Brachytherapy最新文献

{"title":"PO89","authors":"Ming Xu","doi":"10.1016/j.brachy.2023.06.190","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.190","url":null,"abstract":"The objective was to evaluate radioactive angles and dose distribution of partially shielded GYN cylinders during HDR Brachytherapy in a commercial treatment planning system (TPS). Patient treatment plans with partial shielded cylinders were generated in Brachytherapy planning using Eclipse TPS. The AAPM TG-43 dose calculation formalism was commonly used to provide rapid patient treatment. The Acuros algorithm in AAPM TG-186 MBCDAs with the same source position and planned dwell time was used to compare shielding effects and unblocked dose distributions. Acuros calculations employed solid applicators with shielded angles of 90°, 180°, and 270° from the TPS library, with tungsten alloy shielded segments. All calculations were performed in the water phantom. The differences between the AAPM TG-43 and TG-186 algorithms in these applicators were evaluated in terms of shielded angle, radioactive range, low dose bath background, and dose distribution. Patient planning using various shielded angle cylinders anteriorly or posteriorly to minimize local bladder or rectal dose on patient CT images for vaginal cuff treatment. The dwell time at the source position was calculated according to the 3D TG-43 algorithm, ignoring the shielding effect of the applicator to result in a cylindrically symmetrical dose distribution along the cylinder axis. Acuros dose calculation implemented Monte-Carlo (MC) algorithm approach. The 3D asymmetric dose distribution was shown in the sagittal view as expected. Low dose bath in the shielded areas was observed at approximately 10-15% of the prescribed dose. The low dose bath level changed slowly with shielding angle. The physical shielding angle was effectively shielded within the dose distribution range. The radioactive angle can be defined as the angle of the radioactive coverage portion from the source, or the angle between the designed isodose points to the center of cylindrical section. As showed in the figure below, a 180° shielded cylinder can shield a maximum range of about 210° in the posterior portion. When the sum of the shieling angle and radioactive angle was 360°, the radioactive angle was equal to 150°. This behavior was confirmed for shielding angles of 90°, 180°, and 270°, respectively in Acuros calculations. The radioactive angle was found to be smaller than the physical shielding angle. The presence of the metal block appeared to prevent deposition of scattered doses to unshielded tissue. This reduced scatter made the blocking angle projection wider than its physical angle. A slightly longer Acuros dwell time at a few percent was required to achieve the same dose level calculated for TG-43. Acuros calculations for shielded cylinder suggest that the shielded region in dose distribution is wider than the physically shielded part of segment. The radioactive angle is smaller than the physical shielded angle. Shielded areas are kept in low dose baths of prescribed doses. A slightly longer dwell time is required t","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO04","authors":"Yixiang Liao, Ken Tatebe, Julius Turian","doi":"10.1016/j.brachy.2023.06.105","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.105","url":null,"abstract":"Purpose The conventional vaginal cylinder design consists of cylindrical segments and a hemi-spherical top, with a diameter matched to the cylinder portion. This design is driven primarily by geometric simplicity, without much consideration for the dose distribution around the brachytherapy source, nor the anatomy of patients. Careful plan optimization is required to make the prescription isodose line conform to the surface of the cylinder. However, the conformity is not optimal due to the discrepancy between the cylinder shape and the intrinsic dose anisotropy of the source perpendicular to the azimuthal plane. We propose an alternative design for an ergonomic vaginal applicator (EVA), which requires minimal optimization, provides a more natural dose conformity, and is more ergonomic for the patient. Materials and Methods In treating with brachytherapy alone for postoperative endometrial cancer, our typical prescription is 6 Gy x 5 fractions to the surface, covering the top 4 cm of the vaginal cuff. To create the proposed applicator, the existing cylinder channel, using the first 10 dwell positions (5mm-interval), are uniformly loaded for 17.33 seconds with nominal 10 Ci Ir-192 HDR source (GammaMedPlusiX and Eclipse). The