Brachytherapy最新文献

{"title":"A novel approach for the treatment of a rare case of gingival metastasis in renal cell carcinoma using surface-mould brachytherapy","authors":"Sushant Sushant ,&nbsp;Ragavi Radhakrishnan ,&nbsp;VR Anjali ,&nbsp;KP Haresh ,&nbsp;Aparna Sharma ,&nbsp;Atul Sharma ,&nbsp;Seema Kaushal","doi":"10.1016/j.brachy.2025.05.002","DOIUrl":"10.1016/j.brachy.2025.05.002","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Gingival metastasis in renal cell carcinoma is rare and often results from widespread metastasis. Usually, when managed surgically, general anesthesia and extensive and morbid surgery are required. The present case describes one such mandibular gingival metastasis in a patient with RCC successfully managed using a conservative approach of mould brachytherapy.</div></div><div><h3>CASE DESCRIPTION</h3><div>A 54-year-old nonhypertensive, nondiabetic male with, a known case of clear cell RCC, on targeted therapy presented with a new proliferative lesion in the mandibular gingiva, with difficulty in chewing food, pain, and bleeding. On examination, an ulceroproliferative friable lesion was seen in the mandibular gingiva on the right side, approximately 3 × 2 cm, which bled on touch. Biopsy showed metastatic carcinoma, diffusely positive for Pan-cytokeratin and PAX8. He was treated with a palliative dose of 20 Gy in 5 Fr, delivered using surface mould high-dose-rate (HDR) brachytherapy twice a day, 6 hours apart along with Lenvatinib. The surface mould was made using an acrylic dental mould with attached interstitial catheters. The lesion started to regress after 1 month and completely disappeared after 3 months of radiation delivery, with a healthy pink gingiva.</div></div><div><h3>CONCLUSION</h3><div>Although oral metastasis of RCC has a poor prognosis due to the occurrence of concurrent disseminated metastases, HDR brachytherapy may be used as an easier and less invasive method for treating gingival metastasis. It can be sought as an alternative approach to surgery for treating gingival metastases in the future without compromising quality of life. Brachytherapy can be an essential tool for palliative treatment as well.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 828-832"},"PeriodicalIF":1.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669107","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":"Investigation of heterogeneity corrections for accelerated Monte Carlo-based treatment planning of plaque ocular brachytherapy","authors":"Oleksii Semeniuk ,&nbsp;Mark J. Rivard ,&nbsp;Robert A. Weersink","doi":"10.1016/j.brachy.2025.05.004","DOIUrl":"10.1016/j.brachy.2025.05.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To develop and validate a practical method for accurate dose calculations of low-dose-rate brachytherapy treatment of eye tumors.</div></div><div><h3>METHODS</h3><div>Dose calculations of 16 mm Collaborative Ocular Melanoma Study (COMS) and 20 mm notched eye plaques with ¹²⁵I seeds were performed using the egs_brachy package of the EGSnrc Monte Carlo (MC). Several eye phantoms were modeled, including: (1) uniform phantoms made of only tumor (T), water, or vitreous body (VB) medium; (2) scaled water (SW) and scaled VB (SVB) distributions were derived by scaling the precomputed distributions for all-water and all-vitreous geometries by the relative energy absorption coefficient or each ocular structure to that of water or the vitreous body, respectively; (3) fully defined eye phantom with all structural materials defined; and 4) TG-43 calculations. Two contrasting tumor locations were modeled in this work. For investigation of dose distribution with standard plaques, the tumor was symmetrically located on the medial side of the eye. For the notched plaque, dose distributions were investigated with the tumor located posteriorly (abutting the optic nerve).</div></div><div><h3>RESULTS</h3><div>Compared to the fully-defined phantom calculations, all-water phantom calculations underestimated the tumor dose by 15–20%, while overestimating the lens and sclera dose. The optic nerve dose was predicted correctly. VB phantoms underestimated the tumor coverage by ∼3.5%, while T phantoms accurately predicted the target coverage. Both VB and T phantoms overestimated the organ-at-risk (OAR) doses more than all-water phantom. SW and SVB phantoms accurately predict both tumor and OAR doses within 4% of the complete phantom values for small volume metrics. Dose differences decreased to &lt; 2% to volumes &gt; 20%.