Brachytherapy最新文献

{"title":"Overview of treatment plan quality in a high dose rate prostate brachytherapy workflow","authors":"J.V. Panetta,&nbsp;I. Veltchev,&nbsp;E. Horwitz,&nbsp;M. Hallman,&nbsp;K. Wong,&nbsp;R.A. Price,&nbsp;C.M.C. Ma","doi":"10.1016/j.brachy.2024.08.255","DOIUrl":"10.1016/j.brachy.2024.08.255","url":null,"abstract":"<div><h3>PURPOSE</h3><div>High dose rate brachytherapy (HDR-BT) has been shown to be an effective treatment for prostate cancer, with treatment plan quality dependent on a number of factors. In this work, we report on the overall performance of our ultrasound (US)-based workflow and the impact of several treatment-specific variables.</div></div><div><h3>METHODS AND MATERIALS</h3><div>Patients who underwent HDR-BT (boost, monotherapy, and retreatment) using Varian Bravos/US from 2021 to 2023 were sampled for this study. Treatment plan quality was analyzed and plans were categorized with regard to a number of metrics, including: prostate volume, treating physician, planning physicist, number of needles included, estimated planning time, rectum-prostate separation, and bladder-prostate separation. The performance of this program was compared to the performance of our program using previously used modality combinations: Varian Varisource/US, Elekta microSelectron/CT.</div></div><div><h3>RESULTS</h3><div>Plan quality for our Bravos/US workflow was shown to be consistently above acceptability criteria for all personnel involved; on average: prostate V100%: 98.9% ± 0.1%, rectum V75%: 0.04 ± 0.01 cc, bladder V75%: 0.06 ± 0.01cc, urethra V125%: 0.00 ± 0.00 cc. Prostate coverage was statistically improved with this workflow compared to that using our previous modalities. There was a statistical correlation between organ-at-risk sparing/prostate coverage ratio and prostate volume, number of needles/prostate volume, bladder-prostate separation, and rectum-prostate separation. There was no correlation between plan quality and planning time.</div></div><div><h3>CONCLUSIONS</h3><div>Our US-based HDR-BT program led to target coverage and organ-at-risk sparing that exceeded department thresholds. Results were acceptable regardless of the personnel involved and improved plan quality was obtained using more needles/prostate volume and increased spacing between the prostate and the rectum and bladder.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 698-704"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel 3D-printed brachytherapy applicator and Monte Carlo model for the treatment of conjunctival tumors","authors":"C.K. Matrosic ,&nbsp;S. Kronenberg ,&nbsp;H. Demirci ,&nbsp;J.A. Hayman ,&nbsp;H. Han ,&nbsp;C. Lee","doi":"10.1016/j.brachy.2024.07.004","DOIUrl":"10.1016/j.brachy.2024.07.004","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To develop a custom low dose rate brachytherapy applicator for the treatment of conjunctival malignancies which leverages 3D-printing technology to provide enhanced design flexibility and availability.</div></div><div><h3>METHODS</h3><div>An elliptical shell applicator inspired by ocular surgery postoperation conformer shells was developed for the placement of the applicator around the cornea of the eye, with a central hole to provide patient comfort. The applicator featured 2 concentric circles of slots for iodine-125 seeds, providing customization of the dose distribution depending on the location of the target. The applicator was modeled using computer-aided design software. The resultant model STL file was used for 3D printing of the applicator and the development of a Monte Carlo model of the applicator and its dose distribution.</div></div><div><h3>RESULTS</h3><div>The applicator was successfully 3D printed using biocompatible resin, which could be sterilized for treatment after manual source loading. A Geant4 model of the applicator was created directly from the STL model and was applied to a phantom to estimate the dose distribution delivered by the applicator. The toroidal dose distribution allowed for treatment of the conjunctiva while reducing dose to the cornea compared to traditional eye plaque designs.</div></div><div><h3>CONCLUSIONS</h3><div>A custom 3D-printed applicator was successfully developed and modeled for the treatment of conjunctival malignancies. This novel applicator design potentially provides higher quality, more customizable dose distributions for patients and the simplicity of the design makes it accessible for any clinic with 3D-printing technology.