Brachytherapy最新文献

{"title":"BP03 Presentation Time: 4:18 PM","authors":"Sylwia Kellas-Sleczka PhD ,&nbsp;Stankiewicz Magdalena PhD ,&nbsp;Wojcieszek Piotr PhD ,&nbsp;Szlag Marta PhD ,&nbsp;Lelek Piotr MD ,&nbsp;Sleczka Maciej PhD ,&nbsp;Cholewka Agnieszka MS","doi":"10.1016/j.brachy.2024.08.027","DOIUrl":"10.1016/j.brachy.2024.08.027","url":null,"abstract":"<div><h3>Purpose</h3><div>The study aims to present the long-term results of 508 cases of early breast cancer treated with accelerated partial breast irradiation (APBI) using interstitial multicatheter high-dose-rate brachytherapy (HDR-BT) following breast-conserving surgery (BCS) in a single institution.</div></div><div><h3>Materials and Methods</h3><div>Between July 2006 and December 2020, a total of 514 cases of low-risk invasive and in situ carcinoma after BCS were treated with APBI using interstitial multicatheter HDR brachytherapy (MIB) at our department and 508 who met the inclusion criteria were analyzed. The inclusion criteria were: ZUBROD 0 or 1, age ≥50 years, pT1-2aN0 cM0, tumor size ≤3 cm, unifocal, invasive carcinoma without neuroinvasion or angioinvasion, with a minimal surgical margin of 2 mm or DCIS with a minimal margin of 5 mm, without extensive intraductal components, positive estrogen receptors. A total dose of 32 Gy in 8 fractions was delivered twice daily with a minimum 6-hour interval. The recommended dose constraints from the Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC ESTRO) were followed. The primary endpoint was local recurrence.</div></div><div><h3>Results</h3><div>The median age was 65 years (range 46-86 years). The median follow-up was 101 months (range 5-209 months). No serious complications occurred during the procedure and all patients completed the treatment without interruptions. The treatment was well tolerated. In the first 40 cases the 2D treatment planning was used, while in the subsequent cases - 3D treatment planning. The recommended dose-volume limits for the implant, planning target volume (PTV) and organs at risk (OARs) were met. The mean volume of the PTV was 74 cc, with the average coverage with the prescribed dose (PTV ref) of 94%. The mean conformity index (COIN) was 0.69, while the mean dose homogeneity index (DHI) was 0.67. There were no grade ≥ 3 complications. In the whole group, a total of 10 local recurrences (1.96%) were observed. In 3 cases distant metastases (0.6%) and ipsilateral breast tumor recurrence in 8 cases (1.57%) were observed. The 5- and 10-year overall survival (OS) was 97.5% and 96.6%, respectively. The 5- and 10-year disease-free survival (DFS) was 95.6% and 91.3%, respectively.</div></div><div><h3>Conclusions</h3><div>APBI with interstitial multicatheterhigh-dose-rate brachytherapy is a safe and effective treatment, associated with a good toxicity profile and low relapse rates. We believe that patient selection criteria should be revised and possibly expanded. However, further studies are required to validate this approach.</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":"142527271","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":"BP05 Presentation Time: 4:36 PM","authors":"Dylan Richeson MS,&nbsp;Robert Hawranko MS,&nbsp;Dorin Todor PhD","doi":"10.1016/j.brachy.2024.08.029","DOIUrl":"10.1016/j.brachy.2024.08.029","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;High dose-rate brachytherapy can be plagued by a multitude of user errors that could result in late toxicities for patients. A common one reported to NRC is wrong treatment length. This error will result in a shifted dose distribution between planned and delivered dose. To automate and verify delivery with correct treatment lengths, Varian released its Bravos remote afterloader which uses the device's dummy wire for accurate pre-treatment applicator measurements. Bravos measurements are compared with the planned lengths and if differences are small, treatment length is adjusted automatically. In this process, dwell positions are kept unchanged relative to the tip of the applicator. In breast interstitial implants, from our clinical experience, we noticed, through these automated measurements a significant catheter lengthening that occurs between the first