Journal of Contemporary Brachytherapy最新文献

{"title":"Feasibility and clinical implementation of MRI-guided surface brachytherapy","authors":"Michael J. Lavelle, Evangelia Kaza, Christian V. Guthier, Desmond A. O’Farrell, Thomas C. Harris, Robert A. Cormack, Phillip M. Devlin, Ivan M. Buzurovic","doi":"10.5114/jcb.2024.135647","DOIUrl":"https://doi.org/10.5114/jcb.2024.135647","url":null,"abstract":"<b>Purpose:</b><br/>Best practices for high-dose-rate surface applicator brachytherapy treatment (SABT) have long relied on computed tomography (CT)-based imaging to visualize diseased sites for treatment planning. Compared with magnetic resonance (MR)-based imaging, CT provides insufficient soft tissue contrast. This work described the feasibility of clinical implementation of MR-based imaging in SABT planning to provide individualized treatment optimization.<br/><br/><b>Material and methods:</b><br/>A 3D-printed phantom was used to fit Freiberg flap-style (Elekta, The Netherlands) applicator. Images were taken using an optimized pointwise encoding time reduction with radial acquisition (PETRA) MR sequence for catheter visualization, and a helical CT scan to generate parallel treatment plans. This clinical study included three patients undergoing SABT for Dupuytren’s contracture/palmar fascial fibromatosis imaged with the same modalities. SABT planning was performed in Oncentra Brachy (Elekta Brachytherapy, The Netherlands) treatment planning software. A geometric analysis was conducted by comparing CT-based digitization with MR-based digitization. CT and MR dwell positions underwent a rigid registration, and average Euclidean distances between dwell positions were calculated. A dosimetric comparison was performed, including point-based dose difference calculations and volumetric segmentations with Dice similarity coefficient (DSC) calculations.<br/><br/><b>Results:</b><br/>Euclidean distances between dwell positions from CT-based and MR-based plans were on average 0.68 ±0.05 mm and 1.35 ±0.17 mm for the phantom and patients, respectively. The point dose difference calculations were on average 0.92% for the phantom and 1.98% for the patients. The D₉₅ and D₉₀ DSC calculations were both 97.9% for the phantom, and on average 93.6% and 94.2%, respectively, for the patients.<br/><br/><b>Conclusions:</b><br/>The sub-millimeter accuracy of dwell positions and high DSC’s (&gt; 0.95) of the phantom demonstrated that digitization was clinically acceptable, and accurate treatment plans were produced using MR-only imaging. This novel approach, MRI-guided SABT, will lead to individualized prescriptions for potentially improved patient outcomes.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"111 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140324588","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":"Urinary tract symptoms that should be improved to enhance post-operative urinary quality of life in patients treated with low-dose-rate brachytherapy for prostate cancer: An importance–performance analysis","authors":"Takayuki Sakurai, Shigeyuki Takamatsu, Satoshi Shibata, Risako Minamikawa, Masahiro Yamazaki, Akihito Okubo, Risa Nagaoka, Tomoyuki Makino, Renato Naito, Hiroshi Yaegashi, Atsushi Mizokami, Satoshi Kobayashi","doi":"10.5114/jcb.2024.135646","DOIUrl":"https://doi.org/10.5114/jcb.2024.135646","url":null,"abstract":"<b>Purpose:</b><br/>To evaluate international prostate symptom score and urinary quality of life in patients with prostate cancer who underwent low-dose-rate brachytherapy, and to identify lower urinary tract symptoms that must be improved to enhance post-operative urinary quality of life and factors associated with lower urinary tract symptoms.<br/><br/><b>Material and methods:</b><br/>This study included 193 patients who underwent low-dose-rate brachytherapy alone (145 Gy). Importance–performance analysis was conducted to identify lower urinary tract symptoms that should be prioritized to improve urinary quality of life. Association between lower urinary tract symptom scores and each factor was investigated. Receiver operating characteristic curve analysis was used to evaluate dosimetric parameters related to lower urinary tract symptom score to predict an average score of ≥ 3. Cut-off values were determined.