Brachytherapy最新文献

{"title":"GSOR05 Presentation Time: 5:20 PM","authors":"Jim Leng MD , Franco Afyusisye BS , Mwitasrobert Gisiri MD , Pradumna Chaurasia MSc , Godwin Mtali BS , Nestory Masalu MD , Nelson Chao MD, MBA , Junzo Chino MD , Kristin Schroeder MD, MPH , Beda Likonda MD","doi":"10.1016/j.brachy.2024.08.051","DOIUrl":"10.1016/j.brachy.2024.08.051","url":null,"abstract":"<div><h3>Purpose</h3><div>Bugando Medical Centre (BMC) is the only radiotherapy facility in northern Tanzania, and one of only two public facilities for radiotherapy in a country of 60 million. We aimed to characterize gynecologic brachytherapy at BMC and determine patient outcomes. This is the first clinical report from the department since it became operational in 2017.</div></div><div><h3>Materials and Methods</h3><div>This was a retrospective cohort study from 2019, including all patients treated with gynecologic brachytherapy at BMC. Treatment factors, patient characteristics, travel distance/time, and follow-up duration were the primary outcomes. Lack of survival data in available records precluded OS calculations.</div></div><div><h3>Results</h3><div>In 2019, BMC performed 662 brachytherapy procedures, including 204 new starts. HDR brachytherapy was performed with 2D techniques using one Cobalt-60 afterloader. Of the 204 new starts, 195 were evaluable. The median age was 51 years (IQR 44-61 yrs). Stage at diagnosis was 1B in 36 (19%), 2A in 46 (24%), 2B in 49 (25%), 3A in 9 (5%), and 3B in 50 (26%). Histology was squamous cell carcinoma in 139 (71%), adenocarcinoma in 12 (6%), and unknown/other in 44 (23%). HIV status was unknown in 148 (76%), and positive in 22 (11%). 67 patients (34%) were anemic with a hemoglobin of <10 at baseline. Patients came from 36 distinct districts in 11 regions. Median distance traveled was 144 kms (IQR 65-225 kms), and median travel time was 3 hours (IQR 1.8-4.3 hrs). There was no significant difference in disease stage by travel distance or time (p=0.7 & p=0.4). Most patients (86%) were uninsured, and 13% were covered by the national health insurance plan. All patients were treated with curative intent, 177 (91%) were treated with concurrent chemotherapy with EBRT prior to brachytherapy, and 181 (93%) completed planned brachytherapy. Majority of the cases were 3 fractions at 8 Gy/fx prescribed to point A (160 [82%]). Thirteen patients (7%) did not complete planned brachytherapy. Median total duration of treatment was 72 days (IQR 60-109 d). Median duration of EBRT and from EBRT to brachytherapy was 34 days (IQR 34-35 d) and 25 days (IQR 10-78 d) respectively. Median duration of brachytherapy was 14 days (IQR 14-18 d), and 13 (7%) had significant delays of over 40 days to complete brachytherapy. 24 of 167 patients (14%) with data available completed radiation treatment within 55 days. In post-treatment surveillance, 153 (78%) had survival follow up for review in the records. At a median follow up of 15.7 months (IQR 5.7-39.4 mos) for these patients, 2 death events were documented. Assuming a 2-year OS of 65% with 2D brachytherapy based on historical studies, we would have expected approximately 45 events during this timeframe.</div></div><div><h3>Conclusions</h3><div>In this initial report, we detailed the clinical and treatment characteristics of brachytherapy patients at BMC - the only facility in a c","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":"142527135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PPP03 Presentation Time: 10:48 AM","authors":"Vitaly A. Biryukov MD, PhD ,&nbsp;Kseniia S. Makarova MD ,&nbsp;Alexey V. Troyanov MD ,&nbsp;Yulia V. Gumenetskaya MD, PhD ,&nbsp;Tatyana A. Rodina MD ,&nbsp;Elizaveta O. Shchukina MD ,&nbsp;Oleg B. Karyakin (Prof) ,&nbsp;Sergey A. Ivanov (Prof) ,&nbsp;Andrey D. Kaprin (Prof)","doi":"10.1016/j.brachy.2024.08.011","DOIUrl":"10.1016/j.brachy.2024.08.011","url":null,"abstract":"<div><div>Very-high risk [VHR] prostate cancer [PC] is an aggressive subgroup with high risk of distant disease progression. According to a number of studies systemic treatment intensification with docetaxel reduces PC-specific mortality in men receiving external beam radiation therapy [EBRT] with androgen deprivation therapy [ADT]. Whether the addition of chemotherapy to combined modality of radiotherapy (EBRT + brachytherapy [BT] boost) with ADT improves outcomes in this group is unclear.