PO123

Brachytherapy Pub Date : 2023-09-01 DOI:10.1016/j.brachy.2023.06.223

Takashi Kawanaka, Chisato Tonoiso, Akiko Kubo, HItoshi Ikushima, Masafumi Harada

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To reconcile the discrepancy between the surgical cavity and the shape of the SAVI, we devised a hybrid APBI incorporating a supplementary catheter into the surrounding region of the SAVI and validated the dose distribution through simulation with a restricted quantity of supplementary catheters. Utilizing the obtained results, we present the outcomes of the hybrid APBI in actual clinical application. The objective of this investigation was to examine and augment the congruity between the SAVI applicator and the residual excision cavity following partial mastectomy in cases of APBI with SAVI in Japan. Materials and Methods Our evaluation encompasses four instances of APBI with postoperative insertion of SAVI, conducted at our institution between December 2018 and May 2019. The affected breasts included three right and one left, with two cases each affecting regions C and D. Through a postoperative insertion approach, each case was strategically placed from the inframammary fold. The treatment plan was executed using Oncentra brachy (Electa), with a prescribed dose of 34 Gy/10 Fr delivered through IPSA for PTV_EVAL. Our review of the outcomes prompted the implementation of hybrid APBI in three patients from the year 2020. Results The mean volume of the PTV_EVAL was observed to be 75.71 mL in the four cases of Accelerated Partial Breast Irradiation (APBI) with postoperative insertion of the SAVI applicator evaluated in this study. Out of these, three cases demonstrated a deviation of more than 10% in volume between the SAVI applicator and AIR, resulting in suboptimal dose delivery to the target volume (PTV_EVAL), which was evidenced by D90 failing to reach 90% in each case. Upon further analysis, the discrepancy was found to arise from the irregular shape of AIR on the chest wall side or bilaterally on the CT cross-section perpendicular to the SAVI, which had taken on a dog-ear form. To address this issue, a virtual hybrid APBI approach was implemented by adding one or two catheters placed along the SAVI applicator, leading to a substantial improvement in the D90 of PTV_EVAL in all three cases, reaching 90% in each. Based on this result, the hybrid approach was executed by inserting intra-tissue catheters near the prominent AIR, parallel to the SAVI applicator, under ultrasound guidance. The average D90 delivered by the SAVI alone was 74.39%, which improved to 95.90% with the addition of the intra-tissue catheter, thereby demonstrating the efficacy of the hybrid APBI approach in enhancing the compatibility between the residual excision cavity and the SAVI applicator following partial mastectomy. Conclusions The conformation of the SAVI applicator may not align with the partial mastectomy cavity in Japan. The addition of a small number of intra-tissue catheters improves how well the SAVI method works and makes the treatment more effective. In Japan, cylindrical excisions are commonly performed in partial mastectomies for breast-conserving therapy, as opposed to the typical lumpectomies. Hence, when implementing Accelerated Partial Breast Irradiation (APBI) with the use of SAVI, a multi-lumen single catheter for partial breast irradiation with brachytherapy, discrepancies were noted between the shape of the excision cavity and the SAVI. Our institution reexamined the correlation