and second fractions. The first fraction is typically delivered within 2h from implantation and the second fraction is more than 12h later. The catheters length does not seem to change much after that. We seek to quantify the dosimetric impact of such automated adjustments, identify cases and treatment parameters particularly sensitive to these effects and describe the best planning and delivery mitigation strategies to ensure accurate dose delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;A retrospective cohort of 14 successively treated breast cancer patients using multi-catheter implants were selected for analysis. Actual length measurements were used to create plans simulating the dosimetric impact of making or not making these adjustments. Daily QA for two years shows positional accuracy of 0.3±0.3mm and for the dummy and source wires. In these simulations, it was hypothesized that the target did not change in volume or position relative to breast. In planning these treatments, two targets are used, expansions of the lumpectomy cavity, a CTV1cm and CTV1.5cm for which we try to achieve V95&gt;95% and V90&gt;90% respectively. The max skin dose is limited to &lt;100% Prescription dose regimens included 7.5Gyx3fx=22.5Gy(8/14 patients) and 4.3Gyx7fx=30.1Gy(6/14 patients). Dose inhomogeneity was evaluated using V150% and V200% for breast tissue. The skin contour encompassed an area 5mm from the surface of the breast and the maximum dose was evaluated using D0. 1cc.The change in catheter lengths, as measured by Bravos, were recorded for each fraction of a patient's treatment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The following results show single fraction changes between the original clinically delivered plan and the re-plan which does not consider catheter lengthening by the amount measured by Bravos prior to the second fraction) averaged over all 14 cases. The average reductions in the V95% of the cavity 1.0 and V90% of the cavity 1.5 structures were -0.49±0.99% and -2.93±2.85%, respectively. Negligible changes in normal tissue dose were observed with an avera","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":"142527273","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":"Osama Mohamad MD PhD ,&nbsp;Adriana Cavazos BS ,&nbsp;Chad Tang MD ,&nbsp;Henry Mok MD ,&nbsp;Comron Hassanzadeh MD ,&nbsp;Seungtaek Choi MD ,&nbsp;Karen Hoffman MD ,&nbsp;Lauren Mayo MD ,&nbsp;Quynh-Nhu Nguyen MD ,&nbsp;Sean McGuire MD ,&nbsp;Shalin Shah MD ,&nbsp;Brian Chapin MD ,&nbsp;John Davis MD ,&nbsp;Paul Corn MD ,&nbsp;Rajat Kudchadker Phd ,&nbsp;Surendra Prajapati PhD ,&nbsp;Teresa Bruno BS ,&nbsp;Yusung Kim PhD ,&nbsp;Steven Frank MD","doi":"10.1016/j.brachy.2024.08.013","DOIUrl":"10.1016/j.brachy.2024.08.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy boost has been shown to improve biochemical control when added to external beam radiotherapy (EBRT) in patients with unfavorable intermediate- and high-risk prostate cancer. We report the safety and early efficacy of using proton therapy (PT) and low-dose-rate (LDR) brachytherapy boost at the University of Texas MD Anderson Cancer Center.</div></div><div><h3>Methods and Materials</h3><div>A retrospective study was conducted, including all patients with intermediate- or high-risk prostate cancer treated with a combination of PT and LDR boost with or without androgen deprivation therapy (ADT), from 2010 until 2023. Patient, initial disease, and treatment characteristics and toxicity and efficacy outcomes were collected. Biochemical failure (BF) was defined per the Phoenix definition (nadir PSA + 2).