<br/><br/><b>Results:</b><br/>One to nine months post-implantation was a period of significantly increased urinary quality of life scores compared with baseline (<i>p</i> &lt; 0.05 each). The importance–performance analysis conducted for 1-9 months revealed that frequency, nocturia, and weak stream required improvement. Multivariate analysis showed that each lower urinary tract symptom score presented a significant association with its baseline value (<i>p</i> &lt; 0.001 each, positive correlation). Frequency, incomplete emptying, urgency, and straining scores were significantly associated with prostate volume, whereas weak stream and intermittency scores were associated with dose covering 90% of the prostate and dose covering 90% of the urethra, respectively (<i>p</i> &lt; 0.05 each, positive correlations). Cut-off values for these doses were 167.01 Gy and 136.84 Gy, respectively.<br/><br/><b>Conclusions:</b><br/>This study highlights the importance of prioritizing specific lower urinary tract symptoms for improvement in post-operative urinary quality of life, and identifies the associated factors that can help in personalized treatment planning and goal-setting for better patient satisfaction.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"64 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140325699","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":"Safety of high-dose-rate brachytherapy in patients with prostate cancer and inflammatory bowel disease: A case series","authors":"Horatio Thomas, Jie Jane Chen, Haitham Shaheen, Ali Sabbagh, Hasan Abdul-Baki, Oi Wai Chau, Nauman Malik, Alan Ayoub, Comron Hassanzadeh, I-Chow Hsu, Osama Mohamad","doi":"10.5114/jcb.2024.135645","DOIUrl":"https://doi.org/10.5114/jcb.2024.135645","url":null,"abstract":"<b>Introduction:</b><br/>Inflammatory bowel disease (IBD) is a relative contraindication to external beam radiation therapy (EBRT) for prostate cancer patients due to fear of increased risk of gastrointestinal (GI) toxicity. High-dose-rate (HDR) brachytherapy, capable of minimizing radiation dose to surrounding tissues, is a feasible alternative. Given limited data, this study examined the safety profile of HDR brachytherapy in this setting.<br/><br/><b>Material and methods:</b><br/>We conducted a retrospective review of patients with localized prostate cancer and IBD treated with HDR brachytherapy at the University of California San Francisco (UCSF), between 2010 and 2022. Eligibility criteria included biopsy-proven prostate cancer, no distant metastases, absence of prior pelvic radiotherapy, IBD diagnosis, and at least one follow-up visit post-treatment.<br/><br/><b>Results:</b><br/>Eleven patients were included, with a median follow-up of 28.7 months. The median dose administered was 2700 cGy (range, 1500-3150 cGy) over 2 fractions (range, 1-3 fractions). Two patients also received EBRT. Rectal spacers (SpaceOAR) were applied in seven patients. All patients experienced acute genitourinary (GU) toxicity, ten of which were grade 1 and one was grade 2. Eight patients experienced late grade 1 GU toxicity, and three patients had late grade 2 GU toxicity. GI toxicities were similarly low-grade, with six grade 1 acute toxicity, no grade 2 or higher acute toxicity, six grade 1 late toxicity, and one late grade 2 GI toxicity. No grade 3 or higher acute or late GI or GU toxicities were reported.<br/><br/><b>Conclusions:</b><br/>HDR brachytherapy appears to be a safe and tolerable treatment modality for patients with prostate cancer and IBD, with minimal acute and late GI and GU toxicity. These findings warrant multi-institutional validation due to small sample size.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"24 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140325715","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":"Low-dose-rate brachytherapy and long-term treatment outcomes in patients younger than 60 years of age","authors":"Alexander Armstrong, Huong Ho, Mark Tacey, Damien Bolton, Yee Chan, Alwin Tan, Chee Wee Cham, Trung Pham, Kevin McMillan, George Koufogiannis, Paul Manohar, Mario Guerrieri, Michael Ng, Daryl Lim Joon, Farshad Foroudi, Mun Yee Tan, Michael Chao","doi":"10.5114/jcb.2024.135630","DOIUrl":"https://doi.org/10.5114/jcb.2024.135630","url":null,"abstract":"<b>Purpose:</b><br/>Low-dose-rate (LDR) brachytherapy in young men remains controversial amongst urologists due to their concerns regarding long-term biochemical control and treatment-related toxicities. The purpose of this study was to evaluate the treatment outcomes of men under 60 years of age who underwent LDR brachytherapy with iodine-125 (¹²⁵I) for clinically localized low- to intermediate-risk prostate cancer.