between the form of the excision cavity and the shape of SAVI in instances of APBI that utilized post-operative SAVI insertion. To reconcile the discrepancy between the surgical cavity and the shape of the SAVI, we devised a hybrid APBI incorporating a supplementary catheter into the surrounding region of the SAVI and validated the dose distribution through simulation with a restricted quantity of supplementary catheters. Utilizing the obtained results, we present the outcomes of the hybrid APBI in actual clinical application. The objective of this investigation was to examine and augment the congruity between the SAVI applicator and the residual excision cavity following partial mastectomy in cases of APBI with SAVI in Japan. Our evaluation encompasses four instances of APBI with postoperative insertion of SAVI, conducted at our institution between December 2018 and May 2019. The affected breasts included three right and one left, with two cases each affecting regions C and D. Through a postoperative insertion approach, each case was strategically placed from the inframammary fold. The treatment plan was executed using Oncentra brachy (Electa), with a prescribed dose of 34 Gy/10 Fr delivered through IPSA for PTV_EVAL. Our review of the outcomes prompted the implementation of hybrid APBI in three patients from the year 2020. The mean volume of the PTV_EVAL was observed to be 75.71 mL in the four cases of Accelerated Partial Breast Irradiation (APBI) with postoperative insertion of the SAVI applicator evaluated in this study. Out of these, three cases demonstrated a deviation of more than 10% in volume between the SAVI applicator and AIR, resulting in suboptimal dose delivery to the target volume (PTV_EVAL), which was evidenced by D90 failing to reach 90% in each case. Upon further analysis, the discrepancy was found to arise from the irregular shape of AIR on the chest wall side or bilaterally on the CT cross-section perpendicular to the SAVI, which had taken on a dog-ear form. To address this issue, a virtual hybrid APBI approach was implemented by adding one or two catheters placed along the SAVI applicator, leading to a substantial improvement in the D90 of PTV_EVAL in all three cases, reaching 90% in each. Based on this result, the hybrid approach was executed by inserting intra-tissue catheters near the prominent AIR, parallel to the SAVI applicator, under ultrasound guidance. The average D90 delivered by the SAVI alone was 74.39%, which improved to 95.90% with the addition of the intra-tissue catheter, thereby demonstrating the efficacy of the hybrid APBI approach in enhancing the compatibility between the residual excision cavity and the SAVI applicator following partial mastectomy. The conformation of the SAVI applicator may not align with the partial mastectomy cavity in Japan. The addition of a small number of intra-tissue catheters improves how well the SAVI method works and makes the treatment more effective.","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"27 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.2023.06.223","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 In Japan, cylindrical excisions are commonly performed in partial mastectomies for breast-conserving therapy, as opposed to the typical lumpectomies. Hence, when implementing Accelerated Partial Breast Irradiation (APBI) with the use of SAVI, a multi-lumen single catheter for partial breast irradiation with brachytherapy, discrepancies were noted between the shape of the excision