Journal of Contemporary Brachytherapy最新文献

{"title":"The Elekta Esteya^® electronic brachytherapy system in non-melanoma skin cancers: A post-market observational study.","authors":"Jonathan Cheng, Gerrit V Henry, Maureen R Lyden, Daniel I Shrager, Michael H Swann, James B Stubbs, Robert J Willard, Edward K Lee","doi":"10.5114/jcb.2024.146795","DOIUrl":"10.5114/jcb.2024.146795","url":null,"abstract":"<p><strong>Purpose: </strong>The study was conducted to provide support for the delivery of electronic brachytherapy (EBx) in patients with low-risk non-melanoma skin cancer (NMSC) lesions who prefer and benefit a non-surgical treatment.</p><p><strong>Material and methods: </strong>This study included 205 patients with a total of 236 lesions. Six centers participated in this study using high-dose-rate EBx in NMSC. Eligible patients had pathologically confirmed basal cell or squamous cell carcinoma of clinical stage Tis, T1, or T2, with two or fewer high-risk clinical or pathologic features. Treatment doses were chosen from a set of fractionation schemes delivering 69-72 Gy (BED). Maximum follow-up was 5 years.</p><p><strong>Results: </strong>The median age was 74 (range, 56-96) years, and 62% of the subjects were males and 38% females. The median follow-up was 24.2 months, with a maximum of 73.5 months. Healthcare professional (HCP) and patient-rated cosmesis were rated excellent/good (E/G) by both groups at 90-100% rates, except for HCP ratings of 1-3 months post-EBx, where cosmesis was rated 83-87% E/G. Erythema was the most common acute adverse event (34.1% at 1 month), rebounding back to zero by 6 months. There was a single lesion recurrence.</p><p><strong>Conclusions: </strong>This report provides additional phase IV clinical data on NMSC treated with electronic brachytherapy. With 2-year median follow-up, there was one recurrence (0.42%). Patients tolerated the treatments well, as evidenced by strong and longitudinal scores on the skin cancer index as well as cosmetic evaluations performed by both patients and healthcare providers. Adverse rates were low, except for expected acute erythema, chronic hypopigmentation, and telangiectasia. The study provides additional information on EBx delivery for low-risk NMSC lesions in patents who prefer non-surgical treatment, especially those at risk for surgical complications, surgical cosmesis issues, keloid formation, wound care issues, and use of anticoagulant therapy.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"478-488"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early report on abbreviated brachytherapy schema for cervical cancer during the COVID-19 pandemic.","authors":"Youhua Wang, Haowen Pang, Sheng Lin, Xiangxiang Shi","doi":"10.5114/jcb.2024.146515","DOIUrl":"10.5114/jcb.2024.146515","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the efficacy and safety of a high-dose-rate (HDR) brachytherapy regimen with an abbreviated schema for patients with cervical cancer during the COVID-19 pandemic.</p><p><strong>Material and methods: </strong>Patients underwent external beam radiation therapy combined with cisplatin-based chemotherapy. Subsequently, brachytherapy (7 × 4 Gy) was administered for 10 days using an abbreviated schema. The treatment plan aimed to deliver a cumulative dose of at least 85 Gy EQD₂ for α/β = 10 Gy to high-risk clinical target volume (HR-CTV), while minimizing exposure to the bladder, rectum, and sigmoid colon.</p><p><strong>Results: </strong>Sixty-nine patients with cervical cancer received definitive chemoradiation therapy, with a median overall treatment time of 56.2 days. The incidence of acute grade 3 hematological toxicity was 62.3%, and grade 4 toxicity was 11.6%. Grade 3 or higher gastrointestinal and genitourinary toxicity rates were 5.8%, 2.9%, 2.8%, and 4.3%, respectively. Late gastrointestinal toxicities of grade ≥ 2 and grade ≥ 3 occurred in 14 (20.3%) and 3 (4.3%) patients, respectively. Late genitourinary toxicities of grade ≥ 2 and grade ≥ 3 occurred in 8 (11.6%) and 3 (4.3%) patients, respectively. As of December 2023, with a median follow-up of 40 months, 1-year PFS and OS rates were 81.2% and 94.2%, respectively, while 3-year PFS and OS rates were 71.0% and 85.5%, respectively.</p><p><strong>Conclusions: </strong>The abbreviated HDR brachytherapy regimen offered a viable alternative for patients with cervical cancer during the COVID-19 pandemic, suggesting that this treatment schedule maintains therapeutic efficacy and safety, and avoids prolonged treatment duration.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"437-442"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram prediction model for overall survival of late-stage lung cancer patients undergoing iodine-125 particle implantation brachytherapy.","authors":"Tingting Ding, Xiangyan Ge, Shanhu Hao, Zhiguo Wang, Wenwen Zhang, Guoxu Zhang","doi":"10.5114/jcb.2024.146836","DOIUrl":"10.5114/jcb.2024.146836","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to explore the overall survival (OS) rate of late-stage lung cancer patients after receiving iodine-125 (¹²⁵I) particle implantation brachytherapy.