Brachytherapy最新文献

{"title":"MSOR11 Presentation Time: 8:50 AM","authors":"Sung-Woo Lee PhD","doi":"10.1016/j.brachy.2024.08.073","DOIUrl":"10.1016/j.brachy.2024.08.073","url":null,"abstract":"<div><h3>Purpose</h3><div>Lu-177 (Pluvicto) and Ra-223 (Xofigo) have recently been adopted as targeted radiopharmaceutical therapies for castration-resistant prostate cancer patients. Both of these radiopharmaceutical therapies increase life expectancy and improve the prognosis of patients with a relatively simple procedure involving injection. The treatment procedures for Ra-223 and Lu-177 are similar, with Ra-223 administered in up to 6 fractions every 4 weeks, while Lu-177 is administered in the same number of fractions every 6 weeks. Although these treatments could be considered routine procedures in a nuclear medicine department, their implementation poses challenges in a small radiation oncology center due to a lack of staff experience. The purpose of this work is to provide guidance and share experiences for an independent small radiation oncology center preparing to launch such a program.</div></div><div><h3>Materials and Methods</h3><div>Physicians, physicists, and nurses collaborated as a team in the process, led by a physicist who served as a Radiation Safety Officer (RSO). Effective communication among staff is critical for successful workflow. We followed the Maryland regulations specific to radioactive material licenses consistent with the Federal Nuclear Regulatory Commission. The program build-up involved three phases: obtaining the license, conducting emergency planning and safety training for staff, and equipment acceptance and quality assurance (QA), source logistics, and workflow development. As an example, overall procedures from beginning to the first treatment of Ra-223 are depicted in Figure 1.</div></div><div><h3>Results</h3><div>Documentation of radiation safety procedures, staff training, acceptance and initial calibration of dose calibrators and well chambers, and workflow development using ARIA® Electronic Medical Record (EMR) were completed for the first treatment. Some steps, such as acceptance and QA of a dose calibrator and a well chamber for calibration contamination checks, may not be familiar to therapy physicists. Therefore, gaining knowledge through site visits and frequent contact with nuclear medicine personnel is essential. As of now, our institution has treated 8 patients with Ra-223, with a total of 29 injections. Among these patients, 3 have completed a total of 6 rounds of injections, all successfully treated without incident. Quality assurance for the injection program included recording prescribed versus actual injection activities, with an average discrepancy of 2.43%, well below the 10% tolerance level. Radiation surveys were conducted after injection to ensure patient safety, with an average maximum radiation exposure rate of 0.32 R/hr on the patient's surface, indicating safe release immediately after injection. We anticipate treating patients with Lu-177 in the near future, with preparations already in place.</div></div><div><h3>Conclusion</h3><div>Implementation of these therapies requires a te","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S56"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527132","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":"GSOR06 Presentation Time: 5:25 PM","authors":"Osagie Igiebor MD, Lewis Cooper MD, Harriet Eldredge-Hindy MD","doi":"10.1016/j.brachy.2024.08.052","DOIUrl":"10.1016/j.brachy.2024.08.052","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients on chronic anticoagulation (AC) represent a challenge for operative, gynecologic (gyn), intracavitary (IC) and interstitial (IS) brachytherapy (brachy). Frequently, AC is temporarily held to permit use of epidural catheters for anesthesia and pain control, and to minimize the risk of bleeding during applicator insertion and removal. This is complicated by significant risks of thromboembolism during brachy related to patient immobilization, surgery, cancer diagnosis, and comorbidities. There are currently no guidelines for AC management in patients undergoing operative gyn brachy. Thus, the aim of this study is to evaluate the safety and efficacy of our practice approach to patients with thromboembolic disease on chronic AC, undergoing operative brachy for gyn malignancies.