<div><h3>Purpose</h3><div>High dose rate (HDR) brachytherapy remote afterloader carries a radioactive iridium-192 (Ir-192) source to the designated tumor site for specified time intervals to deliver the prescribed radiation dose through intracavitary and interstitial applicators. Precise positioning of applicator and accurate dwell time of the Ir-192 source are required to achieve optimal treatment. Currently, HDR applicator tracking is not routinely performed in the clinic due to lack of effective and practical imaging methods. Instead, pre-treatment quality assurance is performed to verify HDR source dwell position and time accuracy, and the results are presumed to accurately apply to treatment. However, this approach fails to consider intra- and inter-fractional variations, such as those caused by relative motions between patient anatomy and applicators when patients are transported between the CT simulator and HDR rooms. C-arm cone-beam CT (CBCT) is a possible imaging modality for adaptive HDR treatment. We investigated the feasibility of ultra-short CBCT and deep-learning based image reconstruction for adaptive HDR brachytherapy.</div></div><div><h3>Materials and Methods</h3><div>Conventional CT image reconstruction requires a full system rotation. Unlike ring gantry, C-arm x-ray system has limited rotation angle thus cannot perform full field of view CBCT reconstruction. Deep Image Prior (DIP) is a deep-learning based method that can solve ill-posed inverse problem by optimizing the parameters of convolution neural network without training data. We developed DIP based image reconstruction method for limited angle image reconstruction, which allows C-arm CBCT to perform full field of view volumetric imaging in the brachytherapy suite. Based on DIP reconstructed CBCT, we may perform adaptive HDR treatment without moving patient to CT sim. To quantify the potential clinical impact, 10 Gynecological HDR cases planned using the BrachyVision treatment planning system were selected. The plans were exported to RadCalc to simulate the applicator mispositioning in 3 dimensions. Volumetric dose to the tumor and organs at risk (OARs) were computed after the applicator mispositioning simulation. The results were compared to the original plans and the effects on the target coverage and the dose to the OARs were evaluated.</div></div><div><h3>Results</h3><div>DIP method showed promising results in limited angle image reconstruction with body profile outline as prior, as shown in Figure1. Radiation dose comparison between the original plans and simulated ones showed that applicator’s movement in the anterior/posterior direction has the most effect on the bladder and rectum which was expected due to the anatomical locations. However, the anterior/posterior mispositioning of the applicator also showed a significant impact on the small bowel which was not expected. And finally, the applicator mispositioning in the superior/inferior direction has the most impa
{"title":"PHSOP1 Presentation Time: 9:00 AM","authors":"Xin Qian PhD, Yizhou Zhao MS, Ziyu Shu PhD, Jieying Wu MD, Tiezhi Zhang PhD","doi":"10.1016/j.brachy.2025.06.060","DOIUrl":"10.1016/j.brachy.2025.06.060","url":null,"abstract":"<div><h3>Purpose</h3><div>High dose rate (HDR) brachytherapy remote afterloader carries a radioactive iridium-192 (Ir-192) source to the designated tumor site for specified time intervals to deliver the prescribed radiation dose through intracavitary and interstitial applicators. Precise positioning of applicator and accurate dwell time of the Ir-192 source are required to achieve optimal treatment. Currently, HDR applicator tracking is not routinely performed in the clinic due to lack of effective and practical imaging methods. Instead, pre-treatment quality assurance is performed to verify HDR source dwell position and time accuracy, and the results are presumed to accurately apply to treatment. However, this approach fails to consider intra- and inter-fractional variations, such as those caused by relative motions between patient anatomy and applicators when patients are transported between the CT simulator and HDR rooms. C-arm cone-beam CT (CBCT) is a possible imaging modality for adaptive HDR treatment. We investigated the feasibility of ultra-short CBCT and deep-learning based image reconstruction for adaptive HDR brachytherapy.</div></div><div><h3>Materials and Methods</h3><div>Conventional CT image reconstruction requires a full system rotation. Unlike ring gantry, C-arm x-ray system has limited rotation angle thus cannot perform full field of view CBCT reconstruction. Deep Image Prior (DIP) is a deep-learning based method that can solve ill-posed inverse problem by optimizing the parameters of convolution neural network without training data. We developed DIP based image reconstruction method for limited angle image reconstruction, which allows C-arm CBCT to perform full field of view volumetric imaging in the brachytherapy suite. Based on DIP reconstructed CBCT, we may perform adaptive HDR treatment without moving patient to CT sim. To quantify the potential clinical impact, 10 Gynecological HDR cases planned using the BrachyVision treatment planning system were selected. The plans were exported to RadCalc to simulate the applicator mispositioning in 3 dimensions. Volumetric dose to the tumor and organs at risk (OARs) were computed after the applicator mispositioning simulation. The results were compared to the original plans and the effects on the target coverage and the dose to the OARs were evaluated.</div></div><div><h3>Results</h3><div>DIP method showed promising results in limited angle image reconstruction with body profile outline as prior, as shown in Figure1. Radiation dose comparison between the original plans and simulated ones showed that applicator’s movement in the anterior/posterior direction has the most effect on the bladder and rectum which was expected due to the anatomical locations. However, the anterior/posterior mispositioning of the applicator also showed a significant impact on the small bowel which was not expected. And finally, the applicator mispositioning in the superior/inferior direction has the most impa","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S35"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.086
Katelyn Ragland MD, Samuel Marcrom MD
<div><h3>Purpose</h3><div>Brachytherapy is a critical component of curatively treating locally advanced cervical cancer and vaginal recurrences post-hysterectomy. While advances in imaging modalities such as MRI and CT have improved treatment planning, the accuracy of interstitial applicator implantation remains a key determinant of optimal dosimetry. This study evaluates the impact of transrectal ultrasound (TRUS) on interstitial gynecologic brachytherapy needle placement efficiency, plan dosimetry, and clinical workflow.</div></div><div><h3>Materials and Methods</h3><div>Patients requiring interstitial brachytherapy for a gynecologic cancer between 2020 and 2023 performed by our institution’s primary procedural Radiation Oncologist were retrospectively identified. Outcomes were compared between cases performed with and without TRUS guidance. Endpoints include the number of needles placed, needles removed, unloaded needle channels, and dosimetry to the clinical target volume (CTV_HR) and organs at risk.</div></div><div><h3>Results</h3><div>A total of 142 interstitial implants were performed on 139 patients. Of our implants, 42% involved an intact uterus and patent cervix that accommodated a tandem, and 58% did not utilize a tandem, largely representing recurrent tumors at the vaginal cuff or primary vaginal cancers in patients with prior hysterectomy. The overall population had a median CTV_HR volume of 48.10 cc (11.23-189.03 cc), and the patients with definitely treated cervical cancer had a median CTV_HR volume of 81.13 cc (33.59-161.71cc). In order to analyze the CTV_HR volumes, three bins were created using two cutoffs to create three equal percentile groups. TRUS was used in 73% of cases. Use of TRUS was associated with fewer median needles placed across small (14 to 11, p=0.031), medium (17 to 12, <0.001), and large CTV_HR volumes (24 to 18, <0.001). The proportion of cases requiring needle removal dropped significantly from 41% to 3% (<0.001), and the proportion of plans containing unloaded needle channels decreased from 76% to 25% (<0.001). Despite using fewer needles with TRUS, the patients with cervical cancer undergoing HDR boost had comparable target coverage (CTV_HR) to those without TRUS (D90 > 85Gy EQD2 in 79% and 78% of cases, p=0.602). Utilization of TRUS resulted in more patients meeting the ABS / GEC-ESTRO rectal constraint of D2cc < 75 Gy EQD2 (92% vs. 56%, <0.001).</div></div><div><h3>Conclusions</h3><div>TRUS guidance optimizes interstitial needle placement by reducing the number of needle insertions and adjustments while maintaining dosimetric quality. Despite our cervical cancer patient population having large tumors when compared to many published experiences, utilizing TRUS guidance for interstitial needle placement resulted in improved rectal dosimetry while maintaining target coverage; these represent critical components in achieving disease control and minimizing toxicity. Given its accessibility