</div></div><div><h3>CONCLUSION</h3><div>The dose scaling methodology provides a practical approach to account for ocular heterogeneity effects. This leads to accurate dosimetry, without computational penalties associated with patient-specific MC calculations. The methodology is found to be robust and applicable to both standard COMS and notched eye plaques of different sizes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 754-762"},"PeriodicalIF":1.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651515","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 between I-125 seed implantation and stereotactic body radiotherapy (SBRT) in patients with hepatic malignancies","authors":"Xu Zhu ,&nbsp;Bo Zhang ,&nbsp;Qi Kong ,&nbsp;Yuheng Li ,&nbsp;Pengfei Fan ,&nbsp;Dengbin Wu","doi":"10.1016/j.brachy.2025.06.002","DOIUrl":"10.1016/j.brachy.2025.06.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>This study aims to compare the dosimetric values of I-125 seed implantation with stereotactic body radiotherapy (SBRT) in the treatment of hepatic cancer patients.</div></div><div><h3>METHODS AND MATERIALS</h3><div>The study retrospectively analyzed 23 patients with hepatic malignancies treated with SBRT. A virtual I-125 seed implantation plan was simulated for comparison. For I-125 seed implantation, a prescription dose of 110 Gy was delivered to the gross tumor volume (GTV), corresponding to the planned target volume (PTV) in SBRT. Dosimetric values, including target coverage and dose to organs at risk (OARs), were compared using paired t-tests.</div></div><div><h3>RESULTS AND CONCLUSIONS</h3><div>The average PTV volume receiving 100% of the prescription dose was similar between the I-125 and SBRT groups (86.0% vs. 78.7%, <em>p</em> = 0.172). The I-125 group mean PTV V150% 62.9% ± 8.5%, while SBRT plans inherently restrict maximum PTV doses to ≤150% (resulting in 0% V150%). The mean minimum dose to PTV was significantly greater in the I-125 group than in the SBRT group (5562.49 cGy vs. 3289.69 cGy, <em>p</em> &lt; 0.01). Regarding OARs, the liver volume receiving ≥15 Gy was significantly lower in the I-125 group (274.67 cc vs. 485.72 cc, <em>p</em> &lt; 0.01), with similar trends observed for the small intestine, kidneys, stomach, and colon.</div><div>Dosimetric analysis revealed differences in dose distribution within the target volume and efficient OARs sparing using I-125 seed implantation compared with SBRT. Additional studies are required to examine the clinical relevance of these findings and determine whether combining these two methods may offer higher therapeutic benefit.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 820-827"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651514","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":"Rule-based AI automated adaptive treatment planning for image guided cervical cancer brachytherapy","authors":"Linda Rossi ,&nbsp;Rik Bijman ,&nbsp;Supriya Chopra ,&nbsp;Prachi Mittal ,&nbsp;Subhajit Panda ,&nbsp;Henrike Westerveld ,&nbsp;Miranda Christianen ,&nbsp;Inger-Karine Kolkman-Deurloo ,&nbsp;Sebastiaan Breedveld ,&nbsp;Remi Nout ,&nbsp;Ben Heijmen","doi":"10.1016/j.brachy.2025.05.007","DOIUrl":"10.1016/j.brachy.2025.05.007","url":null,"abstract":"<div><h3>BACKGROUND AND PURPOSE</h3><div>A rule-based AI system for automated adaptive treatment planning for image guided adaptive brachytherapy (IGABT) of locally advanced cervical cancer (LACC) was developed at Erasmus MC, and internally and externally validated by Erasmus MC and Tata Memorial Centre (TMC), respectively.</div></div><div><h3>MATERIALS AND METHODS</h3><div>The <em>BiCycle</em> system generates automated plans with adapted requirements for each fraction, considering previously delivered external beam radiotherapy (EBRT) and BT doses, according EMBRACE-II protocol. It optimizes dosimetric parameters and loading patterns for available radioactive source positions. The system’s effectiveness was validated by comparing automatically generated plans (AUTO) with manually generated, clinically delivered plans (MANUAL) of (1) dosimetry parameters and loading pattern visual inspection of 15 previously treated patients, for internal validation and (2) dosimetry and qualitative comparison by two TMC physicians of 20 previously treated patients, for external validation.