<br/><br/><b>Material and methods:</b><br/>All consecutive patients with clinically localized prostate cancer treated at our institution from 2003 to 2016 with ¹²⁵I monotherapy were included in the study. Prescription dose was 145.0 Gy modified peripheral loading (MPD). All patients were assessed for biochemical progression-free survival using Phoenix definition (nadir +2 ng/ml), clinical progression-free survival, overall survival (OS), and any associated treatment toxicity.<br/><br/><b>Results:</b><br/>A total of 161 patients were included, with a median follow-up of 6.8 years (range, 3-14.54 years). Median age at implant was 57 years (range, 53-59 years). Mean prostate specific antigen (PSA) level at diagnosis was 4.43 ng/ml (SD = 2.29). Majority of men had low-risk prostate cancer (70.2%). Biochemical progression-free survival at 8 years was 94% for the entire cohort. Median PSA at 4 years was 0.169 (IQR, 0.096-0.360), with 45% of patients having a PSA greater than 0.2. OS was 96.9%, with 5 deaths reported but only one was secondary to prostate cancer. Late grade &gt; 2 genitourinary toxicities were reported in 18 patients (11.2%). Three patients (1.9%) developed secondary cancers, all considered unrelated to their LDR brachytherapy.<br/><br/><b>Conclusions:</b><br/>With excellent long-term treatment outcomes and minimal associated toxicities, our results showed that LDR brachytherapy can be an effective treatment of choice in younger men.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"31 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602181","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":"Dosimetric comparison of intra-cavitary brachytherapy technique with free-hand (intra-cavitary + interstitial) technique in cervical cancer","authors":"Sumukh Jamadagni, Arul Ponni, Revathy P","doi":"10.5114/jcb.2024.135629","DOIUrl":"https://doi.org/10.5114/jcb.2024.135629","url":null,"abstract":"<b>Purpose:</b><br/>The aim of the study was to dosimetrically compare intra-cavitary brachytherapy technique (ICBT) with free-hand (intra-cavitary + interstitial, IC + IS) technique.<br/><br/><b>Material and methods:</b><br/>Twenty seven locally advanced carcinoma cervix patients were included in the study. Patients with more than medial 1/3^rd parametrial residual disease without extending upto lateral pelvic wall were included, following external beam radiotherapy (EBRT), in which cobalt-60 high-dose-rate (⁶⁰Co HDR) brachytherapy source was used. Dose for both plans were 6.5 Gy × 4 fractions, 2 fractions per day, 6 hours apart, over 2 days. Free-hand brachytherapy technique, consisted of placement of central tandem and 2 ovoids along with needles without using template, was applied. Two plans were generated by activating and deactivating the needles, and compared by normalizing to V₁₀₀.<br/><br/><b>Results:</b><br/>A total of 79 needles were applied. Using paired-t test, dosimetric comparison of both the plans was done. Free-hand plan had a significant higher mean V90 (volume receiving 90% of the dose) of 94.2% compared with 87.22% in ICBT plan (<i>p</i> ≤ 0.0001). Free-hand and ICBT plans presented a mean V₁₀₀ values of 89.06% and 81.51% (<i>p</i> ≤ 0.0001), respectively, favoring free-hand plan. The mean _D90 (dose to 90% volume), D₉₈, and D₁₀₀ of free-hand plan were 6.28 Gray (Gy), 4.91 Gy, and 3.62 Gy, respectively, but equivalent parameters in ICBT plan were 5.26 Gy, 3.72 Gy, and 2.61 Gy, with <i>p</i> value ≤ 0.0001. In both the plans, D_2cc of the bladder, rectum, and sigmoid were 4.59 Gy, 3.98 Gy, 2.77 Gy, and 4.46 Gy, 3.90 Gy, 2.67 Gy, respectively, with no statistical significance.