</div></div><div><h3>Purpose</h3><div>A comparative analysis of the efficacy of EBRT, BT boost and ADT with or without neoadjuvant docetaxel chemotherapy in VHR PC patients.</div></div><div><h3>Materials and Methods</h3><div>A total of 86 men diagnosed between 2016 and 2020 with VHR prostate cancer were stratified into 2 groups: EBRT plus BT boost and ADT (n = 66) or EBRT plus BT boost, ADT and neoadjuvant docetaxel chemotherapy (n = 20). Conformal EBRT was delivered with conventional fractionation to a total dose of 44-46 Gy to the prostate gland and seminal vesicles and the Ir-192 high-dose rate BT was delivered with one single fraction of 15 Gy. Neoadjuvant docetaxel was administered at 75 mg/m2 every 3 weeks for 4 cycles. A median duration of ADT, consisting of a gonadotropin-releasing hormone agonist, was 24 months. Median age was 66 years (range: 46-81 years). Median follow-up was 65 months (range: 21,5 - 108,7 months). The characteristics of the patient groups are presented in table 1.</div></div><div><h3>Results</h3><div>Six-years progression free survival [PFS] was 80,1% for the group with chemotherapy vs. 77,2% for no-chemotherapy group (p = 0,499). The presence of Gleason score 9-10 was associated with a statistically significant increase in the risk of PC recurrence (p = 0.013). Six-years overall survival [OS] was 100% and 82,8% for groups with and without chemotherapy respectively (p = 0,075). Six-years PC-specific survival [PCSS] was 100% and 93,4% for groups with and without chemotherapy respectively (p = 0,306).</div></div><div><h3>Conclusion</h3><div>There was no statistically-significant difference in PFS, OS and PCSS in VHR prostate cancer patients received EBRT+BT+ADT with or without chemotherapy.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":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":"142526547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MSOR11 Presentation Time: 5:50 PM","authors":"Anamaria Guta MS,&nbsp;Molly Cromer MS,&nbsp;Michael Altman PhD,&nbsp;Phillip Wall PhD,&nbsp;Jose Garcia MS,&nbsp;Jacqueline Zaboeri PhD,&nbsp;Justin Mikell PhD","doi":"10.1016/j.brachy.2024.08.045","DOIUrl":"10.1016/j.brachy.2024.08.045","url":null,"abstract":"<div><h3>Purpose</h3><div>Lu177 PSMA and Lu177 DOTATATE are radiopharmaceutical therapies delivered in outpatient settings with fixed activity treatments. A proposed regulatory rule change (NRC-2023-0086) lowers patient release criteria from approximately 8.6 mR/h to 2.2 mR/h for Lu177. Decreasing tumor to kidney absorbed dose with subsequent cycles has been observed for both therapies; consequently the first cycle may be the optimal time to escalate activity. We aim to identify potential compliance issues for standard fixed activity treatments and in the context of dose escalation.</div></div><div><h3>Methods &amp; Materials</h3><div>We conducted an IRB-approved retrospective chart review of all Lu177 PSMA and DOTATATE treatments in our department for the calendar year 2023. Release exposure rate measurements were obtained within approximately 10 minutes following completion of Lu177 DOTATATE infusion or Lu177 PSMA syringe injection. The exposure rate measurements were evaluated for compliance with the proposed NRC rule change. To estimate the amount of dose escalation possible in a cycle while satisfying release regulations, we scaled the current prescribed activity by the ratio of the release criteria to the patient's current exposure rate measurement.