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 712-718"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057579","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":"Are outcomes of locally advanced cervical cancer associated with prebrachytherapy hemoglobin values and transfusion practice? An observational study comparing two large academic centres with divergent clinical guidelines","authors":"Taylor Dear ,&nbsp;Jodi Chiu ,&nbsp;Harley Meirovich ,&nbsp;Amie Malkin ,&nbsp;Razan Amjad ,&nbsp;David D'Souza ,&nbsp;Jeannie Callum ,&nbsp;Eric Leung ,&nbsp;Kate Kelly ,&nbsp;Alejandro Lazo-Langner ,&nbsp;Ziad Solh","doi":"10.1016/j.brachy.2024.07.006","DOIUrl":"10.1016/j.brachy.2024.07.006","url":null,"abstract":"<div><h3>BACKGROUND AND PURPOSE</h3><div>Anemia is common in locally advanced cervical cancer. Clinical practice varies greatly for management of anemia during brachytherapy, with some centres providing red cell transfusion to increase hemoglobin levels above 100 g/L.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This is a retrospective observational cohort study of adult patients with cervical cancer treated with brachytherapy at two academic hospitals. One hospital (H1) uses a liberal transfusion strategy with hemoglobin threshold of 100 g/L during brachytherapy and the other uses a restrictive target of 70 g/L (H2).</div></div><div><h3>RESULTS</h3><div>Overall, 336 patients met inclusion criteria (H1: 150 patients, H2: 186 patients). 11 patients were excluded (2 at H1, 9 at H2). Demographics at both sites were comparable, except for cancer stage and smoking history. External beam radiation and chemotherapy provided was similar. Hemoglobin values were compared at baseline (within 4 weeks of oncology consult), and prior to the first and second brachytherapy treatments. In total, 101red blood cell (RBC) units were transfused to patients at H1 and 19 units to patients at H2. Patients were followed for a median of 37.0 months (0.6-80.5) at H1, and 33.3 months (1.6-82.0) at H2. There was no significant difference in progression-free or overall survival. Multivariable logistic regression analysis showed that FIGO stage was a predictor for both overall survival and cancer progression. Age, tumor size, chemotherapy, and hemoglobin levels were not predictors of disease progression or mortality.</div></div><div><h3>CONCLUSIONS</h3><div>The practice of liberal transfusion should be re-evaluated in the absence of robust data to support its use.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 660-667"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094331","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":"PSMA PET/CT patterns of recurrence after mono-brachytherapy in men with low and intermediate prostate cancer and subsequent management","authors":"Genevieve Loos ,&nbsp;James P Buteau ,&nbsp;Justin Oh ,&nbsp;Sylvia Van Dyk ,&nbsp;David Chang ,&nbsp;Declan G Murphy ,&nbsp;Michael S Hofman ,&nbsp;Scott Williams ,&nbsp;Sarat Chander","doi":"10.1016/j.brachy.2024.07.003","DOIUrl":"10.1016/j.brachy.2024.07.003","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Brachytherapy as monotherapy is a recommended treatment option for men with low to intermediate risk prostate cancer. Local recurrence is difficult to identify. This study investigated PSMA PET/CT for recurrence after brachytherapy, as well as their subsequent management when recurrence occurred only within the prostate.</div></div><div><h3>METHODS</h3><div>We performed a retrospective single-center analysis for patients who were treated with brachytherapy as monotherapy for prostate cancer from May 2002 to May 2021 and who underwent a PSMA PET/CT for BCR. We report the findings on PSMA PET/CT, quantitative parameters, as well as the later management of the patients.</div></div><div><h3>RESULTS</h3><div>Forty patients were identified, who underwent PSMA PET/CT to investigate a rising PSA at a median (IQR) of 7 years (3.0–10.8) after initial therapy. Median (IQR) PSA at time of PSMA PET/CT was 6.54 ng/mL (3.9–15.5). On PSMA PET/CT, 20/40 (50%) men had prostate-only recurrence. Of the 20 patients with prostate-only recurrence, 8/20 (40%) had recurrence in a high-dose radiation zone, versus 7/20 (35%) in an under-covered zone. On PSMA PET/CT, recurrence within the prostate had median (IQR) SUVmax 10.4 (5.1–15.7) and volume 2.9 mL (2.0–11.2). Subsequent management of these patients with local recurrence included surveillance followed by ADT (9/20, 45%). For those with surveillance followed by ADT, the mean time before introduction of ADT was 4.1 years (range 1–8 years).