</div></div><div><h3>Materials and Methods</h3><div>After IRB approval, we reviewed the records of 277 patients consecutively treated from 2013 to 2022 with operative brachy for gyn malignancies to identify 30 patients who had perioperative or chronic thromboembolic disease requiring AC therapy. We determined indications for AC use, operative metrics, oncologic and brachy characteristics, duration of AC interruption, as well as operative or postoperative complications. The primary aim was to determine operative or postoperative (within 90 days) embolic or hemorrhagic complications as measured by the Common Terminology Criteria for Adverse Events (CTCAE).</div></div><div><h3>Results</h3><div>The median age was 66 (range 35-80) years and patients were treated for cervical (n=14), inoperable uterine (n=11), recurrent uterine (n=2), and vaginal (n=3) cancers. Median follow up was 9 (range, 0-70) months after brachy. Indications for AC therapy were DVT (n=13), pulmonary embolism (n=8), and atrial fibrillation/flutter (n=11). AC medications used were apixaban (n=17), enoxaparin (n=5), rivaroxaban (n=3), warfarin (n=2), and intravenous heparin (n=3). Implants were IC (n=14), IS (n=7) and combined IC/IS (n=9), with a median number of 2 (range, 1-3) implants per patient and 4 (range, 2-9) brachy fractions. 16 patients received epidurals prior to the operative procedure. 26 patients were on AC prior to brachy and 4 started in the perioperative period. Therapeutic AC was held in 24 patients prior to operative brachy. The median total duration of AC Interruption was 2 (range, 0-16) days before and 1 (range, 0-4) days after the operative procedure, with median total duration of AC interruption 4 days. DVT prophylaxis was used after applicator placement in most patients, which included: IVC filter (n=3), subcutaneous heparin (n=15), intravenous heparin (n=1), prophylactic dose enoxaparin (n= 5), therapeutic dose enoxaparin (n=2). The median days of bedrest immobilization was 1 (range, 1-8) per implant. Only 3 patients (10%) experienced CTCAE grade≥ 2 operative or postoperative complications with no grade 4 or 5 events. One patient developed postoperative gra","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S44"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527136","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":"MSOR07 Presentation Time: 8:30 AM","authors":"Ema Yoshioka BSN, MSc, Puja S Venkat MD, Ermina Cavcic NP, Maylene Choy Gutierrez BSN, Gabriel Dimalanta BSN","doi":"10.1016/j.brachy.2024.08.069","DOIUrl":"10.1016/j.brachy.2024.08.069","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation is an effective therapy for non-melanomatous cutaneous malignancies, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). One of the side effects of radiation for skin cancer is radiation-induced dermatitis (RID), which can negatively affect patients emotionally and physically. This can occur in patients undergoing brachytherapy (BT) or external beam radiation therapy (EBRT). Despite significant advances in radiation treatments, there are gaps in nursing care such as lack of standardized nursing guidelines for managing RID skin care during BT or EBRT. Therefore, establishing a proper nursing guideline is essential as nurses have a key role in monitoring and managing RID. The purpose of this study is to identify the gaps in nursing care, assessment and intervention for RID during BT or EBRT, and assess the effect of a comprehensive guideline to assist nurses in providing efficient skin care.</div></div><div><h3>Materials and Methods</h3><div>Electronic databases such as PubMed, CINAHL and Embase were used to identify studies from the last decade (2012-2023) related to nursing care regarding RID. A comprehensive skin care guideline was then developed based on peer-reviewed literature and given to nurses working in the radiation oncology department of a large teaching institution with a high volume of both BT and EBRT (N=20). A survey was conducted among these nurses to identify the gaps in nursing care and knowledge before and after the introduction of the skin care guideline. The survey consisted of questions to assess nursing comfort level with skin care, proper documentation of stages of RID and familiarity with wound care products and supplies. The goal of the survey was to compare the nursing team's comfort and competency level before and after the implementation of the nursing guideline.</div></div><div><h3>Results</h3><div>The review of the literature revealed inconsistency in assessment practices, intervention strategies, and a lack of standardized guidelines. While some nursing recommendations exist through various oncology societies, the guidelines are generalized and do not directly address RID during BT. Furthermore, subjective data from the survey highlighted gaps in nursing care management of RID, such as lack of confidence, lack of standardized training, lack of consistency in products used, and ultimately wide variation in patient care delivery. Nursing staff reported that the guidelines for RID provided to them enhanced the quality of nursing care through multiple methods including the implementation of a standardization framework, utilization of evidence-based practice, risk reduction, optimized patient care, and empowerment of nurses. It also helps to foster interdisciplinary collaboration in the management of RID and improve patient satisfaction in both BT and EBRT.