Brachytherapy最新文献

{"title":"Ultrasound and CT-guided implantation of iodine-125 seeds combined with transarterial chemoembolization for recurrent hepatocellular carcinoma at complex sites after hepatectomy","authors":"Yeyan Wang ,&nbsp;Jie Feng","doi":"10.1016/j.brachy.2024.12.002","DOIUrl":"10.1016/j.brachy.2024.12.002","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>The objective of this study was to evaluate the efficacy and safety of TACE combined with 125I seeds (TACE-125I) in the treatment of recurrent HCC at complex sites after hepatectomy.</div></div><div><h3>METHODS</h3><div>This study retrospectively analyzed the clinical data of recurrent HCC patients located at complex sites (such as large blood vessels, diaphragm dome, etc.) after hepatectomy from January 2012 to December 2023, all of whom received TACE-125I or TACE therapy. Recur rence, overall survival (OS), progression-free survival (PFS) and complications were compared be tween the 2 groups.</div></div><div><h3>RESULTS</h3><div>A total of 152 patients with recurrent HCC were enrolled in this study, including 69 in the TACE-125I group and 83 in the TACE group. During follow-up, a total of 41 patients in the TACE-125I group experienced tumor recurrence, compared to 67 patients in the TACE group. The median OS in the TACE-125I group was 31 months, which was significantly higher than that in the TACE group (16 months, <em>p</em> &lt; 0.001). Similarly, the median PFS was significantly higher in the TACE-125I group than in the TACE group.</div></div><div><h3>CONCLUSIONS</h3><div>Compared with TACE treatment, TACE-125I may be a more effective method for the treatment of recurrent HCC located at complex sites.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 293-300"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043970","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":"Safety and early outcomes of proton therapy and low-dose rate brachytherapy boost for patients with prostate cancer","authors":"Osama Mohamad ,&nbsp;Zakaria El Kouzi ,&nbsp;Ramez Kouzy ,&nbsp;Seungtaek Choi ,&nbsp;Henry Mok ,&nbsp;Karen Hoffman ,&nbsp;Quynh-Nhu Nguyen ,&nbsp;Comron J Hassanzadeh ,&nbsp;Chad Tang ,&nbsp;Ryan J Park ,&nbsp;Shalin Jyotindra Shah ,&nbsp;Sean Eric McGuire ,&nbsp;Lauren Layer Mayo ,&nbsp;Yusung Kim ,&nbsp;Surendra Prajapati ,&nbsp;Sarath Vijayan ,&nbsp;Rajat J Kudchadker ,&nbsp;Teresa Lorraine Bruno ,&nbsp;Steven Jay Frank","doi":"10.1016/j.brachy.2024.12.003","DOIUrl":"10.1016/j.brachy.2024.12.003","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Brachytherapy boost improves biochemical control for patients with prostate cancer. Here, we report the safety and early efficacy of proton therapy (PT) with a low-dose-rate (LDR) brachytherapy boost.</div></div><div><h3>METHODS</h3><div>This retrospective study included patients with intermediate- or high-risk prostate cancer treated with PT followed by LDR boost, with or without androgen deprivation therapy (ADT), from 2010 through 2023. Patient, disease, and treatment characteristics, gastrointestinal (GI) and genitourinary (GU) toxicity, and efficacy outcomes are reported.</div></div><div><h3>RESULTS</h3><div>Ninety-nine patients received PT and LDR boost; median age at diagnosis was 68 years (interquartile range [IQR] 61–72). Most patients (<em>n</em> = 77) were White, 12 were African American, 5 Asian, and 3 Hispanic. Thirty-five patients had intermediate-risk (4 favorable and 31 unfavorable), 56 had high-risk, and 8 had very high-risk disease. Median PT dose was 44 Gy(RBE) (range 40–50.4) and median LDR dose was 90Gy (range 90–110). Pd-103 seed strands were used for 95 patients and I-125 for 4; 90 had MRI-assisted radiosurgery brachytherapy; 91 received ADT; and 21 had a rectal spacer. At a median follow-up time of 45 months, 5-year biochemical recurrence-free survival was 98%. There was no local recurrence, distant metastasis, or cancer death. Four patients had acute urinary retention after brachytherapy procedure. Eleven patients (11%) had late grade 2 GU toxicity, and 3 (3%) had late grade 2 GI toxicity. One patient had grade 3 urethral stricture requiring dilatation and transurethral resection.</div></div><div><h3>CONCLUSIONS</h3><div>At 45 months' follow-up time, treatment with PT and LDR boost led to high control rates and low toxicity for men with prostate cancer.