</div></div><div><h3>RESULTS</h3><div>With comparable target doses, AUTO plans had reduced D_2cm³ (expressed as EBRT + BT total EQD2_α/β) for bladder, rectum, sigmoid and bowel compared to MANUAL plans with average gains of 5.3 Gy, 2.4 Gy, 2.5 Gy and 2.7 Gy, respectively, for internal validation, and of 3.6 Gy, 4.3 Gy, 1.9 Gy and 1.1 Gy, respectively, for external validation. The two TMC physicians preferred the AUTO plans in 76.3% and 75.0% of comparisons.</div></div><div><h3>CONCLUSION</h3><div>A novel AI-system for fully automated IGABT treatment planning for LACC allowed high-quality plan optimization in on average 1.6 min. AUTO plans were considered superior in quality compared to MANUAL plans in both internal and external validations, even without optimizing the system’s configuration for the external center.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 711-720"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610605","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":"Joint ABS/GEC-ESTRO Consensus Statement on the objectives of training in brachytherapy for physicians","authors":"Mira Keyes ,&nbsp;Alina Emiliana Sturdza ,&nbsp;Juanita Crook ,&nbsp;Bethany Anderson ,&nbsp;Luca Boldrini ,&nbsp;Junzo Chino ,&nbsp;Stefanie Corradini ,&nbsp;Christopher Deufel ,&nbsp;Andrew Farach ,&nbsp;Michael R. Folkert ,&nbsp;Steven J. Frank ,&nbsp;Jean-Michel Hannoun-Levi ,&nbsp;Peter Hoskin ,&nbsp;Ina Jurgenliemk-Schulz ,&nbsp;Mitchell Kamrava ,&nbsp;Marisa Kollmeier ,&nbsp;Mahta Mirzaei McKee ,&nbsp;Peter Orio F. III ,&nbsp;Peter Rossi ,&nbsp;Bradley R. Pieters ,&nbsp;Gerard Morton","doi":"10.1016/j.brachy.2025.05.006","DOIUrl":"10.1016/j.brachy.2025.05.006","url":null,"abstract":"<div><div><span>Brachytherapy is an essential skill in the practice of </span>radiation oncology and is an important component of high-quality, full-service radiation oncology departments. With rapidly changing technology, the role of brachytherapy is constantly evolving, but it remains critically important for optimal patient care in several disease sites. As a procedural aspect of radiation oncology practice, brachytherapy requires a fundamentally different and more focused training approach, with specific training objectives, a unique knowledge base, and specialized training environment. The existing gap in brachytherapy training and experience is compounded with a lack of standardized training objectives. Consensus statement objectives were in part adapted with permission from the Royal College of Physician and Surgeons of Canada, and then further reviewed, modified and enriched with expert knowledge by all authors. Training objectives were further synchronized with the US Accreditation Council for Graduate Medical Education (ACGME).</div><div>This ABS/GEC-ESTRO Consensus Statement of training objectives will facilitate brachytherapy training by outlining the necessary knowledge and procedural skills for successful practice in brachytherapy. The final brachytherapy curriculum development for any individual program, country and regions, is the responsibility of the individual programs and licensing jurisdictions and should be tailored to their patient population, available equipment and facilities.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 631-643"},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562268","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":"Understanding the value of paracervical block during gynecologic brachytherapy: A systematic review of the literature","authors":"Stephanie Gulstene ,&nbsp;Razan Amjad ,&nbsp;Lucas C. Mendez","doi":"10.1016/j.brachy.2025.04.008","DOIUrl":"10.1016/j.brachy.2025.04.008","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Paracervical block<span><span><span> is a technique to provide local anesthesia<span> with evidence supporting its use for various gynecologic procedures; however, the literature on its use for gynecologic brachytherapy is limited. This </span></span>systematic review seeks to understand the efficacy and safety of paracervical block in </span>cervical cancer brachytherapy.</span></div></div><div><h3>METHODS</h3><div>PubMed and EMBASE/Cochrane Library databases were searched from inception to June 2023. Articles were included if they described or mentioned the use of paracervical block in the context of HDR brachytherapy for cervix cancer. Non-English language or abstract-only articles were excluded. Citations were reviewed for relevant papers. Pain control and toxicity outcomes were abstracted along with technical details of anesthesia and brachytherapy procedure.