prescription isodose line then takes the shape of an ovoid, with 3 cm diameter at middle length, paralleling a typical size used for cylinder applicator treatments. Similarly, uniform loading times of 10, 13.6, 21.8, and 26.5 seconds correspond to maximal diameters of 2, 2.5, 3.5, and 4 cm, respectively. The prescription isodose line is converted to a contour that can be exported and used to construct an applicator. The surface of this applicator naturally conforms to the prescription isodose line, which removes the need for any further plan optimization. Dose along the surface and at 5mm distance from the applicator equator to the tip of the dome are reported. Results Using the 3 cm diameter case as an example, the average surface dose (± Std. Dev) is 100% ± 3.2% with the EVA, compared to 100% ± 5.5% with the conventional cylinder, showing improved surface dose homogeneity with EVA, even after extensive optimization of the cylinder plan. The doses at 5mm depth are comparable: 57.3 ± 6.8% and 57.9 ± 6.2%, respectively. In addition, the tapered tip of EVA is likely easier to implant and would cause less discomfort for patients. Another potential benefit of the EVA is that its tapered tip may be less likely to trap air bubbles between the applicator and the vaginal cuff. Conclusions A novel design for a vaginal applicator is achieved that requires minimal planning optimization, with improved surface dose homogeneity, and better ergonomics. These are expected to provide both superior dosimetry and better overall clinical experience. The conventional vaginal cylinder design consists of cylindrical segments and a hemi-spherical top, with a diameter matched to the cylinder portion. This design is driven primarily by geometric simplic","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO124","authors":"Javier Rodriguez Corredor","doi":"10.1016/j.brachy.2023.06.224","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.224","url":null,"abstract":"Worldwide, non-melanoma skin cancer (NMSC) has a high incidence. In 2020, Colombia, a Latin American country, had a NMSC incidence of 7.9 per 100.000 inhabitants. High Dose Rate (HDR) skin brachytherapy is a validated treatment option, with optimal and promising local control rates and cosmetic results, equivalent to surgical management and external radiation therapy. Nevertheless, this treatment technique may be scarce in Low Middle-Income Countries (LMICs), due to personnel training and technology requirements. We present the largest cohort of patients treated with HDR skin brachytherapy in Colombia, treated at the Colombian National Cancer Institute and a proposal for a low-priced, widely available, marker technique for Computed Tomography (CT) Simulation. This was a retrospective review of all patients with skin tumors treated with Ir-192 high dose rate (HDR) surface cast brachytherapy from January 1, 2019, to January 28, 2023 at the National Institute of Medicine. cancerology, Bogota - Colombia. 44 lesions (36 patients) were identified. The median age at diagnosis was 76 years (range = 50-98). The majority were basal cell carcinomas (82%, n = 36), squamous cell carcinomas (15%, n =7 ), and one cutaneous lymphoma (3%, n = 1). Most of the lesions were located in the head region. and neck. The most used RT dose was 40 Gy/8 interday fractions; all patients had individualized CT-based planning with alternative donut-type fiducial markers. Six months survival (OS) was 94% and 6-month progression-free survival (PFS) was 92%. Most of the deaths were from unrelated causes. Response was assessed in the clinic at 1 week and 2, 4, and 6 months after treatment. Our complete response (CR) rate was 97%, with partial response in one patient, we reported a local control (CL) rate at 6 months of 86%, and local recurrence in one patient. The procedure was well tolerated, with no grade 3-5 acute or late toxicities assessed on the RTOG and LENT/SOME scales. The median depth of the isodose line at 100% was 0.5 cm and the median surface dose = 120%. The median V 90 = 93%. Surface brachytherapy is an excellent alternative for the treatment of non-melanoma cancer, with response rates and effective local cancer control. In low-resource countries, treatments such as brachytherapy improve patient adherence, becoming future perspectives to be implemented. challenges in techniques, dosimetry, and casts provide challenges that evoke recursive solutions like our donut radiopaque fiduciary, thus demonstrating the skills of the radiation oncologist in the face of variability.","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO72","authors":"Evans