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 301-309"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520850","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":"HDR brachytherapy combined with external beam radiotherapy for unfavorable localized prostate cancer: A single center experience from inception to standard of care","authors":"Ka-Kit David Yeung ,&nbsp;Juanita Crook ,&nbsp;Gregory Arbour ,&nbsp;Cynthia Araujo ,&nbsp;Deidre Batchelar ,&nbsp;David Kim ,&nbsp;David Petrik ,&nbsp;Tracey Rose ,&nbsp;Francois Bachand","doi":"10.1016/j.brachy.2024.12.005","DOIUrl":"10.1016/j.brachy.2024.12.005","url":null,"abstract":"<div><h3>PURPOSE</h3><div>High dose rate (HDR) brachytherapy is increasingly adopted for dose escalation in prostate cancer treatment. We report the clinical efficacy and toxicity of HDR prostate brachytherapy combined with external beam radiotherapy (EBRT) and evaluate the predictability of the biochemical definition of cure of 4-year PSA ≤0.2 ng/mL for failure free survival (FFS).</div></div><div><h3>METHODS</h3><div>A single centre retrospective study was conducted, including all patients with high-tier intermediate risk and high-risk prostate cancer treated with HDR brachytherapy combined with EBRT from 2011 to 2019. Patient and prostate cancer characteristics, treatment, clinical endpoints, and follow up were collected.</div></div><div><h3>RESULTS</h3><div>Total 319 patients were analyzed. The median age was 68 with median follow up of 77.1 months. Total 142 had high-tier intermediate and 177 had high-risk disease. Brachytherapy doses were initially 20 Gy/2 fractions, and subsequently 15 Gy/1 fraction. All patients received 46 Gy/23 fractions of EBRT. Overall survival at 5 and 9 years was 92.2% and 77.0%, respectively. Failure-free survival (FFS) was 86.0% at 5 years and 76.1% at 9 years. PSA ≤ 0.2 ng/mL at 4 years was seen in 79.3% of patients and was associated with FFS of 94.1% at 9 years. Grade 3 urethral stricture, hematuria, or proctitis occurred in 2.8%, 0%, and 0%, respectively.</div></div><div><h3>CONCLUSION</h3><div>HDR brachytherapy in addition to EBRT is effective treatment for unfavourable localized prostate cancer with a very acceptable toxicity profile. The biochemical definition of cure of PSA &lt; 0.2 ng/mL at 4 years was predictive for FFS at 9 years.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 318-327"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From patient to pioneer: The inspiring journey of Dr. Brian Moran","authors":"Manuj Agarwal ,&nbsp;Peter Orio","doi":"10.1016/j.brachy.2024.11.002","DOIUrl":"10.1016/j.brachy.2024.11.002","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 199-209"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025040","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":"Escalating the dose of high-dose-rate brachytherapy combined with external beam radiotherapy improves the disease control rate in patients with high- or very-high-risk prostate cancer","authors":"Takaya Inagaki ,&nbsp;Yasutaka Noda ,&nbsp;Yuya Iwahashi ,&nbsp;Takahiro Naka ,&nbsp;Maria Kojima ,&nbsp;Riki Inagaki ,&nbsp;Ryuki Shimono ,&nbsp;Azusa Awaya ,&nbsp;Yasuo Kohjimoto ,&nbsp;Isao Hara ,&nbsp;Tetsuo Sonomura","doi":"10.1016/j.brachy.2024.10.011","DOIUrl":"10.1016/j.brachy.2024.10.011","url":null,"abstract":"<div><h3>PURPOSE</h3><div>High-dose-rate brachytherapy (HDR-BT) combined with external beam radiotherapy (EBRT) is an effective treatment for patients with high- and very-high-risk prostate cancer. We sought to identify the factors associated with reduced biochemical recurrence rates following HDR-BT.</div></div><div><h3>METHODS</h3><div>A total of 304 patients with high- or very-high-risk prostate cancer who underwent HDR-BT and EBRT were analyzed. EBRT comprised 50 Gy in 25 fractions and HDR-BT comprised 18 Gy in 2 fractions. Biochemical recurrence was defined as an increase in prostate specific antigen (PSA) by ≥2.0 ng/mL from the nadir level.</div></div><div><h3>RESULTS</h3><div>The median follow-up time was 8.2 years (range, 3.4‒13.7 years) after HDR-BT. The 5-year biochemical progression-free survival (bPFS), overall survival, and cause-specific survival rates were 87.4%, 93.3%, and 100%, respectively. In univariate and multivariable analyses, a biologically effective dose (α/β = 1.5) ≥ 240 Gy and androgen deprivation therapy (ADT) were significantly associated with better bPFS (<em>p</em> = 0.020 and 0.007, respectively), whereas pretreatment PSA ≥ 40 ng/mL and Gleason score group 5 were significantly associated with worse bPFS (<em>p</em> = 0.080 and 0.021, respectively). Grade ≥ 3 rectal toxicities occurred in 0.3% of patients and grade ≥ 3 urinary toxicities occurred in 3.4% of patients.