Brachytherapy最新文献

Purpose: Patients diagnosed with cancer turn to social media to learn about diagnoses and treatments, but there are concerns of bias and misinformation. Information about brachytherapy on social media has not been evaluated for overall quality. The purpose of this paper is to review YouTube videos on brachytherapy and to analyze their content.

Methods and materials: YouTube was queried on June 30, 2025 using keywords prostate brachytherapy, cervical brachytherapy, endometrial brachytherapy, vaginal brachytherapy, skin brachytherapy, breast brachytherapy, HDR brachytherapy, and LDR brachytherapy. Videos were ordered by relevance and the top five videos with criteria of length <16 min were independently analyzed by a radiation oncology attending (brachytherapy expert), radiation oncology resident, and undergraduate student. Discordant answers were reviewed by the radiation oncology attending and resident.

Results: Forty videos across the eight keywords were reviewed with an average of 18,356 views (range: 36-203,131), 216 likes (range: 0-1900), and 15 comments (range: 0-123). There was fair agreement between the reviewers when looking at bias based on Fleiss' kappa κ = 0.378 (95% CI, 0.197-0.559), p < 0.001, however the radiation oncology attending and resident detected more misinformation and bias in the prostate, skin, HDR, and LDR videos than the undergraduate reviewer using Cochran's q test χ2(2) = 12.29, p = 0.002 and χ2(2) = 20.93, p < 0.001 respectively.

Conclusion: Prostate and skin brachytherapy videos have greater frequency of misinformation and/or bias in comparison to gynecologic brachytherapy videos that patients may not readily detect. Increased efforts to create complete, accurate, and unbiased content for brachytherapy patients is warranted.

Purpose: To report the 30-year updated results of accelerated partial breast irradiation (APBI) using multicatheter interstitial high-dose-rate (HDR) brachytherapy (BT).

Methods and materials: Forty-five prospectively selected patients with T1N0-N1mi, nonlobular breast cancer without the presence of an extensive intraductal component and with negative surgical margins were treated with APBI after breast-conserving surgery (BCS) using interstitial HDR BT. A total dose of 30.3 Gy (n = 8) and 36.4 Gy (n = 37) in 7 fractions within 4 days was delivered to the tumor bed plus a 1-2 cm margin. The median follow-up time was 28.8 years for surviving patients. Local control, disease-free (DFS), cancer-specific (CSS), and overall survival (OS), as well as late side effects, and cosmetic results were assessed.

Results: Five (11.1%) ipsilateral breast tumor recurrences were observed, for a 10-year and 30-year actuarial rate of 9.4%, and 12.6%, respectively. The 30-year DFS, CSS, and OS were 72.6%, 81.3%, and 46.6%, respectively. Fat necrosis requiring surgical intervention occurred in 1 woman (2.2%). Grade 3 fibrosis was observed in 1 patient (2.2%). No patient developed grade 3 late skin toxicity. Cosmetic results were rated excellent or good in 34 patients (75.6%).

Conclusions: Thirty-year results with APBI using HDR multicatheter interstitial implants continue to demonstrate excellent long-term local tumor control, survival, and cosmetic results with a low rate of late side effects.

Background and purpose: For the treatment of medically inoperable endometrial cancer, there is currently no standard recommended fractionation regimen for brachytherapy boost after completion of external beam radiotherapy (EBRT). This study compares disease control and toxicity with 4 fractions (Fx) versus 5 Fx of brachytherapy.

Materials and methods: Single institution retrospective review of medically inoperable patients treated with EBRT followed by high-dose-rate (HDR) brachytherapy boost. Brachytherapy was performed using three-dimensional image-based planning with magnetic resonance (MR) imaging each fraction when able and was delivered as either 25 Gy in 5 Fx or 24 Gy in 4 Fx based on a transition in the institutional standard. Primary endpoints were locoregional failure (LRF) and late toxicity.