{"title":"GSOR05 Presentation Time: 11:50 AM","authors":"Katelyn Ragland MD, Samuel Marcrom MD","doi":"10.1016/j.brachy.2025.06.086","DOIUrl":"10.1016/j.brachy.2025.06.086","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy is a critical component of curatively treating locally advanced cervical cancer and vaginal recurrences post-hysterectomy. While advances in imaging modalities such as MRI and CT have improved treatment planning, the accuracy of interstitial applicator implantation remains a key determinant of optimal dosimetry. This study evaluates the impact of transrectal ultrasound (TRUS) on interstitial gynecologic brachytherapy needle placement efficiency, plan dosimetry, and clinical workflow.</div></div><div><h3>Materials and Methods</h3><div>Patients requiring interstitial brachytherapy for a gynecologic cancer between 2020 and 2023 performed by our institution’s primary procedural Radiation Oncologist were retrospectively identified. Outcomes were compared between cases performed with and without TRUS guidance. Endpoints include the number of needles placed, needles removed, unloaded needle channels, and dosimetry to the clinical target volume (CTV_HR) and organs at risk.</div></div><div><h3>Results</h3><div>A total of 142 interstitial implants were performed on 139 patients. Of our implants, 42% involved an intact uterus and patent cervix that accommodated a tandem, and 58% did not utilize a tandem, largely representing recurrent tumors at the vaginal cuff or primary vaginal cancers in patients with prior hysterectomy. The overall population had a median CTV_HR volume of 48.10 cc (11.23-189.03 cc), and the patients with definitely treated cervical cancer had a median CTV_HR volume of 81.13 cc (33.59-161.71cc). In order to analyze the CTV_HR volumes, three bins were created using two cutoffs to create three equal percentile groups. TRUS was used in 73% of cases. Use of TRUS was associated with fewer median needles placed across small (14 to 11, p=0.031), medium (17 to 12, <0.001), and large CTV_HR volumes (24 to 18, <0.001). The proportion of cases requiring needle removal dropped significantly from 41% to 3% (<0.001), and the proportion of plans containing unloaded needle channels decreased from 76% to 25% (<0.001). Despite using fewer needles with TRUS, the patients with cervical cancer undergoing HDR boost had comparable target coverage (CTV_HR) to those without TRUS (D90 > 85Gy EQD2 in 79% and 78% of cases, p=0.602). Utilization of TRUS resulted in more patients meeting the ABS / GEC-ESTRO rectal constraint of D2cc < 75 Gy EQD2 (92% vs. 56%, <0.001).</div></div><div><h3>Conclusions</h3><div>TRUS guidance optimizes interstitial needle placement by reducing the number of needle insertions and adjustments while maintaining dosimetric quality. Despite our cervical cancer patient population having large tumors when compared to many published experiences, utilizing TRUS guidance for interstitial needle placement resulted in improved rectal dosimetry while maintaining target coverage; these represent critical components in achieving disease control and minimizing toxicity. Given its accessibility","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S51-S52"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.039
John Mohan Mathew MD, Robert Weersink PhD, Alejandro Berlin MD, Enrique Gutierrez MD, Alexandra Rink PhD, Monica Serban PhD, Nauman Malik MD, Carlton Johnny MD, Anisha Patel B Sc, Kitty Chan B Sc, Peter W Chung MD, Rachel M. Glicksman MD
<div><h3>Purpose</h3><div>This series reviews real-time MRI-guided brachytherapy (MRgBT) in complex clinical scenarios where conventional brachytherapy was not feasible, and alternative treatments carried high morbidity.</div></div><div><h3>Materials & Methods</h3><div>Procedures were done in a MRgBT suite equipped with custom-integrated closed-bore MRI, C-arm, and a remote afterloader. Patients were under general anesthesia, positioned feet-first on a flat-topped MR couch, and immobilized with a custom leg strap. A transabdominal or endorectal coil with an HDR (High dose rate) template was used for guidance. MR scans were acquired to assess disease extent, and a 3.5-mm spaced grid template was fused with images. Proton density-weighted imaging verified catheter placement, followed by T2-weighted axial scans for planning. Target volumes were contoured in RayStation. Finalized contours were imported into the treatment planning system, inverse optimization was performed and treatment was delivered.</div></div><div><h3>Results</h3><div>Prostate 1. A 71-year-old man with prior pelvic External Beam Radiation (EBRT) and abdominoperineal resection for rectal cancer 26 years back developed intermediate-risk prostate cancer. Surgery was high-risk, so he received MRgBT boost with 14 catheters (15 Gy/1 Fr HDR, Transrectal Ultrasound was not feasible due to absent rectum) + EBRT to the prostate (46 Gy in 23 Fr), which was well tolerated. 2. A 68-year-old man with prior LDR (Low Dose Rate) brachytherapy developed a mesorectal recurrence after 6 years. MRgBT with 4 catheters (18 Gy and 15 Gy in 2 weekly Fr) initially controlled PSA levels, but the disease later progressed to bone metastases. Sarcoma 3. A 42-year-old man with pelvic myxoid liposarcoma had a para coccygeal recurrence 3 years post-surgery/RT (50Gy in 25 fractions). He declined salvage surgery, so MRgBT (12 Gy/1 Fr with 4 interstitial catheters) with + EBRT (30 Gy/15 Fr) was delivered. He has complete disease regression at 7 years, with minimal toxicity (Figure 1a,b and c). Bladder 4. A 69-year-old woman with muscle-invasive bladder cancer had a positive urethral margin post-cysto-hysterectomy. She received post op MRgBT (7 Gy* 3 fr with vaginal cylinder and 6 interstitial catheters) + adjuvant chemotherapy. She has been disease-free for 8 years with no toxicities. 5. A 77-year-old man with ypT2N0 bladder cancer had malignant cells in urine cytology one year after surgery but no imaging evidence of recurrence. Salvage MRgBT (15 Gy/1 fr) to the urethral stump delivered through a single catheter+ EBRT (37.5 Gy/15 fractions) was given. Persistent positive cytology after treatment was resolved with BCG therapy. Anal Cancer 6. A 68-year-old man treated with chemoradiation (57.6 Gy / 32 fr with concurrent chemo) for T2N0 anal cancer developed periaortic mets (managed with EBRT) and subsequent mesorectal recurrence. MRgBT (7 Gy x 3) controlled the mesorectal nodule initially, but it later progressed,
