kidneys was observed. The kidneys had the highest activity of the OARs, measuring between 0.255±0.0025 kBq and 0.85±0.0046 kBq. The autoradiographs sh","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S52"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.023
Tonghe Wang PhD, Yining Feng PhD, Joel Beaudry MS, David Aramburu PhD, Marisa Kollmeier MD, Antonio L. Damato PhD
Purpose
In the current procedure of high-dose-rate prostate brachytherapy, physicians insert catheters guided by ultrasound in the operating room. Subsequently, CT/MR/ultrasound images are acquired, and manual delineation of target/organs-at-risk is performed for treatment plan optimization. Catheter placement relies on physician experience, lacking feedback on plan quality during the implantation. Sub-optimal catheter implantation may lead to suboptimal plans or additional catheter adjustments requiring additional anesthesia time. In this study, we explored a novel automatic, real-time catheter tracking and target/organ segmentation method, which can be used with the current plan optimization program to potentially provide an instant plan quality feedback permitting physicians to optimize needle placement, and expediting the subsequent planning process.
Materials and Methods
A deep learning neural network was developed to take the last 5 frames of the real-time videos from ultrasound and provide the coordinates of all the catheters it detected, as well as the contours of prostate, rectum and urethra, on the last frame. After the ultrasound probe scanned the entire prostate region, the catheter coordinates on each frame were then fitted to corresponding 3D lines in order to produce the line functions of each catheter in 3D space, as well as the segmented contours of each frame were stacked together. A total of 518 patients who underwent prostate HDR brachytherapy as boost treatment in our clinic were retrospectively investigated, each of which had ultrasound images acquired, contoured and digitized for treatment planning after catheter placement. Among them, 482 patients were used for the training cohort and 36 patients were used for the testing cohort. The median number of catheters per patient was 14.
Results
Among the 477 catheters in the testing patients, the proposed method successfully detected 472 catheters, with an accuracy of 99.0%. The average displacement between the detected catheters and the ground truth catheters on 2D ultrasound images is 0.63±0.55 mm. The mean Dice score for prostate segmentation is 0.90±0.08. The maximum distance of rectum between ground truth and segmentation is 2.80±1.71 mm on average among all patients. The mean center distance of urethra between ground truth and segmentation is 0.76±0.56 mm. The mean time of processing each frame is 15.54±1.31 ms.
Conclusion
The accuracy and efficiency of the proposed method in tracking catheters and segmenting target and organs have been demonstrated with retrospective ultrasound data. It is seen that the proposed artificial intelligence-based method can facilitate a real-time, US-based automatic treatment planning program for prostate HDR brachytherapy.
{"title":"PP04 Presentation Time: 4:27 PM","authors":"Tonghe Wang PhD, Yining Feng PhD, Joel Beaudry MS, David Aramburu PhD, Marisa Kollmeier MD, Antonio L. Damato PhD","doi":"10.1016/j.brachy.2024.08.023","DOIUrl":"10.1016/j.brachy.2024.08.023","url":null,"abstract":"<div><h3>Purpose</h3><div>In the current procedure of high-dose-rate prostate brachytherapy, physicians insert catheters guided by ultrasound in the operating room. Subsequently, CT/MR/ultrasound images are acquired, and manual delineation of target/organs-at-risk is performed for treatment plan optimization. Catheter placement relies on physician experience, lacking feedback on plan quality during the implantation. Sub-optimal catheter implantation may lead to suboptimal plans or additional catheter adjustments requiring additional anesthesia time. In this study, we explored a novel automatic, real-time catheter tracking and target/organ segmentation method, which can be used with the current plan optimization program to potentially provide an instant plan quality feedback permitting physicians to optimize needle placement, and expediting the subsequent planning process.</div></div><div><h3>Materials and Methods</h3><div>A deep learning neural network was developed to take the last 5 frames of the real-time videos from ultrasound and provide the coordinates of all the catheters it detected, as well as the contours of prostate, rectum and urethra, on the last frame. After the ultrasound probe scanned the entire prostate region, the catheter coordinates on each frame were then fitted to corresponding 3D lines in order to produce the line functions of each catheter in 3D space, as well as the segmented contours of each frame were stacked together. A total of 518 patients who underwent prostate HDR brachytherapy as boost treatment in our clinic were retrospectively investigated, each of which had ultrasound images acquired, contoured and digitized for treatment planning after catheter placement. Among them, 482 patients were used for the training cohort and 36 patients were used for the testing cohort. The median number of catheters per patient was 14.</div></div><div><h3>Results</h3><div>Among the 477 catheters in the testing patients, the proposed method successfully detected 472 catheters, with an accuracy of 99.0%. The average displacement between the detected catheters and the ground truth catheters on 2D ultrasound images is 0.63±0.55 mm. The mean Dice score for prostate segmentation is 0.90±0.08. The maximum distance of rectum between ground truth and segmentation is 2.80±1.71 mm on average among all patients. The mean center distance of urethra between ground truth and segmentation is 0.76±0.56 mm. The mean time of processing each frame is 15.54±1.31 ms.</div></div><div><h3>Conclusion</h3><div>The accuracy and efficiency of the proposed method in tracking catheters and segmenting target and organs have been demonstrated with retrospective ultrasound data. It is seen that the proposed artificial intelligence-based method can facilitate a real-time, US-based automatic treatment planning program for prostate HDR brachytherapy.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S28-S29"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527075","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}
