PO10

Suneetha Mulinti, Mahaboob Basha Syed, Naga Satish Golla, Chandra Kumar Racharla, Sushil Beriwal
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All patients were treated with External Beam radiation to a dose of 45 to 50 Gy in 25 fractions with SIB (55 Gy) to gross nodes along with concurrent weekly chemotherapy with Cisplatin @40 mg/m2. This was followed by brachytherapy to a total dose of 21 - 28 Gy in 3 to 4 fractions of IGABT with planning aims of HRCTV - D90 to receive > 85 to 90 Gy and keeping the EQD2 for 2cc Rectum, Sigmoid and Bladder to < 65 - 70 Gy, 70 - 75 Gy and 80 -85 Gy respectively. Each patient had 2 insertions of brachytherapy with 1 to 2 fractions with each insertion, done under short General anesthesia using real time trans abdominal USG guidance. Results A total number of 62 fractions have been performed with a median number of 4 (range 1-5 needles per patient. 8 patients required oblique needles. The average time from insertion to the first fraction treatment was 4 hours. Six hours gap was given between the two fractions done on same day. No acute Grade 3 complications have been recorded including bleeding or organ perforation. The Median EQD2 D90 of HRCTV was 91.77 Gy [80.1 to 101.9 Gy] and Median GTVp dose D98 was 110.12 Gy [81.1 to 123.5 Gy]. Median EQD2 for 2cc Bladder was 77.75 Gy [65.48 to 80.73Gy], Rectum was 56.36 [40.76 to 66.39Gy], Sigmoid colon - 61.18 Gy [52.24 to 72.88Gy], Small bowel - 58.4 [51.98 to 63.42Gy] 12 out of 17 patients completed first follow up at 3 months, out of which 11 patients showed complete response at cervix. Conclusion Our initial results show excellent dosimetry and no significant procedure related complications with MRI based IGABT in our clinic using hybrid applicator. Clinicians at Aarhus University Hospital, Denmark developed the individualized 3D printed needle templates and Varian worked with Aarhus to develop this hybrid applicator with standard needle template. We started using this in our practice in 2022 and present our initial experience using this Aarhus ring and tandem MR compatible hybrid interstitial applicator with both straight and oblique needles in patients with locally advanced cervical carcinoma. A total number of 22 patients from stage IB3 to IIIB were treated with MR based Image guided adaptive brachytherapy between March 2022 to January 2023, of which 17 patients were treated with Hybrid Interstitial brachytherapy with Aarhus applicator after completion of External Beam Radiotherapy. All patients were treated with External Beam radiation to a dose of 45 to 50 Gy in 25 fractions with SIB (55 Gy) to gross nodes along with concurrent weekly chemotherapy with Cisplatin @40 mg/m2. This was followed by brachytherapy to a total dose of 21 - 28 Gy in 3 to 4 fractions of IGABT with planning aims of HRCTV - D90 to receive > 85 to 90 Gy and keeping the EQD2 for 2cc Rectum, Sigmoid and Bladder to < 65 - 70 Gy, 70 - 75 Gy and 80 -85 Gy respectively. Each patient had 2 insertions of brachytherapy with 1 to 2 fractions with each insertion, done under short General anesthesia using real time trans abdominal USG guidance. A total number of 62 fractions have been performed with a median number of 4 (range 1-5 needles per patient. 8 patients required oblique needles. The average time from insertion to the first fraction treatment was 4 hours. Six hours gap was given between the two fractions done on same day. No acute Grade 3 complications have been recorded including bleeding or organ perforation. The Median EQD2 D90 of HRCTV was 91.77 Gy [80.1 to 101.9 Gy] and Median GTVp dose D98 was 110.12 Gy [81.1 to 123.5 Gy]. Median EQD2 for 2cc Bladder was 77.75 Gy [65.48 to 80.73Gy], Rectum was 56.36 [40.76 to 66.39Gy], Sigmoid colon - 61.18 Gy [52.24 to 72.88Gy], Small bowel - 58.4 [51.98 to 63.42Gy] 12 out of 17 patients completed first follow up at 3 months, out of which 11 patients showed complete response at cervix. Our initial results show excellent dosimetry and no significant procedure related complications with MRI based IGABT in our clinic using hybrid applicator.","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"10 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brachytherapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.brachy.2023.06.111","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose Clinicians at Aarhus University Hospital, Denmark developed the individualized 3D printed needle templates and Varian worked with Aarhus to develop this hybrid applicator with