<br/><br/><b>Conclusions:</b><br/>Free-hand brachytherapy (IC + IS) achieves a statistically significant better dose distribution to high-risk clinical target volume (HR-CTV) comparing with ICBT technique with similar dose to organs at risk.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"22 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140324589","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":"Adjuvant pulse-dose-rate brachytherapy for oral cavity and oropharynx carcinoma: Outcome and toxicity assessment of 66 patients","authors":"Sophie Renard, Nicolas Demogeot, Marie Bruand, Nassim Sahki, Vincent Marchesi, William Gehin, Emilie Meknaci, Didier Peiffert","doi":"10.5114/jcb.2024.135626","DOIUrl":"https://doi.org/10.5114/jcb.2024.135626","url":null,"abstract":"<b>Purpose:</b><br/>Brachytherapy (BT) is a validated radiation technique for treatment of early stage tumors of oral cavity and oropharynx. This study aimed to analyze the results of our institute’s patients after replacing low-dose-rate (LDR) with pulse-dose-rate (PDR) brachytherapy.<br/><br/><b>Material and methods:</b><br/>We retrospectively collected data from all patients treated between 2009 and 2020 for squamous cell carcinoma (floor of the mouth, tongue, and oropharynx) using adjuvant interstitial BT with or without external RT. Primary outcome was local control. Secondary outcomes were regional control rate and toxicity. Statistical analysis of local and regional recurrences were described using Kaplan-Meier method. Prognostic value of each factor for recurrence or toxicity was evaluated with bivariate Fine-Gray model.<br/><br/><b>Results:</b><br/>Data from 66 patients were analyzed. Local and regional recurrences were reported in 11% and 20% of the patients, respectively. No significant factors were identified in the present study. Grade 2 and 3 acute mucositis were reported in 21% of patients, and were more frequent in the BT only group. Almost half (47%) of the patients described acute pain following BT, and 26% required stage 2 or 3 analgesics. Trophic disorders were observed in 16 patients. Five patients presented with soft tissue necrosis (STN) and required medical treatment, of whom one subsequently required hyperbaric oxygen therapy. No predictive factors were identified for STN risk. Two patients developed osteoradionecrosis.<br/><br/><b>Conclusions:</b><br/>Oral and oropharyngeal PDR-BT as adjuvant treatment is safe and effective for well-defined indications.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"25 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140325714","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":"Clinical implementation of three-dimensional standardized template-guided brachytherapy for patients with locally advanced cervical cancer","authors":"Yeqiang Tu, Jiahao Wang, Yukai Chen, Yuanyuan Chen, Qiu Tang","doi":"10.5114/jcb.2023.134170","DOIUrl":"https://doi.org/10.5114/jcb.2023.134170","url":null,"abstract":"<b>Purpose:</b><br/>Although customized three-dimensional (3D) templates have shown advantages in brachytherapy, widespread application is still full of challenges. The present work proposed the use of a commercial 3D standardized template-guided intracavitary/interstitial brachytherapy (IC/ISBT) that could provide simple and reproducible needles’ insertion.<br/><br/><b>Material and methods:</b><br/>43 patients received external beam radiotherapy (EBRT) with 45-50.4 Gy and subsequent IC/ISBT with 28 Gy in 4 fractions. In terms of IC/ISBT, 24 patients were treated with 3D standardized templates (ST group), and 19 patients were treated using free-hand implantation (FH group). Consistency of implantation for all needles and dosimetric differences for target and organs at risk (OARs) were then compared between two groups.<br/><br/><b>Results:</b><br/>The mean variation of tip position between insertions for needles was 1.41 mm and 2.74 mm in ST group and FH group, respectively (<i>p</i> &lt; 0.001). ST group was superior in terms of dosimetric conformity index (CI) and D90 for high-risk clinical target volume (HR-CTV), significantly improving to 23.21% (<i>p</i> &lt; 0.001) and 3.58% (<i>p</i> = 0.031) compared with FH group. The D2cc of the bladder and sigmoid in the ST group were lower than those in the FH group (<i>p</i> &lt; 0.05). Meanwhile, a strong correlation between the volume of HR-CTV and its CI in the ST group (<i>R</i> = 0.865, <i>p</i> &lt; 0.001) was found with Spearman’s correlation analysis.