<div><h3>Purpose</h3><div>To report acute and early late toxicity and impact on early quality of life (QoL) of a patient cohort staged with 18F-PSMA-PET/CT, treated with a combination of prostate high dose-rate brachytherapy (HDR-BT) and prostate/seminal vesicle external beam radiation therapy (EBRT) for intermediate and high-risk prostate cancer in a phase II prospective trial (NCT05003752).</div></div><div><h3>Materials and Methods</h3><div>In this prospective phase II trial, a total of 41 patients with intermediate (IR), high (HR) and very high risk (VHR) prostate cancer, were recruited to receive a combination of hypofractionated EBRT to the prostate/seminal vesicles of 36 Gy (12 fractions of 3 Gy each) delivered in consecutive days, followed by single fraction real time HDR-BT of 14 Gy. Patients also received short-term (3-6 months) or long-term (>6 months) androgen deprivation therapy (ADT). All patients were both conventionally staged with prostate multi-parametric MRI (mpMRI), abdomen/pelvis CT and bone scintigraphy, with additional PSMA-PET/CT prior to their study inclusion. Acute, as well as early late genito-urinary (GU) and gastro-intestinal (GI) toxicity was assessed according to Radiation Therapy Oncology Group (RTOG) and European Organisation for Research and Treatment of Cancer (EORTC) questionnaires. Patient QoL was evaluated through Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaires. Erectile function was assessed by International Index for Erectile Function -5 (IIEF-5) questionnaire.</div></div><div><h3>Results</h3><div>Fourty-one patients (NCCN 48.8% UIR, 43.9% HR and 7.3% VHR) completed treatment and reached at least 14 months of follow-up (FU) at the time of the current analysis. Median FU was 20 months (IQ range 14-28). Median age was 72 years, median PSA before treatment was 11.0 ng/mL (5.0-28.3) and median volume of the prostate was 36.5 cc (14.9-68.2). Short-term ADT was administered to 43.9% of patients whereas 48.8% received long-term ADT, the rest of the patients did not receive hormonal therapy. No severe (i.e. Grade 2-4) acute events were recorded. The most common acute GU symptoms were nocturia and dysuria (29% and 20% respectively), whereas the most common acute GI events were increased bowel movements and pain during defecation (10% and 5% respectively). A significant decline from baseline compared to 3 months post treatment was observed both in hormonal and sexual domains, with high severity exhibited as a worsening from 12% to 38% and from 0% to 5%, respectively. No other domains exhibited any significant decline (urinary, and bowel).</div></div><div><h3>Conclusions</h3><div>The evaluation of the primary results of the presented prospective phase II trial suggests that the proposed hypofractionated combined radiotherapeutic scheme is a well-tolerated, presenting no acute or early late severe adverse events. Moreover, patient reported outcomes confirm these results, since
{"title":"PPP04 Presentation Time: 10:57 AM","authors":"Iosif Strouthos MD, PhD , Efstratios Karagiannis MD, PhD , Nicole Zamba MD , Dimitris Sokratous MD , Artemis Christodoulou MD , Georgios Antorkas MSc , Yiannis Roussakis PhD, MSc , Alexis Vrachimis MD, PhD , Constantinos Zamboglou MD, PhD , Konstantinos Ferentinos MD, PhD","doi":"10.1016/j.brachy.2024.08.012","DOIUrl":"10.1016/j.brachy.2024.08.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To report acute and early late toxicity and impact on early quality of life (QoL) of a patient cohort staged with 18F-PSMA-PET/CT, treated with a combination of prostate high dose-rate brachytherapy (HDR-BT) and prostate/seminal vesicle external beam radiation therapy (EBRT) for intermediate and high-risk prostate cancer in a phase II prospective trial (NCT05003752).</div></div><div><h3>Materials and Methods</h3><div>In this prospective phase II trial, a total of 41 patients with intermediate (IR), high (HR) and very high risk (VHR) prostate cancer, were recruited to receive a combination of hypofractionated EBRT to the prostate/seminal vesicles of 36 Gy (12 fractions of 3 Gy each) delivered in consecutive days, followed by single fraction real time HDR-BT of 14 Gy. Patients also received short-term (3-6 months) or long-term (>6 months) androgen deprivation therapy (ADT). All patients were both conventionally staged with prostate multi-parametric MRI (mpMRI), abdomen/pelvis CT and bone scintigraphy, with additional PSMA-PET/CT prior to their study inclusion. Acute, as well as early late genito-urinary (GU) and gastro-intestinal (GI) toxicity was assessed according to Radiation Therapy Oncology Group (RTOG) and European Organisation for Research and Treatment of Cancer (EORTC) questionnaires. Patient QoL was evaluated through Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaires. Erectile function was assessed by International Index for Erectile Function -5 (IIEF-5) questionnaire.</div></div><div><h3>Results</h3><div>Fourty-one patients (NCCN 48.8% UIR, 43.9% HR and 7.3% VHR) completed treatment and reached at least 14 months of follow-up (FU) at the time of the current analysis. Median FU was 20 months (IQ range 14-28). Median age was 72 years, median PSA before treatment was 11.0 ng/mL (5.0-28.3) and median volume of the prostate was 36.5 cc (14.9-68.2). Short-term ADT was administered to 43.9% of patients whereas 48.8% received long-term ADT, the rest of the patients did not receive hormonal therapy. No severe (i.e. Grade 2-4) acute events were recorded. The most common acute GU symptoms were nocturia and dysuria (29% and 20% respectively), whereas the most common acute GI events were increased bowel movements and pain during defecation (10% and 5% respectively). A significant decline from baseline compared to 3 months post treatment was observed both in hormonal and sexual domains, with high severity exhibited as a worsening from 12% to 38% and from 0% to 5%, respectively. No other domains exhibited any significant decline (urinary, and bowel).</div></div><div><h3>Conclusions</h3><div>The evaluation of the primary results of the presented prospective phase II trial suggests that the proposed hypofractionated combined radiotherapeutic scheme is a well-tolerated, presenting no acute or early late severe adverse events. Moreover, patient reported outcomes confirm these results, since ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S21-S22"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.056
Darien N. Colson-Fearon M.P.H. , Akila Viswanathan M.D., M.P.H.