</p><p><strong>Material and methods: </strong>436 late-stage lung cancer patients who underwent ¹²⁵I radioactive particle brachytherapy in the Department of Nuclear Medicine of the General Hospital of Northern Theater Command from December 2013 to June 2019 were retrospectively analyzed. Patients were randomly divided into training set and validation set in a 7 : 3 ratio. Univariate and multivariate Cox proportional hazards models were employed to show independent factors affecting the prognosis of late-stage lung cancer patients. Based on these factors, a nomogram model was constructed to predict OS at 1, 3, and 5 years after ¹²⁵I particle implantation brachytherapy for late-stage lung cancer as well as 1-year progression-free survival (PFS).</p><p><strong>Results: </strong>The results of univariate and multivariate Cox proportional hazards model analyses of OS time showed that smoking, lung atelectasis, superior vena cava obstruction syndrome, and surgical time were significantly associated with OS of patients, and were independent influencing factors. The results of univariate and multivariate Cox proportional hazards model analyses of PFS demonstrated that planning target volume, maximum dose, average dose, pre-operative D₉₀ and V₁₀₀ at 1 cm around the lesion, and surgical time were significantly associated with PFS of patients, and were independent influencing factors. Based on these independent prognostic factors, nomogram models were constructed to predict the 1-, 3-, and 5-year OS and 1-year PFS of late-stage lung cancer patients.</p><p><strong>Conclusions: </strong>This study revealed the potential benefits of ¹²⁵I particle implantation brachytherapy for the OS rate of late-stage lung cancer patients.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"410-427"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate brachytherapy boost: Long-term results of protocol-based treatment of patients with non-metastatic prostate cancer.","authors":"Claudia Schweizer, Vratislav Strnad, Ricarda Merten, Philipp Schubert, Michael Lotter, Stephan Kreppner, Rainer Fietkau, Andre Karius","doi":"10.5114/jcb.2024.146671","DOIUrl":"10.5114/jcb.2024.146671","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy and toxicity of interstitial temporary brachytherapy boost for prostate cancer patients using real-world data.</p><p><strong>Material and methods: </strong>Between 2008 and 2016, 115 patients treated with external beam radiotherapy (EBRT) followed by a brachytherapy boost (BT boost) were eligible for this retrospective analysis. Patients received either interstitial high-dose-rate brachytherapy (HDR-BT) with 2 x 9-9.5 Gray (Gy) schedule or pulsed-dose-rate brachytherapy (PDR-BT) with 35 Gy as boost after EBRT (50.4 Gy), up to a total dose of 86-98 Gy (EQD_2α/β = 3). Primary endpoints of the present analysis were cumulative local recurrence rate (LRR), biochemical recurrence-free survival (bRFS), tumor-specific survival, and overall survival (OS). As secondary objective, treatment-related toxicity was evaluated.</p><p><strong>Results: </strong>The median follow-up time was 87 (range, 9-159) months, and the median age was 72 (range, 48-83) years. The median prostate specific antigen value (PSA) was 12.2 (range, 2.4-288) ng/ml. 78/115 (68%) patients had high-risk prostate cancer according to the D'Amico classification. At 7 years, the cumulative LRR for the whole cohort was 1.8%. The 7-year bRFS, cancer-specific survival, and OS were 85.2%, 97.3%, and 88.9%. The 5-year prevalence of late toxicity grade 3 or higher according to the LENT-SOMA scale was 4%. There were no significant differences for treatment outcome or toxicity for HDR vs. PDR treatment. A prostate gland of 50 cm³ or more was not associated with worse treatment efficacy or increased side effects, apart from the prevalence of urethritis after 5 years (<i>p</i> = 0.035).</p><p><strong>Conclusions: </strong>BT boost in patients with prostate cancer is efficient and well-tolerated, with low rates of side effects also in elderly patients. HDR- and PDR-BT were equally efficient and well-tolerated. A large prostate gland is no contraindication for BT. Therefore, BT boost should be offered to all eligible patients.