{"title":"MSOP04 Presentation Time: 5:15 PM","authors":"John Mohan Mathew MD, Robert Weersink PhD, Alejandro Berlin MD, Enrique Gutierrez MD, Alexandra Rink PhD, Monica Serban PhD, Nauman Malik MD, Carlton Johnny MD, Anisha Patel B Sc, Kitty Chan B Sc, Peter W Chung MD, Rachel M. Glicksman MD","doi":"10.1016/j.brachy.2025.06.039","DOIUrl":"10.1016/j.brachy.2025.06.039","url":null,"abstract":"<div><h3>Purpose</h3><div>This series reviews real-time MRI-guided brachytherapy (MRgBT) in complex clinical scenarios where conventional brachytherapy was not feasible, and alternative treatments carried high morbidity.</div></div><div><h3>Materials & Methods</h3><div>Procedures were done in a MRgBT suite equipped with custom-integrated closed-bore MRI, C-arm, and a remote afterloader. Patients were under general anesthesia, positioned feet-first on a flat-topped MR couch, and immobilized with a custom leg strap. A transabdominal or endorectal coil with an HDR (High dose rate) template was used for guidance. MR scans were acquired to assess disease extent, and a 3.5-mm spaced grid template was fused with images. Proton density-weighted imaging verified catheter placement, followed by T2-weighted axial scans for planning. Target volumes were contoured in RayStation. Finalized contours were imported into the treatment planning system, inverse optimization was performed and treatment was delivered.</div></div><div><h3>Results</h3><div>Prostate 1. A 71-year-old man with prior pelvic External Beam Radiation (EBRT) and abdominoperineal resection for rectal cancer 26 years back developed intermediate-risk prostate cancer. Surgery was high-risk, so he received MRgBT boost with 14 catheters (15 Gy/1 Fr HDR, Transrectal Ultrasound was not feasible due to absent rectum) + EBRT to the prostate (46 Gy in 23 Fr), which was well tolerated. 2. A 68-year-old man with prior LDR (Low Dose Rate) brachytherapy developed a mesorectal recurrence after 6 years. MRgBT with 4 catheters (18 Gy and 15 Gy in 2 weekly Fr) initially controlled PSA levels, but the disease later progressed to bone metastases. Sarcoma 3. A 42-year-old man with pelvic myxoid liposarcoma had a para coccygeal recurrence 3 years post-surgery/RT (50Gy in 25 fractions). He declined salvage surgery, so MRgBT (12 Gy/1 Fr with 4 interstitial catheters) with + EBRT (30 Gy/15 Fr) was delivered. He has complete disease regression at 7 years, with minimal toxicity (Figure 1a,b and c). Bladder 4. A 69-year-old woman with muscle-invasive bladder cancer had a positive urethral margin post-cysto-hysterectomy. She received post op MRgBT (7 Gy* 3 fr with vaginal cylinder and 6 interstitial catheters) + adjuvant chemotherapy. She has been disease-free for 8 years with no toxicities. 5. A 77-year-old man with ypT2N0 bladder cancer had malignant cells in urine cytology one year after surgery but no imaging evidence of recurrence. Salvage MRgBT (15 Gy/1 fr) to the urethral stump delivered through a single catheter+ EBRT (37.5 Gy/15 fractions) was given. Persistent positive cytology after treatment was resolved with BCG therapy. Anal Cancer 6. A 68-year-old man treated with chemoradiation (57.6 Gy / 32 fr with concurrent chemo) for T2N0 anal cancer developed periaortic mets (managed with EBRT) and subsequent mesorectal recurrence. MRgBT (7 Gy x 3) controlled the mesorectal nodule initially, but it later progressed,","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S24"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.044
Kevin Martell MD , Mira Keyes MD , Ericka Wiebe MD , Eric Vigneault MD , Amandeep Taggar MD
Purpose
Over the past decade there has been an expansion of brachytherapy (BT) education and practice in Canada including recognition of several BT fellowship programs as eligible for Area of Focused Competence (AFC) designation by the Royal College of Physicians and Surgeons of Canada. This study aims to characterize the extent of BT availability, expertise and utilization after implementation of these initiatives.
Materials and Methods
A 68-question survey covering expertise, training, resources and future challenges to BT programs was created and sent to a single representative at each of the 36 centers in Canada identified to have an active BT program. Absolute count (proportions) and medians (inter-quartile-range) were used to describe the data.
Results
30 responses (response rate 83%) representing all provinces with at least one available BT program (9) were obtained. Twelve (40%) serviced catchment areas with populations >1 million. The median number of radiation oncologists practicing BT in each centre was 5 (3-6); this represented 33% (23%-43%) of overall workforce at each centre. 9 (30%) centers had at least one AFC trained brachytherapist on site while 27 (90%) had at least one non-AFC fellowship trained brachytherapist on site. Of the 10 respondent centers offering BT fellowship programs, 6 (60%) are AFC accredited. All 30 respondents (100%) offered BT treatment for endometrial cancer, 26 (87%) for cervical cancer, 25 (83%) for prostate cancer and 20 (67%) for vaginal cancer. Breast, penile and anal canal BT was offered at 4 (13%), 3 (10%) and 2 (7%) centers, respectively. No center offered lymph node/metastases or bladder BT. In 2024, the median number of endometrial, cervical, prostate and vaginal cancers cases treated were 38 (22-50), 19 (7-33), 66 (41-138) and 1 (0-3), respectively. Sixteen, (62%) respondents anticipated an increase in demand for BT resources within the next 5 years.
Conclusions
BT programs in Canada are supported by highly trained brachytherapists. BT programs most commonly treat gynecologic cancers (endometrial, cervical and vaginal); while case loads are highest for prostate cancer. These survey results will allow comprehensive assessment of BT access and utilization across the country, and allow strategic planning where there is an anticipated increase in BT demand.
{"title":"MSOP09 Presentation Time: 5:40 PM","authors":"Kevin Martell MD , Mira Keyes MD , Ericka Wiebe MD , Eric Vigneault MD , Amandeep Taggar MD","doi":"10.1016/j.brachy.2025.06.044","DOIUrl":"10.1016/j.brachy.2025.06.044","url":null,"abstract":"<div><h3>Purpose</h3><div>Over the past decade there has been an expansion of brachytherapy (BT) education and practice in Canada including recognition of several BT fellowship programs as eligible for Area of Focused Competence (AFC) designation by the Royal College of Physicians and Surgeons of Canada. This study aims to characterize the extent of BT availability, expertise and utilization after implementation of these initiatives.</div></div><div><h3>Materials and Methods</h3><div>A 68-question survey covering expertise, training, resources and future challenges to BT programs was created and sent to a single representative at each of the 36 centers in Canada identified to have an active BT program. Absolute count (proportions) and medians (inter-quartile-range) were used to describe the data.</div></div><div><h3>Results</h3><div>30 responses (response rate 83%) representing all provinces with at least one available BT program (9) were obtained. Twelve (40%) serviced catchment areas with populations >1 million. The median number of radiation oncologists practicing BT in each centre was 5 (3-6); this represented 33% (23%-43%) of overall workforce at each centre. 9 (30%) centers had at least one AFC trained brachytherapist on site while 27 (90%) had at least one non-AFC fellowship trained brachytherapist on site. Of the 10 respondent centers offering BT fellowship programs, 6 (60%) are AFC accredited. All 30 respondents (100%) offered BT treatment for endometrial cancer, 26 (87%) for cervical cancer, 25 (83%) for prostate cancer and 20 (67%) for vaginal cancer. Breast, penile and anal canal BT was offered at 4 (13%), 3 (10%) and 2 (7%) centers, respectively. No center offered lymph node/metastases or bladder BT. In 2024, the median number of endometrial, cervical, prostate and vaginal cancers cases treated were 38 (22-50), 19 (7-33), 66 (41-138) and 1 (0-3), respectively. Sixteen, (62%) respondents anticipated an increase in demand for BT resources within the next 5 years.</div></div><div><h3>Conclusions</h3><div>BT programs in Canada are supported by highly trained brachytherapists. BT programs most commonly treat gynecologic cancers (endometrial, cervical and vaginal); while case loads are highest for prostate cancer. These survey results will allow comprehensive assessment of BT access and utilization across the country, and allow strategic planning where there is an anticipated increase in BT demand.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S27"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.049
Gaurav Gomber BBA , Samyukta Jhavar BS , Mayank Patel MD, MBA , Anne Hubbard MBA , Ann Klopp MD, PhD , Andrew Farach MD , Michelle Ludwig MD, MPH, PhD
Purpose
Texas has the fourth highest incidence and seventh highest mortality rate of cervical cancer in the United States, with disproportionately high rates in medically underserved areas. Brachytherapy is a critical component of cervical cancer treatment, requiring timely access to improve survival and disease outcomes. Furthermore, geographic information systems (GIS) can enhance public health efforts by assessing healthcare accessibility. Here, we present an interactive mapping tool that highlights brachytherapy centers and providers across Texas, aiming to reduce gaps in cervical cancer care.