standard needle template. We started using this in our practice in 2022 and present our initial experience using this Aarhus ring and tandem MR compatible hybrid interstitial applicator with both straight and oblique needles in patients with locally advanced cervical carcinoma. Materials & Methods A total number of 22 patients from stage IB3 to IIIB were treated with MR based Image guided adaptive brachytherapy between March 2022 to January 2023, of which 17 patients were treated with Hybrid Interstitial brachytherapy with Aarhus applicator after completion of External Beam Radiotherapy. All patients were treated with External Beam radiation to a dose of 45 to 50 Gy in 25 fractions with SIB (55 Gy) to gross nodes along with concurrent weekly chemotherapy with Cisplatin @40 mg/m2. This was followed by brachytherapy to a total dose of 21 - 28 Gy in 3 to 4 fractions of IGABT with planning aims of HRCTV - D90 to receive > 85 to 90 Gy and keeping the EQD2 for 2cc Rectum, Sigmoid and Bladder to < 65 - 70 Gy, 70 - 75 Gy and 80 -85 Gy respectively. Each patient had 2 insertions of brachytherapy with 1 to 2 fractions with each insertion, done under short General anesthesia using real time trans abdominal USG guidance. Results A total number of 62 fractions have been performed with a median number of 4 (range 1-5 needles per patient. 8 patients required oblique needles. The average time from insertion to the first fraction treatment was 4 hours. Six hours gap was given between the two fractions done on same day. No acute Grade 3 complications have been recorded including bleeding or organ perforation. The Median EQD2 D90 of HRCTV was 91.77 Gy [80.1 to 101.9 Gy] and Median GTVp dose D98 was 110.12 Gy [81.1 to 123.5 Gy]. Median EQD2 for 2cc Bladder was 77.75 Gy [65.48 to 80.73Gy], Rectum was 56.36 [40.76 to 66.39Gy], Sigmoid colon - 61.18 Gy [52.24 to 72.88Gy], Small bowel - 58.4 [51.98 to 63.42Gy] 12 out of 17 patients completed first follow up at 3 months, out of which 11 patients showed complete response at cervix. Conclusion Our initial results show excellent dosimetry and no significant procedure related complications with MRI based IGABT in our clinic using hybrid applicator. Clinicians at Aarhus University Hospital, Denmark developed the individualized 3D printed needle templates and Varian worked with Aarhus to develop this hybrid applicator with standard needle template. We started using this in our practice in 2022 and present our initial experience using this Aarhus ring and tandem MR compatible hybrid interstitial applicator with both straight and oblique needles in patients with locally advanced cervical carcinoma. A total number of 22 patients from stage IB3 to IIIB were treated with MR based Image guided adaptive brachytherapy between March 2022 to January 2023, of which 17 patients were treated with Hybrid Interstitial brachytherapy with Aarhus applicator after completion of External Beam Radiotherapy. All patients were treated with External Beam radiation to a dose of 45 to 50 Gy in 25 fractions with SIB (55 Gy) to gross nodes along with concurrent weekly chemotherapy with Cisplatin @40 mg/m2. This was followed by brachytherapy to a total dose of 21 - 28 Gy in 3 to 4 fractions of IGABT with planning aims of HRCTV - D90 to receive > 85 to 90 Gy and keeping the EQD2 for 2cc Rectum, Sigmoid and Bladder to < 65 - 70 Gy, 70 - 75 Gy and 80 -85 Gy respectively. Each patient had 2 insertions of brachytherapy with 1 to 2 fractions with each insertion, done under short General anesthesia using real time trans abdominal USG guidance. A total number of 62 fractions have been performed with a median number of 4 (range 1-5 needles per patient. 8 patients required oblique needles. The average time from insertion to the first fraction treatment was 4 hours. Six hours gap was given between the two fractions done on same day. No acute Grade 3 complications have been recorded including bleeding or organ perforation. The Median EQD2 D90 of HRCTV was 91.77 Gy [80.1 to 101.9 Gy] and Median GTVp dose D98 was 110.12 Gy [81.1 to 123.5 Gy]. Median EQD2 for 2cc Bladder was 77.75 Gy [65.48 to 80.73Gy], Rectum was 56.36 [40.76 to 66.39Gy], Sigmoid colon - 61.18 Gy [52.24 to 72.88Gy], Small bowel - 58.4 [51.98 to 63.42Gy] 12 out of 17 patients completed first follow up at 3 months, out of which 11 patients showed complete response at cervix. Our initial results show excellent dosimetry and no significant procedure related complications with MRI based IGABT in our clinic using hybrid applicator.