</div></div><div><h3>Results</h3><div>A total of 211 (62 patients) Lu177 PSMA injections were administered. The nominal prescribed activity was &lt; 7.4 GBq in 30/211 treatments. Lu177 DOTATATE was infused 96 times (36 patients), and the nominal prescribed activity was 7.4 GBq for all treatments. For Lu177 PSMA, post-injection patient exposure rates were 1.78 ± 0.31 mR/h (0.26 to 3.2) (average ± stdev (min to max)), with 9 out of 211 measurements not meeting proposed release rule changes. For Lu177 DOTATATE, post-infusion patient exposure rates were 2.07 ± 0.28 mR/h (1.38 to 3.0) and 23/96 did not satisfy the proposed rule change. For DOTATATE the average activity escalation possible is 8% ± 15% (-27% to 60%) and 323% ± 60% (187% to 523%) for the proposed rule and current rule, respectively. For PSMA patients prescribed 7.4 GBq, the average activity escalation possible is 23% ± 19% (-31% to 86%) and 379% ± 73% (169% to 629%) for the proposed rule and current rule, respectively.</div></div><div><h3>Conclusion</h3><div>Both Lu177 DOTATATE and Lu177 PSMA are currently impacted by the proposed patient release rule change when administering a nominal prescribed activity of 7.4 GBq. The proposed rule change will further limit activity escalation in a single cycle without modifications to clinical workflows. Additional holding of patients and encouraging bladder voiding may be necessary to satisfy the proposed rule change for all cases.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":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":"142526616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GSOR11 Presentation Time: 5:50 PM","authors":"Alexander Lukez MD ,&nbsp;Brian Egleston MPP, PhD ,&nbsp;Jeremy Price MD, PhD","doi":"10.1016/j.brachy.2024.08.057","DOIUrl":"10.1016/j.brachy.2024.08.057","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;We sought to utilize the National Cancer Database (NCDB) to evaluate trends in radiation therapy (RT) boost modality and to assess outcomes between varying radiation modalities among medically inoperable endometrial cancer patients with locoregionally confined disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;Patients with inoperable International Federation of Gynecology and Obstetrics (FIGO) stage I - IIIC2 endometrial cancer treated with radiation ± chemotherapy were analyzed. Practice patterns compared external beam radiation therapy (EBRT) versus high dose-rate (HDR) brachytherapy (BT) boost over time [2004 - 2019]. Kaplan-Meier method evaluated overall survival (OS) and Cox proportional hazard modeling assessed variables associated with OS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;NCDB included 1,209 cases (EBRT: 780, BT: 429). EBRT boost patients were more often older (median age [y] EBRT: 70, BT: 68; p = 0.002), treated at a community or comprehensive community cancer program (p = 0.034), insured by the government (p = 0.018), and clinically node positive (p = 0.034). Phase I RT dose did not differ (median [cGy] EBRT: 4,500, BT: 4,500; p = 0.273), although phase II RT dose was lower among EBRT patients (median [cGy] EBRT: 1,440, BT: 2,080; p &lt; 0.001). From 2004 to 2019, EBRT and BT boost rates differed (p = 0.001) with increasing rates of BT consolidation over time (cases in 2014 EBRT: 64 [76%], BT: 20 [24%]; cases in 2019 EBRT: 44 [46%], BT: 51 [54%]). Receipt of chemotherapy (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.05 - 2.56; p = 0.028) was predictive of greater BT utilization while urban or metropolitan areas (rural vs urban OR 0.26, CI 0.092 - 0.74; p = 0.012; rural vs metropolitan OR 0.35, CI 0.14 - 0.92; p = 0.034) and nodal involvement (N0 vs N1 OR 0.47, CI 0.23 - 0.96; p = 0.039; N0 vs N2 OR 0.17, CI 0.035 - 0.84; p = 0.030) were associated with lower utilization of BT. Multivariable analysis (MVA) found BT was associated with lower mortality compared to EBRT (hazard ratio [HR] 0.80, CI 0.68 - 0.95; p = 0.011). MVA found these factors associated with inferior survival: increasing age (HR 1.03, CI 1.02 - 1.04; p &lt; 0.001), greater T stage (T1 vs T2 HR 1.94, CI 1.13 - 3.33; p = 0.016; T1 vs T3 HR 1.66, CI 1.02 - 2.70; p = 0.040), greater N stage (N0 vs N1 HR 1.73, CI 1.20 - 2.49; p = 0.004), and moderately, poorly, or un-differentiated tumor grade (well differentiated [WD] vs moderately differentiated HR 1.28, CI 1.02 - 1.61; p = 0.034; WD vs poorly differentiated HR 1.75, CI 1.37 - 2.25; p &lt; 0.001; WD vs undifferentiated HR 2.17, CI 1.32 - 3.57; p = 0.002).