Materials and Methods
Brachytherapy centers were identified using data from the Texas Department of State Health Services (DSHS) Radiation Control Program and verified through direct contact with each treating institution. This information was cross-referenced with brachytherapy provider data from Medicaid billing records and industry-supplied lists. The finalized dataset was mapped using Tableau Public, displaying brachytherapy centers, providers, available procedures, and pertinent contact information.
Results
A total of 48 active centers providing definitive HDR brachytherapy were identified across Texas. Harris County (Houston area) had seven centers, Tarrant County (Fort Worth area) had five, and both Dallas County and Collin County (Dallas area) had three each. Of Texas' 254 counties, only 28 (11%) had an active brachytherapy center, with most located in urban areas. By mapping facility density, provider distribution, and procedure availability, this tool helps providers streamline referrals and enables policymakers to identify and address gaps in access. A link to the tool can be found here: https://tinyurl.com/BrachytherapyTX
Conclusions
This interactive tool offers a data-driven approach to identifying gaps in brachytherapy access and informing policy decisions. By highlighting underserved regions, it can support initiatives such as funding new brachytherapy programs, expanding telehealth-supported referral networks, and optimizing resource allocation to improve geographic coverage. Serving as a bridge between clinical decision-making and health policy, the tool promotes equitable access to cervical cancer treatment across Texas. Future enhancements include enabling providers to update their capabilities and increasing transparency in insurance networks to help patients find in-network brachytherapy options.
{"title":"PL03 Presentation Time: 2:25 PM","authors":"Gaurav Gomber BBA , Samyukta Jhavar BS , Mayank Patel MD, MBA , Anne Hubbard MBA , Ann Klopp MD, PhD , Andrew Farach MD , Michelle Ludwig MD, MPH, PhD","doi":"10.1016/j.brachy.2025.06.049","DOIUrl":"10.1016/j.brachy.2025.06.049","url":null,"abstract":"<div><h3>Purpose</h3><div>Texas has the fourth highest incidence and seventh highest mortality rate of cervical cancer in the United States, with disproportionately high rates in medically underserved areas. Brachytherapy is a critical component of cervical cancer treatment, requiring timely access to improve survival and disease outcomes. Furthermore, geographic information systems (GIS) can enhance public health efforts by assessing healthcare accessibility. Here, we present an interactive mapping tool that highlights brachytherapy centers and providers across Texas, aiming to reduce gaps in cervical cancer care.</div></div><div><h3>Materials and Methods</h3><div>Brachytherapy centers were identified using data from the Texas Department of State Health Services (DSHS) Radiation Control Program and verified through direct contact with each treating institution. This information was cross-referenced with brachytherapy provider data from Medicaid billing records and industry-supplied lists. The finalized dataset was mapped using Tableau Public, displaying brachytherapy centers, providers, available procedures, and pertinent contact information.</div></div><div><h3>Results</h3><div>A total of 48 active centers providing definitive HDR brachytherapy were identified across Texas. Harris County (Houston area) had seven centers, Tarrant County (Fort Worth area) had five, and both Dallas County and Collin County (Dallas area) had three each. Of Texas' 254 counties, only 28 (11%) had an active brachytherapy center, with most located in urban areas. By mapping facility density, provider distribution, and procedure availability, this tool helps providers streamline referrals and enables policymakers to identify and address gaps in access. A link to the tool can be found here: <span><span>https://tinyurl.com/BrachytherapyTX</span><svg><path></path></svg></span></div></div><div><h3>Conclusions</h3><div>This interactive tool offers a data-driven approach to identifying gaps in brachytherapy access and informing policy decisions. By highlighting underserved regions, it can support initiatives such as funding new brachytherapy programs, expanding telehealth-supported referral networks, and optimizing resource allocation to improve geographic coverage. Serving as a bridge between clinical decision-making and health policy, the tool promotes equitable access to cervical cancer treatment across Texas. Future enhancements include enabling providers to update their capabilities and increasing transparency in insurance networks to help patients find in-network brachytherapy options.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S29"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889165","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>Cervical cancer is the most diagnosed cancer in Tanzania, leading to significant morbidity and mortality. Bugando Medical Centre (BMC) is the only radiotherapy facility in northern Tanzania, with a large catchment area. We previously identified gaps in data and care through an initial retrospective review and subsequently established a prospective cohort to characterize and improve outcomes following definitive chemoradiation and brachytherapy at BMC. This is an initial report from this prospective cohort, the first at BMC radiation oncology.</div></div><div><h3>Materials and Methods</h3><div>This was a prospective cohort study from 2024,including cervical cancer patients treated with definitive chemoradiation and brachytherapy at BMC. Patient demographics, clinical characteristics, and treatment parameters were prospectively gathered. Active follow-up is ongoing to establish OS in this population.</div></div><div><h3>Results</h3><div>At the time of this interim analysis, 215 patients were eligible for review. Definitive chemoradiation consisted of 2D EBRT, 50Gy/25fxwith a Co-60 teletherapy unit. HDR brachytherapy was performed with 2Dtechniques using one Cobalt-60 after loader, 24Gy/3fx. The median age was 51years (IQR 43-63 yrs), and the median parity was 7 (IQR 5-9). Patients came from 92 distinct hospitals in 20 regions, with 102 (47%) travelling more than 5hours to reach BMC. The majority (90%) of patients were farmers, and of the 54(25%) with reported recurring monthly income, the median was $40 (range$2-280). 190 patients (88%) were uninsured, and 97% of patients reported being diagnosed after the development of symptoms, with 6 reporting being diagnosed through screening (3%). The median time from symptom onset to seeking medical care was 4 months (IQR 2-9 months). Stage at diagnosis was 1B in 31 (14%), 2Ain 46 (21%), 2B in 70 (33%), 3A in 25 (12%), 3B in 35 (16%), and 4A in 2 (1%).Histology was squamous cell carcinoma in 178 (83%), adenocarcinoma in 18 (8%),and unknown/other in 19 (9%). HIV status was positive in 48 (22%), negative in130 (60%), and unknown in 37 (17%). 69 patients (32%) were anemic with a hemoglobin of <10 at diagnosis. Systemic therapy with weekly cisplatin was planned for 180 (84%) of patients, with the median cycles received being 3 (IQR2-4). Total duration of treatment was within 55 days for 130 (60%) of patients, and within 65 days for 197 (92%) of patients. Given the lack of survival data available in the prior retrospective review, patients in this prospective cohort are being followed and contacted at regular intervals to determine OS.</div></div><div><h3>Conclusions</h3><div>In this interim analysis of a prospective cohort study of cervical cancer patients who underwent definitive chemoradiation and brachytherapy at BMC, we established the current clinical characteristics and patterns of care for the only radiotherapy facility in northern Tanzania. Quality improvements will be focuse
{"title":"GPP01 Presentation Time: 10:30 AM","authors":"Jim Leng MD , Mwitasrobert Gisiri MD , Cepheline Idrisa MD , Getruda Mashashi MD , Franco Afyusisye BS , Pradumna Chaurasia MS , Vivian Buremo BS , Godwin Mtali BS , Nestory Masalu MD , Nelson Chao MD, MBA , Kristin Schroeder MD, MPH , Junzo Chino MD, FABS, FASTRO , Beda Likonda MD","doi":"10.1016/j.brachy.2025.06.071","DOIUrl":"10.1016/j.brachy.2025.06.071","url":null,"abstract":"<div><h3>Purpose</h3><div>Cervical cancer is the most diagnosed cancer in Tanzania, leading to significant morbidity and mortality. Bugando Medical Centre (BMC) is the only radiotherapy facility in northern Tanzania, with a large catchment area. We previously identified gaps in data and care through an initial retrospective review and subsequently established a prospective cohort to characterize and improve outcomes following definitive chemoradiation and brachytherapy at BMC. This is an initial report from this prospective cohort, the first at BMC radiation oncology.</div></div><div><h3>Materials and Methods</h3><div>This was a prospective cohort study from 2024,including cervical cancer patients treated with definitive chemoradiation and brachytherapy at BMC. Patient demographics, clinical characteristics, and treatment parameters were prospectively gathered. Active follow-up is ongoing to establish OS in this population.