</div></div><div><h3>CONCLUSION</h3><div>In patients with high- and very-high-risk prostate cancer treated with EBRT and HDR-BT, dose escalation and ADT were associated with improved tumor control. By comparison, Gleason score group 5 and pretreatment PSA &gt;40 ng/mL were associated with worse tumor control.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 223-230"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose-rate (2 fractions of 13.5 Gy) and low-dose-rate brachytherapy as monotherapy in prostate cancer. Long term outcomes and predictive value of nadir prostate-specific antigen","authors":"Silvia Rodríguez Villalba ,&nbsp;Diana Guevara Barrera ,&nbsp;Luis Suso-Martí ,&nbsp;Enrique Sanchis-Sánchez ,&nbsp;Jose Pérez-Calatayud ,&nbsp;Jose Domingo Lago Martín ,&nbsp;Francisco Blázquez Molina ,&nbsp;Manuel Santos Ortega","doi":"10.1016/j.brachy.2024.10.014","DOIUrl":"10.1016/j.brachy.2024.10.014","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the outcomes of patients treated for low-risk (LR) and favorable intermediate risk (FIR) prostate cancer with brachytherapy (BT) in monotherapy with LDR or HDR and its relationship with nadir PSA (nPSA).</div></div><div><h3>Materials and Methods</h3><div>We retrospectively analyzed 139 patients (2005-2019) with exclusive LDR (46%. 145/160 Gy) /HDR (54%. 2 implants of 13.5 Gy each separated 10 days). 69% LR and 31% FIR. PSA nadir was grouped into two categories: ≤ 0.2 ng/mL and &gt; 0.2 ng/mL.</div></div><div><h3>Results</h3><div>Median patient age was 69 years (46-84). Seventy-six patients (55%) received androgen deprivation therapy, and 37% received neoadjuvant therapy. Median follow-up period was 90 months. Actuarial biochemical failure-free survival (BFFS), local control (LC), overall survival (OS), and cause-specific survival (CSS) rates for the total cohort were 78%, 87%, 68%, and 98% at 10 years, respectively. BFFS, LC, OS and CSS in nPSA ≤ 0,2 ng/ml was 90%, 96%, 67%, 100% at 10 years respectively, whereas, those with a nPSA &gt; 0.2 ng/ml had a BFFS, LC, OS and CSS of was 37%, 51%, 72%, 90% at 10 years respectively Statistical significance between both groups was reached in BFFS (p=0,000), LC (p=0,000) and CSS (p=0,007)). In the univariate analysis, there was no difference between risk stratification, BT technique, ADT, or the development of bouncing.</div></div><div><h3>Conclusions</h3><div>Prostate brachytherapy as monotherapy (LDR and HDR) is an effective treatment option for patients with LR and FIR prostate cancer. nPSA ≤0,2 ng/ml is a representative value that provides prognostic information for favorable outcomes in this group of patients.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 310-317"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824928","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":"Transition from point A to volume based image guided brachytherapy across a network of centers in India through workshop and mentoring","authors":"Harjot Kaur Bajwa ,&nbsp;Manikumar Singamsetty ,&nbsp;Mohan Lal ,&nbsp;Manjinder Singh Sidhu ,&nbsp;Sumeet Aggarwal ,&nbsp;Ritu Agarwal ,&nbsp;Midhun Murali ,&nbsp;Dhanya K S ,&nbsp;Rajesh Natte ,&nbsp;Suresh Chaudhari ,&nbsp;Vibhor Gupta ,&nbsp;Sushil Beriwal","doi":"10.1016/j.brachy.2024.11.005","DOIUrl":"10.1016/j.brachy.2024.11.005","url":null,"abstract":"<div><h3>AIM</h3><div>To demonstrate how workshop and mentoring across a network of radiotherapy centers helped in transitioning from point A to volume-based image guided brachytherapy in carcinoma cervix.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Based on discussion with different centers across the network, the lapses in cervical cancer treatment were identified and a workshop was designed to change the practice pattern. The main focus of the workshop was to streamline EBRT dose prescription protocols and implement volume based image guided brachytherapy through mentoring and hands on training. Patient data was analyzed 1 year post workshop to assess the impact in changing practice pattern.</div></div><div><h3>RESULTS</h3><div>A total of 246 cervical cancer patients treated with radical chemo radiotherapy and image guided brachytherapy were analyzed. 