</div></div><div><h3>Conclusions</h3><div>By implementing standardized guidelines, nurses can follow the same p","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S53-S54"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526898","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":"PPP03 Presentation Time: 10:48 AM","authors":"Vitaly A. Biryukov MD, PhD ,&nbsp;Kseniia S. Makarova MD ,&nbsp;Alexey V. Troyanov MD ,&nbsp;Yulia V. Gumenetskaya MD, PhD ,&nbsp;Tatyana A. Rodina MD ,&nbsp;Elizaveta O. Shchukina MD ,&nbsp;Oleg B. Karyakin (Prof) ,&nbsp;Sergey A. Ivanov (Prof) ,&nbsp;Andrey D. Kaprin (Prof)","doi":"10.1016/j.brachy.2024.08.011","DOIUrl":"10.1016/j.brachy.2024.08.011","url":null,"abstract":"<div><div>Very-high risk [VHR] prostate cancer [PC] is an aggressive subgroup with high risk of distant disease progression. According to a number of studies systemic treatment intensification with docetaxel reduces PC-specific mortality in men receiving external beam radiation therapy [EBRT] with androgen deprivation therapy [ADT]. Whether the addition of chemotherapy to combined modality of radiotherapy (EBRT + brachytherapy [BT] boost) with ADT improves outcomes in this group is unclear.</div></div><div><h3>Purpose</h3><div>A comparative analysis of the efficacy of EBRT, BT boost and ADT with or without neoadjuvant docetaxel chemotherapy in VHR PC patients.</div></div><div><h3>Materials and Methods</h3><div>A total of 86 men diagnosed between 2016 and 2020 with VHR prostate cancer were stratified into 2 groups: EBRT plus BT boost and ADT (n = 66) or EBRT plus BT boost, ADT and neoadjuvant docetaxel chemotherapy (n = 20). Conformal EBRT was delivered with conventional fractionation to a total dose of 44-46 Gy to the prostate gland and seminal vesicles and the Ir-192 high-dose rate BT was delivered with one single fraction of 15 Gy. Neoadjuvant docetaxel was administered at 75 mg/m2 every 3 weeks for 4 cycles. A median duration of ADT, consisting of a gonadotropin-releasing hormone agonist, was 24 months. Median age was 66 years (range: 46-81 years). Median follow-up was 65 months (range: 21,5 - 108,7 months). The characteristics of the patient groups are presented in table 1.</div></div><div><h3>Results</h3><div>Six-years progression free survival [PFS] was 80,1% for the group with chemotherapy vs. 77,2% for no-chemotherapy group (p = 0,499). The presence of Gleason score 9-10 was associated with a statistically significant increase in the risk of PC recurrence (p = 0.013). Six-years overall survival [OS] was 100% and 82,8% for groups with and without chemotherapy respectively (p = 0,075). Six-years PC-specific survival [PCSS] was 100% and 93,4% for groups with and without chemotherapy respectively (p = 0,306).</div></div><div><h3>Conclusion</h3><div>There was no statistically-significant difference in PFS, OS and PCSS in VHR prostate cancer patients received EBRT+BT+ADT with or without chemotherapy.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S21"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526547","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":"PPP05 Presentation Time: 11:06 AM","authors":"Pradnya Chopade MD,&nbsp;Carlton Johnny MD,&nbsp;Robert Weersink PhD,&nbsp;Alexandra Rink PhD,&nbsp;Bernadeth Lao MSc,&nbsp;Anna Simeonov MSc,&nbsp;Anne Di Tomasso MSc,&nbsp;Heather Ballantyne MSc,&nbsp;Jette Borg PhD,&nbsp;Akbar Beiki-Ardakani PhD,&nbsp;Andrew McPartlin MD,&nbsp;Charles Catton MD,&nbsp;Srinivas Raman FRCPC,&nbsp;Rachel Glicksman FRCPC,&nbsp;Peter Chung MD,&nbsp;Alejandro Berlin MD","doi":"10.1016/j.brachy.2024.08.097","DOIUrl":"10.1016/j.brachy.2024.08.097","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Brachytherapy (BT) boost to the whole-gland (i.e., clinical target volume [CTV]) improves oncological outcomes in prostate cancer patients, albeit with higher likelihood of genitourinary (GU) and gastrointestinal (GI) toxicities. Magnetic resonance (MR) imaging can unveil the gross tumour volume (GTV) with high sensitivity and specificity (i.e., 86% (CI 82-89%) and 99% (CI 98-99%), respectively) in patients with localized disease, which also correlates with the most