Amoah, Jeremiah Johnson, Stephen Strup, Ali Soleimani-Meigooni, William St. Clair","doi":"10.1016/j.brachy.2023.06.173","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.173","url":null,"abstract":"Purpose Radiation management literature focused on optimizing care for patients with intellectual disability is sparse. We add our experience to the literature with the goal to improve care to this vulnerable patient population. To this end, we report three cases of prostate cancer in patients with limited cognition who were treated with low dose rate (LDR) prostate brachytherapy to highlight an effective strategy to deliver optimal care to this group of patients. Materials and Methods This is a case series of three adult male patients with limited cognition each of whom developed prostate cancer which was managed primarily with LDR brachytherapy. Results Patient #1: A 53-year-old male with favorable intermediate-risk prostate cancer (PSA 8.8 ng/ml, Grade Group 2), Patient #2: a 68-year-old male with unfavorable intermediate risk prostate cancer (PSA 12.6 ng/ml, Grade Group 3), and Patient #3: a 52-year-old male with high-risk prostate cancer (PSA 24 ng/ml, Grade Group 1), all of whom had intellectual disability, were evaluated for radiation therapy. A thorough discussion occurred with each patient and their legal guardian about prostate cancer therapy options including surgery versus radiation treatment with or without androgen deprivation therapy. Radiation therapy treatment strategies presented included low dose rate brachytherapy versus external beam radiation treatment including SBRT to a total dose of 3625 cGy in 5 fractions every other day or a moderately hypofractionated regimen to a total dose of 7000 cGy in 28 daily fractions Monday to Friday. In each case, a shared decision was made for each patient to undergo interstitial prostate seed implant. Of note, two out of the three patients lived more than an hour away from the radiation treatment center and relied on family support for transportation needs. Each patient initially underwent a prostate volume study with a transrectal ultrasound to 1) determine the dimensions of the prostate and 2) develop a plan for radiation dose coverage of the prostate with interstitial Cs-131 brachytherapy seeds. Each patient then underwent seed implantation under anesthesia followed by fluoroscopy and post-implant CT, to assess for appropriate seed placement as well as the post-implant dosimetry. Patient #1 received a total prescription dose of 110 Gy to the prostate D90 using 61 sources each with a strength of 1.6 U per seed for a total strength of 97.6 U and at 14 months follow up, his PSA had decreased to 1.7 ng/ml from 8.8 ng/ml. Patient #2 received a total prescription dose of 100 Gy to the prostate D90 using 59 sources each with a strength of 1.43 U per seed for a total strength of 84.37 U, and at 38 months follow up, his PSA had decreased to 0.018 ng/ml from 12.6 ng/ml. Patient #3 received 115 Gy to the prostate D90 using 90 sources each with a strength of 1.8 U per seed for a total of 162 U, and at 34 months follow up, his PSA had decreased to 0.8 ng/mL from 24 ng/ml. In all three cases, treatment","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO22","authors":"Yoshiaki Takagawa, Masanori Machida, Ichiro Seto, Shinya Komori, Hiroki Sato, Hiroko Midorikawa, Masao Murakami","doi":"10.1016/j.brachy.2023.06.123","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.123","url":null,"abstract":"","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO32","authors":"Madison Nichols, Gary Lewis","doi":"10.1016/j.brachy.2023.06.133","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.133","url":null,"abstract":"","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO13","authors":"Saryleine Ortiz de Choudens, Christina Small-Tom, Lindsey McAlarnen, Susan Duyar, Rebekah Summey, Erin Bishop, Elizabeth Hopp, William Bradley, Denise Uyar, Janet S. Rader, Meena Bedi, Beth Erickson","doi":"10.1016/j.brachy.2023.06.114","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.114","url":null,"abstract":"Purpose Dose intensive image-based brachytherapy has become the gold standard treatment for cervical cancer, with an improvement in disease control and radiation-induced morbidity. A significant contribution to dose escalation has been the addition of needles to intracavitary applicators, with both hybrid and template-based insertions. These applications afford brachytherapists more flexibility of dose shaping and tumor coverage, while sparing organs at risk. Many of these procedures can now be performed in departmental