Journal of Contemporary Brachytherapy最新文献

{"title":"The evolving landscape of head and neck brachytherapy: A scoping review.","authors":"Marjorie Mae Cua, Carl Jay Jainar, Janella Ann Javenrie Calapit, Michael Benedict Mejia, Warren Bacorro","doi":"10.5114/jcb.2024.140348","DOIUrl":"10.5114/jcb.2024.140348","url":null,"abstract":"<p><strong>Purpose: </strong>Since the last update of GEC-ESTRO (Groupe Européen de Curiethérapie - European Society for Therapeutic Radiology and Oncology) recommendations for head and neck (HN) brachytherapy in 2017, advances in understanding and management of HN cancers have influenced brachytherapy. We conducted a scoping review to depict the evolution of HN brachytherapy research and practice, and identify emerging topics since the previously published guidelines.</p><p><strong>Material and methods: </strong>Systematic literature search was performed in PubMed, EBSCOhost, Europe PMC, and Google Scholar databases for articles on HN brachytherapy from 2017 onwards; the search was last done on June 29, 2023. We included primary studies on HN brachytherapy in English, complemented by bibliography scanning of secondary studies. Iterative team approach was employed in data extraction and charting. Quantitative and qualitative analyses and narrative synthesis were performed.</p><p><strong>Results: </strong>Systematic search yielded 215 unique articles. A total of 132 primary studies were included: 112 on clinical outcomes (retrospective cohorts in majority, <i>n</i> = 72), and 22 were simulation and dosimetric studies. China consistently produced the most research output per year. The most studied sites were the oral cavity (<i>n</i> = 84), oropharynx (<i>n</i> = 37), and salivary glands (<i>n</i> = 20). While most reported on high-dose-rate brachytherapy (<i>n</i> = 57), there was resurgence of studies on low-dose-rate (LDR) brachytherapy (<i>n</i> = 50) in the form of permanent seed implants. In the latter, CT (<i>n</i> = 50) and template (<i>n</i> = 27) guidance were described. While majority discussed definitive brachytherapy, 18 reported on perioperative brachytherapy. Several reported on 3D printing for template and applicator design (<i>n</i> = 11) as well as new approaches to dose calculation or dose optimization algorithms (<i>n</i> = 2).</p><p><strong>Conclusions: </strong>The current scoping review identified recent trends in HN brachytherapy, such as application in other HN sites, use of LDR seed implants, perioperative brachytherapy, and 3D printing in template design. Data from these recent publications provide a foundation for further investigations, which can generate evidence for succeeding guidelines.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 3","pages":"225-231"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774153","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":"Individualized 3D printing for skin cancer brachytherapy: Development, implementation, clinical applications, and treatment assessment.","authors":"Michal Poltorak, Pawel Banatkiewicz, Lukasz Poltorak, Piotr Sobolewski, Damian Zimon, Maciej Szwast, Irena Walecka","doi":"10.5114/jcb.2024.141420","DOIUrl":"10.5114/jcb.2024.141420","url":null,"abstract":"<p><strong>Purpose: </strong>This study outlined the prevalent use of brachytherapy in skin cancers, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The importance of customized applicator fabrication for optimal treatment delivery was highlighted, focusing on adaptable devices tailored to individual patient anatomy, often facilitated by 3D printing technology. The purpose of this work was to investigate the association of medical science and 3D printing in customized applicator fabrication for brachytherapy, leveraging the advancements in fabrication techniques to enhance treatment precision and patient outcomes.</p><p><strong>Material and methods: </strong>The study enrolled five patients with tumor lesions unsuitable for surgical intervention, situated across various anatomical locations, such as earlobe, temple, hand, and cheek. Customized applicators were fabricated <i>via</i> 3D printing (fused deposition modeling) for each patient, followed by radiotherapy protocol delivering a total dose of 51 Gy in 17 fractions. Patient assessments during and post-radiotherapy were done by radiation oncologist using RTOG scale as well as dermatological evaluations with dermatoscopy and reflectance confocal microscopy. Methodologically, applicators were 3D-printed using fused deposition modeling technology. Printing parameters were optimized in Prusa Slicer software, ensuring precise control in printout shape correlated with treatment efficacy.