</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 719-726"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367860","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":"EMVision: An electromagnetic tracking guidance system for accurate placement of interstitial brachytherapy applicators","authors":"Christopher L. Deufel,&nbsp;Eric E. Brost,&nbsp;Justine M. Dupere,&nbsp;Ivy A. Petersen,&nbsp;Michael G. Haddock,&nbsp;Allison E. Garda","doi":"10.1016/j.brachy.2024.06.006","DOIUrl":"10.1016/j.brachy.2024.06.006","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To design, construct, and evaluate a system for image-guided placement of brachytherapy applicators using electromagnetic tracking (EMT) technology for improved procedure quality and efficiency. The system, named EMVision, provides a three-dimensional display of planned needle sites, visibility of the anatomy and needle position during placement, and reference tracking to account for generator or target anatomy shifts.</div></div><div><h3>METHODS</h3><div>The EMVision EMT guidance system registers CT and EMT reference frames using an automated point-based algorithm according to tandem/ovoid locations. Subsequent needle placement and digitization is guided with an intraluminal EMT sensor and user interface that displays the needle's location in axial, coronal, sagittal, and 3D-volumetric CT views. The interface can overlay contours, preplanned needles, and provide 6DOF compensation for tandem movement during needle placement/manipulation. EMVision accuracy was evaluated in phantom and human cadaver by comparing EMVision's DICOM needle positions with a ground-truth, postimplant CT.</div></div><div><h3>RESULTS</h3><div>Proof of concept was demonstrated for EMT-assisted placement of brachytherapy needles. EMVision accuracy in phantom (mean ± standard deviation) on a brachysuite CT table was 0.76 ± 0.13 mm for needle tips placed up to 75 mm from the tandem/ovoids and 0.52 ± 0.27 mm for needle shafts at distances up to 100 mm from the tandem/ovoids. Performance in human cadaver was similar, with tip and shaft accuracies of 0.77 ± 0.14 mm and 0.40 ± 0.21 mm, respectively.</div></div><div><h3>CONCLUSION</h3><div>EMVision provides sub-millimeter accuracy for the placement of brachytherapy needles without repeated or continuous imaging. The technology can be used to reduce brachytherapy procedure times, improve the correspondence between intended and actual needle positions, or decrease the trainee learning curve.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 676-686"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378712","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":"Determination of the optimal time for planning SAVI brachytherapy for APBI","authors":"Dominic Rafie,&nbsp;David Beyer,&nbsp;Kyle Schmanke,&nbsp;Frank Rafie","doi":"10.1016/j.brachy.2024.03.004","DOIUrl":"10.1016/j.brachy.2024.03.004","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Accelerated partial breast irradiation with high dose rate brachytherapy treats early-stage carcinoma. Strut-adjusted volume implant applicators are inserted into the cavity post-lumpectomy. For an unstable applicator, changes in distance are seen each day between struts. If an applicator is asymmetrical with no strut movement on subsequent days, then it is stable. If an asymmetrical applicator continues to change strut distances, it is unstable. Waiting for applicator stabilization improves treatment reproducibility but increases infection risk. There is currently no consensus on stability, with ranges from 24 hours (h) to 72 h. Therefore, this study aims to determine when stability is achieved.</div></div><div><h3>MATERIALS AND METHODS</h3><div>We retrospectively reviewed 242 female breast cancer patients (2014–2022). CT was performed the same day as applicator insertion (Day 0) and repeated each treatment day. If applicators were initially asymmetrical, the distance between adjacent struts was measured, and the percentage change between the next and previous treatment day was calculated to determine how many applicators stabilized. Less than 5% change indicated stability.</div></div><div><h3>RESULTS</h3><div>On Day 0, 208 out of 242 patients (86%) had stable and symmetrical applicators that maintained stability each treatment day, and 34 out of 242 patients (14%) had applicators with asymmetrical struts. Within 24 h post-insertion, 229 out of 242 (95%) patients had stabilized applicators that maintained stability on subsequent treatment days.</div></div><div><h3>CONCLUSION</h3><div>Narrows previously suggested stability (24–72 h) to 24 h, leading to improved treatment efficiency and decreased infection risk as less time is needed to achieve applicator stability.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 737-742"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094332","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":"Comparison of 3D-printed multichannel non–co-planar vaginal applicators and single-channel vaginal applicators for brachytherapy with positive or close surgical margins in cervical cancer","authors":"Chengjun Feng,&nbsp;Xiaomin Wen,&nbsp;Shiting Li,&nbsp;Li Hua,&nbsp;Shaojun Chen","doi":"10.1016/j.brachy.2024.06.004","DOIUrl":"10.1016/j.brachy.2024.06.