</div></div><div><h3>Results</h3><div>At the time of this interim analysis, 215 patients were eligible for review. Definitive chemoradiation consisted of 2D EBRT, 50Gy/25fxwith a Co-60 teletherapy unit. HDR brachytherapy was performed with 2Dtechniques using one Cobalt-60 after loader, 24Gy/3fx. The median age was 51years (IQR 43-63 yrs), and the median parity was 7 (IQR 5-9). Patients came from 92 distinct hospitals in 20 regions, with 102 (47%) travelling more than 5hours to reach BMC. The majority (90%) of patients were farmers, and of the 54(25%) with reported recurring monthly income, the median was $40 (range$2-280). 190 patients (88%) were uninsured, and 97% of patients reported being diagnosed after the development of symptoms, with 6 reporting being diagnosed through screening (3%). The median time from symptom onset to seeking medical care was 4 months (IQR 2-9 months). Stage at diagnosis was 1B in 31 (14%), 2Ain 46 (21%), 2B in 70 (33%), 3A in 25 (12%), 3B in 35 (16%), and 4A in 2 (1%).Histology was squamous cell carcinoma in 178 (83%), adenocarcinoma in 18 (8%),and unknown/other in 19 (9%). HIV status was positive in 48 (22%), negative in130 (60%), and unknown in 37 (17%). 69 patients (32%) were anemic with a hemoglobin of <10 at diagnosis. Systemic therapy with weekly cisplatin was planned for 180 (84%) of patients, with the median cycles received being 3 (IQR2-4). Total duration of treatment was within 55 days for 130 (60%) of patients, and within 65 days for 197 (92%) of patients. Given the lack of survival data available in the prior retrospective review, patients in this prospective cohort are being followed and contacted at regular intervals to determine OS.</div></div><div><h3>Conclusions</h3><div>In this interim analysis of a prospective cohort study of cervical cancer patients who underwent definitive chemoradiation and brachytherapy at BMC, we established the current clinical characteristics and patterns of care for the only radiotherapy facility in northern Tanzania. Quality improvements will be focuse","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S42-S43"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.099
Maylene Choy Gutierrez Bachelor of Science Nursing, Albert Chang MD, Alan Lee MD, Puja Venkat MD
<div><h3>Purpose</h3><div>Proper education on post-treatment care is critical to minimize the risk of patient discomfort, anxiety, medication misuse, and urinary and bowel side effects. In this study, a structured home care education was developed for patients recovering from high-dose rate (HDR) prostate brachytherapy to reduce post-procedural side effects and complications and to enhance patient comfort and recovery.</div></div><div><h3>Materials/Management</h3><div>Two cohorts will be identified randomly, fifteen patients will receive standard discharge instructions, and fifteen patients will receive a comprehensive set of verbal and written post-treatment care instructions. Accompanying illustrations, and frequently asked questions asked by various patients, following their first implant. The patient care team will review these instructions verbally with patients at the time of discharge to ensure clarity and comprehension. The educational material covers key aspects of recovery, including: <em>Dietary Recommendations</em>: Gradual transition from a bland to regular diet, adequate hydration, and avoidance of bladder irritants for one week (e.g., caffeine, alcohol, and spicy foods). <em>Medication Guidelines</em>: Use of general analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, and a urinary tract-specific analgesic such as phenazopyridine or azo for pain and urinary symptoms, with clear instructions on side effects and safe use of opioid analgesics if required. <em>Symptom Management</em>: Strategies to alleviate common issues such as dysuria, hematuria, constipation, and perineal discomfort and discoloration, including the use of sitz baths (if not contraindicated), and stool softeners. <em>Activity Restrictions</em>: recommended to avoid heavy lifting and trauma to the perineum while allowing gradual resumption of tolerated activities. <em>Emergency Protocols</em>: Instructions for recognizing and appropriately addressing emergent complications; such as uncontrolled pain, significant bleeding, and urinary retention, with appropriate follow-up care. The effect of education on patient stress, pain, urinary and bowel side effects, and patient satisfaction will be assessed by the patient perceived stress score, pain visual analog scale, IPSS score, bowel symptom questionnaire, and the surgical care survey, respectively.</div></div><div><h3>Result</h3><div>Thirty patients will participate in the study, with fifteen receiving standard discharge instructions and fifteen receiving additional comprehensive post-treatment care instructions. From clinical experience, patients have reported knowing what to expect during their recovery have decreased stress during their recovery time with proper education, leading to higher patient satisfaction. Further data will be collected at the one-week post-operative follow-up to assess whether the structured education improved patients’ confidence in managing their recovery.<
{"title":"PRSOP07 Presentation Time: 12:00 PM","authors":"Maylene Choy Gutierrez Bachelor of Science Nursing, Albert Chang MD, Alan Lee MD, Puja Venkat MD","doi":"10.1016/j.brachy.2025.06.099","DOIUrl":"10.1016/j.brachy.2025.06.099","url":null,"abstract":"<div><h3>Purpose</h3><div>Proper education on post-treatment care is critical to minimize the risk of patient discomfort, anxiety, medication misuse, and urinary and bowel side effects. In this study, a structured home care education was developed for patients recovering from high-dose rate (HDR) prostate brachytherapy to reduce post-procedural side effects and complications and to enhance patient comfort and recovery.</div></div><div><h3>Materials/Management</h3><div>Two cohorts will be identified randomly, fifteen patients will receive standard discharge instructions, and fifteen patients will receive a comprehensive set of verbal and written post-treatment care instructions. Accompanying illustrations, and frequently asked questions asked by various patients, following their first implant. The patient care team will review these instructions verbally with patients at the time of discharge to ensure clarity and comprehension. The educational material covers key aspects of recovery, including: <em>Dietary Recommendations</em>: Gradual transition from a bland to regular diet, adequate hydration, and avoidance of bladder irritants for one week (e.g., caffeine, alcohol, and spicy foods). <em>Medication Guidelines</em>: Use of general analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, and a urinary tract-specific analgesic such as phenazopyridine or azo for pain and urinary symptoms, with clear instructions on side effects and safe use of opioid analgesics if required. <em>Symptom Management</em>: Strategies to alleviate common issues such as dysuria, hematuria, constipation, and perineal discomfort and discoloration, including the use of sitz baths (if not contraindicated), and stool softeners. <em>Activity Restrictions</em>: recommended to avoid heavy lifting and trauma to the perineum while allowing gradual resumption of tolerated activities. <em>Emergency Protocols</em>: Instructions for recognizing and appropriately addressing emergent complications; such as uncontrolled pain, significant bleeding, and urinary retention, with appropriate follow-up care. The effect of education on patient stress, pain, urinary and bowel side effects, and patient satisfaction will be assessed by the patient perceived stress score, pain visual analog scale, IPSS score, bowel symptom questionnaire, and the surgical care survey, respectively.</div></div><div><h3>Result</h3><div>Thirty patients will participate in the study, with fifteen receiving standard discharge instructions and fifteen receiving additional comprehensive post-treatment care instructions. From clinical experience, patients have reported knowing what to expect during their recovery have decreased stress during their recovery time with proper education, leading to higher patient satisfaction. Further data will be collected at the one-week post-operative follow-up to assess whether the structured education improved patients’ confidence in managing their recovery.<","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S59"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889256","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}
Treatment intensification using either contact X-ray brachytherapy boost (CXB) or chemotherapy (TNT) has become the standard option for rectal preservation. Besides CXB, CT and MRI-based HDR brachytherapy (MR-BCT) are other options to escalate radiation doses. With long-course chemoradiation, MR-BCT is usually added after a gap of 2-6 weeks. Similar information on adding BCT with a TNT setting is not known. We report here the feasibility of MR-BCT in locally advanced rectal cancer patients (>5 cm) being treated with intent for non-operative management (NOM) using short-course radiotherapy (SCRT) followed by 18 weeks of adjuvant chemotherapy (TNT) in a prospective phase II study (SCOTCH study; NCT05856305).