common area of local recurrence after radiation treatment. To improve the therapeutic index of BT boost, one potential approach is circumscribing it to the MR-depicted GTV (i.e., focal BT boost). Another approach is the use of rectal spacers, which significantly decrease the occurrence of radiation-related toxicities. However, their use is limited in ultrasound-guided BT given their echogenic noise limiting visualization of prostate and catheters. An MR-guided BT setting can converge the benefits of improved soft-tissue resolution and rectal spacers in the absence of device-related imaging artifacts. Herein, we present the results of a prospective study using rectal spacers for MR-guided focal BT boost combined with stereotactic body radiotherapy (SBRT) to the prostate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;Patients with localized prostate cancer and visible GTV on MR were enrolled in a prospective study (NCT00913939). All patients underwent insertion of rectal spacer under ultrasound guidance. Subsequently, patients received MR-guided HDR BT boost (15Gy in 1 fraction), followed by SBRT to prostate (33Gy to CTV, 30Gy to PTV, in 5 fractions). The present study reports on the first 73 patients enrolled.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Seventy-three patients are included in this analysis, with a median follow-up of 42 months (IQR 30-57). Most patients (47/73; 64.4%) had Grade Group 2 disease; while 37 (50.7%) and 27 (37%) were respectively categorised as NCCN favourable and unfavourable intermediate-risk, and 9 (12.3%) high-risk disease. Thirty percent of patients received combinatorial ADT for a medial duration of 6 months (IQR 6-20). Median number of BT catheters were 5 (IQR 4-7). Acute Grade 1 GI and GU toxicities were seen in 22 (30.1%) and 66 (90.4%) of patients, respectively. Only one case reported Grade 2 acute GU toxicity (dysuria). Late (i.e., 3-months after treatment) Grade 1 GI and GU toxicities were observed in 4 (5.5%) and 29 (39.7%) cases, respectively. There was a single case of late Grade 2 GU toxicity (haematuria). No incidence of acute or late Grade 3-4 toxicities was observed. Seven (9.6%) biochemical recurrence events were recorded, with an associated BCR-free survival of 83.7% at 5 years. Among those with BCR, 6 cases had recurrence localization by imaging: two local recurrences alone (both intra-prostatic outside the focal boost volume), while four had regional and/or distant recurrences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S71"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526757","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":"PPP06 Presentation Time: 11:15 AM","authors":"David Antonio Martinez Perez (Dr) ,&nbsp;Brenda Carrion Peñafiel (Dr) ,&nbsp;Alberto Lachos Davila (Dr) ,&nbsp;Roberto Carlos Chumbimuni Contreras MSc ,&nbsp;Paulina Noreña (Dr) ,&nbsp;Isabel Giraldo (Dr) ,&nbsp;Lina Marcela Arbelaez Leon (Dr) ,&nbsp;Armando Cristian Castellanos MSc ,&nbsp;Luz Adriana Maya MSc ,&nbsp;Jose Antonio Diaz Merchan MSc ,&nbsp;Oscar Andres Gamboa Garay (Dr)","doi":"10.1016/j.brachy.2024.08.098","DOIUrl":"10.1016/j.brachy.2024.08.098","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Objective(s)&lt;/h3&gt;&lt;div&gt;To describe long-term outcomes of a useful technique to decrease rectal dose during HDR prostate brachytherapy given as a boost to EBRT or as monotherapy. Prostate brachytherapy has evolved in recent years. It has become popular to use HDR and 3D planning, using CT and/or MRI, which has helped improve treatment capabilities to dose scaling, due to the real visualization allows to optimize the therapeutic index, escalate dose into the tumor, and protect OARs. The long-term outcomes analysis of a multicentric Latin American experience from Peru and Colombia with patients treated with this premise, using blood as OAR spacer, presented as an alternative to this procedure in developing countries with limited resources.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials/Methods&lt;/h3&gt;&lt;div&gt;from 2017 - 2020, 300 patients underwent HDR prostate brachytherapy in 3 institutions in Latin America, the first experience in Peru and Colombia. Under spinal anesthesia and sedation, approx. 