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The utilization of a brachytherapy boost for medically inoperable endometrial cancer has increased over time. Brachytherapy consolidation remains an effective RT modality for medically inoperable endometrial cancer, associated with lower mortality compared to EBRT consolidation.&lt;/div&gt;&lt;/","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":"142527071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GPP05 Presentation Time: 9:36 AM","authors":"Areion Allmond BS,&nbsp;Onyinye Balogun MD, MSc,&nbsp;Eve McDavid BJ","doi":"10.1016/j.brachy.2024.08.007","DOIUrl":"10.1016/j.brachy.2024.08.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Gynecologic Brachytherapy is the standard of care for cervical cancer diagnoses and is critical to patient survival. Patients who have accessed brachytherapy have a significantly higher 5-year survival rate compared to patients who do not. However, brachytherapy treatment induces significant degrees of patient discomfort, anxiety, and physical and psychological distress. Limited patient experience research conducted, demonstrates the toll that current brachytherapy practices have on cervical cancer survivors’ ability to survive treatment and then face physical, mental, and sexual health side effects. This is documented in medical literature but has yet to influence brachytherapy procedure protocols in practice today. Knowledge and communication gaps coupled with inconsistent procedure preparation and administration leave patients underprepared for current treatment protocols and suffering in pain with long-term side effects. Improving patient treatment compliance and quality of life outcomes entails standardizing and implementing pain control, offering thorough patient education, and innovative technological advances. Thus, this study aims to 1) raise awareness for critical unmet needs in gynecologic brachytherapy; 2) assess the survivorship impact of current treatment practices; and 3) identify medical information, communication and tools necessary to improve quality of life outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;Eighteen cervical cancer survivors who received brachytherapy treatment were interviewed on video in-person and in virtual video conferencing meetings. The semi-structured interview was conducted to document the patient experience and identify opportunities to address challenges both patients and providers face in care. Study group participants were recruited by connections with US and international patient advocacy and survivorship networks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Thematic review revealed a significant need for five critical unmet needs: 1) treatment safety and comfort challenges associated with current procedure medical device equipment, “I would love if the process was updated to something that was less like a torture device”; 2) establishing procedure pain management standard of care, “I wasn't under general aesthetic and they just put them in, which was super traumatic”; 3) all provider staff and patients educated to discuss the common physical, mental and sexual treatment side effects, “information wasn't necessarily communicated, so no, I was not informed on what that would entail for me”; 4) addressing mental and sexual health side effects and referring patients to supporting medical professionals, “every single woman that goes through cervical cancer treatment should be given as part of their aftercare, a sexual health therapist as well as just a therapist; and 5) provider training on gender and sensitivity competency to humanize care, “there are people behind these ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":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":"142526543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MSOR08 Presentation Time: 8:35 AM","authors":"Emily MacDuffie MD ,&nbsp;Joy Ogunmuyiwa MD ,&nbsp;Michael LeCompte MD ,&nbsp;Kelsey Corrigan MD ,&nbsp;Abhishek Kumar MD ,&nbsp;Mustafa Basree DO ,&nbsp;Amishi Bajaj MD ,&nbsp;Andrew Farach MD ,&nbsp;Jenna Kahn MD ,&nbsp;Mitchell Kamrava MD ,&nbsp;Idalid Franco MD, MPH","doi":"10.1016/j.brachy.2024.08.070","DOIUrl":"10.1016/j.brachy.2024.08.070","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;The Association of Residents in Radiation Oncology (ARRO) annual survey aims to better understand graduating radiation oncology (RO) residents’ perceptions of their training programs and readiness to enter practice. Residents graduating from US training institutions between 2020-2023 were asked about their confidence in performing brachytherapy (BT) by the completion of their residency program.