207 patients received CT based intracavitary brachytherapy whereas 39 patients received MR based hybrid brachytherapy. In patients who received EBRT and brachytherapy at the same center, the EBRT prescription dose was 45Gy in 25 fractions in 95% patients. The mean dose received by 90% of the HRCTV was 80.8Gy EQD2 in CT based intracavitary brachytherapy and 89.48Gy EQD2 in MR based hybrid brachytherapy. The mean bladder, rectum, sigmoid and small bowel D2cc doses were 63.87Gy, 62.18Gy, 61.2Gy and 55.1Gy EQD2 respectively.</div></div><div><h3>CONCLUSION</h3><div>This report demonstrates successful implementation and change of carcinoma cervix treatment practice pattern through workshop and mentoring across a network of radiotherapy centers in India.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 2","pages":"Pages 348-353"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901216","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":"HDR brachytherapy salvage for nodular prostate fossa recurrence: A mechanistic review and initial report of clinical outcomes","authors":"Lauren M. Andring ,&nbsp;Rebecca F. Krc ,&nbsp;Elleana Paradise ,&nbsp;Brandon Li ,&nbsp;Arjit Baghwala ,&nbsp;Brian Miles ,&nbsp;Raj Satkunasivam ,&nbsp;Dharam Kaushik ,&nbsp;Ramiro Pino ,&nbsp;Bin S. Teh ,&nbsp;E. Brian Butler ,&nbsp;Andrew M. Farach","doi":"10.1016/j.brachy.2024.12.006","DOIUrl":"10.1016/j.brachy.2024.12.006","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Biochemical recurrence (BCR) occurs in approximately 30% of men after upfront prostatectomy (RP) for prostate cancer. Salvage fossa brachytherapy offers a promising local treatment option. Here we describe a salvage technique and report initial outcomes.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Patients with local BCR and no evidence of distant metastases were included. Clinical, toxicity and dosimetry were collected.</div></div><div><h3>RESULTS</h3><div>At a single institution, 23 patients completed prostate fossa brachytherapy salvage. Seven patients had received prior pelvic EBRT for an initial recurrence after RP and received HDR BT as definitive treatment for a second local recurrence. The remaining 16 patients were treated with combination EBRT + BT for initial recurrence after RP. Median age was 69 and PSA prior to salvage was 1.12 ng/mL. Ten patients (43.5%) received androgen directed therapy at the time of salvage, and 13 (56.5%) received local therapy only. After median follow up of 12 months, the median PSA decreased to 0.1 ng/mL. Eight patients (34.8%) remain on ADT. All patients have local disease control. Three patients developed locoregional failures, and two developed distant metastases. There were 17 (73.9%) acute grade 1 GU toxicities, two acute grade 2 GU toxicities (8.7%), and a single grade 3 (4.3%) GU toxicity. There were 6 acute grade 1 GI toxicities (26.1%), and a single patient with late grade 3 GU toxicity (4.3%). No grade 4 or higher toxicities were reported.</div></div><div><h3>CONCLUSIONS</h3><div>This study found prostate bed BT to be safe and feasible for patients with nodular prostate fossa recurrences in both the initial salvage and salvage reirradiation setting. On preliminary follow up, PSA control rates are acceptable.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 404-412"},"PeriodicalIF":1.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517634","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":"On the value of an EM tracking quality assurance system for pretreatment verification of needle digitization accuracy in ultrasound-based prostate HDR brachytherapy","authors":"Christopher L. Deufel,&nbsp;Eric E. Brost,&nbsp;Justine M. Dupere,&nbsp;Jessica M. Wilson,&nbsp;Mark R. Waddle,&nbsp;Bradley J. Stish","doi":"10.1016/j.brachy.2025.01.003","DOIUrl":"10.1016/j.brachy.2025.01.003","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To develop and deploy an electromagnetic (EM) tracking-based platform for pretreatment, patient-specific quality assurance of brachytherapy applicator digitization, with the goals of intercepting human errors and quantifying treatment planning dose uncertainties.</div></div><div><h3>METHODS</h3><div>An EM tracking platform, EMQA, was developed for patient-specific quality assurance of HDR treatment plan needle reconstructions. EMQA compared needle geometry between a manually digitized clinical HDR treatment plan and EM-tracked positions. Pretreatment quality assurance (QA) was performed for 25 implants (20 patients). Distance and dose metric differences were reported. Factors influencing accuracy were analyzed, including radial distance from the ultrasound probe and EM field generator (EFG), needle ‘shadowing’ artifacts, needle depth adjustments using exposed needle length protruding from the implant template, and TRUS calibrated speed of sound, <span><math><msub><mi>v</mi><mrow><mtext>Sound</mtext><mspace></mspace><mtext>Effective</mtext></mrow></msub></math></span>.