Brachytherapy最新文献

{"title":"Gastrointestinal and genitourinary toxicity following high dose rate vaginal cuff brachytherapy for endometrial cancer","authors":"Niki Tselepidakis ,&nbsp;Ruyun Jin ,&nbsp;Bethany Horton ,&nbsp;Wendy Zheng ,&nbsp;Einsley Marie Janowski ,&nbsp;Kara Romano","doi":"10.1016/j.brachy.2025.02.005","DOIUrl":"10.1016/j.brachy.2025.02.005","url":null,"abstract":"<div><h3>PURPOSE</h3><div>There are currently no organs at risk dose constraints for adjuvant HDR vaginal cuff brachytherapy (VBT). This study evaluates OAR dosimetry and the association with acute and chronic gastrointestinal (GI) or genitourinary (GU) toxicity.</div></div><div><h3>METHODS</h3><div>Patients treated at a single institution with VBT of 21 Gray (Gy) in 3 fractions (Fx) prescribed to 5 mm depth twice weekly and CT-based 3D planning were reviewed. OAR doses (D2cc, D1cc, and D0.1cc) were recorded. Acute and chronic toxicities were graded by Common Terminology Criteria for Adverse Events v5.0. Boxplot and Wilcoxon–Mann–Whitney tests compared dose thresholds.</div></div><div><h3>RESULTS</h3><div>177 patients with stage I–IV endometrial cancer received a mean D2cc to rectum, sigmoid, small bowel, and bladder of 5.7 Gy (range: 2.8–8.7), 3.3 Gy (0.6–9.3), 3.8 Gy (0.0–9.1), and 5.4 Gy (2.0–8.2). Overall, 6.2% (<em>n</em> = 11) and 7.3% (<em>n</em> = 13) of patients experienced acute GI and GU toxicity of any grade. 14.7% (<em>n</em> = 26) and 14.7% (<em>n</em> = 26) of patients experienced chronic GI and GU toxicity of any grade, respectively. There were two grade 3 toxicities include one chronic GI and one acute GU. No dosimetric factors were identified that correlated with a higher likelihood of acute or chronic toxicity.</div></div><div><h3>CONCLUSIONS</h3><div>The overall rate of GI and GU toxicity following VBT of 21 Gy in 3 Fx is low, and there are no dosimetric parameters that correlate with toxicity. The optimal dose fractionation schedule that balances high local control with minimal toxicity is yet to be determined</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 389-394"},"PeriodicalIF":1.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694832","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":"Outcomes and dosimetric analysis of reirradiation of oral cavity and oropharyngeal cancers with high-dose-rate brachytherapy","authors":"Christina Phuong,&nbsp;Lisa Ni,&nbsp;Manju Sharma,&nbsp;J. Adam M Cunha,&nbsp;Sue S. Yom,&nbsp;I-Chow Hsu,&nbsp;Jason W. Chan","doi":"10.1016/j.brachy.2025.02.002","DOIUrl":"10.1016/j.brachy.2025.02.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>This study sought to evaluate the outcomes and toxicities from oral cavity (OC) and oropharynx (OP) high-dose-rate brachytherapy (HDRBT) for re-irradiation (reRT) of head and neck squamous cell carcinoma (HNSCC).</div></div><div><h3>METHODS</h3><div>Patients who previously received curative-intent external beam radiotherapy for primary HNSCC and were treated with OC/OP reRT with HDRBT from January 2000 to December 2021 were included. Patients were selected by a multidisciplinary tumor board to be appropriate candidates for HDRBT for one of two reRT indications: (1) definitive reRT or (2) postoperative reRT. Survival outcomes were estimated using the Kaplan-Meier method. Efficacy and toxicity outcomes were analyzed for the entire cohort and separately based on reRT indication.</div></div><div><h3>RESULTS</h3><div>27 patients were evaluated with a median follow up of 20 (IQR 12-41) mo. 14 (52%) and 13 (48%) patients were treated for a recurrent or second primary OC and OP HNSCC, respectively. Median dose of prior EBRT was 68.4 (IQR 60-70) Gy. Median interval between completion of EBRT to HDRBT reRT was 42 (IQR 14-85) mo. Median target volume was 16 (IQR 10-29) cc; median D90% was 31 (IQR 30-36) Gy. In cohorts A and B, 2-year LC/late grade ≥3 toxicity were 70%/57% and 60%/15%, respectively.