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;Postgraduate year five RO residents were emailed a 50-56 question survey in May of their graduating year. Questions regarding brachytherapy asked respondents to describe their level of training and degree of comfort to practice high-dose rate (HDR) intracavitary and interstitial gynecological BT as well as HDR and low-dose rate (LDR) prostate brachytherapy after graduation. They were also asked to rate their satisfaction with various aspects of their training program. Responses were analyzed and compared. Differences between groups were analyzed using descriptive statistics and chi-square analyses. Ordinal variables were compared using the Kruskal-Wallis H test.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The average response rate was 87.0% (77.8%-94.2%) and the total number of responses collected was 655. Confidence in delivering HDR interstitial and intracavitary gynecological BT rated as sufficient or adequate was 73.4% and 92.7%, respectively, while no or minimal training was 4.7% and &lt;1%, respectively (Figure 1). Sufficient or adequate confidence in practicing HDR and LDR prostate brachytherapy was 40.9% and 43.5%, respectively, while no or minimal training was 42.1% and 29.9%, respectively. Confidence did not differ across survey years for any type of BT. Increased comfort in delivery of interstitial gynecological BT was associated with respondents’ satisfaction with treatment plan evaluation training (p&lt;0.001), overall program training (p&lt;0.001), clinical didactics (p&lt;0.001), and faculty teaching (p&lt;0.001). Intracavitary gynecological BT confidence was associated with residency size (p&lt;0.001) and satisfaction with treatment plan evaluation training (p=0.001). Confidence in LDR prostate BT delivery was associated with satisfaction in treatment plan evaluation training (p&lt;0.001) and residency size (p=0.001). There were no associations between HDR prostate BT comfort and program features or resident satisfaction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Over three-quarters of RO residents graduating from 2020-2023 reported at least adequate training and comfort in performing gynecological BT. However, fewer than half of residents reported adequate training in prostate BT and a similar proportion reported little or no training at all during their residency, suggesting a potential training gap in prostate BT for US residents. Several factors were associated with increased confidence in these procedures; most notably the level of resident-reported satisfaction in th","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":"142526900","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":"GSOR09 Presentation Time: 5:40 PM","authors":"Ramez Kouzy MD,&nbsp;Michael Rooney MD,&nbsp;Osama Mohamad MD, PhD,&nbsp;Christopher Weil MD,&nbsp;Lilie Lin MD,&nbsp;Anuja Jhingran MD,&nbsp;Patricia Eifel MD,&nbsp;Melissa Joyner MD, MBA,&nbsp;Lauren Colbert MD MSCR,&nbsp;Ann Klopp MD, PhD","doi":"10.1016/j.brachy.2024.08.055","DOIUrl":"10.1016/j.brachy.2024.08.055","url":null,"abstract":"<div><h3>Purpose</h3><div>The utilization of artificial intelligence in analyzing patient discussions on online platforms can uncover valuable experiential data that are often overlooked in structured surveys. Sentiment analysis, a branch of natural language processing (NLP), interprets and classifies emotions within text, offering insights into patient sentiments as positive, negative, or neutral. This study aimed to apply AI techniques to analyze the sentiments of posts on a cervical cancer-related online forum, specifically focusing on discussions related to brachytherapy.