</div></div><div><h3>RESULTS</h3><div>Needle digitization differences between the clinical plan and EM tracking had a magnitude (mean ± standard deviation [minimum, maximum]) of 0.46 ± 0.36 (0.002, 2.19) millimeters for the needle depths and 0.62 ± 0.44 (0.01, 3.26) millimeters for needle shafts. Dose metric differences (% of Rx) for PTV, CTV, bladder, rectum, and urethra were &lt;1.7% on average, but differences &gt;5% were observed in two patients. Accuracy was notably worse for locations shadowed by more than one needle, decreased with distance from the probe and EFG, and was optimal for <span><math><msub><mi>v</mi><mrow><mtext>Sound</mtext><mspace></mspace><mtext>Effective</mtext></mrow></msub></math></span>=1570 m/s.</div></div><div><h3>CONCLUSION</h3><div>Clinical evaluation of an EMQA platform demonstrated the potential to intercept errors in the digital reconstruction of ultrasound-based prostate HDR brachytherapy needles prior to radiation delivery, which may be due to poor image quality or human error. Manual needle digitization accuracy was typically submillimeter, however errors as great as 3 mm were observed. The adoption of EMQA as standard of care is expected to reduce the potential for mistreatment.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 450-460"},"PeriodicalIF":1.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451356","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":"3D-printed needle guides for cervical cancer brachytherapy: Optimized dosimetry and improved local control outcomes","authors":"Santino Butler,&nbsp;Thomas Niedermayr ,&nbsp;Elizabeth A. Kidd","doi":"10.1016/j.brachy.2025.01.001","DOIUrl":"10.1016/j.brachy.2025.01.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>We previously designed three-dimensionally-printed needle guides (3D-NG) for cervical cancer brachytherapy, which improved procedure efficiency and tumor coverage while achieving similar organs at risk (OAR) sparing compared to non-3D-printed techniques (non-3D). The subject of this study was whether 3D-NG can help improve local control and other brachytherapy outcomes.</div></div><div><h3>METHODS</h3><div>This single institution cohort study includes 130 patients who underwent definitive external-beam radiotherapy and high-dose-rate intracavitary +/− interstitial brachytherapy from February 2017 to July 2023. 3D-NG were implemented for all cases after December 2019 (N = 77). Non-3D included applicator-only/no-needles (N = 28) or freehand-placed needles (N = 25).</div></div><div><h3>RESULTS</h3><div>Median follow-up was 24 months. 3D-NG, versus non-3D, achieved higher mean D90 (+5.2 Gy, <em>p</em> &lt; 0.001), D98 (+4.3 Gy, <em>p</em> &lt; 0.001), and V100_average (+5.9%, <em>p</em> &lt; 0.001)—with greater improvement for larger tumors (high-risk[HR]-CTV&gt;30 cubic-centimeters[cc]) (P_interaction&lt;0.10 for all). Maximum D2cc for all OAR were comparable between 3D-NG and non-3D (<em>p</em> &gt; 0.05). 2-year LF was lower with 3D-NG compared to non-3D (8.2% vs. 22.0%; aHR 0.31, <em>p</em> = 0.036)—and compared to freehand-needles alone (8.2% vs. 20.6%, <em>p</em> &lt; 0.001 [log-rank])—particularly among cases with higher cumulative HR-CTV dose (D90 &gt;85 Gy; <em>p</em>_interaction = 0.013) and lower HR-CTV volume (≤30 cc; <em>p</em>_interaction = 0.048). 2-year LF was also lower with concurrent cisplatin (aHR 0.20, <em>p</em> = 0.001) and ≥40% decrease in tumor diameter after EBRT (aHR 0.16, <em>p</em> = 0.010); but higher among minority race (aHR 4.21, <em>p</em> = 0.06).</div></div><div><h3>CONCLUSIONS</h3><div>3D-NG for cervix brachytherapy were associated with improved 2-year LF compared to non-3D/freehand-needles, with higher achievement of EMBRACE II goals for D90 and D98, with similar OAR doses. This study highlights the potential for 3D-NG to simplify needle insertion while simultaneously improving needle position, dosimetry, and disease control outcomes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 3","pages":"Pages 379-388"},"PeriodicalIF":1.7,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426777","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}