Results: Ninety-four patients were included; 5 Fx n = 64, 4 Fx n = 30. Overall median follow-up was 39.8 months; 5 Fx 50.6 months, 4 Fx 25.8 months. Both groups received similar doses in equivalent 2 Gy fractions (EQD2) to the high-risk clinical target volume (HRCTV) (p = 0.26), and the 4 Fx group received significantly less dose to critical organs at risk (OARs) including the rectum (p = 0.02), sigmoid (p < 0.01), and bladder (p = 0.02). Comparing the 5 Fx group to the 4 Fx group, there was no significant difference in 5-year LRF (11.2% vs. 0.0%, p = 0.24) or in 5-year overall grade 3+ late toxicity (7.7% vs. 5.9%, p = 0.81).

Conclusion: Treatment of inoperable endometrial cancer with 4 Fx of brachytherapy boost compared to 5 Fx after EBRT does not compromise cancer control or toxicity and was associated with less dose to OARs; this de-escalation suggests potential to widen the therapeutic ratio for HDR brachytherapy boost.

Background and aim: With increasing life expectancy, cancer incidence in the elderly is rising. Elderly patients often have comorbidities and social limitations that require supportive care for safe treatment. Brachytherapy is a practical radiotherapy modality for elderly gynecologic cancer patients. This study aimed to assess the prognostic value of the G8 screening tool in women aged ≥ 60 receiving vaginal brachytherapy for cervix or endometrium carcinoma.

Methods: Fifty-five patients treated between 2020 and 2024 were retrospectively evaluated. G8 scores were collected at baseline and categorized as ≤ 14 (frail) and > 14 (non-frail). The correlation of G8 scores with clinical features and survival outcomes were statistically analyzed.

Results: Patients with G8 scores > 14 had significantly better overall survival (OS: 46.9 ± 1.6 vs. 38.5 ± 3.3 months, p = 0.04) and progression-free survival (PFS: 47.1 ± 1.6 vs. 35.1 ± 3.5 months, p = 0.019). A G8 score > 14 was significantly associated with higher Karnofsky Performance Status ≥ 60 (p = 0.009), and fewer distant metastasis (p = 0.025). No significant differences were found in pathology, FIGO stage or EBRT administration between frail and non-frail groups.

Conclusion: The G8 screening tool is a simple and practical instrument for assessing vulnerability in elderly patients undergoing surgery and adjuvant vaginal brachytherapy for gynecological cancers. Low G8 scores were associated with poorer survival, worse functional status, and higher risk of distant metastasis, independent of tumor factors. These findings suggest that the G8 may have prognostic significance in this population; however, they remain hypothesis-generating and require prospective validation before the G8 can be recommended for guiding clinical decision-making.

Purpose: Few comparative studies have evaluated longitudinal changes in International Prostate Symptom Score (IPSS) between low-dose-rate brachytherapy (LDR-BT) and high-dose-rate brachytherapy (HDR-BT) in the setting of combined modality treatment. We aimed to compare the dosimetric characteristics and longitudinal changes in lower urinary tract symptoms (LUTS) and urinary quality of life (uQOL) between HDR-BT and LDR-BT, both combined with external beam radiation therapy (EBRT), for prostate cancer, and identify LUTS deterioration predictors.

Methods and materials: We retrospectively evaluated 200 patients treated with HDR-BT (13 Gy, n = 125) or LDR-BT (110 Gy, n = 75) (EBRT 44-46/45 Gy) between 2010 and 2023. Dosimetric parameters included clinical target volume (CTV) D90, V100 and V150, urethral D10 and D30 (uD10/uD30), and total biologically effective dose (BED). LUTS and uQOL were assessed using the IPSS.