</div></div><div><h3>Materials/Methods</h3><div>Utilizing a Reddit Application Programing Interface, we extracted posts and comments from the subreddit r/cervicalcancer, focusing on discussions about brachytherapy between November 2020 and January 2024. We then processed the data in multiple steps including cleaning, lowercasing, removing illegible text, and tokenization. We analyzed the entries using RoBERTa (Robustly Optimized Bidirectional Encoder Representations from Transformers Pretraining Approach), a sophisticated pre-trained deep learning model, to refine and categorize sentiments. The model assessed the probabilities of the posts being positive, negative, or neutral. We further evaluated and categorized posts using pre-defined keyword tagging to uncover dominant topics within the conversations. These topics were modeled based on recently published literature related to the experiences of patients undergoing cervical brachytherapy.</div></div><div><h3>Results</h3><div>The analysis encompassed 879 out of 1,073 unique textual entries. Of these, overall sentiments were categorized as 40.1% positive, 30.1% negative, and 29.8% neutral. A specific focus on 'Bowel Domain’ discussions revealed a predominance of negative sentiments (51.2%)—the highest across all topics. Similarly, 'Urinary Domain' (46.8%), 'Fatigue' (42.4%), 'Anesthesia' (41.4%), and 'Pain' (43.4%) discussions largely reflected negative sentiments. In contrast, 'Physical Therapy' and 'Survivorship' discussions were predominantly positive, with 51.2% and 45.5% of posts, respectively. The sentiments on 'Sex' and 'Mental Health' related topics displayed a more balanced distribution between positive and negative perspectives.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the value of using advanced AI models, such as sentiment analysis, to easily understand online patient discussions. These tools can bridge the gap between clinical insights and patient experiences, enhancing the feedback loop into clinical decisions, consent discussions, and patient education. Further research into the use of such models is necessary to fully leverage the insights they provide.</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":"142527069","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":"Friday, July 12, 20241:30 PM - 2:45 PM PL01 Presentation Time: 1:30 PM","authors":"Jui Chih Cheng BSc, MD ,&nbsp;Juanita Crook MD ,&nbsp;Nikitha Moideen MD ,&nbsp;Greg Arbour MSc ,&nbsp;Felipe Castro Canovas MD ,&nbsp;Deidre Batchelar PhD ,&nbsp;Cynthesia Araujo PhD ,&nbsp;Ross Halperin MD ,&nbsp;Michelle Hilts PhD ,&nbsp;David Kim MD ,&nbsp;David Petrik MD ,&nbsp;Jim Rose MD ,&nbsp;Francois Bachand MD","doi":"10.1016/j.brachy.2024.08.059","DOIUrl":"10.1016/j.brachy.2024.08.059","url":null,"abstract":"<div><h3>Purpose</h3><div>This single-center randomized trial compared health-related QOL for men with unfavorable localized prostate cancer treated with combined pelvic external beam radiation (EBRT) and prostate brachytherapy (BT), randomly selected for either High Dose Rate (HDR) or Low Dose Rate (LDR). We now report the efficacy outcomes.</div></div><div><h3>Materials and Methods</h3><div>Consenting patients receiving pelvic EBRT (46Gy/23) combined with prostate BT were randomized to either LDR (110Gy) or HDR (15Gy) boost. HDRBT preceded EBRT by one week, while LDRBT followed. Androgen deprivation was used in 76%, beginning with three months neoadjuvant and continued for median 12 months. EBRT delivered 46 Gy/23 fractions using IMRT or VMAT in 68% and 3DcRT in 32%. Image guidance was either daily cone beam CT or implanted fiducials. All patients were followed up at 1-, 3-, and 6-mo, every 6 mo to 3 years, then annually. PSA ≤ 0.2 at 4 years defined cure. Biochemical failure-free survival (bFFS), and overall survival (OS) were calculated by Kaplan Meier methods.</div></div><div><h3>Results</h3><div>From 01/2014 to 12/2019, a random number generator assigned 191 men (42% IR/ 58% HR): 108 to HDR and 87 to LDR. Median age was 71. Clinical stage was T1c in 15%, T2a/b in 48%, T2c/T3a in 35% and T3b in 2%. 