Brachytherapy最新文献

{"title":"PHSOR03 Presentation Time: 9:10 AM","authors":"Birjoo Vaishnav PhD, DABR","doi":"10.1016/j.brachy.2024.08.077","DOIUrl":"10.1016/j.brachy.2024.08.077","url":null,"abstract":"<div><h3>Purpose</h3><div>Clinical experience or nomograms guide day to day clinical decisions for HDR prostate brachytherapy such as whether there ought to be one more catheter to ensure coverage or whether a given catheter would be unusable as it is too close to urethra. AI or machine learning offers the possibility to mimic this with backing from clinical data. The purpose of this study utilizing simulated data was to explore feasibility of using AI/Machine Learning in answering routine questions during the HDR prostate planning process, such as the number of catheters needed to ensure optimal coverage while ensuring urethral sparing.</div></div><div><h3>Materials and Methods</h3><div>Data from the catheter insertion and planning during HDR prostate cases such as volume of prostate in the ultrasound and CT, number of catheters are available during insertion and after digitization and optimization the D10% for the Urethra, V150 and V200 for the prostate for a V100 ∼ 95% is obtained. To separate the characteristics of the AI modeling from the peculiarities of the clinical data, a simulated dataset with a gaussian distribution with similar bounds as the typical clinical data was created. AutoML is a subset of machine learning which automates the model validation and evaluation. Using various preset criteria, models are trained on data using fivefold cross validation and a portion of data is held for future testing as a holdout. The scoring metric from this is then used for automatically evaluating the performance of models and choosing the optimal model. Various software solutions were explored for deploying AutoML with low or no code and ability to evaluate the underlying machine learning model predictions being the criterion. The user interface for two of the vendors datarobot and symon.ai were intuitive and easily deployable in comparison to the bigger vendors in the field, of the two, free trial online version of datarobot was used for this study. AutoML was trained and deployed on a set of 51 rows with four of the predictive features - TRUS volume of prostate, number of slices, CT volume and the Dose to 10% of the urethra were used as the training data set for machine learning, with the number of catheters as the target. After completion of the run, the output of top five of the algorithms (elastic net, extreme gradient boosted trees, ridge regressor, light gradient and random forest) were calculated just to evaluate how far off they were from each other and ground truth, using another set of 48 rows of data with some overlap with the training data.</div></div><div><h3>Results</h3><div>While it was easy to deploy and create a model with this platform, several other platforms such from leaders in the field were much harder to set up and troubleshoot. The outputs for the test data were evaluated relative to the ground truth and the elastic net had the least deviation from the ground truth both in terms of the overall data spread and the deviat","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526754","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":"MSOR8 Presentation Time: 5:35 PM","authors":"Kiriti Chiriki DNB, Umesh Mahantshetty MD, DNB, DMRT, Rohit Vadgoankar MD, Pankaj Chauhan MDS, PhD, Sasi Krishna Kavutarapu Mch, Rao N Nageswara Mch, KK Sree Lakshmi MSC, DRP, Raghavendra Hajare MSc, DRP, Sneha Nachu BDS, Raviteja Miriyala MD","doi":"10.1016/j.brachy.2024.08.042","DOIUrl":"10.1016/j.brachy.2024.08.042","url":null,"abstract":"<div><h3>Purpose</h3><div>To elucidate systematic approach towards commissioning, implementing and establishing a high dose rate (HDR) interstitial brachytherapy (ISBT) program for head and neck cancers in a new tertiary cancer centre in India.</div></div><div><h3>Materials and Methods</h3><div>We present the systematic approach and challenges encountered during the implementation of ISBT for head and neck cancers and early outcome of patients treated between September 2020 and September 2022 at our Institution.