16 mL of blood was extracted from the patient via antecubital venipuncture and mixed with 4 ml of iodine venous contrast as the technique firstly described in 2008 by Morancy from Boston for prostate LDR brachytherapy. The perineum was prepared for a sterile procedure. Under ultrasound guidance, an 18G spinal needle was placed to open the space below the Denonvilliers fascia for hydro-dissection, after that, the volume of blood was then instilled within the peri-rectal space on each side, as the needle was withdrawn, using the sagittal ultrasound image for guidance as the technique described by Hatiboglu in 2012 in Heidelberg. After the creation of the blood patch, a standard brachytherapy needle insertion to the prostate is performed under US guidance, followed by CT Simulation, and then MR fusion is performed for treatment planning. Following completion of the procedure, the change in the anterior peri‐rectal space was determined by comparing the diagnostic CT‐ and post‐patch contours. The dose plan was held constant by superimposing the post‐patch plan over the diagnostic CT contours. Needle positions were shifted posteriorly based on the change in peri‐rectal space. Prescribed dose to PTV in monotherapy 2 fractions of 13.5 Gy and as Boost to EBRT 15 Gy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A blood patch was successfully applied in all 300 patients. The blood patch thickness will decrease by 50% in 10 to 15 days after the application. All the rectal dose parameters above the V20 - V80 were significantly improved by the blood patch, also the Dmax and it was correlated with the homogeneity of the blood patch application, V5-V10 weren't significant because these isodoses are 5 to 6 cm far from the target. The average pre-rectal space obtained was 0.83 cm. The diametric potential advantages of the blood patch are that the mean dose to 0.1 cc of the rectum was limited to 57.4% and the mean dose to 2 cc of the rectum being 40%, also parameters such as D90 and V100 w","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S71-S72"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526758","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":"MSOR6 Presentation Time: 5:25 PM","authors":"Gustavo R. Sarria MD,&nbsp;Cas Dejonckheere MD,&nbsp;Julian Layer MD,&nbsp;Katharina Layer MD,&nbsp;Andrea Glasmacher MD,&nbsp;Davide Scafa MD,&nbsp;Eleni Gkika MD","doi":"10.1016/j.brachy.2024.08.040","DOIUrl":"10.1016/j.brachy.2024.08.040","url":null,"abstract":"<div><h3>Purpose</h3><div>Intraoperative radiotherapy (IORT) has become a viable treatment option for resectable brain metastases (BMs). As data on local control and radiation necrosis rates are maturing, we focus on meaningful secondary endpoints such as time to next treatment (TTNT), duration of postoperative corticosteroid treatment, and in-hospital time.</div></div><div><h3>Methods</h3><div>Patients prospectively recruited within an IORT study registry between November 2020 and June 2023 were compared with consecutive patients receiving adjuvant stereotactic radiotherapy (SRT) of the resection cavity within the same time frame. TTNT was defined as the number of days between BM resection and start of the next extracranial oncological therapy (systemic treatment, surgery, or radiotherapy) for each of the groups.</div></div><div><h3>Results</h3><div>Of 95 BM patients screened, IORT was feasible in 84 cases (88%) and ultimately performed in 64 (67%). The control collective consisted of 53 SRT patients. There were no relevant differences in clinical baseline features. Mean TTNT (range) was 36 (9 − 94) days for IORT patients versus 52 (11 − 126) days for SRT patients (<em>p</em> = 0.01). Mean duration of postoperative corticosteroid treatment was similar (8 days; <em>p</em> = 0.83), as was mean postoperative in-hospital time (11 versus 12 days; <em>p</em> = 0.97). Mean total in-hospital time for BM treatment (in- and out-patient days) was 11 days for IORT versus 19 days for SRT patients (<em>p</em>  0.001).</div></div><div><h3>Conclusion</h3><div>IORT for BMs results in faster completion of interdisciplinary treatment when compared to adjuvant SRT, without increasing corticosteroid intake or prolonging in-hospital times. A randomised phase III trial will determine the clinical effects of shorter TTNT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S38"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526611","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":"MSOR11 Presentation Time: 5:50 PM","authors":"Anamaria Guta MS,&nbsp;Molly Cromer MS,&nbsp;Michael Altman PhD,&nbsp;Phillip Wall PhD,&nbsp;Jose Garcia MS,&nbsp;Jacqueline Zaboeri PhD,&nbsp;Justin Mikell PhD","doi":"10.1016/j.brachy.2024.08.045","DOIUrl":"10.1016/j.brachy.2024.08.045","url":null,"abstract":"<div><h3>Purpose</h3><div>Lu177 PSMA and Lu177 DOTATATE are radiopharmaceutical therapies delivered in outpatient settings with fixed activity treatments. A proposed regulatory rule change (NRC-2023-0086) lowers patient release criteria from approximately 8.6 mR/h to 2.2 mR/h for Lu177. Decreasing tumor to kidney absorbed dose with subsequent cycles has been observed for both therapies; consequently the first cycle may be the optimal time to escalate activity. We aim to identify potential compliance issues for standard fixed activity treatments and in the context of dose escalation.