<div><h3>Purpose</h3><div>According to the American Brachytherapy Society, brachytherapy (BT) is recommended for the treatment of vaginal cancer, particularly cases of bulky and/or recurrent disease. However, previous studies noted a decline in rates during the early 2010s in accordance with similar declines observed in the use of BT for cervical cancer treatment. Recent studies have demonstrated potential recovery in BT utilization in cervical cancer. As such, this study examines more recent trends in BT utilization for vaginal cancer from 2004 to 2020 to assess whether a similar reversal in trends has begun since increased recognition of the importance of BT.</div></div><div><h3>Material and Methods</h3><div>This study analyzed data from the National Cancer Database (NCDB) of all patients with FIGO stage I to IVA vaginal cancer treated with pelvic radiation therapy between 2004 and 2020, identifying 6,412 patients. Patients were excluded if they were missing radiation treatment details, or if their survival was less than 5 months. A univariate log binomial regression with robust variance was used to estimate incidence rate ratios (IRRs) of BT utilization overtime and identify potential risk factors associated with receipt. Factors found to be significant in univariate analysis were considered for inclusion in a multivariate model to assess for a relationship with BT use. Additionally, a Cochran Armitage test was conducted to assess for overall trends in BT use.</div></div><div><h3>Results</h3><div>Brachytherapy use increased from 48.0% in 2004 to 67.7% in 2020. In univariate analysis, when compared to 2004, utilization began to significantly increase starting in 2018. Additionally, the test for linear trend was statistically significant (<em>p</em> <0.01). In multivariate model, factors associated with increased brachytherapy use included having non-Medicaid/Medicare government insurance (IRR: 1.28 95% CI: 1.04 - 1.58) when compared to being uninsured, receiving care at an academic/research program (IRR: 1.35 95% CI: 1.16 - 1.57), integrated cancer program (IRR: 1.22 95% CI: 1.04 - 1.42) or other specified type of program (IRR: 1.42 95% CI: 1.14 - 1.78) when compared to community cancer programs, having squamous histology (IRR: 1.08 95% CI: 1.02 - 1.15), and diagnosis after 2018 (IRR: 1.29 95% CI: 1.19 - 1.40). Factors associated with decreased use included American Indian or Alaskan Native race (IRR: 0.57 95% CI: 0.33 - 0.98) when compared to white race, age over 80 (IRR: 0.67 95% CI: 0.61 - 0.77) when compared to age less than 50, and stage II (IRR: 0.94 95% CI: 0.87 - 0.96), III (IRR: 0.69 95% CI: 0.65 - 0.74), or IVA (IRR: 0.41 95% CI: 0.35 - 0.48) disease when compared to stage I. Finally, geographic differences were also observed in BT use. Receiving treating in facilities located in New England (IRR: 0.84 95% CI: 0.74 - 0.95), Middle Atlantic (IRR: 0.87 95% CI: 0.79 - 0.95), South Atlantic (IRR: 0.85 95% CI: 0.78 - 0.93), East North C
{"title":"GSOR10 Presentation Time: 5:45 PM","authors":"Darien N. Colson-Fearon M.P.H. , Akila Viswanathan M.D., M.P.H.","doi":"10.1016/j.brachy.2024.08.056","DOIUrl":"10.1016/j.brachy.2024.08.056","url":null,"abstract":"<div><h3>Purpose</h3><div>According to the American Brachytherapy Society, brachytherapy (BT) is recommended for the treatment of vaginal cancer, particularly cases of bulky and/or recurrent disease. However, previous studies noted a decline in rates during the early 2010s in accordance with similar declines observed in the use of BT for cervical cancer treatment. Recent studies have demonstrated potential recovery in BT utilization in cervical cancer. As such, this study examines more recent trends in BT utilization for vaginal cancer from 2004 to 2020 to assess whether a similar reversal in trends has begun since increased recognition of the importance of BT.</div></div><div><h3>Material and Methods</h3><div>This study analyzed data from the National Cancer Database (NCDB) of all patients with FIGO stage I to IVA vaginal cancer treated with pelvic radiation therapy between 2004 and 2020, identifying 6,412 patients. Patients were excluded if they were missing radiation treatment details, or if their survival was less than 5 months. A univariate log binomial regression with robust variance was used to estimate incidence rate ratios (IRRs) of BT utilization overtime and identify potential risk factors associated with receipt. Factors found to be significant in univariate analysis were considered for inclusion in a multivariate model to assess for a relationship with BT use. Additionally, a Cochran Armitage test was conducted to assess for overall trends in BT use.</div></div><div><h3>Results</h3><div>Brachytherapy use increased from 48.0% in 2004 to 67.7% in 2020. In univariate analysis, when compared to 2004, utilization began to significantly increase starting in 2018. Additionally, the test for linear trend was statistically significant (<em>p</em> <0.01). In multivariate model, factors associated with increased brachytherapy use included having non-Medicaid/Medicare government insurance (IRR: 1.28 95% CI: 1.04 - 1.58) when compared to being uninsured, receiving care at an academic/research program (IRR: 1.35 95% CI: 1.16 - 1.57), integrated cancer program (IRR: 1.22 95% CI: 1.04 - 1.42) or other specified type of program (IRR: 1.42 95% CI: 1.14 - 1.78) when compared to community cancer programs, having squamous histology (IRR: 1.08 95% CI: 1.02 - 1.15), and diagnosis after 2018 (IRR: 1.29 95% CI: 1.19 - 1.40). Factors associated with decreased use included American Indian or Alaskan Native race (IRR: 0.57 95% CI: 0.33 - 0.98) when compared to white race, age over 80 (IRR: 0.67 95% CI: 0.61 - 0.77) when compared to age less than 50, and stage II (IRR: 0.94 95% CI: 0.87 - 0.96), III (IRR: 0.69 95% CI: 0.65 - 0.74), or IVA (IRR: 0.41 95% CI: 0.35 - 0.48) disease when compared to stage I. Finally, geographic differences were also observed in BT use. Receiving treating in facilities located in New England (IRR: 0.84 95% CI: 0.74 - 0.95), Middle Atlantic (IRR: 0.87 95% CI: 0.79 - 0.95), South Atlantic (IRR: 0.85 95% CI: 0.78 - 0.93), East North C","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S46-S47"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.086