</div></div><div><h3>CONCLUSIONS</h3><div>HDRBT for reRT of small (&lt;4 cm), recurrent, or second primary OC/OP HNSCC provided LC and late grade ≥3 toxicity rates similar to historical outcomes with EBRT reRT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 413-419"},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674889","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":"High-Tailored Anal canal Radiotherapy (HIT-ART): Long term results of MR image-guided interventional radiotherapy (brachytherapy) boost","authors":"Luca Tagliaferri ,&nbsp;Stefania Manfrida ,&nbsp;Bruno Fionda ,&nbsp;Nicola Dinapoli ,&nbsp;Brunella Barbaro ,&nbsp;Viola De Luca ,&nbsp;Elisa Placidi ,&nbsp;Roberta Bertolini ,&nbsp;Fabio Marazzi ,&nbsp;Valentina Lancellotta ,&nbsp;Vincenzo Frascino ,&nbsp;Alessio Giuseppe Morganti ,&nbsp;Maria Antonietta Gambacorta","doi":"10.1016/j.brachy.2025.01.006","DOIUrl":"10.1016/j.brachy.2025.01.006","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The aim of this study is to investigate the outcomes in terms of survival, treatment compliance and toxicity in a cohort of patients treated with personalized chemoradiation (RCT) followed by image guided Interventional Radiotherapy (IG-IRT), stratified by clinical baseline stage and treatment response.</div></div><div><h3>METHODS AND MATERIALS</h3><div>We analyzed patients with histologically proven squamous anal carcinoma treated using intensity modulated radiation therapy (IMRT) with curative intent, and IRT boost. External beam radiation was delivered using personalized IMRT technique with a simultaneous-integrated boost (SIB) to deliver 45 to 55 Gy in 25 fractions according to clinical stage. After the end of the RCT patients underwent clinical and imaging re-evaluation, and according to initial stage of disease and tumor response, a radiotherapy boost was administered through IG-IRT, performing MRI with IRT applicator on site (trans-anal position) and defining GTV on MRI imaging. All patients’ treatments and outcomes data were collected by an internal database. The endpoints were in terms of overall treatment time (OTT), toxicity, clinical complete response (cCR), locoregional failure (LRF), colostomy free survival, overall survival (OS) and disease-free survival (DFS). Univariate survival analysis with Kaplan- Meier curves was performed to allow between-group comparison.</div></div><div><h3>RESULTS</h3><div>73 patients treated between February 2012 and January 2023 were included in the analysis. 72.6 % were female, with a median age of 65.4 years (range 39.1–89). 62 were staged T2-T4 (T2 42.5.5%, T3 19.2%, T4 27.4%) and 50 (68.5%) had positive nodes. Combined RCT was administered mainly using mitomycin C and 5-fluorouracil. The mean dose received by patients was 50 Gy; after a median time of 43 days (range 9-128) a sequential boost dose was delivered in 1-2 fractions (median dose of 4 Gy). OTT median was 85 days (range 44–225). The median follow-up period was 50.6 months. LRF was 17.8%, and at 3 and 5 years LC was 80.1% and 77.2%, CFS was 80.5 and 77.8%, DFS was 79.3% and 75.9% and OS 95.1%, 84.3% and 61.4% at 10 years. Moreover, we verified that OS was higher in patients who had an OTT lower than 93 days. Toxicity was acceptable: 45.2% of patients experienced a G1-G2 abdominal discomfort (only 5.5% had G3).</div></div><div><h3>CONCLUSIONS</h3><div>Our experience confirms that MR Image Guided Interventional Radiotherapy boost is a feasible treatment option with a significant impact on outcomes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 439-449"},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674869","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":"Implementation of 3D image-guided brachytherapy for penile cancer: Impact of urethral dose on long-term morbidity","authors":"Samir Achkar ,&nbsp;Mouhamadou Bachir ,&nbsp;Rémi Bourdais ,&nbsp;Manon Kissel ,&nbsp;Tony Felefly ,&nbsp;Alexandre Escande ,&nbsp;Sophie Espenel ,&nbsp;Roger Sun ,&nbsp;Cyrus Chargari","doi":"10.1016/j.brachy.2024.02.007","DOIUrl":"10.1016/j.brachy.2024.02.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Interstitial brachytherapy is a conservative treatment approach for localized penile glans cancer. We report our experience with pulse dose rate interstitial brachytherapy (PDR-BT) in the treatment of penile cancer and evaluated urethral dose-volume constraints for clinical practice.</div></div><div><h3>Methods and materials</h3><div>Medical records of patients treated with PDR-BT for localized squamous cell carcinoma of the glans penis in our institution between July 2008 and February 2019 were reviewed. All patients underwent posthectomy followed by CT-guided PDR-BT. Urethral doses were calculated and predictors of urethral stenosis among various clinical and dosimetric characteristics were examined.