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"391-397"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of adjuvant external beam radiotherapy and brachytherapy in squamous cell carcinoma of oral tongue: Long-term outcomes.","authors":"Shayan Shojaei, Asma Mousavi, Payman Rahimzadeh, Ali Kazemian, Mahdi Aghili, Reza Ghalehtaki","doi":"10.5114/jcb.2024.146837","DOIUrl":"10.5114/jcb.2024.146837","url":null,"abstract":"<p><strong>Purpose: </strong>Squamous cell carcinoma of oral tongue (TSCC) poses a significant health challenge. Radiotherapy is the mainstay of treatment, with external beam radiotherapy (EBRT) and brachytherapy (BT) offering distinct advantages. This study investigated the long-term outcomes associated with each technique.</p><p><strong>Material and methods: </strong>A retrospective analysis was done reviewing medical records of patients diagnosed with TSCC between 2012 and 2022, who underwent surgery and received adjuvant curative-intent radiotherapy. Patients were categorized based on treatment modality: EBRT alone, EBRT combined with brachytherapy (EBRT+ BT boost), or BT alone. Overall survival (OS) and disease-free survival (DFS) were evaluated at 5 years.</p><p><strong>Results: </strong>A total of 84 patients were included, with 57 receiving EBRT, 14 receiving BT alone, and 13 receiving EBRT + BT boost. The median follow-up was 70 months. The 5-year OS rates were 68% for EBRT, 88% for BT alone, and 92% for EBRT + BT boost. The 5-year DFS rates were 62% for EBRT, 88% for BT alone, and 84% for EBRT + BT boost. The 5-year LRC rates were 85% for EBRT, 100% for BT alone, and 92% for EBRT + BT boost. No significant differences between these modalities in terms of median OS, DFS, and LRC were observed.</p><p><strong>Conclusions: </strong>This study explored the long-term outcomes of EBRT and EBRT + BT boost in TSCC patients. While the initial findings suggest potentially improved outcomes with the combined approach, more studies are necessary for validation. Future research should investigate the impact of these techniques on treatment-related toxicities, providing a more comprehensive picture.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"398-409"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injectable bio-absorbable spacers in brachytherapy for gynecological cancers: A scoping review.","authors":"Carminia Lapuz, Mollie Kain, Michael Chao, Daryl Lim Joon, Claire Dempsey, Jenny Sim","doi":"10.5114/jcb.2024.146834","DOIUrl":"10.5114/jcb.2024.146834","url":null,"abstract":"<p><strong>Purpose: </strong>Insertion of a spacer between tumor and an adjacent organ at risk may improve the therapeutic ratio in gynecological cancer brachytherapy. The purpose of this review was to assess the available literature on the use of injectable bio-absorbable spacers in brachytherapy for gynecological cancers.</p><p><strong>Material and methods: </strong>Embase, PubMed, Medline, and Cochrane Central Register of Controlled Trials were searched until March 28, 2024. Studies reporting on injectable bio-absorbable spacers in gynecological cancer brachytherapy were included. Two independent reviewers completed screening, assessment for eligibility, and data extraction of included studies. Data were collected on spacer material, technique, safety, feasibility, spacer quality, dosimetric values, clinical outcomes, and cost-effectiveness.</p><p><strong>Results: </strong>Seventeen studies met inclusion criteria, with a total of 312 patients and 169 spacers. Clinical application was primarily in cervix cancer brachytherapy (47%) and spacer placement in the recto-vaginal space (88%). Eight different products were used, with no significant spacer-related adverse effects reported. Spacer insertion reduced rectal dose in eight studies, bladder dose in one study, sigmoid dose in four studies, and permitted tumor dose escalation in three studies. Five studies reported on tumor outcomes and eight studies on late toxicities. There were no studies evaluating patient-reported outcomes and cost-effectiveness.</p><p><strong>Conclusions: </strong>Injectable bio-absorbable spacers offer a promising approach for improving the therapeutic ratio in gynecological cancer brachytherapy. There is low certainty evidence available in the literature for their use, and rigorous prospective studies are needed to provide evidence on outcomes.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"467-477"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of using 3D-printed applicators for high-dose-rate brachytherapy in gynecological malignancy.","authors":"Wiwatchai Sittiwong, Pittaya Dankulchai, Utumporn Puangragsa, Tissana Prasartseree, Pongpop Tuntapakul, Chanida Sathitwatthanawirot, Janiya Kittikornchaichan, Sansanee Kongkum, Niyada Piputpanukul, Kantarat Rojanapan","doi":"10.5114/jcb.2024.146670","DOIUrl":"10.5114/jcb.2024.146670","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the clinical outcomes and toxicities of using 3D-printed applicators for image-guided adaptive brachytherapy (IGABT) in gynecological cancer patients.