43% had Gleason 8 or 9. Median PSA was 11.6 ng/ml, mean 27.0 ng/ml, max 145 ng/ml. The median follow up was 73 months (43m - 116m). The median PSA nadir was 0.07 in HDR and 0.08 in LDR (p=0.16). The median time to PSA nadir was 13.8 mo in HDR and 14.1 in LDR (p=0.87). At four years, 81% of HDR and 83% of LDR had a PSA ≤ 0.2 (p=0.91). At five years, bFFS (nadir+2) for HDR and LDR were 94% and 90% respectively, and at 8 years 86% and 85% respectively. The 8-year OS for HDR and LDR was 73% and 70%. One patient in each arm had intraprostatic local failure. All failures were identified by imaging (CT, bone scan and/or PET) ± biopsy. 12 failures were distant, 3 regional and 2 combined regional and distant.</div></div><div><h3>Conclusions</h3><div>Previously reported primary QOL endpoint confirmed faster symptom recovery for HDR patients. In this small, randomized comparison, efficacy analysis shows no difference between LDR and HDR boost in biochemical disease-free survival at 5 and 8 years.</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":"142527073","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: 9:27 AM","authors":"Lauren M. Andring MD ,&nbsp;Ramez Kouzy MDR ,&nbsp;Kelsey L. Corrigan MD, MPH ,&nbsp;Neil Bailard MD ,&nbsp;Maliah Domingo BS ,&nbsp;Bryan Fellman BS ,&nbsp;Jasmine Varkey AGNP ,&nbsp;Tomar Foster-Mills AGNP ,&nbsp;Lilie Lin MD ,&nbsp;Anuja Jhingran MD ,&nbsp;Lauren Colbert MD ,&nbsp;Ann H. Klopp MD, PhD ,&nbsp;Melissa M. Joyner MD, MBA","doi":"10.1016/j.brachy.2024.08.006","DOIUrl":"10.1016/j.brachy.2024.08.006","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;An ERP is a standardized patient-centered protocol that aims to minimize symptom burden and enhance functional recovery after surgery. ERPs are widely adopted by many surgical specialties and have demonstrated improved outcomes; however, there remains no data looking at the role of an ERP for patients undergoing brachytherapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A prospective trial of cervical cancer patients treated at a single institution with definitive chemoradiation (CRT) and brachytherapy boost, before (n=33) and after (n=33) the implementation of an ERP. The ERP included referral to nutrition and social work at initial consult, pre-operative carbohydrate loading, peri-operative prophylactic symptom management, goal-directed fluid delivery, early mobility, and referral to pelvic floor physical therapy at follow-up (FU). Patient reported outcomes (PROs) were assessed using the EORTC QLQ-C30 and EORTC QLQ-CX24 validated survey metrics and were collected before CRT, at the end of treatment (EOT), and 60-day FU. Higher scores for functional scales and global health status represent favorable outcomes, while higher scores for symptom scales are unfavorable. The difference in individual patient score from EOT to FU was calculated for each domain and the median difference for each cohort was analyzed to evaluate post-procedure functional recovery. A difference of 10 points was considered significant. Wilcoxon signed rank test was used to compare median length of hospital stay between cohorts, p&lt;0.05 was significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Thirty-three patients were enrolled on the pre-ERP arm of this study, 28 (85%) completed baseline, 22 (67%) EOT, and 21 (64%) follow-up PRO metrics. An additional 33 patients were enrolled post-ERP, 28 (85%) completed baseline, 25 (76%) EOT, and 22 (67%) follow-up questionnaires. Median health related quality of life (HRQOL) at FU was significantly higher post-ERP (41.7 vs 25, p=0.001), with a median improvement from EOT of 6.7pts compared to a median decline of -8.4pts in the pre-ERP cohort. From EOT to FU both groups had an overall decrease in symptom burden, median decrease of -15.2pts post-ERP vs. -6pts pre-ERP. The post-ERP cohort reported significant improvement in dyspnea (-33pts) and emotional function (8.3pts) at FU, compared to median change of 0 in the pre-ERP cohort &lt;strong&gt;(Figure 1)&lt;/strong&gt;. From the start of radiation to 60 days FU, the total number of emergency room visits without admission was 9 in the pre-ERP cohort compared to 13 in the post-ERP cohort. However, the total number of hospital admissions was significantly higher in the pre-ERP cohort (17 vs 9) and the associated median length of hospital stay was significantly longer (3.9 vs 1.8 days, p =0.028).