Lindsey H. Bloom MS , Julie Raffi PhD , Rajesh Venkataramen PhD , Yongbok Kim PhD , Paul Segars PhD , Diandra Ayala-Peacock MD , Oana Craciunescu PhD
<div><h3>Purpose</h3><div>Utilizing a female pelvic phantom and following TG-132 methodologies, we developed a novel digital phantom to validate the MR/TRUS contour-based elastic registration algorithm embedded in the commercial needle-tracking software developed by Eigen Health. The reliability of this registration algorithm is crucial for commissioning a pre-existing prostate needle-tracking biopsy system as a gynecological HDR brachytherapy tool.</div></div><div><h3>Methods</h3><div>A previously optimized female pelvic phantom was embedded with six vitamin D fiducial markers. Four markers were placed on the exterior uterine surface (2 lateral, 1 anterior, 1 superior), and two were placed on the uterine interior (1 central, 1 anterior surface). A T2w MR image set of the phantom was acquired and segmented in 3DSlicer, an open-source image analysis software, to define the uterus and fiducials, which were then exported as STL files. Manual deformations were applied in Rhinoceros, a 3D CAD software, and proprietary scripts converted the deformed contours into raw binary images. A custom MATLAB code converted these images into DICOM format for import into Eigen's ProFuseCAD software which was used to segment the deformed uterus and define the fiducials as regions of interest (ROIs). The uterus contour and fiducial ROIs were then imported into Eigen's needle-tracking system. Using a BK Medical linear side-fire TRUS probe, a 150-degree lateral-to-lateral sweep of the non-deformed phantom was acquired. The uterus was segmented on the resulting 3D TRUS volume. Registration between the MRI and TRUS volumes was performed by first rigidly registering the two volumes in the sagittal and transverse planes based on 2 paired points on the uterus. A surface based elastic registration algorithm was then applied to complete the registration process. Target Registration Error (TRE) was estimated between the automatically marked centroid of each fiducial ROI and the manually marked fiducial centers from visual inspection in the acquired TRUS volume. This process was repeated for six different manual deformations applied to the digital phantom uterus to evaluate the system's registration quality. A control case without deformations was also examined.</div></div><div><h3>Results</h3><div>All six of the embedded fiducials were successfully visualized on MR and included in the digital phantom. The limited US FOV restricted visibility of the anterior fiducial, making its coordinates unreliable. For the five visible fiducials, the average ΔX, ΔY, ΔZ between the automatically generated point and the manually defined centroid point was 2.29±1.53, 0.94±1.02, 3.65±1.40mm, respectively. The overall average vector displacement of the location was 4.68 ± 1.49 mm.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates a novel method to validate the deformable registration algorithm used by the Eigen system. Distance results in each plane for all visible fiducials were wi
目的利用女性盆腔模型并遵循 TG-132 方法，我们开发了一种新型数字模型来验证 Eigen Health 开发的商用针追踪软件中嵌入的基于 MR/TRUS 轮廓的弹性配准算法。该配准算法的可靠性对于将已有的前列腺针跟踪活检系统作为妇科 HDR 近距离放射治疗工具投入使用至关重要。四个标记置于子宫外表面（2 个外侧、1 个前侧、1 个上侧），两个置于子宫内部（1 个中央、1 个前表面）。在开源图像分析软件 3DSlicer 中获取并分割模型的 T2w MR 图像集，以定义子宫和靶标，然后将其导出为 STL 文件。手动变形应用于三维 CAD 软件 Rhinoceros，专有脚本将变形轮廓转换为原始二进制图像。定制的 MATLAB 代码将这些图像转换成 DICOM 格式，以便导入 Eigen 的 ProFuseCAD 软件，该软件用于分割变形的子宫，并将靶标定义为感兴趣区（ROI）。然后将子宫轮廓和靶标 ROI 导入 Eigen 的针追踪系统。使用 BK Medical 线性侧射 TRUS 探头，对非变形模型进行 150 度横向扫描。在生成的三维 TRUS 体积上对子宫进行分割。首先根据子宫上的两个配对点，在矢状面和横向面上对两个容积进行刚性配准，从而在核磁共振成像和 TRUS 容积之间进行配准。然后应用基于表面的弹性配准算法完成配准过程。在获取的 TRUS 容量中，通过目视检查估算每个靶标 ROI 的自动标记中心点与人工标记的靶标中心点之间的目标注册误差（TRE）。为评估系统的配准质量，对数字模型子宫进行了六种不同的手动变形，并重复了这一过程。结果所有六个嵌入的靶标都成功地在磁共振成像上显示出来，并包含在数字模型中。有限的 US FOV 限制了前部靶标的可见度，使其坐标不可靠。对于五个可见的靶标，自动生成点与手动定义的中心点之间的平均ΔX、ΔY、ΔZ分别为2.29±1.53、0.94±1.02、3.65±1.40mm。我们的研究展示了一种验证 Eigen 系统所使用的可变形配准算法的新方法。所有可见靶标在每个平面上的距离结果都在 TG-132 规定的 2-3 毫米 TRE 容差范围内。但是，总体位移矢量通常大于容差。手动选择不规则形状靶标的中心点存在相当大的不确定性。还需要进一步研究来完善验证过程，并调查配准结果的不确定性来源。
{"title":"PHSOR12 Presentation Time: 9:55 AM","authors":"Lindsey H. Bloom MS , Julie Raffi PhD , Rajesh Venkataramen PhD , Yongbok Kim PhD , Paul Segars PhD , Diandra Ayala-Peacock MD , Oana Craciunescu PhD","doi":"10.1016/j.brachy.2024.08.086","DOIUrl":"10.1016/j.brachy.2024.08.086","url":null,"abstract":"<div><h3>Purpose</h3><div>Utilizing a female pelvic phantom and following TG-132 methodologies, we developed a novel digital phantom to validate the MR/TRUS contour-based elastic registration algorithm embedded in the commercial needle-tracking software developed by Eigen Health. The reliability of this registration algorithm is crucial for commissioning a pre-existing prostate needle-tracking biopsy system as a gynecological HDR brachytherapy tool.