Materials and Methods
Seventy-six patients were accrued in the study, randomized (1:1) to receive either the NrF-2 activator (Chlorophyllin) or placebo (double-blinded), along with SCRT-based TNT. As per the protocol, all patients, irrespective of the study arm, were planned to be assessed at 8-12 (±4) weeks post-SCRT for suitability to undergo MR-BCT. Two independent radiation oncologists assessed this by doing a digital rectal examination. Patients were offered MR-BCT if they had a significant local response with residual disease/scar craniocaudal length of <3 cm and <75% circumference (ideally <50%), rectal lumen at least 2 cm in diameter (corresponding applicator diameter), and distance from the anal verge within 10 cm. The patients identified thus underwent MR-BCT of 5-7 Gy x 3 fractions prescribed to the outer surface of the tumor, with tumor-mucosa restricted to 200% dose. The opposite rectal mucosal dose was limited to <50% using two inflatable balloons over an indigenously designed 3D-printed six-channel applicator. The data presented shows when patients may be suitable for MR-BCT when assessed 8 -12 weeks post SCRT on TNT and reasons for non-suitability. This study is ongoing.
Results
Of the 76 randomized patients, 73 were assessed for MR-BCT. Sixty-three (86.3%) were found suitable at a median of 10 weeks (IQR: 9.1-11.1) post-SCRT. Of these, 61 (96.8%) completed MR-BCT, while two refused MR-BCT and continued TNT. Suitable patients received MR-BCT at a median of 12 weeks (IQR: 10.1-13.2) from SCRT. Ten percent of patients were suitable as early as the 8-9th week, while another 10% were as late as the 15th-16th week. The median CCL of tumors at presentation was 5.8 cm (IQR: 5.07-6.4) on MRI at diagnosis. Overall, there was a median 65.3% shrinkage in CCL and 91.97% shrinkage in volume at MR-BCT. Of the 10 patients (13.7%) who were ineligible for brachytherapy, nine were due to technical reasons (seven: fibrotic lumen <2 cm; two: residual >10 cm from the anal verge) and one clinical (a suspicious local ulcer involving the dentate region with severe pain affecting ADL). This patient underwent surgery and was found to have a pCR.
目的使用接触x线近距离增强治疗（CXB）或化疗（TNT）已成为直肠保存的标准选择。除CXB外，基于CT和mri的HDR近距离治疗（MR-BCT）是提高辐射剂量的其他选择。对于长期放化疗，MR-BCT通常在间隔2-6周后添加。关于添加TNT设置的BCT的类似信息尚不清楚。在一项前瞻性II期研究（SCOTCH研究；NCT05856305）中，我们报告了MR-BCT在局部晚期直肠癌患者（> 5cm）的可行性，这些患者使用短期放疗（SCRT）进行非手术治疗（NOM），然后进行18周的辅助化疗（TNT）。材料和方法76例患者被纳入研究，随机（1:1）接受NrF-2激活剂（叶绿素）或安慰剂（双盲），以及基于scrt的TNT。根据方案，所有患者，无论研究组，计划在scrt后8-12（±4）周进行评估，以确定是否适合接受MR-BCT。两名独立的放射肿瘤学家通过直肠指检对其进行了评估。如果患者有明显的局部反应，残留的疾病/疤痕颅尾长度为3cm和75%周长（理想情况下为50%），直肠管腔直径至少为2cm（相应的涂抹器直径），距离肛门边缘在10cm以内，则给予MR-BCT。因此确定的患者接受肿瘤外表面5-7 Gy x 3剂量MR-BCT，肿瘤粘膜剂量限制为200%。在本地设计的3d打印六通道涂药器上使用两个充气气球，对侧直肠粘膜剂量限制为50%。所提供的数据显示了在TNT上进行SCRT后8 -12周评估患者可能适合MR-BCT的时间和不适合的原因。这项研究正在进行中。结果76例随机患者中，73例接受MR-BCT检查。63例（86.3%）被发现适合在scrt后中位10周（IQR: 9.1-11.1）。其中61例（96.8%）完成MR-BCT， 2例拒绝MR-BCT，继续TNT治疗。合适的患者在SCRT后的中位12周（IQR: 10.1-13.2）接受MR-BCT。10%的患者适合早在8-9周，另有10%的患者晚于15 -16周。肿瘤首发时MRI中位CCL为5.8 cm （IQR: 5.07-6.4）。总体而言，CCL的中位收缩率为65.3%，MR-BCT的中位体积收缩率为91.97%。在10例（13.7%）不适合近距离放疗的患者中，9例是由于技术原因（7例：纤维性管腔2厘米；2例：距肛门边缘10厘米残留）和1例临床原因（可疑的局部溃疡累及齿状区并伴有严重疼痛影响ADL）。该患者接受了手术，并被发现有pCR。结论smr - bct在TNT治疗9-11周的大多数患者中是可行的，其中约10%的患者在16周时符合条件。
{"title":"MPP05 Presentation Time: 4:36 PM","authors":"Rahul Krishnatry MD , Aditi Jain MD , Shivkumar Gudi MD , Vikram Gota MD , Reena Engineer MD","doi":"10.1016/j.brachy.2025.06.027","DOIUrl":"10.1016/j.brachy.2025.06.027","url":null,"abstract":"<div><h3>Purpose</h3><div>Treatment intensification using either contact X-ray brachytherapy boost (CXB) or chemotherapy (TNT) has become the standard option for rectal preservation. Besides CXB, CT and MRI-based HDR brachytherapy (MR-BCT) are other options to escalate radiation doses. With long-course chemoradiation, MR-BCT is usually added after a gap of 2-6 weeks. Similar information on adding BCT with a TNT setting is not known. We report here the feasibility of MR-BCT in locally advanced rectal cancer patients (>5 cm) being treated with intent for non-operative management (NOM) using short-course radiotherapy (SCRT) followed by 18 weeks of adjuvant chemotherapy (TNT) in a prospective phase II study (SCOTCH study; NCT05856305).</div></div><div><h3>Materials and Methods</h3><div>Seventy-six patients were accrued in the study, randomized (1:1) to receive either the NrF-2 activator (Chlorophyllin) or placebo (double-blinded), along with SCRT-based TNT. As per the protocol, all patients, irrespective of the study arm, were planned to be assessed at 8-12 (±4) weeks post-SCRT for suitability to undergo MR-BCT. Two independent radiation oncologists assessed this by doing a digital rectal examination. Patients were offered MR-BCT if they had a significant local response with residual disease/scar craniocaudal length of <3 cm and <75% circumference (ideally <50%), rectal lumen at least 2 cm in diameter (corresponding applicator diameter), and distance from the anal verge within 10 cm. The patients identified thus underwent MR-BCT of 5-7 Gy x 3 fractions prescribed to the outer surface of the tumor, with tumor-mucosa restricted to 200% dose. The opposite rectal mucosal dose was limited to <50% using two inflatable balloons over an indigenously designed 3D-printed six-channel applicator. The data presented shows when patients may be suitable for MR-BCT when assessed 8 -12 weeks post SCRT on TNT and reasons for non-suitability. This study is ongoing.</div></div><div><h3>Results</h3><div>Of the 76 randomized patients, 73 were assessed for MR-BCT. Sixty-three (86.3%) were found suitable at a median of 10 weeks (IQR: 9.1-11.1) post-SCRT. Of these, 61 (96.8%) completed MR-BCT, while two refused MR-BCT and continued TNT. Suitable patients received MR-BCT at a median of 12 weeks (IQR: 10.1-13.2) from SCRT. Ten percent of patients were suitable as early as the 8-9th week, while another 10% were as late as the 15th-16th week. The median CCL of tumors at presentation was 5.8 cm (IQR: 5.07-6.4) on MRI at diagnosis. Overall, there was a median 65.3% shrinkage in CCL and 91.97% shrinkage in volume at MR-BCT. Of the 10 patients (13.7%) who were ineligible for brachytherapy, nine were due to technical reasons (seven: fibrotic lumen <2 cm; two: residual >10 cm from the anal verge) and one clinical (a suspicious local ulcer involving the dentate region with severe pain affecting ADL). This patient underwent surgery and was found to have a pCR.</div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S17"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.092
Jennifer Chiang MD, MS, Sara Richter MS, Thomas Niedermayr PhD, Elizabeth Kidd MD
Purpose