Results: CTV D90, V150, uD10/30, and total BED3.0/10.0 were significantly higher with LDR-BT; total BED1.5 was significantly higher with HDR-BT (all P<0.001). Interpatient variability in dosimetric parameters was significantly greater in LDR-BT (p < 0.05). Compared with LDR-BT, HDR-BT was associated with earlier return to baseline of IPSS (9 months vs 18 months), irritative-IPSS (i-IPSS; 6 months vs 12 months), uQOL (6 months vs 18 months), and obstructive-IPSS (o-IPSS; 9 months vs 18 months). Adjuvant hormonal therapy was associated with smaller o-IPSS increase in HDR-BT (p = 0.029). In LDR-BT, uD10 was associated with greater i-IPSS increase (p = 0.018); uD10 <150% was associated with earlier return to baseline of symptom scores.

Conclusions: HDR-BT has less interpatient variability and faster recovery. Higher uD10 in LDR-BT predicts LUTS deterioration.

Purpose: Image-guided brachytherapy (BT) recommendations define dose limits for 2 cc of rectum and sigmoid; however, while rectal dose correlations with toxicity are well-established, similar evidence for the sigmoid dose is lacking. Due to its high positional variability, we previously proposed a surrogate marker, the "sigmoid point" (Point S), which now requires prospective validation for its association with late recto-sigmoid adverse events (AEs).

Methods: Cervical cancer patients treated with chemoradiation and MRI-based intracavitary or hybrid BT were included. Late recto-sigmoid AEs were prospectively recorded per CTCAE v4. Point S was retrospectively identified on BT plans. Equivalent dose in 2 Gy fractions (EQD2) for rectum 2 cc, sigmoid 2 cc/0.1 cc, and Point S were calculated. Univariate analysis assessed correlations between these doses and late AEs.

Results: Sixty patients were analyzed with a median follow-up of 48 months. Nine (15%) developed grade ≥2 recto-sigmoid bleeding. Median EQD2 doses for patients with grade <2 versus grade ≥2 AEs were: rectum 2 cc: 67.4 versus 72 Gy₃ (p = 0.39); sigmoid 2 cc: 70.4 versus 71.3 Gy₃ (p = 0.65); sigmoid 0.1 cc: 91.8 versus 94.5 Gy₃ (p = 0.40); Point S: 74.4 versus 92.3 Gy₃ (p = 0.017). On univariate analysis, only Point S dose ≥75 Gy₃ was significantly associated with increased risk of recto-sigmoid bleeding (p = 0.017). Logistic regression confirmed higher Point S dose increased the likelihood of grade ≥2 bleeding (p < 0.003).

Conclusions: Point S is a promising surrogate for sigmoid dose estimation during BT. A Point S dose ≥75 Gy₃ is significantly associated with higher risk of grade ≥2 recto-sigmoid toxicity.

Purpose: MRI-guided brachytherapy for locally advanced cervical cancer improves oncological and toxicity outcomes; however, it is a time-intensive process. We hypothesize that integrating MRI with device inserted and moderate sedation with epidural for patients receiving cervical brachytherapy will not increase total treatment time relative to processes that use general or moderate anesthesia without MRI with device inserted.

Methods: From 2019-2023, 32 patients with cervical cancer, stage FIGO IB2-IVB, were selected to form 3 cohorts: Cohort 1 (n = 9) received general anesthesia without MRI; cohort 2 (n = 7) received moderate sedation; cohort 3 (n = 6) received epidural, moderate sedation, and MRI. Time differences between groups were compared. Primary endpoints were total treatment time, epidural time, case time, recovery time, MRI time, treatment planning and delivery in minutes. Secondary endpoints included percentage of patients completing treatment within the 56-day package time and receiving brachytherapy within 7 days from external radiation therapy.

Results: MRI imaging with the device in place and epidural use increased median treatment time among cohorts. The use of moderate sedation in the radiation department decreased median total treatment time among cohorts. Median total treatment time [median (IQR)] were not significantly different; 433 (376, 456), 350 (333, 394), 413 (336, 455) min, among cohorts 1, 2 and 3 respectively (p > 0.05). The 56-day package time or median time from external beam radiation therapy to brachytherapy was not significantly different among cohorts (p > 0.05).