</div></div><div><h3>Results</h3><div>In an established infrastructure for high Dose rate Brachytherapy, we explored implementing H & N BT. Joint tumor board discussions, reviewing of existing treatment guidelines and shared decision making with patients helped to start the program. A comprehensive disease mapping was done using clinical drawings (figure 1) & clinical pictures taken before EBRT and BT. Appropriate check list for performing BT procedure, discussions for anaesthesia requirements, dedicated team of Nurse, RTT & Medical physicist, BT planning and dose parameters were reviewed. A successful collaboration with dental surgeon to work on prosthesis especially to spare mandible for high dose regions was established which evolved from using simple rubber catheters, wax to customized acrylic spacers. All suitable patients were either offered radical BT or BT boost after completion of EBRT.A total of 18 patients diagnosed with early-stage oral cancer underwent treatment with ISBT, either as a boost following VMAT (n=13) or 3DCRT (n=2), or as BT Alone (n=3). The primary tumour sites were lateral border of the tongue (n=13), lip (n=3), and buccal mucosa (n=2). The median tumour size was 2 cm, with 13 cases classified as T1 and 5 as T2 with infiltrative lesion in 13 pts and proliferative lesion in remaining 5 pts.Three patients received ISBT alone (1 with buccal mucosa cancer, 2 with lip cancer), while 15 underwent concurrent neck irradiation alongside primary tumour treatment, with a median dose of 50 Gy in 25 fractions over 5 weeks, followed by HDR ISBT after a median gap of 31 days (IQR, 18-34 days). Most patients (n=9,50%) required implantation in two planes, with a median of 11 catheters (range 9-15). The median dose for ISBT boost cases was 22.5Gy in 5 fractions @ 4.5Gy/fraction, while for radical ISBT, it ranged from 40 Gy in 10 fr to 49.5 Gy in 11 fr. The EQD2 was 74 Gy (range: 69-77.5 Gy EQD2), and the median overall treatment time for combined EBRT and ISBT boost was 67 days (range: 47 - 88 days). Mandibular ISBT doses were limited to a median of 4.3 Gy (D 0.1 cc) and 3.15 Gy (D 1cc) per fraction with cumulative dose(Dmax) in EQD2 of 53Gy. The prescribed dose for radical ISBT ranged from 40 to 48 Gy in 10-15 fr.At the last follow-up, grade 1 xerostomia was reported in 38.9% of patients, with none experiencing grade 2 or higher xerostomia. One patient developed osteoradionecrosis of the mandible with minimal exposure","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526755","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":null,"pages":null},"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":"PL05 Presentation Time: 2:30 PM","authors":"Csaba Polgar MD, PhD, MSc, DSc ,&nbsp;Vratislav Strnad MD, PhD ,&nbsp;Jose Luis Guinot MD ,&nbsp;Cristina Gutierrez Miguelez MD ,&nbsp;Tibor Major PhD, DSc ,&nbsp;Kristina Lössl MD ,&nbsp;Bülent Polat MD ,&nbsp;Peter Niehoff MD, PhD ,&nbsp;Christine Gall PhD ,&nbsp;Wolfgang Uter PhD","doi":"10.1016/j.brachy.2024.08.063","DOIUrl":"10.1016/j.brachy.2024.08.063","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the 10-year late side-effects and cosmetic results of the GEC-ESTRO multicentric phase 3 accelerated partial breast irradiation (APBI) trial.</div></div><div><h3>Materials and Methods</h3><div>Women aged 40 years or older with stage 0-IIA breast cancer who underwent breast-conserving surgery (BCS) with clear resection margins were randomly assigned to receive either whole-breast irradiation (WBI) of 50 Gy with a tumor-bed boost of 10 Gy or APBI with interstitial brachytherapy. The non-inferiority of APBI in terms of local tumor control as primary end-point has been confirmed. Here, we report the secondary endpoints of late side-effects and cosmesis at 7.5 and 10 years of follow-up. This trial is registered with ClinicalTrials.gov number NCT00402519.</div></div><div><h3>Results</h3><div>Between 2004, and 2009, we randomly assigned 1328 women to receive either WBI (n=673) or APBI with interstitial brachytherapy (n=655); 1184 patients comprised the as-treated population and among these 10-year data on late side-effects and cosmetic results were available in 688 patients (313 in the WBI group and 375 in the APBI group). At 7.5 and 10 years 10 (2.7%) and 4 (1.3%) patients in the WBI group and 2 (0.4%) and 1 (0.3%) patients in the APBI group had grade 3 skin teleangiectasia (p=0.02 at 7.5 years and p=0.18 at 10 years). At 7.5 and 10 years 2 (0.5%) and 5 patients (1.6%) in the WBI group and 2 (0.4%) and 3 (0.8%) in the APBI group developed grade 3 late subcutaneous tissue toxicity (p=0.62 at 7.5 years and p=0.53 at 10 years). The incidence of grade 2-3 breast pain at 7.5 and 10 years was 1.6% and 1.0% after WBI versus 1.1% and 0.8% after APBI (p=0.39 at 7.5 years and p=0.93 at 10 years). At 7.5 years brachial lymphoedema occurred more frequently after WBI compared to APBI (5.4% vs 2.2%; p=0.03). At 7.5 and 10 years’ follow-up, according to the patients’ view, 31.9% and 33.8% of patients had excellent cosmetic results in the WBI group versus 44.3% and 45.0% of patients in the APBI group (p=0.001 at 7.5 years and p=0.002 at 10 years); when judged by the physicians, 31.7% and 33.2% of patients in the WBI group versus 40.0% and 40.0% of patients in the APBI group, had excellent cosmetic results, respectively (p=0.05 at 7.5 years and p=0.2 at 10 years).