</div></div><div><h3>Methods</h3><div>A previously optimized female pelvic phantom was embedded with six vitamin D fiducial markers. Four markers were placed on the exterior uterine surface (2 lateral, 1 anterior, 1 superior), and two were placed on the uterine interior (1 central, 1 anterior surface). A T2w MR image set of the phantom was acquired and segmented in 3DSlicer, an open-source image analysis software, to define the uterus and fiducials, which were then exported as STL files. Manual deformations were applied in Rhinoceros, a 3D CAD software, and proprietary scripts converted the deformed contours into raw binary images. A custom MATLAB code converted these images into DICOM format for import into Eigen's ProFuseCAD software which was used to segment the deformed uterus and define the fiducials as regions of interest (ROIs). The uterus contour and fiducial ROIs were then imported into Eigen's needle-tracking system. Using a BK Medical linear side-fire TRUS probe, a 150-degree lateral-to-lateral sweep of the non-deformed phantom was acquired. The uterus was segmented on the resulting 3D TRUS volume. Registration between the MRI and TRUS volumes was performed by first rigidly registering the two volumes in the sagittal and transverse planes based on 2 paired points on the uterus. A surface based elastic registration algorithm was then applied to complete the registration process. Target Registration Error (TRE) was estimated between the automatically marked centroid of each fiducial ROI and the manually marked fiducial centers from visual inspection in the acquired TRUS volume. This process was repeated for six different manual deformations applied to the digital phantom uterus to evaluate the system's registration quality. A control case without deformations was also examined.</div></div><div><h3>Results</h3><div>All six of the embedded fiducials were successfully visualized on MR and included in the digital phantom. The limited US FOV restricted visibility of the anterior fiducial, making its coordinates unreliable. For the five visible fiducials, the average ΔX, ΔY, ΔZ between the automatically generated point and the manually defined centroid point was 2.29±1.53, 0.94±1.02, 3.65±1.40mm, respectively. The overall average vector displacement of the location was 4.68 ± 1.49 mm.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates a novel method to validate the deformable registration algorithm used by the Eigen system. Distance results in each plane for all visible fiducials were wi","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S64"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.038
Tomer Cooks PhD , Yossi Nishri PhD , Maayan Vatarescu PhD , Ishai Luz PhD , Lior Epstein PhD , Mirta Dumančić PhD , Sara Del Mare PhD , Amit Shai MSc , Michael Schmidt PhD , Lisa Deutsch PhD , Robert B. Den MD , Itzhak Kelson PhD , Yona Keisari PhD , Lior Arazi PhD , Vered Domankevich PhD
<div><h3>Purpose</h3><div>Diffusing alpha-emitters radiation therapy (DaRT) is a unique treatment modality for solid tumors capitalizing on Radium-224-loaded (Alpha DaRT) sources designed to disperse alpha-emitting atoms into the tumor tissue. These diffused radioactive atoms create a destructive 'kill-zone' millimeters away from the source, without harming adjacent tissue. This treatment was reported to effectively inhibit tumor growth in various human and murine cancers in pre-clinical testing. Here, the effect of Alpha DaRT was investigated <em>in-vitro</em> and <em>in-vivo</em> using subcutaneous (s.c.) Glioblastoma Multiforme (GBM) tumors in combination with GBM ‘standard of care’ treatments (Temozolomide, TMZ or Bevacizumab, BEV). We also studied the effect of the Alpha DaRT monotherapy in orthotopic GBM tumors.</div></div><div><h3>Methods and Materials</h3><div>The effect of alpha radiation with TMZ was evaluated in human U87 cells by cytotoxicity and colony formation assays. VEGF secretion was assessed using ELISA assay. U87 s.c. tumor-bearing mice were treated with Alpha DaRT or inert (non-radioactive) sources in combination with TMZ or BEV, and monitored for efficacy. To assess tumor vasculature, we performed immunohistochemical staining of the vascular marker CD31. Alpha DaRT effective diameter receiving high dose (>10 Gy) was determined by autoradiography. The clearance of radioactive atoms from the tumor was determined by radioactivity measurements of the tumor and source 4 days post implantation compared with the initial activity. Murine GL-261 GBM cells were used for the inoculation of orthotopic GBM, and their growth was monitored using MRI before they were treated with Alpha DaRT or Inert sources.</div></div><div><h3>Results</h3><div>The combined treatment of alpha radiation and TMZ doubled the cytotoxic effect compared to the monotherapies. U87 cells treated with the combined treatment showed lower survival fraction than the monotherapies or than x-ray combined with TMZ treatment. U87 s.c. tumor bearing mice treated with Alpha DaRT and TMZ showed increased delay in tumor growth compared to the monotherapies. Unlike other radiation types, alpha radiation did not increase VEGF secretion by U87 cells. As expected, BEV administration decreased CD31 staining and when combined with Alpha DaRT, the effective diameter was increased and the clearance of the radioactivity was reduced. <em>In-vivo</em> studies showed that administration of BEV a few days after Alpha DaRT insertion improved tumor control - in comparison to Alpha DaRT or BEV alone. Improved results were obtained in larger tumors when the BEV protocol was initiated before the Alpha DaRT insertion. We were able to establish an orthotopic model of GBM and fabricate a designated Alpha DaRT applicator and source suitable for mice brains. We successfully monitored tumor growth and Alpha DaRT insertion using MRI as well as in-vivo real-time imager.</div></div><div><h3>Conclusion