Conclusion: Treatment day MRI with device plus the use of epidural and moderate sedation for analgesia does not prolong total treatment time.

Purpose: To evaluate hydrogel visualization as a marker on CT and MR imaging and consider any potential dosimetric effects incurred by placement of the marker on brachytherapy for the treatment of gynecologic malignancies.

Methods: This prospective cohort study enrolled 25 patients with gynecologic cancers who underwent brachytherapy at Johns Hopkins Hospital. MR and CT imaging were used to compare TraceIT^TM hydrogel visualization immediately after placement with the brachytherapy applicator in place. Rectal dosimetric data of a 2 cm3 volume (D2cc) and equi-effective doses of 2 Gy fractions (EQD2) were obtained. For patients with data collected before and after spacer placement, a comparative analysis was conducted to assess the impact of the marker on rectal dose.

Results: Hydrogel was safely injected into the space between the rectum and vagina in 25 patients, with no side effects related to gel placement. When comparing the agreement in gel visualization by 2 interpreters, inter-rater reliability (kappa statistic) was calculated and showed 58.3% (moderate) agreement (p = 0.0007). In patients who received a brachytherapy fraction both before and after TraceIT^TM placement, the average rectal displacement was 1.33 cm. The change in EQD2 D2cc rectum was significantly lower, with an average pre-TraceIT^TM dose of 5.02 Gy and a post-TraceIT^TM average of 4.60 Gy (p = 0.002).

Conclusions: Hydrogel placement is feasible during brachytherapy procedures for the treatment of gynecologic malignancies. Using TraceIT^TM as a marker resulted in better visualization on MR than on CT. Displacement significantly reduced the D_2cc to the rectum. Further research is needed to determine the optimal amount of hydrogel for spacing in gynecologic cancer patients.

Purpose: Magnetic Resonance Imaging (MRI) is the gold standard image guidance of cervical brachytherapy treatments. Many clinics are moving towards MRI-only planning procedures. In this work, the reconstructions using images acquired from the commercially-available 2D, T2- weighted PROPELLER sequence, and 3D, T1-weighted LAVA-Flex sequences are compared to reconstructions on CT images and assessed for geometric and dosimetric accuracy.

Methods and materials: A cohort of 11 cervical brachytherapy patients was obtained during the commissioning of a new MRI-only gynecological brachytherapy program. Patients underwent CT, 2D-T2-PROPELLER, and T1-3D-LAVA-Flex image acquisition. Geometric distortions in the MRI reconstructed images were evaluated. The applicator and catheters for each image were independently reconstructed in the Oncentra treatment planning system (Elekta), and plans were manually copied to each imaging modality. A gamma analysis using acceptance criteria of 3%, 2mm was used to access the dosimetric consistency between the reconstructions on MRI versus CT.

Results and conclusions: An average geometric distortion of 2.4mm was measured for both the 2D-T2-PROPELLER and T1-3D-LAVA-Flex sequence reconstructions; maximum distortions were 7.5 and 6.4mm respectively. Larger geometric distortions are attributed to obtaining measurements on the periphery of the field-of-view and not in the region of applicator and catheter reconstruction. Gamma pass rates of 96.1±2.8% and 96.6±3.1% were found for the 2D-T2-PROPELLER and 3D-T1- LAVA-Flex MRI reconstructions when compared to CT reconstructions. Minimum gamma pass rates were 90.2% and 90.5% respectively. Significant differences in gamma pass rates were not found between T2-2D-PROPELLER and T1-3D-LAVA-FLEX; however, T1-3D-LAVA-FLEX results were skewed towards higher pass rates. T1-3D-LAVA-FLEX also performed significantly better than T2-2D-PROPELLER for a larger number of catheters.