</div></div><div><h3>Results</h3><div>One hundred patients received PT and LDR boost, with median age at diagnosis of 68 (IQR 61-72). Most patients (n=78) were Caucasian, 12 were Black, 5 Asian, 3 Hispanic. Thirty-five patients had NCCN intermediate-risk (4 favorable and 31 unfavorable), 55 had high- and 10 had very high-risk disease. The median PT and LDR doses were 44 CGE (range 40-50.4) and 90 Gy (range 90-110). Pd-103 was used in 96 patients, I-125 in 4 patients, and 91 patients had MRI-assisted radiosurgery (MARS) brachytherapy. ADT was used in 92 patients. Rectal spacer was used in 22 patients. After a median follow-up of 43 months, two patients developed BF for a 5-year biochemical recurrence-free survival of 95%. Of the 2 patients with BF, one patient had a PSA 3.2 at 23 months and unknown disease site recurrence and the second developed lymph node metastasis when PSA was 5.1 at 60 months and is receiving intermittent ADT. No patients developed local recurrence or distant metastasis, and none died of prostate cancer. One patient died of other causes with PSA &lt;0.1 at time of death. One patient has increasing PSA but has not met BF criteria. Median PSA nadir was 0.01 (range 0.0-0.4). All patients (n=30) with at least 4 years of PSA follow-up achieved a nadir PSA of 0.2 or less. Four patients had acute urinary retention. Late grade 2 GU or GI toxicity was found in 11 patients (11%) and 3 patients (3%), respectively. Only one patient had a grade 3 toxicity (urethral stricture requiring dilatation and TURP).</div></div><div><h3>Conclusions</h3><div>Acknowledging the intermediate follow-up duration, PT and LDR boost with and without ADT can achieve high control rates and low toxicity for prostate cancer patients with unfavorable intermediate and high-risk prostate cancer. MARS has enabled the use of MRI at each step of the quality assurance process.</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":"142527061","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 MPP01 Presentation Time: 4:00 PM","authors":"Mahbubur Rahman PhD ,&nbsp;Yash Soni MD ,&nbsp;Mary Gronberg PhD ,&nbsp;Ambrosia Simmons MD, PhD ,&nbsp;Shaghayegh Rezaie M.S.N., APRN, FNP-C, OCN ,&nbsp;Joseph Kwon MD ,&nbsp;Brett Tortelli MD ,&nbsp;Shameca Ragan BS, MBA ,&nbsp;Jennifer Cleaton BS, MBA ,&nbsp;Shahed Badiyan MD ,&nbsp;Audra Schwalk MD ,&nbsp;Muhanned Abu-Hijleh MD ,&nbsp;Hsienchang Chiu MD ,&nbsp;Kim Styrvoky MD ,&nbsp;Brian Hrycushko PhD ,&nbsp;Aurelie Garant MD","doi":"10.1016/j.brachy.2024.08.015","DOIUrl":"10.1016/j.brachy.2024.08.015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;There have been recent disruptions in supply chains related to centering baskets intended for use with high dose rate (HDR) endobronchial brachytherapy. The standard plastic catheter (1.6mm diameter) without a centering basket gives too high of a surface dose to the bronchial mucosa to safely prescribe at distances of 5-10mm. We present on the commissioning and first reported clinical use of intraluminal endobronchial HDR brachytherapy by placing a standard plastic catheter within a robotic bronchoscope working channel, functioning as a fixed spacer of the source from the bronchial mucosa.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;In this first in-human hybrid technique, a 68-year-old patient with an endobronchial tumor obstructing the lower left lobe in the superior segment of the bronchus received a definitive treatment with the HDR source. The patient previously received external beam radiation to the right upper lobe (24Gy in 1 Fractions) and 2 nodules in the left lower lobe (60Gy in 5 Fractions) of the lungs. The system was commissioned by measuring attenuation from the robotic bronchoscope (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to determine scaling required for water-based TG43 dose calculations. Well chamber readings were taken with the Ir-192 HDR source inside the plastic catheter with and without the bronchoscope using a custom 3D printed well chamber insert. In preparation for clinical use, standard treatment plans were created in Eclipse (Varian Medical Systems, Inc., Palo Alto, CA, USA) in cm increments prescribing at 5mm or 10mm from the bronchoscope wall. Following general anesthesia, a therapeutic bronchoscope was inserted to perform tumor ablation and mechanical dilation in the occluded airway. After airway patency was achieved, the shape sensing robotic assisted bronchoscope was passed distal the endobronchial tumor. Tumor length was determined with the robotic bronchoscope, by marking the junction of the robotic catheter at its intersection of the endotracheal tube, both distal and proximal to the tumor. The HDR brachytherapy catheter was then inserted through the robotic catheter and placement was verified with fluoroscopic imaging and a radiopaque wire with fiducials