<br/><br/><b>Conclusions:</b><br/>The implementation of 3D standardized template can potentially improve the precision and consistency in the needle insertion procedure that may replace some customized 3D templates, and achieve clinical satisfied dose distribution in IC/ISBT plans for patients with LACC.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"10 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139412423","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":"Current status and future readiness of Indian radiation oncologists to embrace prostate high-dose-rate brachytherapy: An Indian Brachytherapy Society survey","authors":"Susovan Banerjee, Soumya Sarkar, Umesh Mahantshetty, Sorun Shishak, Venkatesan Kaliyaperumal, Shyam Singh Bisht, Deepak Gupta, Kushal Narang, Mayur Mayank, V Srinivasan, Vivek Anand, Kanhu Charan Patro, Rajiv Ranjan Prasad, Tejinder Kataria","doi":"10.5114/jcb.2023.134168","DOIUrl":"https://doi.org/10.5114/jcb.2023.134168","url":null,"abstract":"<b>Purpose:</b><br/>This survey aimed to understand the practice pattern and attitude of Indian doctors towards prostate brachytherapy.<br/><br/><b>Material and methods:</b><br/>A 21-point questionnaire was designed in Google form and sent to radiation oncologists practicing in India, using texts, mails, and social media. Responses were collated, and descriptive statistical analysis was performed.<br/><br/><b>Results:</b><br/>A total of 212 radiation oncologists from 136 centers responded to the survey questionnaire, with majority (66%) being post-specialty training &gt; 6 years. We found that about 44.3% (<i>n</i> = 94) of respondents do not practice interstitial brachytherapy for any site, and majority (83.3%, <i>n</i> = 175) do not practice high-dose-rate (HDR) prostate brachytherapy. Only 2.8% (<i>n</i> = 6) of doctors preferred boost by brachytherapy compared with 38.1% (<i>n</i> = 80) of respondents, who favored stereotactic body radiation therapy (SBRT) boost. When asked about the indication of HDR prostate brachytherapy in Indian setting, 32.5% (<i>n</i> = 67) of respondents favored monotherapy, 46.1% (<i>n</i> = 95) of oncologists thought boost as a good indication, and 21.4% (<i>n</i> = 44) preferred re-irradiation/salvage setting. The most cited reason for prostate brachytherapy not being popularly practiced in India was lack of training (84.8%, <i>n</i> = 179). It was also noted that out of 80 respondents who practiced SBRT for prostate boost, 37 would prefer HDR brachytherapy boost if given adequate training and facilities.<br/><br/><b>Conclusions:</b><br/>The present survey provided insight on practice of prostate brachytherapy in India. It is evident that majority of radiation oncologists do not practice HDR prostate brachytherapy due to lack of training and infrastructure. Indian physicians are willing to learn and start prostate brachytherapy procedures if dedicated training and workshops are organized.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139398542","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":"Comparison of dosimetric analysis of organs at risk and target volumes for ovoids and cylinders in endometrial carcinoma","authors":"Yashaswini BR, Tanvir Pasha, Rekha Reddy, Naveen T, Siddanna R Palled, Uday Krishna, Lokesh V, Sridhar P, Nikhila R, Thejaswini B, Chundru Swaroopa","doi":"10.5114/jcb.2023.134171","DOIUrl":"https://doi.org/10.5114/jcb.2023.134171","url":null,"abstract":"<b>Purpose:</b><br/>To compare dose volume parameters of target and organs at risk in vaginal vault brachytherapy using ovoids or cylinder in post-operative endometrial carcinoma.<br/><br/><b>Material and methods:</b><br/>The study was done among 25 histologically proven post-operative endometrial carcinoma patients requiring vaginal brachytherapy. All patients underwent both cylinder and ovoids application alternatively on weekly basis. Ovoids size ranged from 2 to 3 cm diameter. Diameters of cylinder ranged between 2.5 and 3.5 cm. Bladder, rectum, urethra, and clinical target volume (CTV) were contoured on CT simulation images. Prescribed dose was 6-7 Gy in 2-3 fractions at 0.5 cm from the surface of applicator.