</div></div><div><h3>Results</h3><div>65 patients were identified. Eight patients (12%) presented initially with inguinal lymph node metastasis. The median brachytherapy dose was 60 Gy (37–65 Gy). The median number of pulses was 150 pulses (87–175 pulses). With a median follow-up of 37 months (3–120 months), 12 patients (18.4%) had tumor local relapse. Three-year overall survival (OS) and disease-free survival (DFS) rates were 88.2% (95%CI: 79.7–97.7%) and 74.4% (95%CI: 63.9–86.6%) respectively. Twelve patients (20%) presented grade 2 painful ulceration resolving spontaneously and 13 patients (21.5%) experienced grade 2 meatal stenosis. No clinical or dosimetric factors correlated with painful ulceration were identified. The risk of meatal stenosis correlated with distal urethra D0.1cc (<em>p</em> = 0.0016) and D0.2cc (<em>p</em> = 0.0019) in multivariate analysis. The optimal cutoff for these constraints were 82 Gy (HR = 0.12, 95%CI: 0.04–0.38) and 79 Gy (HR = 0.19, 95%CI: 0.06–0.56) for D0.1 cc and D0.2 cc respectively.</div></div><div><h3>Conclusions</h3><div>This institutional experience shows that 3D PDR-BT could be a valid option for penile preservation. Dosimetric constraints for late distal urethral toxicity were identified.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 395-403"},"PeriodicalIF":1.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588824","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":"Intraluminal brachytherapy using 125I seed strand combined with PTBD and Hepatic arterial infusion chemotherapy for unresectable Bismuth-Corlette III and IV stage hilar cholangiocarcinoma","authors":"Zi-Han Zhang ,&nbsp;Min Li ,&nbsp;Hui-Yi Sun ,&nbsp;Fei-Hang Wang ,&nbsp;Min-Jie Yang ,&nbsp;Zhi-Ping Yan ,&nbsp;Fu-You Li ,&nbsp;Ling-Xiao Liu","doi":"10.1016/j.brachy.2024.12.004","DOIUrl":"10.1016/j.brachy.2024.12.004","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To evaluate the safety and efficacy of ¹²⁵I seed strand combined with percutaneous transhepatic biliary drainage (PTBD) and hepatic arterial infusion chemotherapy (HAIC) for unresectable Bismuth–Corlette III and IV stage hilar cholangiocarcinoma (HCCA).</div></div><div><h3>METHODS</h3><div>From January 2018 to December 2021, a total of 128 Bismuth–Corlette III and IV stage HCCA patients with obstructive jaundice were included in this single-center retrospective study. Forty-eight patients underwent ¹²⁵I seed strand combined with PTBD and HAIC (group A). The mean intended dose (<em>r</em> = 10 mm; <em>z</em> = 0; 240 days) in group A was 63.8 ± 0.6 Gy. Eighty cases underwent PTBD plus HAIC (group B). Median overall survival (OS) and median bile duct patency time (BDPT) were compared between the two groups.</div></div><div><h3>RESULTS</h3><div>In the propensity-score matched (PSM) cohort, the median OS and median BDPT were significantly longer in group A than in group B (44 PSM pairs; OS, 13.6 ± 0.4 vs. 8.7 ± 1.4 months, <em>p</em> &lt; 0.001; BDPT, 12.1 ± 0.5 vs. 6.4 ± 0.7 months, <em>p</em> &lt; 0.001). Multivariate analysis revealed that the treatment regimen was an independent prognostic factor of OS. There were no serious complications related to ¹²⁵I seed strand implantation.</div></div><div><h3>CONCLUSIONS</h3><div>¹²⁵I seed strand combined with PTBD and HAIC for unresectable Bismuth–Corlette III and IV stage HCCA is safe and effective.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 431-438"},"PeriodicalIF":1.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574936","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":"Development and implementation of a 3d-HDR brachytherapy program for cervical cancer in a sub-Saharan African centre","authors":"Adedayo Joseph ,&nbsp;Onyinye Balogun ,&nbsp;Bolanle Adegboyega ,&nbsp;Omolola Salako ,&nbsp;Omoruyi Credit Irabor ,&nbsp;Azeezat Ajose ,&nbsp;Samuel Adeneye ,&nbsp;Adewumi Alabi ,&nbsp;Ephraim Ohazurike ,&nbsp;Chibuzor F. Ogamba ,&nbsp;Aishat Oladipo ,&nbsp;Olufunmilayo Fagbemide ,&nbsp;Muhammad Habeebu ,&nbsp;David Puthoff ,&nbsp;Adedayo Onitilo ,&nbsp;Wilfred Ngwa ,&nbsp;Chika Nwachukwu","doi":"10.1016/j.brachy.2024.10.002","DOIUrl":"10.1016/j.brachy.2024.10.002","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Cervical cancer is the second most common cancer among women in Nigeria where, the gap between need for, and access to, radiation therapy including brachytherapy is significant. This report documents the implementation of the first three-dimensional high-dose-rate (3D-HDR) brachytherapy service for cervical cancer in Nigeria.