</div></div><div><h3>RESULTS</h3><div>Of the 396 articles identified, eight were included. Two gave general recommendations around the role of paracervical block. The rest described its use during brachytherapy at their respective institutions. There was heterogeneity in paracervical block technique across different publications. The majority of included articles describe use of paracervical block for procedural pain control, while only one describe its use for postprocedure pain control. Pain was well controlled with &lt;10% of patients experiencing moderate or higher pain. However, there were no studies specifically assessing pain management with versus without use of paracervical block. The rate of grade 3+ toxicity associated with its use was &lt;5%.</div></div><div><h3>CONCLUSIONS</h3><div>Paracervical block is safe and can be part of effective pain management for patients receiving cervical brachytherapy. However, the incremental benefit of adding paracervical block is not well assessed in the current literature.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 5","pages":"Pages 694-702"},"PeriodicalIF":1.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556177","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":"Twice daily template-based interstitial brachytherapy for gynecologic cancers: What is the optimal dose?","authors":"Ria Mulherkar ,&nbsp;David Grimm ,&nbsp;Paniti Sukumvanich ,&nbsp;Madeleine Courtney-Brooks ,&nbsp;Michelle Boisen ,&nbsp;Jessica Berger ,&nbsp;Sarah Taylor ,&nbsp;Jamie Lesnock ,&nbsp;Shannon Rush ,&nbsp;Allison Garrett ,&nbsp;Haider Mahdi ,&nbsp;John Comerci ,&nbsp;Alexander Olaiwaye ,&nbsp;Robert Edwards ,&nbsp;Elangovan Doraisamy ,&nbsp;Michael Hajduk ,&nbsp;Christopher J. Houser ,&nbsp;Hayeon Kim ,&nbsp;John Austin Vargo IV","doi":"10.1016/j.brachy.2025.03.002","DOIUrl":"10.1016/j.brachy.2025.03.002","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Several factors of template-based interstitial brachytherapy in gynecologic cancers, including large tumor size, invasion into adjacent organs or fistula, dose heterogeneity, and twice daily fractionation cause inherent dose-escalation effects, potentially increasing toxicity. This study reports a single-institutional dose escalation experience in twice daily template-based interstitial brachytherapy treatments to demonstrate tumor control and toxicity outcomes, with the hypothesis that with image-based planning dose-escalation with interstitial brachytherapy is safe and efficacious.</div></div><div><h3>METHODS</h3><div>Patients treated with template-based interstitial brachytherapy at our institution from 2006 to 2022 were identified. Over time, HDR brachytherapy boost dose at our institution has been dose-escalated from 18.75 Gy in 5 fractions to 27.5 Gy in 5 fractions. Local control and survival outcomes were analyzed using the Kaplan–Meier method and log-rank test to compare between groups. Formal tumor control probability (TCP) analysis was performed using logistic dose-response modeling.</div></div><div><h3>RESULTS</h3><div>214 patients were identified with median follow-up of 28.1 months (IQR 8.2–58.7). Total HDR dose correlated significantly with local and locoregional control when analyzed as a continuous variable, and when dichotomized around median dose of 25 Gy (<em>p</em> = 0.024). TCP analysis showed a dose-response effect between HR CTV D90 and local control in the entire cohort, and separately in cervical and vaginal cancer subsets. The actuarial 5-year incidence of grade 3 or worse toxicity was 6.1%, and there was no significant association between toxicity and total HDR dose or HR CTV D90.</div></div><div><h3>CONCLUSION</h3><div>In patient treated with twice-daily template-based interstitial brachytherapy for gynecologic cancers brachytherapy dose correlates with local control with no significant association between brachytherapy dose and toxicity, thus suggesting room for dose-escalation.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 495-503"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A dosimetric evaluation of ureteric doses with and without ureter as avoidance organ in patients treated with MR hybrid brachytherapy for cervical cancer","authors":"Harjot Kaur Bajwa ,&nbsp;Sushil Beriwal ,&nbsp;Rajesh Natte ,&nbsp;Racharla Chandra Kumar ,&nbsp;Rampally Kumar ,&nbsp;Suresh Chaudhari","doi":"10.1016/j.brachy.2025.02.007","DOIUrl":"10.1016/j.brachy.2025.02.