<br/><br/><b>Results:</b><br/>The mean values of D₉₀, D₅₀, V₁₅₀, V₁₀₀, V₉₀, and V₅₀ of CTV were comparable between cylinder and ovoids plans. The mean dose of CTV was significantly higher with cylinder than with ovoids, and D₁₀₀ was significantly higher with ovoids (mean = 15.63 Gy vs. 14.64 Gy, <i>p</i> = 0.016, and D₁₀₀ = 37.82% vs. 42.86%, <i>p</i> = 0.042, for cylinder vs. ovoids). In the dosimetry of the vault, D₉₀, D₅₀, V₁₀₀, V₉₀, V₅₀, and mean of the vault did not show any significant difference between cylinder and ovoids. The V₁₅₀ was significantly higher with cylinder plans than ovoids, and D₁₀₀ of the vault was significantly higher with ovoids plans (V₁₅₀ = 14.81% vs. 6.86%, <i>p</i> = 0.02, and D₁₀₀ = 37.77% vs. 44.80%, <i>p</i> = 0.029, for cylinder vs. ovoids). D_0.1cc, D_1cc, D_2cc, and mean for the bladder, rectum, and urethra were comparable between the cylinder and ovoid plans.<br/><br/><b>Conclusions:</b><br/>The present study showed that the dose to organs at risk, most of the dosimetric parameters of CTV, and vault were comparable between the cylinder and ovoid plans. Both applicators provide good reproducibility. The choice of applicator will ultimately depend on the institutional policies and oncologist decision. However, in patients with dog-ear configuration of the vagina, ovoids may be preferred as per ABS guidelines.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"127 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139412087","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":"Clinical outcomes of single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy for locally advanced cervical cancer: A multi-institution initial experience","authors":"Eugene T Yap, Mark P Dumago, Carl Jay Jainar, Maureen Bojador, Stellar Marie Cabrera, Gil S Gonzalez, Jocelyn Z Mariano, Aida Bautista, Jhustine Mababangloob, Janell Marie Genson, Teresa Sy Ortin, Warren R Bacorro","doi":"10.5114/jcb.2023.134169","DOIUrl":"https://doi.org/10.5114/jcb.2023.134169","url":null,"abstract":"<b>Purpose:</b><br/>The aim of the study was to evaluate the safety and clinical outcomes of single application multi-fractionated computed tomography (CT)-guided interstitial high-dose-rate brachytherapy given in four fractions in locally advanced cervical cancer.<br/><br/><b>Material and methods:</b><br/>Patients with locally advanced cervical cancer stage IIB-IVA treated definitively with external radiation ± weekly cisplatin, followed by single application multi-fractionated CT-guided interstitial high-dose-rate brachytherapy in four fractions were included. Dosimetry data, clinical response, and toxicity records were reviewed.<br/><br/><b>Results:</b><br/>Between January 2018 and December 2022, twenty-two patients were included. Clinical stage distribution was as follows: IIB – 13.6%, IIIB – 27.3%, IIIC – 22.7%, and IVA – 36.4%. Mean high-risk clinical target volume (HR-CTV) was 66.19 ±32.69 cm³, and HR-CTV D90 dose was 86.8 ±1.7 Gy. 2 cc doses to bladder, rectum, and sigmoid were 84.6 ±2.8 Gy, 71.5 ±2.4 Gy, and 65.6 ±4.0 Gy, respectively. Mean overall treatment time was 66 ±21 days. With a median follow-up of 11.5 months (range, 5-44 months), median survival and local control were not achieved. One-year local control rate, one-year progression-free survival, and one-year overall survival were 82%, 66%, and 78%, respectively. Univariate analysis showed overall treatment time to be the only variable associated with all oncologic outcomes. For acute toxicity, grade 3 toxicity in four patients and grade 4 toxicity of infection in one patient were observed. For late toxicity, grade 3 gastrointestinal toxicity was noted in two patients.<br/><br/><b>Conclusions:</b><br/>Initial results suggest that single application multi-fractionated CT-guided interstitial brachytherapy given in four fractions in locally advanced cervical cancer seems to be feasible and safe, but additional evidence is needed to generate more validated conclusions.<br/><br/>","PeriodicalId":51305,"journal":{"name":"Journal of Contemporary Brachytherapy","volume":"37 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139398450","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}