</div></div><div><h3>PURPOSE</h3><div>This report details the steps taken to implement the 3D-HDR brachytherapy program, the challenges faced, and the adaptive strategies employed to overcome them. Our objective is to provide a guide for teams and centers in similar resource-restricted settings to implement 3D-HDR brachytherapy services, by leveraging our shared experience and lessons learned.</div></div><div><h3>METHOD AND METERIALS</h3><div>The implementation process required investment in infrastructure: creating a dedicated brachytherapy suite equipped with modern technology; and human capital: conducting both virtual and hands-on training for staff; and involving international experts during the initial treatment phases. Quality assurance protocols were established to ensure the accuracy and safety of treatments. Key adaptations included extensive remote training, international experts flying in for the initiation phase, and preemptively re-ordering the radioisotope to prevent delays.</div></div><div><h3>RESULTS</h3><div>The 3D-HDR brachytherapy program was successfully implemented, with five cases treated in the first 2 months despite challenges such as high equipment costs, expertise and proficiency needs, and source replacement delays. Continuous training and quality assurance measures ensured the program's sustainability and effectiveness.</div></div><div><h3>CONCLUSIONS</h3><div>Implementing a 3D-HDR brachytherapy program in a system with restricted resources is possible with thorough planning, flexible strategies, and adaptive measures. We document our experience to provide insights for other institutions aiming to establish similar programs. Collaboration and innovative financial strategies are essential for ensuring sustainable access to cancer treatment in the region. Strategies such as remote training and proactive resource management, are critical for overcoming implementation barriers.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 258-264"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901206","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":"Early outcomes following local salvage treatment with MRI-assisted low-dose rate brachytherapy (MARS) for MRI-visible postsurgical bed recurrences and focal intraprostatic recurrences","authors":"Comron Hassanzadeh ,&nbsp;Osama Mohamad ,&nbsp;Teresa Bruno ,&nbsp;Lin Wang ,&nbsp;Rajat Kudchakar ,&nbsp;Tharakeswara Bathala ,&nbsp;Jeremiah Sanders ,&nbsp;Henry Mok ,&nbsp;Sean McGuire ,&nbsp;Deborah Kuban ,&nbsp;Karen Hoffman ,&nbsp;Quynh Nguyen ,&nbsp;Ryan Park ,&nbsp;Howard Thames ,&nbsp;Paul Corn ,&nbsp;Brian Chapin ,&nbsp;Seungtaek Choi ,&nbsp;Chad Tang ,&nbsp;Steven Frank","doi":"10.1016/j.brachy.2024.10.015","DOIUrl":"10.1016/j.brachy.2024.10.015","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>To determine outcomes of MRI-assisted radiosurgery (MARS) for salvage brachytherapy using the radioisotope ¹⁰³Pd after various upfront treatments including surgery, external beam radiotherapy, and brachytherapy.</div></div><div><h3>METHODS</h3><div>We retrospectively reviewed data for patients who underwent salvage MARS for intraprostatic lesions or prostate bed recurrences from 2016 to 2022. Biochemical recurrence, prostate cancer–specific, and overall survival, and the cumulative incidences of toxicities, were determined by Kaplan-Meier estimates. Cox proportional hazards models were used to determine associations between clinical and treatment variables and risk of toxicity.</div></div><div><h3>RESULTS</h3><div>Study included 31 patients with local recurrence after initial definitive treatment. Four (13%) were initially treated with prostatectomy and salvage radiation, twenty-four (77%) with external beam radiation, and three with brachytherapy. Most had intermediate- or high-risk prostate cancer at the time of diagnosis. Twenty-two patients (71%) had focal-gland and nine (29%) had whole-gland MARS LDR salvage brachytherapy. Median follow-up was 35–28 months. By last follow-up, 5 patients (16%) experienced recurrence and started ADT, 3 patients started ADT before experiencing recurrence due to physician discretion, and 23 patients (74%) remained without recurrence. No patients died of prostate cancer. Median PSA nadir for recurrence-free patients was 0.2 ng/mL (range, 0–0.9 ng/mL). Grade 3 toxicities occurred in 4 patients (13%) including 3 patients (13%) with genitourinary events only and 1 patient (3%) with both a grade 3 genitourinary and a grade 3 gastrointestinal event.