</div></div><div><h3>Conclusions</h3><div>Long-term toxicity profiles and cosmetic results were similar in patients treated with BCS followed by either APBI with interstitial brachytherapy or conventional WBI, with significantly fewer skin teleangiectasia and brachial lymphoedema accompanied with a slightly better cosmetic results after APBI with interstitial brachytherapy. These findings provide further clinical evidence for the routine use of sole interstitial multicatheter brachytherapy after BCS.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527029","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":"PP03 Presentation Time: 4:18 PM","authors":"Samantha Simiele PhD ,&nbsp;Manik Aima PhD ,&nbsp;Frank-Andre Siebert PhD ,&nbsp;Joel Poder PhD ,&nbsp;Luc Beaulieu PhD ,&nbsp;Christopher Melhus PhD ,&nbsp;Susan Richardson PhD","doi":"10.1016/j.brachy.2024.08.022","DOIUrl":"10.1016/j.brachy.2024.08.022","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;The documented decline in brachytherapy (BT) utilization in some parts of the world has caused concern for the impact this may have on resident (or equivalent) training and education. The AAPM established a BT survey subunit (UN72) in 2018 with the goals of (1) assessing the current state of medical physics resident BT education on a global scale and (2) collecting data to allow comparison of BT training challenges and opportunities between different organizational systems.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;UN72 collaborated with representatives from COMP, GEC-ESTRO, and ABG. The team designed a survey consisting of 26 questions of four types, including multiple choice, select all that apply, free response, and five-point scale. Information was collected in six subject areas including: (1) Trainee demographics, (2) Training methods, (3) Caseload and confidence levels, (4) Future plans and interest in performing BT, (5) Interest in additional BT training opportunities, and (6) Trainee practice impressions. The survey was reviewed and approved for distribution by the AAPM as well as the UN72 collaborators. Within the AAPM, the survey was distributed to current residents and recent graduates of CAMPEP-accredited medical physics residency programs. This survey closed in March 2022 and the results are summarized in a manuscript currently under review. The same survey was distributed separately to resident members of COMP, GEC-ESTRO, and ABG and was closed for responses in March 2022. This abstract summarizes the results of the international survey, considering the contributions of GEC-ESTRO, ABG, and COMP.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The survey received 183 (AAPM), 41 (ABG), 106 (GEC-ESTRO), and 13 (COMP) responses. The majority of respondents from AAPM (60%), ABG (67%), and GEC-ESTRO (69%) had completed their training whereas 62% of COMP respondents were currently enrolled in their program at the time of survey completion. The results presented are for those who had completed their training program. At least 63% of respondents in each organization expressed interest in performing BT at their first post-residency position and at least 55% in each organization indicated their first position would require them to perform BT. 64% (AAPM), 56% (GEC-ESTRO), 59% (ABG) and 40% (COMP) of respondents wished they had additional BT training opportunities. Of those expressing interest in additional training opportunities, the majority in each organization said they would be ‘very likely’ or ‘likely’ to select BT as an elective rotation if one were offered at their training institute, the majority expressed interest in performing a post-residency fellowship (Figure 1) if one were available, and 76% (AAPM), 83% (GEC-ESTRO), 84% (ABG), and 50% (COMP) expressed interest in completing a BT rotation at an institution with a higher caseload or a greater variety of cases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The majo","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527067","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":"GSOR02 Presentation Time: 5:05 PM","authors":"Jasmine Zhang BA ,&nbsp;Erin Herbert BS ,&nbsp;Teresa M. Meier MD ,&nbsp;Thomas L. Minges DNP, CRNA ,&nbsp;Jordan Kharofa MD ,&nbsp;Sarah M.C. Sittenfeld MD","doi":"10.1016/j.brachy.2024.08.048","DOIUrl":"10.1016/j.brachy.2024.08.048","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;In 2015, we transitioned from performing gynecologic brachytherapy procedures in an operating room in the hospital under general anesthesia, to a departmental procedure room with preference for spinal anesthesia. MRI was in the main hospital and generally obtained with fraction 1 and fused to CT scans for subsequent fractions. We sought to review the feasibility and tolerability of this workflow utilizing spinal anesthesia and