</p><p><strong>Material and methods: </strong>Fourteen patients with gynecological cancers, both primary and recurrent, treated with in-house 3D-printed applicators between 2021 and 2022 were included in the study, and their data were retrospectively reviewed. Timing and patterns of response to treatment were recorded. Kaplan-Meier estimates at 2 years post-treatment were analyzed to obtain local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates. Actuarial rates of genitourinary (GU), gastrointestinal (GI), and skin and mucosal toxicities were also reported.</p><p><strong>Results: </strong>The median follow-up time for all patients was 27 (IQR: 15.4-32.5) months. Among the primary cases, 2 patients had cervical cancer and 3 had extra-mammary Paget's disease of the vulva. For the recurrent cases, all patients had vaginal relapses. The most common primary cancers were cervical cancer (44.4%) and ovarian cancer (33.3%). At 3 months post-treatment, 13 patients (92.9%) achieved a complete response (CR), and 1 patient (7.1%) showed a partial response (PR). The 2-year rates of LRFS, DMFS, PFS, and OS for primary/recurrent cases were 100%/74.07%, 100%/88.9%, 100%/64.8%, and 100%/88.9%, respectively. The actuarial rates of ≥ grade 2 acute GU and GI toxicities were 7.1% for both groups. For late GU and GI toxicities, the actuarial rates were 14.3% and 21.4%, respectively. In terms of skin and mucosal toxicities, 4 patients (28.6%) developed acute grade 3 toxicity, and 1 patient (7.1%) experienced persistent grade 3 vaginal toxicity.</p><p><strong>Conclusions: </strong>IGABT treatment using 3D-printed applicators for HDR brachytherapy in challenging cases due to incompatibility of the standard applicators with the patient's anatomy or highly advance disease, has demonstrated encouraging outcomes and acceptable toxicity profiles.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"428-436"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of GUI-based simple independent dose calculation software without DICOM data transfer for high-dose-rate brachytherapy.","authors":"Yuha Kim, Yang Sheng, Chunhao Wang, Ke Lu","doi":"10.5114/jcb.2024.146835","DOIUrl":"10.5114/jcb.2024.146835","url":null,"abstract":"<p><strong>Purpose: </strong>Dose calculation in clinical treatment plans must be verified by an independent dose calculation prior to treatment. This study presented an independent second check dose calculation software developed for clinical use.</p><p><strong>Material and methods: </strong>A software developed using Python 3 tool on Google Colab platform enabled its deployment on standard computer systems. The software utilized AAPM TG-43 formalism and AAPM consensus dataset for TG-43 parameters, which were consistent with those of a commercial treatment planning system (TPS; Varian Brachy-Vision). As input, the software only used treatment plan report from TPS. Dosimetric comparisons were performed between software-calculated dose at reference points and corresponding TPS values across 117 clinical treatment plans (102 gynecological cases and 15 intra-operative radiation therapy [IORT] cases using high-dose-rate [HDR] brachytherapy). Gynecological cases were categorized into 12 applicator groups, depending on various combination of tandem, ovoids, and needles, and dose calculation points were manually selected close to prescribed dose.</p><p><strong>Results: </strong>234 dose points (2 points per plan) were calculated. The dose discrepancy between software and TPS was -1% ±0.36% (mean ± standard deviation), with maximum of -3%. The accuracy of the software met AAPM guideline requirement (< 5% deviation). The simplicity of input file in graphical user interface (GUI) environment enabled the software to operate on any computer without additional software, data transfer, or manual data entry. This capability can be particularly advantageous in IORT procedures, which require quick turn-around second check without network connectivity to TPS for DICOM data transfer.</p><p><strong>Conclusions: </strong>A streamlined second check software using TG-43 formalism was developed in Python 3 tool and converted into independent executable GUI, to verify commercial TPS dose calculations in HDR brachytherapy. The software meets current practice guideline and is compatible with commonly used computer systems (Windows, MacOS, and Linux), requiring no additional software, manual data entry, or connection to TPS. The software will also be published online with free public access.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 6","pages":"457-466"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of MRI-based planning in transperineal interstitial brachytherapy for vaginal-involving tumors.","authors":"Diana Guevara Barrera, Silvia Rodríguez Villalba, Luis Suso-Martí, Enrique Sanchis-Sánchez, Jose Perez-Calatayud, Francisco Blázquez Molina, Maria Jose Pérez-Calatayud, Manuel Santos Ortega","doi":"10.5114/jcb.2024.144683","DOIUrl":"10.5114/jcb.2024.144683","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to analyze patients with vaginal-involving recurrences of gynecological tumors and primary vaginal tumors, treated with transperineal interstitial brachytherapy (P-ISBT). Dosimetric, clinical, and toxicity analysis of these patients was conducted, incorporating MRI in volume definition and dose-volume dosimetry.