cavity and the SAVI. Our institution reexamined the correlation between the form of the excision cavity and the shape of SAVI in instances of APBI that utilized post-operative SAVI insertion. To reconcile the discrepancy between the surgical cavity and the shape of the SAVI, we devised a hybrid APBI incorporating a supplementary catheter into the surrounding region of the SAVI and validated the dose distribution through simulation with a restricted quantity of supplementary catheters. Utilizing the obtained results, we present the outcomes of the hybrid APBI in actual clinical application. The objective of this investigation was to examine and augment the congruity between the SAVI applicator and the residual excision cavity following partial mastectomy in cases of APBI with SAVI in Japan. Materials and Methods Our evaluation encompasses four instances of APBI with postoperative insertion of SAVI, conducted at our institution between December 2018 and May 2019. The affected breasts included three right and one left, with two cases each affecting regions C and D. Through a postoperative insertion approach, each case was strategically placed from the inframammary fold. The treatment plan was executed using Oncentra brachy (Electa), with a prescribed dose of 34 Gy/10 Fr delivered through IPSA for PTV_EVAL. Our review of the outcomes prompted the implementation of hybrid APBI in three patients from the year 2020. Results The mean volume of the PTV_EVAL was observed to be 75.71 mL in the four cases of Accelerated Partial Breast Irradiation (APBI) with postoperative insertion of the SAVI applicator evaluated in this study. Out of these, three cases demonstrated a deviation of more than 10% in volume between the SAVI applicator and AIR, resulting in suboptimal dose delivery to the target volume (PTV_EVAL), which was evidenced by D90 failing to reach 90% in each case. Upon further analysis, the discrepancy was found to arise from the irregular shape of AIR on the chest wall side or bilaterally on the CT cross-section perpendicular to the SAVI, which had taken on a dog-ear form. To address this issue, a virtual hybrid APBI approach was implemented by adding one or two catheters placed along the SAVI applicator, leading to a substantial improvement in the D90 of PTV_EVAL in all three cases, reaching 90% in each. Based on this result, the hybrid approach was executed by inserting intra-tissue catheters near the prominent AIR, parallel to the SAVI applicator, under ultrasound guidance. The average D90 delivered by the SAVI alone was 74.39%, which improved to 95.90% with the addition of the intra-tissue catheter, thereby demonstrating the efficacy of the hybrid APBI approach in enhancing the compatibility between the residual excision cavity and the SAVI applicator following partial mastectomy. Conclusions The conformation of the SAVI applicator may not align with the partial mastectomy cavity in Japan. The addition of a small number of intra-tissue catheters improves how well the SAVI method works and makes the treatment more effective. In Japan, cylindrical excisions are commonly performed in partial mastectomies for breast-conserving therapy, as opposed to the typical lumpectomies. Hence, when implementing Accelerated Partial Breast Irradiation (APBI) with the use of SAVI, a multi-lumen single catheter for partial breast irradiation with brachytherapy, discrepancies were noted between the shape of the excision cavity and the SAVI. Our institution reexamined the correlation between the