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;A standardized ERP for cervical cancer patients undergoing definitive CRT and brachytherapy led to improved HRQOL, fewer hospital admissions, decreased","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":"142526614","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":"PHSOR10 Presentation Time: 9:45 AM","authors":"Åsa Carlsson Tedgren (Professor) ,&nbsp;Linda Persson PhD ,&nbsp;Ilias Billas PhD ,&nbsp;Graham Bass PhD ,&nbsp;Thorsten Sander PhD ,&nbsp;Simon Dahlander MSc","doi":"10.1016/j.brachy.2024.08.084","DOIUrl":"10.1016/j.brachy.2024.08.084","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Objective&lt;/h3&gt;&lt;div&gt;In radiotherapy, independent verification of the treatment fields is standard practice. However, for &lt;sup&gt;106&lt;/sup&gt;Ru eye plaque brachytherapy there is no such method available. This has led to many hospitals performing treatments without verification of plaque absorbed dose rate to water [1], as also addressed by the AAPM TG No 221 [2]. To enhance the safety of brachytherapy treatments for intraocular tumors, we devised an independent measurement protocol to determine depth-dose curves from &lt;sup&gt;106&lt;/sup&gt;Ru eye-plaques using a new high precision setup equipment and diode detector.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material/Methods&lt;/h3&gt;&lt;div&gt;The absorbed dose rate to water was measured from five plaques (Bebig Eckert and Ziegler), four CCB types and one CCA type, using three PTW microSilicon detectors with a prototype, dedicated setup equipment from the plaque vendor named BetaCheck-106. The diodes were calibrated in &lt;sup&gt;60&lt;/sup&gt;Co at the Swedish secondary standards metrology laboratory. Beam quality correction factors along the lines of the TRS-398 protocol [3] were calculated with the PENELOPE Monte Carlo code and detector blueprints. Absorbed dose rate measurements were performed in the water-filled PMMA phantom. Furthermore, the depth-dose curves were validated against vendor data and data from alanine detectors measurements with the latter performed at the primary standard laboratory of the National Physical Laboratory, UK and traceable to a &lt;sup&gt;60&lt;/sup&gt;Co primary standard of absorbed dose to water.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Result&lt;/h3&gt;&lt;div&gt;The absorbed dose rates to water measured with the diodes and alanine detectors fell within the vendor's expanded measurement uncertainty, 11% (&lt;em&gt;k&lt;/em&gt;=2), but were lower than the vendor's values. For the CCB applicators at the 2 mm distance reference point, the absorbed dose rates measured with the diode detectors were on average 9% lower, while the absorbed dose rates measured with alanine detectors were 7.4% lower. For the CCA applicator, the absorbed dose rate was 7% and 4.6% lower for diode- and alanine detectors, respectively. Preliminary results are shown in Figure 1.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Our study shows an efficient measurement protocol for verifying &lt;sup&gt;106&lt;/sup&gt;Ru eye-plaque absorbed dose-rates. The dose rates measured by diode and alanine detectors both show lower dose rates compared to vendor certificates, but are still within the vendor's expanded measurement uncertainty. The discrepancy will be further investigated. The dedicated setup equipment provided high repeatability, which is crucial for reliably measuring the steep dose gradients from &lt;sup&gt;106&lt;/sup&gt;Ru. Diode detectors calibrated in &lt;sup&gt;60&lt;/sup&gt;Co with Monte Carlo calculated detector correction factors provide vendor independent traceability. The methodology offers hospitals a feasible way to verify absorbed dose-rate to water depth dose curves and so increase safety of patient treatments and f","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":"142527201","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}