brachytherapy suites within radiation oncology departments, where support from other hospital teams is not always readily available. One of the most feared complications during removal of interstitial brachytherapy applicators is a bleeding event, which can range from minor blood loss to life threatening bleeding. In particular, the use of needles that are inserted into the highly vascular vaginal, cervical and parametrial tissues can increase the risk of these events, including injury of venous and arterial structures. Being prepared for potential bleeding events is of the utmost importance in order to ensure a rapid and effective response. Materials and Methods Our goal is to establish a set of guidelines which can be used to prepare for and treat bleeding events during gynecologic brachytherapy. The proposed methods have been used at our institution and were developed in collaboration with the gynecology oncology team. Results First, we recommend pre-operative evaluation of blood counts following chemoradiation, pre-existing bleeding disorders, anticoagulant use, non-steroidal anti-inflammatory drug use, and disease location. A full pre-operative evaluation by a trained anesthesiologist can expedite this evaluation. Blood counts and electrolytes should be obtained on procedure day and prior to needle insertion, and if necessary, significant pre-procedure abnormalities addressed with transfusions or other supplements. Assessment of the location of residual disease and proximity to nearby vessels, as well as the projected location and number of needles is strategic. Considerations for removal of inpatient applications where multiple fractions have been delivered over several days should include timing of prophylactic anticoagulation discontinuation, pre-pull hemoglobin/hematocrit/platelet levels, and if needed, transfusion prior to applicator removal. For all patients, continuous monitoring of vitals before and during applicator removal, as well as dual IV access and blood type and crossing should be considered. IV fluids should be readily available should bleeding cause a drop in blood pressure. Preparation of a fully equipped vaginal packing kit complete with speculums, ring forceps, packing gauze, saline, lubricant and Monsel's solution is essential. For severe bleeding events, with rapid emergence of symptomatic anemia including tachycardia, hypotension, pallor, dizziness or other subjective symptoms, a rapid response team sh","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO99","authors":"Kaile Li","doi":"10.1016/j.brachy.2023.06.200","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.200","url":null,"abstract":"","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO44","authors":"Memory Fadziso Bvochora-Nsingo, Rohini Bhatia, Elliphine Gwangwava, Thabiso Itshabeng, Surbhi Grover","doi":"10.1016/j.brachy.2023.06.145","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.145","url":null,"abstract":"Purpose Cervical cancer is the most common cancer treated with radiation in Botswana. There is a single linear accelerator and a single HDR brachytherapy unit in the country, treating a median of 200 cervical cancer cases year. About 80% of these are treated with curative intent, using concurrent chemoradiation with brachytherapy boost. Patients in Botswana often present with advanced disease and very bulky tumours. Traditionally, patients who can not have brachytherapy are sent for external beam boost. This not only adds burden onto the very busy single Linac, but also outcomes of patients are compromised. We highlight here seven cases with novel insertions for patients who would have been deemed ineligible for brachytherapy. Materials and Methods We retrospectively revised the records of cervical cancer patients treated with brachytherapy in January 2023, 29 in total. Brachytherapy was delivered in the final week of external beam radiation, or after completion for bulky tumours. The mean age was 46 years and most patients (22, 76%) presented with stage IIB or IIIB, six patients had undergone hysterectomy for stage IB disease. Applicators available were tandem and ovoids, tandem and ring, tandem and cylinder, and cylinder post hysterectomy. Twelve patients (41%) needed interstitial needles. However, seven patients(24%) would previously have been deemed unsuitable for brachytherapy with these applicators due to: 1. Bulky disease with poor response to external beam brachytherapy (three patients). 