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Ureteric stenosis is a known complication with radiotherapy with studies showing correlation of ureteric dose with stenosis. This study was done to assess the dose delivered to the ureters with and without ureter as avoidance organ in cervical cancer patients treated with hybrid brachytherapy.</div></div><div><h3>MATERIAL AND METHODS</h3><div>Cervical cancer patients treated with EBRT and MR hybrid brachytherapy were retrospectively analyzed. They were treated without ureter contoured as organ at risk. The right and left ureters were retrospectively contoured on T2 weighted MRI images. Dose to 0.1cc volume of ureter was documented.</div></div><div><h3>RESULTS</h3><div>26 patients treated with hybrid brachytherapy were analyzed. The median HRCTV volume was 23.9cc. The median HRCTV D90 &amp; GTV D98 EQD2 were 91.09Gy (IQR 92.36–87.28) and 104.67Gy (IQR 113.90–95.04) respectively. The median D2cc for bladder, rectum and sigmoid were 75.46Gy, 58.10Gy and 61.3Gy EQD2 respectively. The mean minimum distance of the left ureter from HRCTV was 3.2mm (IQR 6.75–1) &amp; right ureter was 2.3mm (IQR 8–0). The mean D_0.1cc to the left ureter was 75.16Gy EQD2 (IQR 88.28–58.20) and to the right ureter was 69.73Gy EQD2 (IQR 76.77–56.01). The ureter D_0.1cc exceeded 77Gy in 13/26 patients. Replanning and reducing needle loading near the ureter resulted in reduction of ureter 0.1cc dose to less than 77Gy in all but 2 patients, without compromising the HRCTV coverage.</div></div><div><h3>CONCLUSION</h3><div>The ureter is at risk of receiving high doses when we use hybrid applicator. MR planning to delineate the ureter and careful optimization of needles can result in significant reduction of ureter dose with similar target coverage.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 504-509"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045015","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":"GPP03  Presentation Time: 9:33 AM","authors":"Claire Zhang PhD ,&nbsp;Shiqin Su PhD ,&nbsp;Choonik Lee PhD ,&nbsp;Elizabeth Jaworski MD ,&nbsp;Shruti Jolly MD ,&nbsp;Joseph Evans MD ,&nbsp;Joann Prisciandaro PhD","doi":"10.1016/j.brachy.2025.06.014","DOIUrl":"10.1016/j.brachy.2025.06.014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Interstitial gynecologic (GYN) brachytherapy is an effective treatment for endometrial and cervical cancers, but conventional forward planning is technically challenging, time-consuming, and often requires expertise and skills. Over the past decade, inverse planning has gained popularity, showing potential to improve efficiency and plan quality. We present a standardized inverse planning workflow for multi-dose-level interstitial GYN brachytherapy, utilizing the VEGO optimization algorithm (Eclipse v16). The workflow aims to enhance planning consistency and robustness while minimizing manual intervention, thereby reducing dependence on planners’ clinical experience, which has historically been a significant barrier to the adoption of interstitial brachytherapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;The workflow (Figure 1a) involves creating optimization structures including ring structures (1 cm margin around the CTV, excluding overlaps with OARs) and a dwell position structure (zDwell) combining all CTVs with a 1 cm margin. Initial dwell positions are defined within zDwell, and a standardized objective template was applied in VEGO TG43 inverse planning. This STAMP (structure- and template-assisted multi-dose-level planning) approach was retrospectively applied to 26 GYN interstitial brachytherapy patients at a single institution. The median high-risk CTV (CTV_HR) prescription was 26 Gy (range: 22.4-30 Gy) over four fractions, with 15 patients also receiving 14 Gy (range: 4.8-24 Gy) for intermediate-risk CTVs (CTV_IR). EMBRACE II constraints guided OAR planning objectives, and plans were normalized to achieve CTV_HR D90=100%. STAMP plans, generated without manual dwell time adjustments, were compared to clinical plans in total OAR D2cc (EBRT + brachytherapy, estimating maximum possible D2cc), D90 of CTV_IR, and total dwell time. A two-sided Wilcoxon rank-sum test was used to assess statistical significance (p=0.05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The median (range) number of optimization iterations for all STAMP plans was 4 (1-7). Both clinical and STAMP plans met EMBRACE I dose constraints for all OARs. Among the twenty-six cases, the number of clinical plans