</p><p><strong>Results: </strong>This study examined the therapeutic outcomes of brachytherapy in five patients with inoperable skin cancer lesions. Utilizing customized 3D-printed applicators, the patients underwent brachytherapy regimen delivering a cumulative dose of 51 Gy in 17 fractions. The evaluation with RTOG scale revealed varied treatment responses, with complete remission achieved in all cases. Reflectance confocal microscopy showed post-treatment normalization of epidermal morphology and notable scar formation. Optical profilometry demonstrated consistent micro-structures on the applicator surfaces, without compromising treatment efficacy. These findings indicated the potential of 3D-printed applicators in optimizing brachytherapy outcomes in skin cancer management.</p><p><strong>Conclusions: </strong>Our study demonstrates the effectiveness of 3D-printed applicators in treating inoperable skin cancer lesions with high precision. In personalized fabrication, optimal conformity with anatomical features was achieved, resulting in complete remission in all patients. This approach minimizes treatment-related side effects and enhances overall patient outcomes, suggesting a promising future for 3D printing technology in skin cancer treatment applications. Further research and clinical validation are needed to establish 3D printing as a standard practice in skin cancer treatment.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 3","pages":"173-183"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774602","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":"Letter to the Editor-in-Chief regarding \"Adjuvant pulse-dose-rate brachytherapy for oral cavity and oropharynx carcinoma: Outcome and toxicity assessment of 66 patients\".","authors":"Erkan Topkan, Efsun Somay, Ugur Selek","doi":"10.5114/jcb.2024.141188","DOIUrl":"10.5114/jcb.2024.141188","url":null,"abstract":"","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 3","pages":"171-172"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774604","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":"Dosimetric comparison between single-channel vaginal cylinder and free-hand interstitial needles in vaginal brachytherapy of gynecological cancers.","authors":"Kaiqiang Chen, Yanhong Zhuo, Zirong Li, Penggang Bai, Jihong Chen, Yibin Lin, Jing Liu, Li Li, Yang Yang, Junping Pan, Yanwen Song, Tianming Wu, Xiuchun Zhang, Qin Xu","doi":"10.5114/jcb.2024.141169","DOIUrl":"10.5114/jcb.2024.141169","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the dosimetric differences in vaginal brachytherapy (VBT) using single-channel vaginal cylinder (SCVC) and free-hand interstitial needles (FIN).</p><p><strong>Material and methods: </strong>Twenty-two women with malignant gynecologic tumors were prospectively treated with image-guided high-dose-rate (HDR) brachytherapy after surgery and external beam radiation therapy (EBRT). All HDR treatments were delivered using FIN implant technique. For dosimetric comparison purposes only, SCVCs of 2.5 cm diameter were placed in all patients. No sources were dwelled in cylinder applicator during clinical treatment. CT-guided brachytherapy treatment planning was performed according to GEC-ESTRO guidelines, with high-risk clinical target volume (HR-CTV) delineated based on clinical exams and MRI T2 sequences. Dose-volume parameters to HR-CTV and surrounding organs at risk (OARs) from interstitial plans were compared with those achieved from cylinder plans.</p><p><strong>Results: </strong>Compared with SCVC group, FIN group showed the same HR-CTV coverage. FIN group had higher V_150% and V_200% (<i>p</i> < 0.05). In addition, it had lower HI (<i>p</i> < 0.05). However, doses to the rectum D_0.1cc (538.5 ±119.8 cGy), D_1cc (415.4 ±73.3 cGy), D_2cc (355.7 ±66.6 cGy), and D_mean (162.8 ±43.7 cGy) as well as the bladder D_0.1cc (516.1 ±85.2 cGy) and D_1cc (392.9 ±59.8 cGy) were lower in FIN group than in SCVC group (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>FIN technique can be a dosimetrically preferable alternative to the commonly used SCVC for HDR VBT boost in patients with gynecological malignancies. It provides adequate coverage of target volumes, with minimal radiation dose to surrounding organs at risk.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 3","pages":"219-224"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774545","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":"Incidence of vaginal toxicities following definitive chemoradiation in intact cervical cancer: A meta-analysis.","authors":"Shraddha Raj, Rajiv Ranjan Prasad, Alok Ranjan","doi":"10.5114/jcb.2024.141402","DOIUrl":"10.5114/jcb.2024.141402","url":null,"abstract":"<p><strong>Purpose: </strong>Cervical cancer is a significant global health burden, with advancements in treatment modalities improving outcomes. However, vaginal toxicities following definitive chemoradiation remain a concern, impacting patients' quality of life. The aim of this systematic review and meta-analysis was to estimate the incidence of vaginal toxicities, explore associated factors, and assess the relationship with radiation dose in intact cervical cancer patients undergoing radical chemoradiation.