2. Effaced or destroyed cervix and cavitation at vault post EBRT, traditional tandem and cylinder would not fit (three patients) 3. Stenosis at vault smallest ovoids could not fit and tandem and cylinder would not give adequate dose to bulky tumour (one patient). Results We successfully used three non-conventional methods to complete brachytherapy using available applicators, to treat the 7 patients who would have been deemed ineligible for brachytherapy. Fig. 1. illustrates images from three of the seven patients treated this way. Patient 1: A 55 year old patient with bulky local disease and poor response to EBRT. On day 55, mass still bulky; failed to insert traditional instruments. We inserted tandem and interstitial wires only with no ovoids. Patient 2: A 42 year old patient with stage IIB cancer of the cervix. Cervix had been completely destroyed post external beam radiation, which then created a small cavity at the vault. No gross residual disease. An intrauterine tandem was inserted, then a small (2cm) cylinder was placed into the vault cavity, followed by three 3.5cm cylinders. Patient 3: A 60 year old patient with Stage IIIB cancer of the cervix with bulk of tumour on the left.The smallest ovoids could not fit at the vault, yet tandem and cylinder would not give enough dose coverage especially to the left. A tandem and left ovoid only were inserted, with interstitial wires on the left. All three patients managed to complete radical chemo radiatio","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PO80","authors":"Juan Wang, Zezhou Liu, Yansong Liang, Jinxin Zhao, Huiming Yu, Hongtao Zhang, Ke Xu","doi":"10.1016/j.brachy.2023.06.181","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.181","url":null,"abstract":"Purpose To explore the value of modified intraoperative real-time 125I seed implantation planning for lumbar lymph nodes metastases. Method We collected 26 lymph nodes metastases patients, who received 125I seed implantation from January 2015 to December 2021. 13 patients procedure were guided by modified intraoperative real-time treatment plan, and the rest were guided by conventional treatment plan. To compare the differences of the dosimetric parameters between pre-plan and post-plan of the 2 groups, and the percentage difference of the dosimetric parameters between the 2 groups. Then evaluate the curative effect and side effects after 6-month. Result There were no significant differences in dosimetric parameters between pre-plan and post-plan in modified intraoperative real-time treatment plan group, and showed significant differences in V150between pre-plan and post-plan in conventional treatment plan group(z=-3.045,P<0.001), and the rest dosimetric parameters of conventional treatment plan group showed no significant differences beforeand after operation(P>0.05). The percentage difference of V150 between the 2 groups showed statistically significant(z=2.103 ,P=0.004), and the rest dosimetric parameters showed no significant differences(P>0.05).6 months after the brachytherapy, the effective rate of Modified intraoperative real-time treatment plan group was 77%(10/13), and 46%(6/13) in Conventional treatment plan group, and no peritonitis and hemorrhage were observed. Conclusion The application of modified real-time planning improved accuracy of dosimetric, reduced the high dose rate area, and provide guarantee for 125I seed implantation planning for lumbar lymph nodes metastases. To explore the value of modified intraoperative real-time 125I seed implantation planning for lumbar lymph nodes metastases. We collected 26 lymph nodes metastases patients, who received 125I seed implantation from January 2015 to December 2021. 13 patients procedure were guided by modified intraoperative real-time treatment plan, and the rest were guided by conventional treatment plan. To compare the differences of the dosimetric parameters between pre-plan and post-plan of the 2 groups, and the percentage difference of the dosimetric parameters between the 2 groups. Then evaluate the curative effect and side effects after 6-month. There were no significant differences in dosimetric parameters between pre-plan and post-plan in modified intraoperative real-time treatment plan group, and showed significant differences in V150between pre-plan and post-plan in conventional treatment plan group(z=-3.045,P<0.001), and the rest dosimetric parameters of conventional treatment plan group showed no significant differences beforeand after operation(P>0.05). The percentage difference of V150 between the 2 groups showed statistically significant(z=2.103 ,P=0.004), and the rest dosimetric parameters showed no significant differences(P>0.05).6 months after the brachytherapy, the","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}