failing to meet EMBRACE II limits for the bladder, rectum, sigmoid, and bowel were 9, 16, 3, and 5, respectively, compared to 8, 13, 2, and 5 for STAMP plans (clinical plans aimed to meet EMBRACE II goals; however, some constraints were not achievable due to clinical considerations). All cases achieved CTV_HR D90=100% coverage. For the 15 cases with a CTV_IR prescription, 3/15 clinical plans failed to achieve D90 &gt; 100%, while all STAMP plans met this criterion. Boxplots in Figure 1b-d compare OAR doses, CTV_IR coverage (D90), and total dwell time between clinical and STAMP plans. STAMP plans showed slightly lower OAR doses (except for the bowel) and shorter total dwell times. CTV_IR coverage was comparable between the two plans, with STAMP sh","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S9-S10"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888829","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":"GPP04  Presentation Time: 9:42 AM","authors":"Santino Butler MD,&nbsp;Nikhil Kotha MD,&nbsp;Thomas Niedermayr PhD,&nbsp;Elizabeth Kidd MD","doi":"10.1016/j.brachy.2025.06.015","DOIUrl":"10.1016/j.brachy.2025.06.015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Locally advanced cervical cancers can particularly benefit from the addition of interstitial needles during brachytherapy. We designed a three-dimensionally (3D)-printed ovoid-based needle guide (OVI)—which contains medial and lateral needle channels, and can also function in conjunction with 3D-printed tandem-based needle templates — to create a tool to aid needle placement. Example OVI implant shown in Fig. 1A. This study aimed to evaluate the dosimetric advantages from utilizing OVI, and determine which patients benefit most.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;This single institution cohort study included 88 cervical brachytherapy implants (OVI, N=77; non-OVI, N=11) across 22 patients treated definitively with OVI for ≥2 fractions from 2020 to 2024. Dose and clinical features were compared across implants and tumor-score (T-score: an EMBRACE-validated prognostic tumor score shown to outperform FIGO stage in predicting for local control and survival). Logistic regression analyzed predictors of high-risk clinical target volume (HR-CTV) dose (each fraction analyzed separately using predicted cumulative D90 [assuming identical dose for all fractions]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Sixty-four percent of patients received OVI for all four implants (all-OVI), and 36% received OVI for 2-3 implants (part-OVI). There were no significant differences between all-OVI and part-OVI patients with respect to FIGO 2014 stage, pre-HDR tumor size, HR-CTV width at cervical os, HR-CTV volume, or T-score. Overall, 64% had FIGO III-IV [41% FIGO IV], 73% HR-CTV volume &gt;30cc, and 41% T-score ≥10; median width at cervical os was 4.8 cm (range, 3.6-6.5 cm). FIGO IV disease and HR-CTV volume ≥30cc were associated with higher T-scores (P&lt;0.001 for both). However, with respect to HR-CTV dose achieved, T-score ≥10 (vs &lt;10) was the most predictive variable for lower mean D90 (-4.1 Gy&lt;sub&gt;EQD2&lt;/sub&gt;, P&lt;0.001), compared to FIGO IV (vs I-III; -2.9 Gy&lt;sub&gt;EQD2&lt;/sub&gt;, P=0.001) and HR-CTV volume &gt;30cc (vs ≤30cc; -0.2 Gy&lt;sub&gt;EQD2&lt;/sub&gt;, P=0.86). Tumors with T-score ≥10 were also less likely to achieve D90 &gt;85 Gy (58.3% vs 86.5%, P=0.005). OVI implants had a higher mean D90 (88.7 vs 80.1 Gy&lt;sub&gt;EQD2&lt;/sub&gt;, P&lt;0.001) and remained more likely than non-OVI to achieve D90 &gt;85 Gy (83.1% vs 18.2%; aOR 13.8 [95% CI, 2.44-78.5] P=0.003) after adjusting for implant year and T-score. OVI (vs non-OVI) implants had no difference in mean dose to rectum (D2cc&lt;sub&gt;rectum&lt;/sub&gt;: 66.0 vs 64.9 [+1.1 Gy&lt;sub&gt;EQD2&lt;/sub&gt;] P=0.58) or bladder (D2cc&lt;sub&gt;bladder&lt;/sub&gt;: 83.2 vs 81.0 [+2.2 Gy&lt;sub&gt;EQD2&lt;/sub&gt;] P=0.24), but had a trend towards improved bowel dose (D2cc&lt;sub&gt;bowel&lt;/sub&gt;: 67.2 vs 72.1 [-4.9 Gy&lt;sub&gt;EQD2&lt;/sub&gt;] P=0.066). With respect to HR-CTV D90 achieved (Fig 1B), fractions utilizing OVI had the greatest relative benefit for tumors with T score ≥ 10. For non-OVI fractions, mean D90 was 8.4 Gy&lt;sub&gt;EQD2&lt;/sub&gt; lower (P=0.03) for T-","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S10-S11"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888830","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}