</div></div><div><h3>CONCLUSIONS</h3><div>In this modern series of patients undergoing salvage MARS with ¹⁰³Pd, we observed acceptable toxicity and early, promising biochemical disease control. These findings highlight the broader applicability of salvage MARS regardless of upfront treatment modality.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 231-237"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928865","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":"Impact of robust optimization on patient specific error thresholds for high dose rate prostate brachytherapy source tracking","authors":"Dylan Koprivec ,&nbsp;Cedric Belanger ,&nbsp;Luc Beaulieu ,&nbsp;Philippe Y. Chatigny ,&nbsp;Anatoly Rosenfeld ,&nbsp;Dean Cutajar ,&nbsp;Marco Petasecca ,&nbsp;Andrew Howie ,&nbsp;Joseph Bucci ,&nbsp;Joel Poder","doi":"10.1016/j.brachy.2024.11.012","DOIUrl":"10.1016/j.brachy.2024.11.012","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The purpose of this study was to compare the effect of catheter shift errors and determine patient specific error thresholds (PSETs) for different high dose rate prostate brachytherapy (HDRPBT) plans generated by different forms of inverse optimization.</div></div><div><h3>METHODS</h3><div>Three plans were generated for 50 HDRPBT patients and PSETs were determined for each of the 3 plans. Plan 1 was the original Oncentra Prostate (v4.2.2.4, Elekta Brachytherapy, Veenendaal, The Netherlands) plan, the second plan used the graphical processor unit multi-criteria optimization (gMCO) algorithm, and plan 3 used gMCO but had a robustness parameter as an additional optimization criterion (gMCOr). gMCO and gMCOr plans were selected from a pool of 2000 pareto optimal plans. gMCO plan selection involved increasing prostate V100% and reducing rectum Dmax/urethra D01.cc progressively until only 1 plan remained. The gMCOr plan was the most robust plan (using robustness parameter) that met the clinical DVH criteria (V100% ≥ 95%, rectum Dmax ≤ 80%, urethra D0.1cc ≤ 118%). PSETs were determined using catheter shift software.</div></div><div><h3>RESULTS</h3><div>The initial dose volume histogram (DVH) characteristics showed all 50 patient plans met a prostate V100% &gt; 95% and resulted in significant reduction in rectum Dmax and urethra D0.1cc for gMCO and gMCOr plans. No single plan showed benefits in PSETs for all shift directions compared to the other plans, however gMCO and gMCOr plans exhibit the best initial DVH characteristics assuming no errors occur. The robustness parameter showed no significant impact when considered in plan optimization.</div></div><div><h3>CONCLUSIONS</h3><div>PSETs were found to be equivalent regardless of optimization method. Indicating, no single optimization method can significantly increase the patient specific thresholds.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 281-292"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848628","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":"Mature effectiveness and toxicity outcomes associated with three treatment schedules of high-dose-rate brachytherapy monotherapy for favorable-risk prostate cancer","authors":"Kamran Salari ,&nbsp;Hong Ye ,&nbsp;Alvaro A. Martinez ,&nbsp;Evelyn Sebastian ,&nbsp;Amy Limbacher ,&nbsp;Kim Marvin ,&nbsp;Andrew B. Thompson ,&nbsp;Sirisha R. Nandalur ,&nbsp;Peter Y. Chen ,&nbsp;Daniel J. Krauss","doi":"10.1016/j.brachy.2024.10.008","DOIUrl":"10.1016/j.brachy.2024.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To present long-term toxicity and effectiveness outcomes of three prostate high-dose-rate (HDR) brachytherapy schedules: 38 Gy in 4 fractions, 24 Gy in 2 fractions, and 27 Gy in 2 fractions for men with low- or intermediate-risk prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>Patients treated with HDR brachytherapy monotherapy for prostate cancer were identified in a prospectively maintained, single institution database. Patients with AJCC T-stage ≤ T2b, Gleason score ≤ 7, prostate-specific antigen level ≤ 20 ng/mL, and ≥2 years of follow-up were included.