</p><p><strong>Material and methods: </strong>Forty-two patients were retrospectively analyzed. They were treated with radical or adjuvant intent (in hysterectomized patients with high-risk of relapse). P-ISBT was performed with MUPIT (CT-based planning) in 18 patients (42.9%) and with Template Benidorm (TB) (MRI-based planning) in 24 patients (57.1%).</p><p><strong>Results: </strong>Median age was 59 years (range, 39-78 years). Median clinical target volume (CTV) was 81.4 cc (range, 33.8-286.2 cc) in MUPIT, and 47.5 cc (range, 10-156.4 cc) in TB-treated patients (<i>p</i> = 0.01). Median EQD₂ for EBRT and brachytherapy D₉₀ CTV was 69.2 Gy (range, 27.9-88.8 Gy) in MUPIT, and 77.2 Gy (range, 31-84.3 Gy) in TB. Median rectal D_2cc was 69.2 Gy (range, 23.5-82.6 Gy) in MUPIT, and 66.3 Gy (range, 16.4-75 Gy) in TB. Median bladder D_2cc was 71.5 Gy (range, 23.6-90.8 Gy) in MUPIT, and 66.9 Gy (range, 18.2-78.3 Gy) in TB. Median follow-up was 36.5 months (range, 4-188 months). Local control was 95% at 3 and 5 years. Overall survival was 77% at 3 years, and 66% at 5 years. Disease-specific survival was 81% at 3 years, and 75% at 5 years. Chronic grade 1-2 proctitis presented in 10 patients (24%; 8 treated with MUPIT and 2 treated with TB; <i>p</i> = 0.01). Grade 3 toxicity was documented in 4 patients (9.6%).</p><p><strong>Conclusions: </strong>MRI-based planning is superior to CT-based planning in P-ISBT. It allows for better definition of CTV, resulting in smaller and more selective treatment volumes. Our results show a tendency towards higher D₉₀ CTV dose and lower rectal/bladder D_2cc dose, leading to less events of late rectal toxicity.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 5","pages":"335-343"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-depth feasibility study on conservative surgery, perioperative high-dose-rate brachytherapy, and external beam radiation therapy, with a focus on interstitial brachytherapy for soft tissue sarcomas: Insights from a single-institute experience.","authors":"Purnima Thakur, Vineet Aggarwal, Manish Gupta, Anjali Azad, Naina Negi, Vishal Verma, Parul Sharma, Neeraj Parihar","doi":"10.5114/jcb.2024.144816","DOIUrl":"10.5114/jcb.2024.144816","url":null,"abstract":"<p><strong>Purpose: </strong>Soft tissue sarcomas (STS) due to their aggressive nature, pose challenges in achieving optimal local control (LC) rates following surgery. Brachytherapy offers precise delivery of high radiation doses to target tissues, potentially enhancing LC rates. This feasibility study explored the efficacy of perioperative high-dose-rate brachytherapy (PHDRB) and external beam radiation therapy (EBRT) in improving LC rates for STS, with a particular focus on interstitial brachytherapy and dose escalation strategies for high-risk patient sub-groups.</p><p><strong>Material and methods: </strong>Seven patients with STS underwent conservative surgery and PHDRB between October 2020 and October 2023. PHDRB doses ranged from 3.0 to 3.5 Gy BID in 10 fractions, with or without subsequent EBRT, as indicated. EBRT was delivered in 4-5 weeks after surgical procedure at a dose of 45-50 Gy in 25 treatments, with daily dose of 1.8-2.0 Gy. Brachytherapy techniques and dosimetry guidelines were meticulously implemented to ensure optimal treatment delivery and minimize toxicity.</p><p><strong>Results: </strong>All seven patients tolerated treatment well without acute or late radiation-related complications. Excellent local disease control was achieved in all cases, but three patients developed distant metastases. The overall feasibility and efficacy of PHDRB in combination with EBRT were promising.</p><p><strong>Conclusions: </strong>This study underscores the feasibility and potential efficacy of PHDRB and EBRT for STS treatment. Despite limitations in sample size, the results are promising, warranting further investigation through multi-centric studies. The use of dose-escalated PHDRB in high-risk cases enabled more intensive treatment delivery directly to the tumor bed, which may be critical for enhancing local control in patients with aggressive or large tumors. In facilities with limited resources and a high patient burden, where conformal radiotherapy is unavailable, brachytherapy remains an excellent modality for boosting the tumor bed or serving as a radical radiotherapy treatment.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 5","pages":"362-370"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}