</p><p><strong>Material and methods: </strong>A systematic search of PubMed, Google Scholar, and Cochrane databases was conducted. Studies reporting on vaginal toxicities post-radical chemoradiation in intact cervical cancer patients were included. Data extraction and analysis were performed according to PRISMA guidelines.</p><p><strong>Results: </strong>Twenty-four studies with various designs were included. The meta-analysis revealed a pooled estimate of 39% (95% CI: 21-56%) for overall vaginal toxicities among cervical cancer patients following definitive chemoradiation. Vaginal stenosis was the most commonly reported toxicity, with a median incidence of 61.5% (range, 20-77.8%) across the studies. Severe toxicities (grade ≥ 3) were reported at rates of 12.74% (CTCAE v. 4.0), 0.98% (CTCAE v. 3.0), 10.41% (RTOG/EORTC), and 0% (LENT-SOMA). Factors, such as age, initial vaginal involvement, and radiation dose were associated with increased toxicity risk. Significant heterogeneity was observed in study populations and methodologies.</p><p><strong>Conclusions: </strong>Vaginal toxicities are common following definitive chemoradiation in intact cervical cancer patients, with vaginal stenosis being predominant. Standardization of toxicity scoring methods and radiotherapy dose reporting parameters is crucial for accurate comparison and interpretation of findings. Future research should focus on optimizing treatment strategies to minimize vaginal toxicities while maximizing efficacy and patient outcomes.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 3","pages":"241-256"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774598","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 efficacy of iodine-125 radioactive particle implantation with deep hyperthermia in malignant tumor treatment: A retrospective analysis.","authors":"Yuting Yuan, Yunfeng Kou, Jian Yu, Shenghe Zhang, Songbai Chen, Ruoyu Wang, Zhe Wang, Jun Zhou, Chuang Li","doi":"10.5114/jcb.2024.141407","DOIUrl":"10.5114/jcb.2024.141407","url":null,"abstract":"<p><strong>Purpose: </strong>In the current study, the clinical efficacy of iodine-125 (¹²⁵I) radioactive particle implantation with deep hyperthermia in malignant tumor treatment was retrospectively analyzed.</p><p><strong>Material and methods: </strong>Sixty patients with malignant tumors treated at Zhongshan Hospital affiliated with Dalian University, from January 2021 to January 2023, were included in this retrospective analysis. Computed tomography (CT)-guided ¹²⁵I radioactive particles were implanted into lesions, followed by deep hyperthermia administered for 3 days after surgery. Lesion size was evaluated monthly using CT or magnetic resonance imaging (MRI), and objective response rate (ORR) and local control rate (DCR) were calculated. Mean pain numerical score and European Organization for Research and Treatment of Cancer quality of life core scale C30 (EORTC QLQ-C30 v. 3.0) were assessed pre-treatment and post-treatment, and post-operative adverse reactions were comparatively analyzed.</p><p><strong>Results: </strong>After 6 months, the combined treatment resulted in a 73.33% ORR and an 81.67% DCR among 60 patients experiencing pre-treatment pain, and 49 (81.67%) exhibited effective pain relief. EORTC QLQ-C30 v. 3.0 evaluation revealed improved quality of life post-treatment. Adverse reactions during combined treatment were mitigated with targeted supportive measures, and no adverse reactions of level 2 or higher were observed.</p><p><strong>Conclusions: </strong>¹²⁵I radioactive particle implantation with deep hyperthermia is shown to be an effective combination therapy for malignant tumors, yielding significant clinical efficacy. Notably, it enhances patient quality of life, reduces tumor burden, mitigates adverse reactions, and alleviates pain. Given its minimal trauma and mild adverse reactions, this combination therapy warrants widespread clinical application.</p>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"16 3","pages":"202-210"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774492","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":"Differential outcomes of re-stratified high-risk prostate cancer patients treated with external beam radiation therapy plus high-dose-rate brachytherapy boost","authors":"Damien Carignan, Brandon Morales, Philippe Després, William Foster, André-Guy Martin, Eric Vigneault","doi":"10.5114/jcb.2024.139277","DOIUrl":"https://doi.org/10.5114/jcb.2024.139277","url":null,"abstract":"<b>Purpose:</b><br/>We report outcomes of high-risk prostate cancer (PCa) patients, initially classified according to a 3-tier NCCN classification system, treated with external beam radiation therapy (EBRT) and high-dose-rate brachytherapy boost (HDR-BT). Patients were analyzed based on a re-stratification of their risk grouping using CAPRA score and a newer 5-tier NCCN classification.