{"title":"MSOR4 Presentation Time: 5:15 PM","authors":"Tomer Cooks PhD , Yossi Nishri PhD , Maayan Vatarescu PhD , Ishai Luz PhD , Lior Epstein PhD , Mirta Dumančić PhD , Sara Del Mare PhD , Amit Shai MSc , Michael Schmidt PhD , Lisa Deutsch PhD , Robert B. Den MD , Itzhak Kelson PhD , Yona Keisari PhD , Lior Arazi PhD , Vered Domankevich PhD","doi":"10.1016/j.brachy.2024.08.038","DOIUrl":"10.1016/j.brachy.2024.08.038","url":null,"abstract":"<div><h3>Purpose</h3><div>Diffusing alpha-emitters radiation therapy (DaRT) is a unique treatment modality for solid tumors capitalizing on Radium-224-loaded (Alpha DaRT) sources designed to disperse alpha-emitting atoms into the tumor tissue. These diffused radioactive atoms create a destructive 'kill-zone' millimeters away from the source, without harming adjacent tissue. This treatment was reported to effectively inhibit tumor growth in various human and murine cancers in pre-clinical testing. Here, the effect of Alpha DaRT was investigated <em>in-vitro</em> and <em>in-vivo</em> using subcutaneous (s.c.) Glioblastoma Multiforme (GBM) tumors in combination with GBM ‘standard of care’ treatments (Temozolomide, TMZ or Bevacizumab, BEV). We also studied the effect of the Alpha DaRT monotherapy in orthotopic GBM tumors.</div></div><div><h3>Methods and Materials</h3><div>The effect of alpha radiation with TMZ was evaluated in human U87 cells by cytotoxicity and colony formation assays. VEGF secretion was assessed using ELISA assay. U87 s.c. tumor-bearing mice were treated with Alpha DaRT or inert (non-radioactive) sources in combination with TMZ or BEV, and monitored for efficacy. To assess tumor vasculature, we performed immunohistochemical staining of the vascular marker CD31. Alpha DaRT effective diameter receiving high dose (>10 Gy) was determined by autoradiography. The clearance of radioactive atoms from the tumor was determined by radioactivity measurements of the tumor and source 4 days post implantation compared with the initial activity. Murine GL-261 GBM cells were used for the inoculation of orthotopic GBM, and their growth was monitored using MRI before they were treated with Alpha DaRT or Inert sources.</div></div><div><h3>Results</h3><div>The combined treatment of alpha radiation and TMZ doubled the cytotoxic effect compared to the monotherapies. U87 cells treated with the combined treatment showed lower survival fraction than the monotherapies or than x-ray combined with TMZ treatment. U87 s.c. tumor bearing mice treated with Alpha DaRT and TMZ showed increased delay in tumor growth compared to the monotherapies. Unlike other radiation types, alpha radiation did not increase VEGF secretion by U87 cells. As expected, BEV administration decreased CD31 staining and when combined with Alpha DaRT, the effective diameter was increased and the clearance of the radioactivity was reduced. <em>In-vivo</em> studies showed that administration of BEV a few days after Alpha DaRT insertion improved tumor control - in comparison to Alpha DaRT or BEV alone. Improved results were obtained in larger tumors when the BEV protocol was initiated before the Alpha DaRT insertion. We were able to establish an orthotopic model of GBM and fabricate a designated Alpha DaRT applicator and source suitable for mice brains. We successfully monitored tumor growth and Alpha DaRT insertion using MRI as well as in-vivo real-time imager.</div></div><div><h3>Conclusion","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S37"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.010
Vitaly A. Biryukov MD, PhD , Elizaveta O. Shchukina MD , Natalia B. Ermakova PhD , Dmitry B. Sanin PhD , Olga G. Lepilina PhD , Oleg B. Karyakin (Prof.) , Sergey A. Ivanov (Prof.) , Andrey D. Kaprin (Prof.)
In the Russian Federation the number of patients with prostate cancer in stage I-II has increased from 48.4% to 63.0% over the past 10 years (2012 - 2022). It is the second most common cancer in men after lung cancerin 2021 in Russia. One of the most common methods of treating localized prostate cancer is brachytherapy. In the Department of radiation and surgical treatment of urological diseases with the prostate cancer brachytherapy group of the A.F.Tsyb MRRC, HDR-BT as monotherapy has been performed since 2016 with the use of Ir-192.
Purpose
Compare the efficiency of modes of HDR-BT with the use of Ir-192 in the treatment of localized prostate cancer.
Materials and Methods
In the study the review is given to the results of treatment of patients with localized prostate cancer of low and intermediate risk progression groups who were treated at the A.F.Tsyb MRRC from April 2016 to December 2019. 276 patients were randomized to receive HDR-BT as either a single fraction of 19 Gy or as two fractions of 15 Gy two week apart. The number of patients in the 2 × 15 Gy group was 146, in the 1 × 19 group - 130. The characteristics of the patients are presented in Table 1. Brachytherapy was performed with the use of Ir-192 under spinal anesthesia. Follow-up included a TRUS of prostate, recording of toxicity, and measurement of serum PSA. Patients with biochemical failure (nadir + 2 ng/ml) or clinical suspicion of recurrence were investigated with multiparametric MRI of prostate, and PSMA-PET. Any radiographic suspicion of local recurrence was confirmed on biopsy.
Results
Biochemical relapse was documentedin32 patients: 5 patients in group 15 Gy х 2 and 27 patients in group 19 Gy. The dependence of the risk of relapse on the HDR-BT mode, estimated using the Mantel-Cox log-rank criterion, was statistically significant (p<0.001). The analysis performed using the Kaplan-Meyer method showed that the average time of recurrence among patients who received 2 fractions of HDR-BT was 88.25±1.77 months (95% CI: 84.78 - 91.72), among patients who received one fraction of HDR-BT - 67.45±1.98 (95% CI: 63.58 - 71.32). The median was not reached in both groups of patients.
Conclusions
In conclusion, HDR monotherapy delivered as two fraction of15 Gy have a high cancer control rate than as one fraction of 19 Gy. Single fraction monotherapy provides inferior results and is not used in our center now.