form of the excision cavity and the shape of SAVI in instances of APBI that utilized post-operative SAVI insertion. To reconcile the discrepancy between the surgical cavity and the shape of the SAVI, we devised a hybrid APBI incorporating a supplementary catheter into the surrounding region of the SAVI and validated the dose distribution through simulation with a restricted quantity of supplementary catheters. Utilizing the obtained results, we present the outcomes of the hybrid APBI in actual clinical application. The objective of this investigation was to examine and augment the congruity between the SAVI applicator and the residual excision cavity following partial mastectomy in cases of APBI with SAVI in Japan. Our evaluation encompasses four instances of APBI with postoperative insertion of SAVI, conducted at our institution between December 2018 and May 2019. The affected breasts included three right and one left, with two cases each affecting regions C and D. Through a postoperative insertion approach, each case was strategically placed from the inframammary fold. The treatment plan was executed using Oncentra brachy (Electa), with a prescribed dose of 34 Gy/10 Fr delivered through IPSA for PTV_EVAL. Our review of the outcomes prompted the implementation of hybrid APBI in three patients from the year 2020. The mean volume of the PTV_EVAL was observed to be 75.71 mL in the four cases of Accelerated Partial Breast Irradiation (APBI) with postoperative insertion of the SAVI applicator evaluated in this study. Out of these, three cases demonstrated a deviation of more than 10% in volume between the SAVI applicator and AIR, resulting in suboptimal dose delivery to the target volume (PTV_EVAL), which was evidenced by D90 failing to reach 90% in each case. Upon further analysis, the discrepancy was found to arise from the irregular shape of AIR on the chest wall side or bilaterally on the CT cross-section perpendicular to the SAVI, which had taken on a dog-ear form. To address this issue, a virtual hybrid APBI approach was implemented by adding one or two catheters placed along the SAVI applicator, leading to a substantial improvement in the D90 of PTV_EVAL in all three cases, reaching 90% in each. Based on this result, the hybrid approach was executed by inserting intra-tissue catheters near the prominent AIR, parallel to the SAVI applicator, under ultrasound guidance. The average D90 delivered by the SAVI alone was 74.39%, which improved to 95.90% with the addition of the intra-tissue catheter, thereby demonstrating the efficacy of the hybrid APBI approach in enhancing the compatibility between the residual excision cavity and the SAVI applicator following partial mastectomy. The conformation of the SAVI applicator may not align with the partial mastectomy cavity in Japan. The addition of a small number of intra-tissue catheters improves how well the SAVI method works and makes the treatment more effective.

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PO123