<br/><br/><b>Material and methods:</b><br/>471 high-risk PCa patients treated with EBRT, HDR-BT, and androgen deprivation therapy (ADT) between 1999 and 2018 were included. Competing risk survival analyses to compare individuals with CAPRA scores &lt; 6 vs. ≥ 6 for biochemical relapse (BCR) and metastasis incidence were conducted. Also, overall survival (OS) for both groups using Kaplan-Meier analysis was assessed. The same analyses were repeated using a 5-tier NCCN stratification comparing those classified as high-risk vs. very high-risk patients.<br/><br/><b>Results:</b><br/>The median age was 71 years, and the median follow-up period was 72 months. The whole cohort received an EQD₂ of 74 Gy or greater, with a median EQD₂ of 106.89 Gy. Both a CAPRA score ≥ 6 and belonging to the NCCN very high-risk group were associated with BCR, with subdistribution hazard ratios (sHRs) of 3.04 (<i>p</i> = 0.015) and 2.53 (<i>p</i> = 0.013), respectively. For metastasis incidence, both the CAPRA and NCCN groups had similar sHRs of 2.60 (<i>p</i> = 0.094) and 2.71 (<i>p</i> = 0.037), respectively. For 10-year OS, patients with CAPRA score ≥ 6 and belonging to the NCCN very high-risk group presented similar HRs of 2.11 (<i>p</i> = 0.005) and 2.10 (<i>p</i> = 0.002).<br/><br/><b>Conclusions:</b><br/>We showed that high-risk PCa patients classified according to the 3-tier NCCN system benefit from further stratification using the CAPRA score or the 5-tier NCCN stratification method. Patients with a CAPRA score ≥ 6 or classified as very high-risk demonstrate a higher hazard of BCR, metastasis, and death. These patients might benefit from further intensification of their investigations and treatment, based on ongoing research.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"51 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141148701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of EUS-guided iodine-125 seed implantation in patients with unresectable ampullary cancer after relief of obstructive jaundice","authors":"Ting-ting Cui, Xin-xiang Guo, Bai-rong Li, Zi-Kai Wang, Nian-Jun Xiao, Fang Liu, Xiang-Dong Wang, Wen Li","doi":"10.5114/jcb.2024.139279","DOIUrl":"https://doi.org/10.5114/jcb.2024.139279","url":null,"abstract":"<b>Purpose:</b><br/>Few studies have focused on the management of inoperable ampullary carcinoma (AC), and patients with jaundice suffer from biliary stents replacement frequently. Iodine-125 (¹²⁵I) brachytherapy has been used in the treatment of malignant tumors owing to its curative effect, minimal surgical trauma, and tolerable complications. The aim of the study was to investigate the role of ¹²⁵I seed implantation in patients with unresectable ampullary carcinoma after relief of obstructive jaundice.<br/><br/><b>Material and methods:</b><br/>A total of 44 patients with obstructive jaundice resulting from unresectable ampullary carcinoma from January 1, 2010 to October 31, 2020 were enrolled in the study. Eleven patients underwent implantation of ¹²⁵I seeds under endoscopic ultrasound (EUS) after receiving biliary stent placement <i>via</i> endoscopic retrograde cholangiopancreatography (ERCP) (treatment group), and 33 patients received a stent alone <i>via</i> ERCP (control group). Cox regression model was applied in this single-center retrospective comparison study.<br/><br/><b>Results:</b><br/>The median maximum intervention interval for biliary obstruction was 381 days (interquartile range [IQR]: 204-419 days) in the treatment group and 175 days (IQR: 126-274 days) in the control group (<i>p</i> &lt; 0.05). Stent occlusion rates at 90 and 180 days in the control group were 12.9% and 51.6%, respectively. No stent occlusion occurred in the treatment group. Patients in the treatment group obtained longer survival time (median, 26 vs. 13 months; <i>p</i> &lt; 0.01) and prolonged duodenal obstruction (median, 20.5 vs. 11 months; <i>p</i> &lt; 0.05). No brachytherapy-related grade 3 or 4 adverse events were observed.<br/><br/><b>Conclusions:</b><br/>Longer intervention interval for biliary obstruction and survival as well as better stent patency and prolonged time to duodenal obstruction could be achieved by implanting ¹²⁵I seeds combined with biliary stent in patients with unresectable ampullary cancer.