Journal of Contemporary Brachytherapy最新文献

{"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}

{"title":"Post-operative complications following dose adaptation of intra-operative electron beam radiation therapy in locally advanced or recurrent rectal cancer","authors":"Floor Piqeur, Heike M.U. Peulen, Jeltsje S. Cnossen, Cathryn C.A. Huibregtse Bimmel-Nagel, Harm J.T. Rutten, Jacobus W.A. Burger, An-Sofie E. Verrijssen","doi":"10.5114/jcb.2024.139276","DOIUrl":"https://doi.org/10.5114/jcb.2024.139276","url":null,"abstract":"<b>Purpose:</b><br/>The benefit of intra-operative radiotherapy (IORT) in the treatment of locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) lie in its ability to provide high-dose of radiation to limited at-risk volume, thereby eliminating microscopic disease and decreasing toxicity. A comparative study between high-dose-rate (HDR) brachytherapy, named intra-operative brachytherapy (IOBT), and intra-operative electron radiotherapy (IOERT) was performed showing favorable LRFS after IOBT, possibly due to a higher surface dose that is inherent in IOBT technique. The IOERT technique in Catharina Hospital Eindhoven was adapted to increase the surface dose, aiming to improve local control. Post-operative complications due to an increased radiation dose remain the matter of concern. This retrospective study was performed to compare complication rates before and after adapted IOERT dose.<br/><br/><b>Material and methods:</b><br/>All patients undergoing surgery with IOERT for LARC or LRRC from September 2019 until July 2023, were considered. Patients selected until August 31, 2021 were included in control cohort (<i>n</i> = 108), and those chosen from September 1, 2021 onwards were included in intervention cohort (<i>n</i> = 92). Perioperative and (major) post-operative complications were classified retrospectively, during admission, at 30 days, and at 90 days.<br/><br/><b>Results:</b><br/>In LARC patients, a decrease in post-operative complications was observed (<i>p</i> = 0.009). 19% of LARC patients experienced major post-operative surgical complications, i.e., Clavien-Dindo grade 3b-5, regardless of treatment group. No difference in major 90-day complications was noted (<i>p</i> = 0.142). In LRRC patients, the use of induction chemotherapy decreased from 78% to 29% (<i>p</i> &lt; 0.001), which complicated comparison. However, no difference in major post-operative complications was observed at 30 days (<i>p</i> = 0.222) or 90 days (<i>p</i> = 0.977) after surgery.<br/><br/><b>Conclusions:</b><br/>Increased surface dose of IOERT does not seem to lead to an increase in post-operative complications. Further research is needed to evaluate the efficacy of dose adaptation in IOERT to improve local oncological control rates. Routine evaluation of CTCAE scores in follow-up will help uncover possible long-term radiation-induced toxicity.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"45 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141148620","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":"Contact X-ray brachytherapy (CXB) as a salvage treatment for rectal cancer patients who developed local tumor re-growth after watch-and-wait approach","authors":"Ngu Wah Than, Mark Pritchard, Carrie. A. Duckworth, David M. Hughes, Helen Wong, Rajaram Sripadam, Arthur Sun Myint","doi":"10.5114/jcb.2024.139049","DOIUrl":"https://doi.org/10.5114/jcb.2024.139049","url":null,"abstract":"<b>Purpose:</b><br/>A watch-and-wait approach is an alternative to surgery for rectal cancer patients who have achieved a clinical complete response (cCR) following neoadjuvant (chemo)radiotherapy. However, approximately 25-38% of patients experience subsequent local tumor re-growth that requires salvage surgery. We evaluated the effectiveness of contact X-ray brachytherapy (CXB) as an alternative method of salvage therapy for those patients who were either unfit for or refused surgery. Oncological outcomes, tolerability, and feasibility of subsequent surgery for local treatment failure following CXB were reported.<br/><br/><b>Material and methods:</b><br/>From 2009-2021, all patients treated with CXB as salvage therapy for local rectal cancer re-growth after watch-and-wait approach at our center were analyzed.<br/><br/><b>Results:</b><br/>Contact X-ray brachytherapy as a salvage treatment (range, 90-110 Gy) was offered to 56 patients who experienced tumor re-growth following (chemo)radiation and watch-and-wait protocol. Median age was 76 (IQR = 66-83) years. Most patients (82%) had early-stage re-growth (ycT1/ycT2, ycN0), and 18% had more advanced stages (ycT3/ycT4, ycN0). After a median of 37-month follow-up (IQR = 19-53), 48% of patients who had early-stage re-growth achieved a sustained complete remission after CXB compared with 20% of those who had more advanced tumor stages. Disease-free and overall survivals for the whole cohort were 69% and 100% at 1-year, 51% and 82% at 3-year, and 51% and 65% at 5-years. CXB effectively controlled local re-growth-related symptoms. Mild post-CXB side effects occurred in 18% of cases. All (100%) eight patients who developed further local relapse, and 29% of those who had residual disease post-CXB salvage were successfully managed with subsequent surgery.<br/><br/><b>Conclusions:</b><br/>Contact X-ray brachytherapy offers a new treatment option for patients in this situation whose other therapy options are not suitable for or refused initial surgery. Early local tumor re-growth responded best with minimal treatment-related toxicity and excellent symptom control. Disease-free and overall survival rates were acceptable, and delaying surgical salvage for local re-growth did not compromise patients’ eventual long-term outcomes.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"45 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141148658","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}