PO10
丹麦奥胡斯大学医院的临床医生开发了个性化的3D打印针头模板,瓦里安与奥胡斯合作开发了这种带有标准针头模板的混合涂抹器。我们于2022年开始在我们的实践中使用这种方法,并介绍了我们在局部晚期宫颈癌患者中使用直针和斜针的奥胡斯环和串联磁共振兼容混合间质涂抹器的初步经验。材料与方法在2022年3月至2023年1月期间,共22例IB3 ~ IIIB期患者接受了基于MR图像引导的适应性近距离放疗,其中17例患者在完成外束放疗后采用奥胡斯涂抹器进行混合间质近距离放疗。所有患者均接受45 - 50gy剂量的外束放射治疗,分25个分量,SIB (55 Gy)照射总淋巴结,同时每周使用顺铂40mg /m2进行化疗。随后进行IGABT 3 - 4次近距离治疗,总剂量为21 - 28 Gy, HRCTV - D90计划目标为接受> 85 - 90 Gy, 2cc直肠、乙状窦和膀胱的EQD2分别为< 65 - 70 Gy、70 - 75 Gy和80 -85 Gy。每位患者在短时间全身麻醉下使用实时经腹USG引导进行2次近距离治疗,每次1 - 2次。结果共进行了62个部分,中位数为4针(1-5针/例)。8例患者需要斜针。从插入到第一次分段治疗的平均时间为4小时。在同一天完成的两个分数之间有6小时的间隔。没有记录急性3级并发症,包括出血或器官穿孔。HRCTV的中位EQD2 D90为91.77 Gy [80.1 ~ 101.9 Gy], GTVp的中位剂量D98为110.12 Gy [81.1 ~ 123.5 Gy]。2cc膀胱EQD2中位数为77.75 Gy [65.48 ~ 80.73Gy],直肠为56.36 Gy [40.76 ~ 66.39Gy],乙状结肠为61.18 Gy [52.24 ~ 72.88Gy],小肠为58.4 Gy [51.98 ~ 63.42Gy], 17例患者中12例在3个月完成首次随访,其中11例宫颈完全缓解。结论:我们的初步结果显示,在我们的临床使用混合涂抹器,基于MRI的IGABT具有良好的剂量学,没有明显的手术相关并发症。丹麦奥胡斯大学医院的临床医生开发了个性化的3D打印针头模板,瓦里安与奥胡斯合作开发了这种带有标准针头模板的混合涂抹器。我们于2022年开始在我们的实践中使用这种方法,并介绍了我们在局部晚期宫颈癌患者中使用直针和斜针的奥胡斯环和串联磁共振兼容混合间质涂抹器的初步经验。2022年3月至2023年1月,共有22例IB3期至IIIB期患者接受了基于MR图像引导的适应性近距离放疗,其中17例患者在完成外束放疗后接受了奥胡斯涂抹器混合间质近距离放疗。所有患者均接受45 - 50gy剂量的外束放射治疗,分25个分量,SIB (55 Gy)照射总淋巴结,同时每周使用顺铂40mg /m2进行化疗。随后进行IGABT 3 - 4次近距离治疗,总剂量为21 - 28 Gy, HRCTV - D90计划目标为接受> 85 - 90 Gy, 2cc直肠、乙状窦和膀胱的EQD2分别为< 65 - 70 Gy、70 - 75 Gy和80 -85 Gy。每位患者在短时间全身麻醉下使用实时经腹USG引导进行2次近距离治疗,每次1 - 2次。共进行了62次分针,中位数为4针(每位患者1-5针)。8例患者需要斜针。从插入到第一次分段治疗的平均时间为4小时。在同一天完成的两个分数之间有6小时的间隔。没有记录急性3级并发症,包括出血或器官穿孔。HRCTV的中位EQD2 D90为91.77 Gy [80.1 ~ 101.9 Gy], GTVp的中位剂量D98为110.12 Gy [81.1 ~ 123.5 Gy]。2cc膀胱EQD2中位数为77.75 Gy [65.48 ~ 80.73Gy],直肠为56.36 Gy [40.76 ~ 66.39Gy],乙状结肠为61.18 Gy [52.24 ~ 72.88Gy],小肠为58.4 Gy [51.98 ~ 63.42Gy], 17例患者中12例在3个月完成首次随访,其中11例宫颈完全缓解。我们的初步结果显示,在我们的临床使用混合涂布器,基于MRI的IGABT的剂量学很好,没有明显的手术相关并发症。
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