Brachytherapy is a cornerstone of treatment for gynecologic cancers, yet applicator selection (type and size) often relies on intraoperative judgment. Pre-brachytherapy MRI (pre-MRI) may offer predictive insights and streamline procedural planning. Precise applicator placement is critical for achieving optimal disease outcomes. Relatedly, minimizing procedure duration can help to decrease patient discomfort and the risk of anesthesia-related complications. This study aims to explore the association between volumes of the upper vaginal canal on pre-MRI and applicator utilization.
Materials and Methods
Ninety-seven consecutive cervical cancer patients treated with brachytherapy for up to four fractions at a single institution (2022-2024) were retrospectively analyzed. Demographic characteristics and treatment parameters, including applicator type (3D-printed vaginal interstitial applicator [VIA] that accommodates a tandem and different combinations of ovoid sizes), were recorded. Pre-MRIs were used to delineate and measure the upper 1 cm and 2 cm volumes of the vaginal canal, which were then analyzed in relation to applicator type and size used.
Results
The median age of this cohort was 53 years, with 45% identifying as Caucasian and 39% as Hispanic/Latino. Most patients had FIGO stage III/IV (73%) and squamous cell carcinoma (74%) histology. The same applicator type was used in every fraction for most patients (60%). The median volumes of the upper 1 and 2 cm of the canal were 2.5 and 7.7 cm3. VIAs were used in 26% of all fractions. Of the 74% of fractions in which ovoids were used, the combination of 2 cm ovoids bilaterally was used most frequently (44%), followed by dual mini (27%) and mini x 2 cm (22%) ovoids. Applicator type was found to be significantly associated with the volume of the upper 2 cm of the canal in each fraction (P < 0.01). In the 1st fraction, a trend was observed between upper 2 cm volume and applicator type (Figure 1). The median volume in patients treated with VIAs was 4.9 cm3. Among patients treated with ovoids, the median volumes were 6.4 cm³ for dual mini ovoids, 7.5 cm³ for mini x 2 cm ovoids, 9.1 cm³ for dual 2 cm ovoids, and 11.9 cm³ for 2 × 2.5 cm ovoids.
Conclusions
This study highlights the significant association between pre-MRI-derived volumes of the upper vaginal canal and brachytherapy applicator selection, particularly at the first fraction. A quantitative relationship between canal volume and applicator type was found, with an upper 2 cm volume less than 5 cm3 benefiting from a smaller alternative applicator. These findings support further evaluation of volumetric data from pre-MRIs as a predictor of applicator choice, which may guide procedural planning. By incorporating these pre-MRI measurements into clinical workflows, intraoperative uncer
{"title":"GSOR11 Presentation Time: 12:20 PM","authors":"Jennifer Chiang MD, MS, Sara Richter MS, Thomas Niedermayr PhD, Elizabeth Kidd MD","doi":"10.1016/j.brachy.2025.06.092","DOIUrl":"10.1016/j.brachy.2025.06.092","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy is a cornerstone of treatment for gynecologic cancers, yet applicator selection (type and size) often relies on intraoperative judgment. Pre-brachytherapy MRI (pre-MRI) may offer predictive insights and streamline procedural planning. Precise applicator placement is critical for achieving optimal disease outcomes. Relatedly, minimizing procedure duration can help to decrease patient discomfort and the risk of anesthesia-related complications. This study aims to explore the association between volumes of the upper vaginal canal on pre-MRI and applicator utilization.</div></div><div><h3>Materials and Methods</h3><div>Ninety-seven consecutive cervical cancer patients treated with brachytherapy for up to four fractions at a single institution (2022-2024) were retrospectively analyzed. Demographic characteristics and treatment parameters, including applicator type (3D-printed vaginal interstitial applicator [VIA] that accommodates a tandem and different combinations of ovoid sizes), were recorded. Pre-MRIs were used to delineate and measure the upper 1 cm and 2 cm volumes of the vaginal canal, which were then analyzed in relation to applicator type and size used.</div></div><div><h3>Results</h3><div>The median age of this cohort was 53 years, with 45% identifying as Caucasian and 39% as Hispanic/Latino. Most patients had FIGO stage III/IV (73%) and squamous cell carcinoma (74%) histology. The same applicator type was used in every fraction for most patients (60%). The median volumes of the upper 1 and 2 cm of the canal were 2.5 and 7.7 cm<sup>3</sup>. VIAs were used in 26% of all fractions. Of the 74% of fractions in which ovoids were used, the combination of 2 cm ovoids bilaterally was used most frequently (44%), followed by dual mini (27%) and mini x 2 cm (22%) ovoids. Applicator type was found to be significantly associated with the volume of the upper 2 cm of the canal in each fraction (<em>P < 0.01)</em>. In the 1<sup>st</sup> fraction, a trend was observed between upper 2 cm volume and applicator type (Figure 1). The median volume in patients treated with VIAs was 4.9 cm<sup>3</sup>. Among patients treated with ovoids, the median volumes were 6.4 cm³ for dual mini ovoids, 7.5 cm³ for mini x 2 cm ovoids, 9.1 cm³ for dual 2 cm ovoids, and 11.9 cm³ for 2 × 2.5 cm ovoids.</div></div><div><h3>Conclusions</h3><div>This study highlights the significant association between pre-MRI-derived volumes of the upper vaginal canal and brachytherapy applicator selection, particularly at the first fraction. A quantitative relationship between canal volume and applicator type was found, with an upper 2 cm volume less than 5 cm<sup>3</sup> benefiting from a smaller alternative applicator. These findings support further evaluation of volumetric data from pre-MRIs as a predictor of applicator choice, which may guide procedural planning. By incorporating these pre-MRI measurements into clinical workflows, intraoperative uncer","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S55"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.021
Aneesh Dhar MD , Victoria Brennan MD , Sankalp Pandya Research Associate , Daniel Gorovets MD , Assaf Moore MD , Himanshu Nagar MD , Sean McBride MD , Antonio Damato PhD , Joel Beaudry PhD , Marisa A. Kollmeier MD
Purpose
Whole gland salvage brachytherapy (BT) is established as safe and effective for locally recurrent prostate cancer (PCa) after primary radiation therapy (RT). Focal therapy, in appropriately selected patients, may be an alternative to effectively treat disease recurrence and reduce toxicity. We describe our experience on the safety and efficacy of focal HDR and LDR BT.