</div></div><div><h3>Results</h3><div>671 patients were evaluated. 310 patients received 38 Gy in 4 fractions, 129 received 24 Gy in 2 fractions, and 232 received 27 Gy in 2 fractions. Median follow-up was 12.8 years, 10.6 years, and 8.1 years (<em>p</em> &lt; 0.001), respectively. 231 (74.5%), 92 (71.3%), and 81 (34.9%) patients (<em>p</em> &lt; 0.001) had low-risk disease. Rates of acute grade ≥2 GU toxicity were 11.1%, 12.3%, and 25.0% (<em>p</em> = 0.004), while chronic grade ≥2 GU toxicity were 17.0%, 22.6%, and 26.5% (<em>p</em> = 0.06). For low-risk patients, 10-year overall survival (OS), freedom from biochemical failure (ffBF), local control (LC), and freedom from distant metastasis (ffDM) were 86.6%, 93.3%, 97.9%, and 99.3%. For intermediate-risk patients, 10-year OS, ffBF, LC, and ffDM were 89.5%, 82.6%, 90.5%, and 97.4%. Higher PSA, higher Gleason score, perineural invasion, and 24 Gy or 27 Gy treatment schedules were predictors of biochemical failure.</div></div><div><h3>Conclusions</h3><div>HDR brachytherapy monotherapy with 38 Gy in 4 fractions was associated with improved long-term ffBF compared with 24 Gy/27 Gy in 2 fractions, without any associated increase in GI or GU toxicity rates.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 210-222"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824932","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 influence of time and implants in high-dose rate image-guided adaptive brachytherapy for locally advanced cervical cancer","authors":"Leonel Varela Cagetti ,&nbsp;Laurence Gonzague-Casabianca ,&nbsp;Marjorie Ferré ,&nbsp;Julia Gilhodes ,&nbsp;Eric Lambaudie ,&nbsp;Guillaume Blache ,&nbsp;Camille Jauffret ,&nbsp;Magalie Provansal ,&nbsp;Renaud Sabatier ,&nbsp;Agnès Tallet","doi":"10.1016/j.brachy.2024.11.010","DOIUrl":"10.1016/j.brachy.2024.11.010","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To compare the clinical outcomes of two different schedules of modern image-guided adaptive brachytherapy (IGABT) in patients underwent chemoradiotherapy (CCRT) and high-dose rate (HDR) brachytherapy (BT) for locally advanced cervical cancer treated (LACC)</div></div><div><h3>METHODS AND MATERIALS</h3><div>Data from medical records of all consecutive patients with histologically proven cervical cancer (FIGO 2018 stage IB-IVA) treated by HDR-BT after CCRT at our institution between 2016 and 2021 were reviewed.</div></div><div><h3>RESULTS</h3><div>Two hundred and 8 patients with LACC FIGO 2018 stages (IB 20.7%; II 26.5%, III 51%, IVA 1.9%) underwent brachytherapy at our institution. Depending on initial clinical features of disease and the clinical response to CCRT, HDR-BT was delivered with one implant (BT1i) or two implants (BT2i) in 39% and 61% of patients respectively. FIGO stages (≥IIB) were 63% vs. 78% for BT1i and BT2i patient group respectively. Combined brachytherapy technique [endocavitary/interstitial (IC/IS)] was required in 14.8% vs. 68.5% for BT1i and BT2i respectively. With a median follow-up of 32.5 months (95% confidence interval, [29.7–35.8]), l<em>ocal relapse was observed in sixteen patients: 8 patients (3.8%) had local (exclusive) relapse and 8 patients (3.8%) had locally persistent and progressive disease</em>, without significant difference for each BT modality group (<em>p</em> = 0.27), even if BT2i group had more aggressive initial disease. The estimated 3-year disease free survival and overall survival for the entire population was 69% (95% confidence interval, [62–75%]) and 88% (95% confidence interval, [82–92%]) respectively. There was a significant difference in the incidence of global toxicity grade G≥2 in favour to the BT2i group (<em>p</em> = 0.026).</div></div><div><h3>CONCLUSIONS</h3><div>HDR brachytherapy delivered with a long time interval between fractions, two implants, and combined IC/IS brachytherapy is the best way to ensure local control and to perform IGABT with low toxicity, even in advanced stages of disease.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 248-257"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960229","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}