extra-departmental MRI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;This was an IRB-approved, retrospective review of gynecologic brachytherapy procedures performed in a departmental procedure room at a single center from 4/2015-3/2023. Demographic information and treatment-related data including procedure details, imaging used for treatment planning, type of anesthesia, total time in the department, and highest pain score were obtained. OR procedures that required admission with implant in place were excluded from analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 141 patients undergoing 541 procedures were included. The most common diagnosis was cervical cancer (n = 118) followed by endometrial and vaginal cancer. Most patients (98%) underwent external beam radiation therapy ± chemotherapy prior to brachytherapy. The most common brachytherapy regimen was 28 Gy in 4 fractions, delivered twice weekly, and the average overall treatment time was 52.6 days. Tandem and ring was the most frequently used applicator (n = 89), and 38 patients had hybrid or interstitial implants. Eighty-two percent of patients received spinal anesthesia. For those undergoing general anesthesia, the most common reasons were low platelets (52%) or anticoagulation (32%). There were no complications from spinal anesthesia in this cohort. Sixty-seven percent of patients underwent MRI with applicator in place and 22% had pre-brachytherapy MRI. For fractions performed when only a CT scan was obtained for planning, average total time in the department was 346 minutes (min). Patients who received spinal anesthesia spent a longer time in the department than patients who received general anesthesia (average of 353 min vs. 325 min, p=0.00005). Similar trend was seen on fractions when an MRI was obtained, with average time in the department of 371 min for those under spinal anesthesia vs. 346 min for those under general anesthesia (p=0.04). When comparing fractions when an MRI was obtained vs. CT scan only, the MRI added an average of 20 min to the total time (366 min vs. 346 min). Patients receiving spinal anesthesia had a lower average pain score than those receiving general anesthesia (1.63 vs. 2.34, p=0.02). Overall, only 17% of patients required narcotics for post-procedure pain control regardless of type of anesthesia received, and the majority of these (91%) required only 5-10 mg of oxycodone or equivalent for adequate pain control.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Spinal anesthesia is feasible and offers goo","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526542","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: 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":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Implementation of these therapies requires a te","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"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,&nbsp;Lewis Cooper MD,&nbsp;Harriet Eldredge-Hindy MD","doi":"10.1016/j.brachy.2024.08.052","DOIUrl":"10.1016/j.brachy.2024.08.052","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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":null,"pages":null},"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":"Thursday, July 11, 20244:00 PM - 5:00 PM PP01 Presentation Time: 4:00 PM","authors":"Christopher Jason Tien Ph.D. ,&nbsp;Sean Mullane M.S. ,&nbsp;Emily Draeger Ph.D. ,&nbsp;Mark J. Rivard Ph.D. ,&nbsp;Zhe (Jay) Chen Ph.D.","doi":"10.1016/j.brachy.2024.08.020","DOIUrl":"10.1016/j.brachy.2024.08.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;In Ir-192-based high dose rate (HDR) brachytherapy, the dose delivered at the central axis of single-channel vaginal cylinder (SCVC) is inherently lower than the surrounding areas due to the anisotropic dose distribution of the Ir-192 seed. In principle, this situation could be addressed by introducing custom shielding into the dome of SCVC to shape the dose distribution near the central axis. Aided by advanced dose calculation methods, including both Monte Carlo (MC) simulations and Model-Based Dose Calculation Algorithms (MBDCAs), the shape and density of the shielding materials could provide additional degrees of freedom for inverse dose optimization. In this work, we investigate the potential benefits of this approach by investigating the efficacy of an SCVC with custom shielding (SCVC+S) design to flatten the distal dose profile.