</div></div><div><h3>Methods &amp; Materials</h3><div>We conducted an IRB-approved retrospective chart review of all Lu177 PSMA and DOTATATE treatments in our department for the calendar year 2023. Release exposure rate measurements were obtained within approximately 10 minutes following completion of Lu177 DOTATATE infusion or Lu177 PSMA syringe injection. The exposure rate measurements were evaluated for compliance with the proposed NRC rule change. To estimate the amount of dose escalation possible in a cycle while satisfying release regulations, we scaled the current prescribed activity by the ratio of the release criteria to the patient's current exposure rate measurement.</div></div><div><h3>Results</h3><div>A total of 211 (62 patients) Lu177 PSMA injections were administered. The nominal prescribed activity was &lt; 7.4 GBq in 30/211 treatments. Lu177 DOTATATE was infused 96 times (36 patients), and the nominal prescribed activity was 7.4 GBq for all treatments. For Lu177 PSMA, post-injection patient exposure rates were 1.78 ± 0.31 mR/h (0.26 to 3.2) (average ± stdev (min to max)), with 9 out of 211 measurements not meeting proposed release rule changes. For Lu177 DOTATATE, post-infusion patient exposure rates were 2.07 ± 0.28 mR/h (1.38 to 3.0) and 23/96 did not satisfy the proposed rule change. For DOTATATE the average activity escalation possible is 8% ± 15% (-27% to 60%) and 323% ± 60% (187% to 523%) for the proposed rule and current rule, respectively. For PSMA patients prescribed 7.4 GBq, the average activity escalation possible is 23% ± 19% (-31% to 86%) and 379% ± 73% (169% to 629%) for the proposed rule and current rule, respectively.</div></div><div><h3>Conclusion</h3><div>Both Lu177 DOTATATE and Lu177 PSMA are currently impacted by the proposed patient release rule change when administering a nominal prescribed activity of 7.4 GBq. The proposed rule change will further limit activity escalation in a single cycle without modifications to clinical workflows. Additional holding of patients and encouraging bladder voiding may be necessary to satisfy the proposed rule change for all cases.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S40-S41"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526616","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":"GPP05 Presentation Time: 9:36 AM","authors":"Areion Allmond BS,&nbsp;Onyinye Balogun MD, MSc,&nbsp;Eve McDavid BJ","doi":"10.1016/j.brachy.2024.08.007","DOIUrl":"10.1016/j.brachy.2024.08.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Gynecologic Brachytherapy is the standard of care for cervical cancer diagnoses and is critical to patient survival. Patients who have accessed brachytherapy have a significantly higher 5-year survival rate compared to patients who do not. However, brachytherapy treatment induces significant degrees of patient discomfort, anxiety, and physical and psychological distress. Limited patient experience research conducted, demonstrates the toll that current brachytherapy practices have on cervical cancer survivors’ ability to survive treatment and then face physical, mental, and sexual health side effects. This is documented in medical literature but has yet to influence brachytherapy procedure protocols in practice today. Knowledge and communication gaps coupled with inconsistent procedure preparation and administration leave patients underprepared for current treatment protocols and suffering in pain with long-term side effects. Improving patient treatment compliance and quality of life outcomes entails standardizing and implementing pain control, offering thorough patient education, and innovative technological advances. Thus, this study aims to 1) raise awareness for critical unmet needs in gynecologic brachytherapy; 2) assess the survivorship impact of current treatment practices; and 3) identify medical information, communication and tools necessary to improve quality of life outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;Eighteen cervical cancer survivors who received brachytherapy treatment were interviewed on video in-person and in virtual video conferencing meetings. The semi-structured interview was conducted to document the patient experience and identify opportunities to address challenges both patients and providers face in care. Study group participants were recruited by connections with US and international