Materials/Methods
We conducted a retrospective review of patients who underwent focal (partial gland) HDR or LDR BT for locally radiorecurrent PCa between January 1, 2017, and December 31, 2024. Prior to August 2022, salvage HDR BT was delivered with either 19Gy in 1 fraction or 22Gy in 2 fractions, separated by 1-2 weeks. After August 2022, all salvage HDR BT was 22Gy in 2 fractions. ADT was used in 57 patients. Baseline patient and treatment characteristics were recorded. The target consisted of a partial prostate volume (n = 66), one or both seminal vesicles (n = 18), or a combination (n = 16). The median target volume treated was 9.4 (IQR: 6.3 - 13.4) mL. Patients were followed post-salvage with PSA and toxicity assessments every 6 months for 2-3 years, then annually. Patient reported outcomes were obtained using IPSS questionnaires. Nadir +2 definition was used for biochemical failure (BF). Biochemical progression-free survival (bPFS) was defined as a patient being alive without BF. Local failure-free survival (LFFS), regional failure-free survival (RFFS), and distant failure-free survival (DFFS) were defined as a patient being alive without local failure, regional failure, and distant failure from PCa, respectively. Kaplan Meier and Cox regression analyses were performed to assess outcomes and multivariable analyses. The median follow-up for the entire cohort was 26.5 months (IQR 11.75 - 49).
Results
In total, 100 patients were included in this analysis (one fraction HDR, n = 56; two fraction HDR, n = 32; and LDR (Pd-103), 125Gy, n = 12). The median PSA prior to focal salvage was 4.1 (range: 0.6 - 29.5). At the time of focal salvage BT, 1 patient had low grade disease (GG1 = 1), 64 were intermediate (GG2=31; GG3=33), 32 were high (GG4=14; GG5= 18), and 3 patients had negative biopsies. Of the 97 patients with known pre-salvage biopsy data, 56 were upgraded from initial biopsy, 33 had a similar GG score, and 8 were downgraded. The median baseline IPSS for the entire cohort was 7 (IQR: 3 - 11). 23 patients had a bPFS event at a median of 49 months (range: 19 - 94). The bPFS at 24 and 48 months for the entire cohort were 88% and 63%. The DFFS at the same timepoints were 95% and 76%, respectively. On univariate and multivariate analyses, the only significant predictor for bPFS was PSA >2ng/ml prior to salvage BT (HR 1.14, 95% CI 1.04 - 1.25). There were no significant differences in bPFS when comparing salvage BT type (p = 0.8), GG at salvage (p = 0.5), or ADT use (p = 0.6). There were no signif
{"title":"PRPP04 Presentation Time: 10:57 AM","authors":"Aneesh Dhar MD , Victoria Brennan MD , Sankalp Pandya Research Associate , Daniel Gorovets MD , Assaf Moore MD , Himanshu Nagar MD , Sean McBride MD , Antonio Damato PhD , Joel Beaudry PhD , Marisa A. Kollmeier MD","doi":"10.1016/j.brachy.2025.06.021","DOIUrl":"10.1016/j.brachy.2025.06.021","url":null,"abstract":"<div><h3>Purpose</h3><div>Whole gland salvage brachytherapy (BT) is established as safe and effective for locally recurrent prostate cancer (PCa) after primary radiation therapy (RT). Focal therapy, in appropriately selected patients, may be an alternative to effectively treat disease recurrence and reduce toxicity. We describe our experience on the safety and efficacy of focal HDR and LDR BT.</div></div><div><h3>Materials/Methods</h3><div>We conducted a retrospective review of patients who underwent focal (partial gland) HDR or LDR BT for locally radiorecurrent PCa between January 1, 2017, and December 31, 2024. Prior to August 2022, salvage HDR BT was delivered with either 19Gy in 1 fraction or 22Gy in 2 fractions, separated by 1-2 weeks. After August 2022, all salvage HDR BT was 22Gy in 2 fractions. ADT was used in 57 patients. Baseline patient and treatment characteristics were recorded. The target consisted of a partial prostate volume (n = 66), one or both seminal vesicles (n = 18), or a combination (n = 16). The median target volume treated was 9.4 (IQR: 6.3 - 13.4) mL. Patients were followed post-salvage with PSA and toxicity assessments every 6 months for 2-3 years, then annually. Patient reported outcomes were obtained using IPSS questionnaires. Nadir +2 definition was used for biochemical failure (BF). Biochemical progression-free survival (bPFS) was defined as a patient being alive without BF. Local failure-free survival (LFFS), regional failure-free survival (RFFS), and distant failure-free survival (DFFS) were defined as a patient being alive without local failure, regional failure, and distant failure from PCa, respectively. Kaplan Meier and Cox regression analyses were performed to assess outcomes and multivariable analyses. The median follow-up for the entire cohort was 26.5 months (IQR 11.75 - 49).</div></div><div><h3>Results</h3><div>In total, 100 patients were included in this analysis (one fraction HDR, n = 56; two fraction HDR, n = 32; and LDR (Pd-103), 125Gy, n = 12). The median PSA prior to focal salvage was 4.1 (range: 0.6 - 29.5). At the time of focal salvage BT, 1 patient had low grade disease (GG1 = 1), 64 were intermediate (GG2=31; GG3=33), 32 were high (GG4=14; GG5= 18), and 3 patients had negative biopsies. Of the 97 patients with known pre-salvage biopsy data, 56 were upgraded from initial biopsy, 33 had a similar GG score, and 8 were downgraded. The median baseline IPSS for the entire cohort was 7 (IQR: 3 - 11). 23 patients had a bPFS event at a median of 49 months (range: 19 - 94). The bPFS at 24 and 48 months for the entire cohort were 88% and 63%. The DFFS at the same timepoints were 95% and 76%, respectively. On univariate and multivariate analyses, the only significant predictor for bPFS was PSA >2ng/ml prior to salvage BT (HR 1.14, 95% CI 1.04 - 1.25). There were no significant differences in bPFS when comparing salvage BT type (p = 0.8), GG at salvage (p = 0.5), or ADT use (p = 0.6). There were no signif","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S14"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888854","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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