in cm increments. Once alignment was verified, the brachytherapy catheter was secured to the robotic catheter using adhesive. The treatment plan was created with 1 cm proximal and distal margins. Catheter length was confirmed and obstruction check through the catheter was completed prior to delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The attenuation measurements from the bronchoscope were &lt;1% over a length of 1 to 8 cm indicating no need to scale treatment delivery time. The bronchoscope's diameter of 3.8 mm significantly reduced the bronchial mucosal dose (by ∼2 times, ∼70 Gy vs. ∼30 Gy at tissue surface for 7.5 Gy/Fraction) compared to the standard plastic catheter without a centering basket. The patients’ tumor w","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":"142527063","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":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":"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":"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":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":"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":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":"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":"PHSOR07 Presentation Time: 9:30 AM","authors":"Inger-Karine Kolkman-Deurloo PhD,&nbsp;Linda Rossi PhD,&nbsp;Andras Zolnay PhD,&nbsp;Miranda Christianen PhD MD,&nbsp;Henrike Westerveld PhD MD,&nbsp;Lorne Luthart Mr,&nbsp;Michele Huge Mrs,&nbsp;Anna Sheremet Mrs,&nbsp;Sebastiaan Breedveld PhD,&nbsp;Wilco Schillemans MSc,&nbsp;Remi Nout PhD MD,&nbsp;Ben Heijmen PhD","doi":"10.1016/j.brachy.2024.08.081","DOIUrl":"10.1016/j.brachy.2024.08.081","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Radiotherapy for locally advanced cervical cancer (LACC) according to Embrace-II consists of EBRT and image guided adaptive intracavitary/interstitial BT. BT for LACC is known to be a complex and time consuming procedure. To speed up the process, we developed BiCycle for fast and automated treatment planning. In retrospective and prospective validations, BiCycle resulted in more consistent and often superior treatment plan quality and significant decrease in planning time [Radiother Oncol 148(143), 2020; 170(S390), 2022; 182(S92), 2023]. The European Medical Device Regulation (MDR) has been applicable since May 26, 2021. Its main aim is to ensure safety and effectiveness of medical devices. The purpose here is to describe key elements of the conversion of BiCycle as a research tool into an MDR-compliant medical device.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;BiCycle was implemented as an add-on to our current clinical commercial TPS. Implant reconstruction and target- and OAR delineation are performed in the commercial system and then exported to BiCycle, which optimizes the dwell times, that are subsequently imported in the commercial TPS to calculate the final dose distribution. After regular QA by the multidisciplinary team, the plan is sent to the afterloader and used for treatment. MDR article 5(5) enables health institutions to use in-house developed medical devices, provided that, among others, the following conditions are met. The health institution: 1) Justifies in its documentation that the target patient group's specific needs cannot be met by an equivalent device available on the market; 2) Draws up documentation that makes it possible to have an understanding of the manufacturing facility and -process, design and performance data of the device, including the intended purpose, and that is sufficiently detailed to enable the competent authority to ascertain that the general safety and performance requirements are met; 3) Implements and maintains an appropriate Quality Management System (QMS) to control manufacturing and use of the device; 4) Reviews experience gained from clinical use of the device and takes all necessary corrective actions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Clinical implementation and documentation of BiCycle according to MDR lasted ∼12 months. 1) Consultation of the market revealed that none of the commercially available TPS fulfilled all performance requirements (i.e. fully automated and non-inferior). 