目的在日本，相对于典型的乳房肿瘤切除术，圆柱状切除通常在乳房部分切除术中用于保乳治疗。因此，当使用SAVI(一种多腔单导管进行近距离乳房部分照射)实施加速部分乳房照射(APBI)时，发现切除腔的形状与SAVI之间存在差异。我们的机构重新检查了在APBI中使用术后SAVI插入的切除腔的形式与SAVI形状之间的关系。为了调和手术腔与SAVI形状之间的差异，我们设计了一种混合APBI，将辅助导管插入SAVI周围区域，并通过有限数量的辅助导管模拟验证剂量分布。利用所获得的结果，我们介绍了混合APBI在实际临床应用中的效果。本研究的目的是检查和增加SAVI涂抹器和残余切除腔之间的一致性，在日本的APBI合并SAVI的病例部分乳房切除术后。材料和方法我们的评估包括2018年12月至2019年5月在我们机构进行的4例APBI术后插入SAVI。受影响的乳房包括三个右乳房和一个左乳房，分别有两个影响C区和d区。通过术后插入方法，每个病例都从乳房下襞策略性地放置。治疗方案采用Oncentra brachy (Electa)，处方剂量为34 Gy/10 Fr，通过IPSA给药治疗PTV_EVAL。我们对结果的回顾促使从2020年开始对三名患者实施混合APBI。结果本研究评估的4例加速部分乳房照射(APBI)术后插入SAVI涂药器的患者PTV_EVAL平均体积为75.71 mL。其中，3例病例显示SAVI应用器与AIR之间的体积偏差超过10%，导致剂量递送到目标体积(PTV_EVAL)不理想，这证明了D90未能达到90%。进一步分析发现，这种差异是由于垂直于SAVI的CT横截面上胸壁侧或双侧AIR形状不规则，呈狗耳形所致。为了解决这个问题，通过在SAVI应用器上添加一个或两个导管，实现了虚拟混合APBI方法，在所有三种情况下，PTV_EVAL的D90都得到了显著改善，每种情况下都达到了90%。基于该结果，在超声引导下，在突出的AIR附近插入组织内导管，平行于SAVI涂抹器，执行混合入路。单独使用SAVI的平均D90为74.39%，加入组织内导管后D90提高至95.90%，可见混合APBI入路在增强乳房部分切除术后残余切除腔与SAVI涂抹器的相容性方面的有效性。结论SAVI应用器的构象可能与日本部分乳房切除术腔不一致。少量组织内导管的加入提高了SAVI方法的效果，使治疗更有效。在日本，圆柱形切除通常在乳房部分切除术中用于保乳治疗，而不是典型的乳房肿瘤切除术。因此，当使用SAVI(一种多腔单导管进行近距离乳房部分照射)实施加速部分乳房照射(APBI)时，发现切除腔的形状与SAVI之间存在差异。我们的机构重新检查了在APBI中使用术后SAVI插入的切除腔的形式与SAVI形状之间的关系。为了调和手术腔与SAVI形状之间的差异，我们设计了一种混合APBI，将辅助导管插入SAVI周围区域，并通过有限数量的辅助导管模拟验证剂量分布。利用所获得的结果，我们介绍了混合APBI在实际临床应用中的效果。本研究的目的是检查和增加SAVI涂抹器和残余切除腔之间的一致性，在日本的APBI合并SAVI的病例部分乳房切除术后。我们的评估包括2018年12月至2019年5月在我们机构进行的4例APBI术后插入SAVI。受影响的乳房包括三个右乳房和一个左乳房，C区和D区各有两个病例。目的在日本，相对于典型的乳房肿瘤切除术，圆柱状切除通常在乳房部分切除术中用于保乳治疗。因此，当使用SAVI(一种多腔单导管进行近距离乳房部分照射)实施加速部分乳房照射(APBI)时，发现切除腔的形状与SAVI之间存在差异。我们的机构重新检查了在APBI中使用术后SAVI插入的切除腔的形式与SAVI形状之间的关系。为了调和手术腔与SAVI形状之间的差异，我们设计了一种混合APBI，将辅助导管插入SAVI周围区域，并通过有限数量的辅助导管模拟验证剂量分布。利用所获得的结果，我们介绍了混合APBI在实际临床应用中的效果。本研究的目的是检查和增加SAVI涂抹器和残余切除腔之间的一致性，在日本的APBI合并SAVI的病例部分乳房切除术后。材料和方法我们的评估包括2018年12月至2019年5月在我们机构进行的4例APBI术后插入SAVI。受影响的乳房包括三个右乳房和一个左乳房，分别有两个影响C区和d区。通过术后插入方法，每个病例都从乳房下襞策略性地放置。治疗方案采用Oncentra brachy (Electa)，处方剂量为34 Gy/10 Fr，通过IPSA给药治疗PTV_EVAL。我们对结果的回顾促使从2020年开始对三名患者实施混合APBI。结果本研究评估的4例加速部分乳房照射(APBI)术后插入SAVI涂药器的患者PTV_EVAL平均体积为75.71 mL。其中，3例病例显示SAVI应用器与AIR之间的体积偏差超过10%，导致剂量递送到目标体积(PTV_EVAL)不理想，这证明了D90未能达到90%。进一步分析发现，这种差异是由于垂直于SAVI的CT横截面上胸壁侧或双侧AIR形状不规则，呈狗耳形所致。为了解决这个问题，通过在SAVI应用器上添加一个或两个导管，实现了虚拟混合APBI方法，在所有三种情况下，PTV_EVAL的D90都得到了显著改善，每种情况下都达到了90%。基于该结果，在超声引导下，在突出的AIR附近插入组织内导管，平行于SAVI涂抹器，执行混合入路。单独使用SAVI的平均D90为74.39%，加入组织内导管后D90提高至95.90%，可见混合APBI入路在增强乳房部分切除术后残余切除腔与SAVI涂抹器的相容性方面的有效性。结论SAVI应用器的构象可能与日本部分乳房切除术腔不一致。少量组织内导管的加入提高了SAVI方法的效果，使治疗更有效。在日本，圆柱形切除通常在乳房部分切除术中用于保乳治疗，而不是典型的乳房肿瘤切除术。因此，当使用SAVI(一种多腔单导管进行近距离乳房部分照射)实施加速部分乳房照射(APBI)时，发现切除腔的形状与SAVI之间存在差异。我们的机构重新检查了在APBI中使用术后SAVI插入的切除腔的形式与SAVI形状之间的关系。为了调和手术腔与SAVI形状之间的差异，我们设计了一种混合APBI，将辅助导管插入SAVI周围区域，并通过有限数量的辅助导管模拟验证剂量分布。利用所获得的结果，我们介绍了混合APBI在实际临床应用中的效果。本研究的目的是检查和增加SAVI涂抹器和残余切除腔之间的一致性，在日本的APBI合并SAVI的病例部分乳房切除术后。我们的评估包括2018年12月至2019年5月在我们机构进行的4例APBI术后插入SAVI。受影响的乳房包括三个右乳房和一个左乳房，C区和D区各有两个病例。通过术后插入方法，每个病例都从乳房下襞策略性地放置。治疗方案采用Oncentra brachy (Electa)，处方剂量为34 Gy/10 Fr，通过IPSA给药治疗PTV_EVAL。我们对结果的回顾促使从2020年开始对三名患者实施混合APBI。在本研究评估的4例加速部分乳房照射(APBI)术后插入SAVI应用器的患者中，PTV_EVAL的平均体积为75.71 mL。其中，3例病例显示SAVI应用器与AIR之间的体积偏差超过10%，导致剂量递送到目标体积(PTV_EVAL)不理想，这证明了D90未能达到90%。进一步分析发现，这种差异是由于垂直于SAVI的CT横截面上胸壁侧或双侧AIR形状不规则，呈狗耳形所致。为了解决这个问题，通过在SAVI应用器上添加一个或两个导管，实现了虚拟混合APBI方法，在所有三种情况下，PTV_EVAL的D90都得到了显著改善，每种情况下都达到了90%。基于该结果，在超声引导下，在突出的AIR附近插入组织内导管，平行于SAVI涂抹器，执行混合入路。单独使用SAVI的平均D90为74.39%，加入组织内导管后D90提高至95.90%，可见混合APBI入路在增强乳房部分切除术后残余切除腔与SAVI涂抹器的相容性方面的有效性。SAVI涂抹器的构象可能与日本部分乳房切除术腔不一致。少量组织内导管的加入提高了SAVI方法的效果，使治疗更有效。通过术后插入方法，每个病例都从乳房下襞策略性地放置。治疗方案采用Oncentra brachy (Electa)，处方剂量为34 Gy/10 Fr，通过IPSA给药治疗PTV_EVAL。我们对结果的回顾促使从2020年开始对三名患者实施混合APBI。在本研究评估的4例加速部分乳房照射(APBI)术后插入SAVI应用器的患者中，PTV_EVAL的平均体积为75.71 mL。其中，3例病例显示SAVI应用器与AIR之间的体积偏差超过10%，导致剂量递送到目标体积(PTV_EVAL)不理想，这证明了D90未能达到90%。进一步分析发现，这种差异是由于垂直于SAVI的CT横截面上胸壁侧或双侧AIR形状不规则，呈狗耳形所致。为了解决这个问题，通过在SAVI应用器上添加一个或两个导管，实现了虚拟混合APBI方法，在所有三种情况下，PTV_EVAL的D90都得到了显著改善，每种情况下都达到了90%。基于该结果，在超声引导下，在突出的AIR附近插入组织内导管，平行于SAVI涂抹器，执行混合入路。单独使用SAVI的平均D90为74.39%，加入组织内导管后D90提高至95.90%，可见混合APBI入路在增强乳房部分切除术后残余切除腔与SAVI涂抹器的相容性方面的有效性。SAVI涂抹器的构象可能与日本部分乳房切除术腔不一致。少量组织内导管的加入提高了SAVI方法的效果，使治疗更有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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