patient advocacy and survivorship networks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Thematic review revealed a significant need for five critical unmet needs: 1) treatment safety and comfort challenges associated with current procedure medical device equipment, “I would love if the process was updated to something that was less like a torture device”; 2) establishing procedure pain management standard of care, “I wasn't under general aesthetic and they just put them in, which was super traumatic”; 3) all provider staff and patients educated to discuss the common physical, mental and sexual treatment side effects, “information wasn't necessarily communicated, so no, I was not informed on what that would entail for me”; 4) addressing mental and sexual health side effects and referring patients to supporting medical professionals, “every single woman that goes through cervical cancer treatment should be given as part of their aftercare, a sexual health therapist as well as just a therapist; and 5) provider training on gender and sensitivity competency to humanize care, “there are people behind these ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S18-S19"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526543","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":"BP10 Presentation Time: 5:21 PM","authors":"Miren Gaztañaga MD ,&nbsp;Juan Segura MD ,&nbsp;Alejandro Pascual MD ,&nbsp;Inés Gil MD ,&nbsp;María José Ciudad MD ,&nbsp;Manuel Gonzalo Vázquez MD","doi":"10.1016/j.brachy.2024.08.034","DOIUrl":"10.1016/j.brachy.2024.08.034","url":null,"abstract":"<div><h3>Purpose</h3><div>Accelerated partial breast irradiation (APBI) with multicatheter technique is a standard treatment in patients with low-risk breast cancer. In our institution it has been performed perioperatively for the last 10 years. We report our experience and results with this technique, with the different treatment schemes used as a result of the evidence available at the time.</div></div><div><h3>Materials and Methods</h3><div>Data from patients treated with APBI with perioperative HDR brachytherapy were evaluated. Inclusion criteria were: age ≥ 50 years, tumor size ≤3 cm, cN0, no evidence of distant metastases, hormone sensitive invasive tumors, her2 negative, ki67&lt;25% and negative margins after lumpectomy. In situ tumors &lt; 25 mm were eligible. Patients with tumors close to the skin (≤5mm), a known BRCA mutation, linfovascular invasion, extensive intraductal carcinoma, or multifocal disease were not included. All cases were presented to a multidisciplinary committee and evaluated by a radiation oncologist prior to surgery, and all patients had a pre-surgical functional imaging test (MRI or contrast enhaced spectral mammography). The tumor bed was marked with radiopaque markers. Catheters were implanted intraoperatively using a freehand technique after the pathologist ruled out axillary involvement and confirmed negative margins. Forty-eight hours after surgery, a CT scan and 3D planning were performed and a final pathology report was obtained. The fractionation used was either 34 Gy in 10 fractions, 30.1 Gy in 7 fractions, or 22.35 Gy in 3 fractions. Clinical and dosimetric data were collected (acute and late toxicity according to CTCAE, cosmetic assessment with De Wazer scale). Data were collected retrospectively in patients treated with 10 and 7 fractions and prospectively in patients treated with the ultra-accelerated technique.</div></div><div><h3>Results</h3><div>Between 2014 and 2024, 169 implants were evaluated in 166 patients. The median follow-up was 20 months. Patient, tumor and implant characteristics are shown in Table 1. Ipsilateral recurrence has been reported in one patient at 47 months post-treatment, and disease-free and cancer-specific survival rates were 99.4% and 100%, respectively. There were no acute or late grade 3 or greater toxicities. Acute and late grade 1-2 toxicities were observed in 9.6% and 10.8% of patients, respectively.</div></div><div><h3>Conclusions</h3><div>Perioperative accelerated partial breast irradiation using the multicatheter technique is a safe and time-efficient treatment option for selected patients. Long-term tumor control results will be reported with further follow-up. Because toxicity data were collected retrospectively in some patients and prospectively in others, toxicity rates have not been compared; however, overall data are favorable with approximately 10% grade 1 and 2 toxicity rates.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S34-S35"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527278","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}