{"title":"PPP02 Presentation Time: 10:39 AM","authors":"Vitaly A. Biryukov MD, PhD , Elizaveta O. Shchukina MD , Natalia B. Ermakova PhD , Dmitry B. Sanin PhD , Olga G. Lepilina PhD , Oleg B. Karyakin (Prof.) , Sergey A. Ivanov (Prof.) , Andrey D. Kaprin (Prof.)","doi":"10.1016/j.brachy.2024.08.010","DOIUrl":"10.1016/j.brachy.2024.08.010","url":null,"abstract":"<div><div>In the Russian Federation the number of patients with prostate cancer in stage I-II has increased from 48.4% to 63.0% over the past 10 years (2012 - 2022). It is the second most common cancer in men after lung cancerin 2021 in Russia. One of the most common methods of treating localized prostate cancer is brachytherapy. In the Department of radiation and surgical treatment of urological diseases with the prostate cancer brachytherapy group of the A.F.Tsyb MRRC, HDR-BT as monotherapy has been performed since 2016 with the use of Ir-192.</div></div><div><h3>Purpose</h3><div>Compare the efficiency of modes of HDR-BT with the use of Ir-192 in the treatment of localized prostate cancer.</div></div><div><h3>Materials and Methods</h3><div>In the study the review is given to the results of treatment of patients with localized prostate cancer of low and intermediate risk progression groups who were treated at the A.F.Tsyb MRRC from April 2016 to December 2019. 276 patients were randomized to receive HDR-BT as either a single fraction of 19 Gy or as two fractions of 15 Gy two week apart. The number of patients in the 2 × 15 Gy group was 146, in the 1 × 19 group - 130. The characteristics of the patients are presented in Table 1. Brachytherapy was performed with the use of Ir-192 under spinal anesthesia. Follow-up included a TRUS of prostate, recording of toxicity, and measurement of serum PSA. Patients with biochemical failure (nadir + 2 ng/ml) or clinical suspicion of recurrence were investigated with multiparametric MRI of prostate, and PSMA-PET. Any radiographic suspicion of local recurrence was confirmed on biopsy.</div></div><div><h3>Results</h3><div>Biochemical relapse was documentedin32 patients: 5 patients in group 15 Gy х 2 and 27 patients in group 19 Gy. The dependence of the risk of relapse on the HDR-BT mode, estimated using the Mantel-Cox log-rank criterion, was statistically significant (p<0.001). The analysis performed using the Kaplan-Meyer method showed that the average time of recurrence among patients who received 2 fractions of HDR-BT was 88.25±1.77 months (95% CI: 84.78 - 91.72), among patients who received one fraction of HDR-BT - 67.45±1.98 (95% CI: 63.58 - 71.32). The median was not reached in both groups of patients.</div></div><div><h3>Conclusions</h3><div>In conclusion, HDR monotherapy delivered as two fraction of15 Gy have a high cancer control rate than as one fraction of 19 Gy. Single fraction monotherapy provides inferior results and is not used in our center now.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S20-S21"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.026
Birte Christina Sauer (M. Sc.), Rainer Fietkau (Prof. Dr. Med.), Vratislav Strnad (Dr. med.), Christoph Bert (Prof. Dr.), Christopher Dürrbeck Dr.
Purpose
Interstitial brachytherapy of the breast is a well-established treatment option with very good clinical results. However, it is prone to human failures according to several safety reports [1-4], indicating that a timely detection and prevention of treatment errors is advised. An extensive patient specific quality assurance procedure could be implemented using electromagnetic tracking (EMT), which has shown its potential by enabling a line-of-sight independent and dose free tracing of implanted catheters or needles.
Materials and Methods
We retrospectively analyzed and categorized potential treatment errors in a cohort of 72 patients comprising more than 580 fractions and more than 8000 catheters. All patients were treated between October 2016 and November 2023 and participated in our EMT study. The implant geometry was assessed after each treatment fraction and after the planning CT by means of EMT. The detection and classification of errors is based on deviations between expected and measured catheter positions.
Results
Concerning planning errors, we did not find any (partial) swaps, but detected one inversion of the reconstruction direction (tip-end-swap). Before treatment delivery, we detected shifts larger than 0.8 mm in 35 % of all measured catheters, out of which 50 % were > 2 mm, 15 % were > 5 mm and 2 % were > 10 mm. The highest recorded shift reached 21.9 mm, the median magnitude was 3.0 mm. Delivery errors also included three swaps of neighboring catheters that were visually verified. It should be noted that the EMT enabled afterloader does not carry an active source, therefore, the transfer tubes had to be manually reconnected. This means that the detected swaps may not represent the clinical state, however, they provide an estimate for the probability of swaps to occur in clinical practice.
Conclusions
This study presents a first of its kind systematic treatment error analysis. It emphasizes the necessity for a patient specific quality assurance and treatment verification in interstitial breast brachytherapy to prevent potential errors, especially in view of ever shorter fractionation schemes.