2) Software development was supported by the Redmine issue tracking system (&lt;span&gt;&lt;span&gt;https://www.redmine.org/&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;). Issue types were organized in a hierarchical way so that development activities were linked to requirements. Requirements were represented by parent issues, and corresponding programming, configuration, regression and acceptance testing issues were added as child issues. Changes to the source code were tracked by the software ve","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":"142527204","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":"PHSOR05 Presentation Time: 9:20 AM","authors":"Hayeon Kim PhD ,&nbsp;Hania Al-Hallaq PhD ,&nbsp;Juergen Meyer PhD ,&nbsp;Angelia Landers PhD ,&nbsp;Jessica Lowenstein MS ,&nbsp;Jacqueline E. Zoberi PhD","doi":"10.1016/j.brachy.2024.08.079","DOIUrl":"10.1016/j.brachy.2024.08.079","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To assess practice patterns and physics staffing levels for a range of HDR brachytherapy (BT) procedures across different clinical settings within the US.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;A survey was designed to assess practice patterns of the US physics brachytherapy workforce. The survey was distributed in October 2023 by IROC-Houston (U24CA180803) using RedCap in the form of an email with background, instructions, and a non-personalized link to the survey. The survey covered: i) demographics, employment, experience level, and equipment, ii) practice patterns, and case load, iii) time and intensity as a function of procedure complexity and challenges/satisfaction associated with HDR BT. We present survey responses from section (ii) and results from a sub-analysis performed to assess physics FTE allocation. Chi-squared tests were used for group comparisons with significance assessed at the &lt;em&gt;p&lt;/em&gt;&lt;0.05 level.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 429 respondents, 365 respondents performed HDR BT and were included for analysis. The percentage of respondents reporting particular HDR BT practice patterns is noted in () below in 1)- 4) and a sub-analysis for assessing physics full time equivalent (FTE) allocation is in 5). 1) Gynecologic (GYN) treatments using single channel (96%), 2-3 channels (78%), 4-12 channels (44%), and GYN ≥13 channels (33%), in addition to skin (33%), prostate (32%), breast (22%), and sarcoma (10%). 2) MRI-based treatment planning performed frequently (14%), sometimes (19%), or never (67%). 3) Interstitial BT performed frequently (33%), sometimes (23%), or never (44%). 4) The average number of physicist FTE allocated to HDR BT &lt;1.0 (53%), 1.0-1.9 (23%), ≥ 2.0 (10%). 5) The percentage of FTE ≥1.0 assigned to different practice settings is shown below in a)-d) and compared, indicating statistically significant differences (&lt;em&gt;p&lt;/em&gt;&lt;0.05) for: a) Planning with MRI vs. without MRI: 52% vs. 32%. b) Interstitial vs. no interstitial: 50% vs. 26%. c) Annual volume grouped by applicator type (&lt;25 patients vs. ≥25 patients): GYN single; 27% vs. 52%. GYN 2-3 channels; 34% vs. 64%. GYN 4-12 channels; 48% vs. 74%. GYN 13+ channels; 55% vs. 88%. Prostate interstitial; 44% vs. 69%. d) Hospital setting (non-academic vs. academic); 31.2% vs. 56%. If MRI based planning or interstitial BT is performed, the likelihood of physics FTE ≥1.0 was higher than their counterpart groups. Regardless of complexity, respondents reported a higher physics FTE when treating a higher volume of patients per year (≥ 25 patients). Also, academic hospitals were associated with ≥1.0 physics FTE. Of note, the current overall MRI utilization rate for HDR BT (33%) did not change compared to the ABS practice patterns survey for MRI- based HDR BT for GYN cancer in 2014.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;To our knowledge, this is the first survey of US medical physicists for HDR BT practice patterns an","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":"142527206","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":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":"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}