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;A standard SCVC with 140 mm cylinder height (h) and 30 mm outer diameter (OD) with an air channel of 1.6 mm along the central axis for the source transit was used in the initial investigation. The cylinder is capped by a half-spherical dome with a matching diameter (d) of 30 mm. While the existing SCVC is composed entirely of water-equivalent material, the SCVC+S design includes a cavity within the dome which will be injected with stainless steel (mass density of 8.0 g/cc, 6.49 electron density, 13415 HU) shielding material. Three distinct SCVC+S dome designs were explored: A) dome composed of entirely stainless steel except an air channel of d=5 mm along the central axis; B) dome containing one disk “washer” (OD=27 mm, inner diameter (ID)=20 mm, h=1 mm); C) dome containing one disk “washer” (OD=13 mm, ID=3 mm, h=2.5 mm) stacked on a short cylinder (d=13 mm, h=2.5 mm). The SCVC/SCVC+S geometries were independently modeled, with the GammaMed Plus 232 HDR &lt;sup&gt;192&lt;/sup&gt;Ir (dosimetrically identical to Bravos 232A HDR192) radioactive source model for 1) AcurosBV v1.8.0.867816 (Varian Medical Systems, Palo Alto, CA) MBDCA, with dose reported to medium for a 1 × 1 × 1 mm&lt;sup&gt;3&lt;/sup&gt; grid; and 2) Geant4 MC with TOPAS v3.8 toolkit, with tracklength estimator (TLE) dose for 1 × 1 × 1 mm&lt;sup&gt;3&lt;/sup&gt; grid, with n=1 × 10&lt;sup&gt;8&lt;/sup&gt; histories.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After modeling the 4 (one SCVC and three SCVC+S) applicator designs in EclipseBV and TOPAS, the dose grids were obtained. PORTEC A3 (3.5 mm lateral, 5 mm superior) reference point and lateral dose profiles up to lateral radius (r) of 15 mm were extracted from a plane 5 mm superior to the SCVC tip (normalized to 100% dose at the central axis). The traditional SCVC has region of lowest dose at central axis, with large shoulders, 109% dose at A3, 116% dose at r=10 mm. Design A of SCVC+S has its highest relative dose at central axis, with no shoulders, 92% dose at A3, 61% dose at r=10 mm. Design B of SCVC+S has a wide flat region with shoulders, 100% dose at A3, 104% dose at r=10 ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142525875","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":"MSOR5 Presentation Time: 5:20 PM","authors":"Christopher P. Cifarelli MD, PhD, MMM ,&nbsp;Kevin Petrecca MD ,&nbsp;Henning Kahl MD ,&nbsp;Oliver Ganslandt MD, PhD ,&nbsp;Tamer Abdelrhman MD, PhD ,&nbsp;Stephanie Combs MD ,&nbsp;Gustavo Sarria MD ,&nbsp;Frank A. Giordano MD","doi":"10.1016/j.brachy.2024.08.039","DOIUrl":"10.1016/j.brachy.2024.08.039","url":null,"abstract":"<div><h3>Purpose</h3><div>While the use of 5-ALA has been used to increase the extent of surgical resection in glioblastoma (GBM), its potential to act as a radiosensitizer has not been widely studied in the CNS. Whereas typical external beam radiotherapy (EBRT) treatments occur weeks after surgery and 5-ALA administration, intraoperative radiotherapy (IORT) delivers radiation while protoporphyrin IX is still present in residual tumor. This current study examines the potential for radiation necrosis (RN) development following IORT and subsequent fractionated radiotherapy.</div></div><div><h3>Methods</h3><div>Interim data from the INTRAGO II study for newly diagnosed GBM (NCT02685605) were analyzed for the incidence of radiation necrosis (RN) based on 5-ALA use, IORT treatment vs SOC control (60Gy EBRT), and extent of resection. Statistical analysis was performed via univariate (ANOVA), multivariate (Cox regression), and K-M estimations with significance of p&lt;0.05.</div></div><div><h3>Results</h3><div>234 patients were enrolled in INTRAGO II between 2016 and 2022. Of these, 185 (79%) had a surgical resection performed with the use of 5-ALA tumor fluorescence visualization. Following surgical resection with 5-ALA, 94 (51%) received IORT (30Gy to the margin) and an additional 60Gy EBRT (ARM A). Imaging confirmed RN occurred in 11 (12%) of ARM A patients who had 5-ALA assisted resection, compared to 3 (3.3%) of ARM B patients who received only 60Gy EBRT. In the 49 patients not receiving 5-ALA, the imaging confirmed the RN rate in ARM A patients was 21% (5/24) compared to 12% in ARM B (3/25). The median time to development of RN was 236 days post-IORT and 158 days post completion of EBRT. ANOVA demonstrated a significantly (p=0.025) higher rate of RN in ARM A patients overall, but not with the addition of 5-ALA. Cox regression analysis confirmed that only significant predictor of RN on multivariate analysis was IORT plus EBRT (p=0.033) and KM estimations-Log Rank test of RN incidence were greater in Arm A/IORT patients than SOC/Arm B (p=0.029).</div></div><div><h3>Conclusions</h3><div>While patients receiving IORT at the time of surgical resection had a higher rate of RN after SOC 60Gy EBRT, the use of 5-ALA in conjunction with surgical resection did not increase RN incidence. Further analysis will need to consider local PFS rates and the impact of 5-ALA use with IORT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526610","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}