{"title":"BP02 Presentation Time: 4:09 PM","authors":"Birte Christina Sauer (M. Sc.), Rainer Fietkau (Prof. Dr. Med.), Vratislav Strnad (Dr. med.), Christoph Bert (Prof. Dr.), Christopher Dürrbeck Dr.","doi":"10.1016/j.brachy.2024.08.026","DOIUrl":"10.1016/j.brachy.2024.08.026","url":null,"abstract":"<div><h3>Purpose</h3><div>Interstitial brachytherapy of the breast is a well-established treatment option with very good clinical results. However, it is prone to human failures according to several safety reports [1-4], indicating that a timely detection and prevention of treatment errors is advised. An extensive patient specific quality assurance procedure could be implemented using electromagnetic tracking (EMT), which has shown its potential by enabling a line-of-sight independent and dose free tracing of implanted catheters or needles.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively analyzed and categorized potential treatment errors in a cohort of 72 patients comprising more than 580 fractions and more than 8000 catheters. All patients were treated between October 2016 and November 2023 and participated in our EMT study. The implant geometry was assessed after each treatment fraction and after the planning CT by means of EMT. The detection and classification of errors is based on deviations between expected and measured catheter positions.</div></div><div><h3>Results</h3><div>Concerning planning errors, we did not find any (partial) swaps, but detected one inversion of the reconstruction direction (tip-end-swap). Before treatment delivery, we detected shifts larger than 0.8 mm in 35 % of all measured catheters, out of which 50 % were > 2 mm, 15 % were > 5 mm and 2 % were > 10 mm. The highest recorded shift reached 21.9 mm, the median magnitude was 3.0 mm. Delivery errors also included three swaps of neighboring catheters that were visually verified. It should be noted that the EMT enabled afterloader does not carry an active source, therefore, the transfer tubes had to be manually reconnected. This means that the detected swaps may not represent the clinical state, however, they provide an estimate for the probability of swaps to occur in clinical practice.</div></div><div><h3>Conclusions</h3><div>This study presents a first of its kind systematic treatment error analysis. It emphasizes the necessity for a patient specific quality assurance and treatment verification in interstitial breast brachytherapy to prevent potential errors, especially in view of ever shorter fractionation schemes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S30"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.brachy.2024.08.091
Thomas Niedermayr PhD, Elizabeth Kidd MD
<div><h3>Purpose</h3><div>The disease control and toxicity benefits of adding interstitial needles to cervix intracavitary implants are well established, as are the advantages of MRI for tumor visualization. Yet widespread adoption of these advanced techniques remains elusive, limited by access to frequent MR imaging and the technical challenges of precisely placing needles into the tumor. Ultrasound (US) remains the most accessible form of live imaging but the poorer image quality limits clear visualization of the tumor area and the inserted interstitial needles. We describe a novel system which combines a freehand, stepper-less transrectal ultrasound probe with an electro-magnetic (EM) tracker to continuously fuse a pre-acquired MR, offering a reconstructed MR image to the corresponding live ultrasound image. Inserted needles can be easily visualized using an EM tracked stylet/mandrin, placing a solid circle on the live ultrasound image where the needle is located.</div></div><div><h3>Materials and Methods</h3><div>The clinical ultrasound system, the BK Spekto with a biplanar side-fire 9048 US probe, was instrumented with a Northern Digital Inc. EM tracker, part of the 3D Guidance Trakstar system. Software was developed using the 3D Slicer toolkit to enable live and continuous fusion of a pre-acquired MR. Contours generated on the MR can be imported and displayed on the live US image. An additional EM tracker can be placed inside a needle to visualize its location on the live US image and removed for treatment.</div></div><div><h3>Results</h3><div>The system was assessed on a Viomerse Gyn phantom before being deployed in clinical implants (Fig 1A). Initial registration between the live US image and the MR is accomplished by placing the freehand transrectal US probe within the patient to a known location, such as the top of the vaginal canal/cervix area. The corresponding MR/US fusion is then locked, any movement of the freehand probe will update both the US and MR images correspondingly. Fine tuning of the registration can be done in all six degrees of freedom as necessary to accommodate any shifts and/or deformations during the procedures. Needles can easily be identified on the live US when a stylet equipped with a miniature EM tracker is inserted: a yellow circle appears on the live US at the intersection on the imaging plane where the needle is expected (Fig 1B). In case of multiple needles, the trajectory of each needle can be digitally saved within the EM frame of reference, providing a colored mark where each needle was placed on the live US. HR-CTV contours can be overlaid on the live US to help highlight the area of interest (Fig 1C).</div></div><div><h3>Conclusion</h3><div>A novel system has been developed and clinically tested to enhance the capabilities of US imaging for gyn brachytherapy procedures by incorporating clarifying MR information and easy needle recognition. These features can help guide the practitioner during the proce
目的 在宫颈腔内植入物中加入间质针所带来的疾病控制和毒性益处以及核磁共振成像在肿瘤可视化方面的优势已得到公认。然而，这些先进技术的广泛应用仍然遥遥无期，原因是受限于频繁的磁共振成像以及将针头精确置入肿瘤的技术难题。超声（US）仍然是最容易获得的实时成像形式，但较差的图像质量限制了肿瘤区域和插入间质针的清晰可视性。我们介绍了一种新型系统，该系统将自由操作的无步进经直肠超声探头与电磁（EM）跟踪器相结合，不断融合预先获取的磁共振图像，将重建的磁共振图像与相应的实时超声图像相结合。插入的针头可以通过电磁追踪器/肛门直肠镜轻松观察到，在实时超声图像上针头所在的位置会出现一个实心圆圈。EM跟踪器，它是 3D Guidance Trakstar 系统的一部分。使用 3D Slicer 工具包开发的软件可以实时、连续地融合预先获取的 MR。在 MR 上生成的轮廓可以导入并显示在实时 US 图像上。结果该系统在临床植入前在 Viomerse Gyn 体模上进行了评估（图 1A）。将自由经直肠 US 探头置于患者体内的已知位置（如阴道顶部/宫颈区域），即可完成实时 US 图像与 MR 之间的初始配准。然后锁定相应的 MR/US 融合，自由探针的任何移动都会相应地更新 US 和 MR 图像。可根据需要在所有六个自由度上对套准进行微调，以适应手术过程中的任何移动和/或变形。当插入装有微型电磁追踪器的针头时，可在实时 US 上轻松识别针头：在实时 US 上，针头所在成像平面的交叉点上会出现一个黄色圆圈（图 1B）。如果有多根针，每根针的轨迹都可以通过数字方式保存在电磁参考框架内，在实时 US 上每根针刺入的位置都会出现彩色标记。HR-CTV 轮廓可叠加到实时 US 上，以帮助突出感兴趣的区域（图 1C）。 结论：我们已开发出一种新型系统并进行了临床测试，通过整合清晰的 MR 信息和轻松识别针头，增强了妇科近距离放射治疗过程中 US 成像的功能。这些功能有助于在手术过程中指导医生植入几何形状更坚固的植入物，并提供可操作的反馈。
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