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"45 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141148558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A unified strategy to focal brachytherapy incorporating transperineal biopsy, image fusion, and real-time implantation with and without rectal spacer simulated in prostate phantoms","authors":"Ben G.L. Vanneste, Basile Skouteris, Luis Campos Pinheiro, Robert Voncken, Evert J. Van Limbergen, Ludy Lutgens, Valérie Fonteyne, Charles Van Praet, Nicolaas Lumen, Rendi Sheu, Richard Stock, Nelson N. Stone","doi":"10.5114/jcb.2024.139280","DOIUrl":"https://doi.org/10.5114/jcb.2024.139280","url":null,"abstract":"<b>Purpose:</b><br/>To develop an approach to the diagnosis and treatment of prostate cancer using one platform for fusion biopsy, followed by focal gland ablation utilizing permanent prostate brachytherapy with and without a rectal spacer.<br/><br/><b>Material and methods:</b><br/>Prostate phantoms containing multiparametric magnetic resonance imaging (mpMRI) regions of interest (ROI) underwent fusion biopsy, followed by image co-registration of positive sites to a treatment planning brachytherapy program. A partial hemi-ablation and both posterior lobes using a Mick applicator and linked stranded seeds were simulated. Dummy sources were modeled as iodine-125 (¹²⁵I) with a prescribed dose of at least 210 Gy to gross tumor (GTV) and clinical target volume (CTV), as defined by mpMRI visible ROI and surrounding negative biopsy sites. Computer tomograms (CT) were performed post-implant prior to and after rectal spacer insertion. Different prostate and rectal constraints were compared with and without the spacer.<br/><br/><b>Results:</b><br/>The intra-operative focal volumes of CTV ranged from 6.2 to 14.9 cc (mean, 11.3 cc), and the ratio of focal volume/whole prostate volume ranged between 0.19 and 0.42 (mean, 0.31). The intra- and post-operative mean focal D₉₀ of GTV, CTV, and for the entire prostate gland was 265 Gy and 235 Gy, 214 Gy and 213 Gy, and 66.1 Gy and 57 Gy, respectively. On average, 13 mm separation was achieved between the prostate and the rectum (range, 12-14 mm) on post-operative CT. The mean doses in Gy to 2 cc of the rectum (D_2cc) without spacer vs. with spacer were 39.8 Gy vs. 32.6 Gy, respectively.<br/><br/><b>Conclusions:</b><br/>Doses above 200 Gy and the implantation of seeds in clinically significant region for focal therapy in phantoms are feasible. All rectal dosimetric parameters improved for the spacer implants, as compared with the non-spacer implants. Further validation of this concept is warranted in clinical trials.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"43 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141153944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute toxicity outcomes from salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after prior radiotherapy","authors":"Breanna Fang, Philip McGeachy, Siraj Husain, Tyler Meyer, Kundan Thind, Kevin Martell","doi":"10.5114/jcb.2024.139278","DOIUrl":"https://doi.org/10.5114/jcb.2024.139278","url":null,"abstract":"<b>Purpose:</b><br/>Isolated intra-prostatic recurrence of prostate adenocarcinoma after definitive radiotherapy presents a challenging clinical scenario. Salvage options require specialized expertise and pose risks of harm. This study aimed to present the acute toxicity results from using salvage high-dose-rate brachytherapy (sHDR-BT) as treatment in locally recurrent prostate cancer cases.<br/><br/><b>Material and methods:</b><br/>Seventeen consecutive patients treated with sHDR-BT between 2019 and 2022 were evaluated retrospectively. Eligible patients had to have received curative intent prostate radiotherapy previously, and showed evidence of new biochemical failure. Evaluation with American Urological Association (AUA) and Common Terminology Criteria for Adverse Events (CTCAE) symptom assessments were performed for each case.<br/><br/><b>Results:</b><br/>The median (inter-quartile range) age prior to salvage treatment was 68 (66-74) years. The median post-sHDR-BT follow-up time was 20 (13-24) months. At baseline prior to sHDR-BT, 8 (47%) patients had significant lower urinary tract symptoms. The median AUA score prior to sHDR-BT was 7 (3-18). Three (18%) patients reported irregular bowel function and 2 (12%) reported hematochezia prior to sHDR-BT. One-month post-treatment, the median AUA score was 13 (8-21, <i>p</i> = 0.21). Using CTCAE scoring, there were no cases of grade 2+ bowel or rectal toxicity, and no cases of grade 3+ urinary toxicity. Reported grade 2 urinary toxicities included 10 (59%) cases of bladder spasms, 2 (12%) cases of incontinence, 1 (6%) urinary obstruction, and 4 (24%) reports of urinary urgency. All these adverse events were temporary.<br/><br/><b>Conclusions:</b><br/>This study adds to the existing literature by demonstrating that the acute toxicity profile of sHDR-BT is acceptable even without intra-operative magnetic resonance (MR) guidance or image registration. Further study is ongoing to determine long-term efficacy and toxicity of treatment.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"96 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141148698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}