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study was conducted to compare the differences between 3D-printed multichannel non–co-planar vaginal applicators and single-channel vaginal applicators in cervical cancer patients with positive or close surgical margins.</div></div><div><h3>METHODS</h3><div>Between January 2015 and June 2023, 104 cervical cancer patients who underwent radical surgery with positive or close surgical margins were enrolled to receive concurrent intensity-modulated chemoradiotherapy combined with 3D-printed multichannel non–co-planar vaginal applicators (3D-printed group, 41 patients) or single-channel vaginal applicators (single-channel group, 63 patients) guided brachytherapy. The dosimetric parameters, 5-year local control (LC), progression-free survival (PFS), overall survival (OS) of two groups were retrospectively analyzed.</div></div><div><h3>RESULTS</h3><div>The high-risk clinical target volume (D90, D100) and high-dose volume fraction (V150) in 3D-printed group were significantly higher than those in single-channel group (<em>p</em> &lt; 0.05), and the homogeneity index (HI) and conformal index (COIN) were equally better in 3D-printed group. In 3D-printed group, the D2cc, D1cc, and D0.1cc of the bladder and rectum were significantly lower than those of the single-channel group (<em>p</em> &lt; 0.05). The 3D-printed group had significantly superior 5-year LC (70.0% vs. 51.3%, <em>p</em> = 0.041) and PFS (63.0% vs. 44.2%, <em>p</em> = 0.045), but OS were not significantly different between treatment groups (75.4% vs. 59.7%, <em>p</em> = 0.112). The incidence of radiation enteritis and cystitis was lower in the 3D-printed group than in the single-channel group, but no statistical difference was noted.</div></div><div><h3>CONCLUSIONS</h3><div>The 3D-printed multichannel non–co-planar vaginal insertion applicators show the advantage of target dose, improve the LC and PFS in patients with positive or close surgical margins after cervical cancer surgery. Thus, the popularization of this method and its application may be of value.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 641-647"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057580","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":"National Cancer Database analysis of radiation therapy consolidation modality and dose for inoperable endometrial cancer","authors":"Alexander Lukez ,&nbsp;Brian L. Egleston ,&nbsp;Peter L. Lee ,&nbsp;Krisha J. Howell ,&nbsp;Jeremy G. Price","doi":"10.1016/j.brachy.2024.06.005","DOIUrl":"10.1016/j.brachy.2024.06.005","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>We utilized the National Cancer Database (NCDB) to evaluate trends and assess outcomes in radiation therapy (RT) boost modality and total dose among medically inoperable endometrial cancer (EC) patients with locoregional disease.</div></div><div><h3>METHODS</h3><div>Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I – IIIC2 inoperable EC treated with RT ± chemotherapy were analyzed. Practice patterns compared external beam RT (EBRT) versus high-dose-rate brachytherapy (BT) boost and total RT dose (palliative: ≤3000 cGy, definitive low dose [DLD]: 4500 – 6249 cGy, definitive high dose [DHD]: ≥6250 cGy) over time. Kaplan-Meier method evaluated overall survival (OS) and Cox proportional hazard modeling assessed variables associated with OS.</div></div><div><h3>RESULTS</h3><div>NCDB included 1755 total cases, of which 1209 received a radiotherapy boost. From 2004 to 2019, boost modality rates differed with increasing utilization of BT consolidation and a decreasing rate of palliation. Predictors of a palliative dose were stage III disease, Black race, N2 disease, and poorly or undifferentiated grade. Multivariable analysis found BT boost was associated with lower mortality compared to EBRT (HR: 0.81, CI: 0.68–0.97; <em>p</em> = 0.019). Mortality rates were higher for palliation versus DHD. Additional factors associated with inferior survival were increasing age, worse Charlson-Deyo score, higher T stage, higher N stage, and moderately, poorly, or undifferentiated grade.</div></div><div><h3>CONCLUSIONS</h3><div>Utilization of BT boost for locoregionally confined, medically inoperable EC has increased since 2004. Brachytherapy consolidation remains an effective RT modality for medically inoperable EC, associated with lower mortality compared to EBRT consolidation.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 623-633"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038007","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":"Prostate-specific antigen (PSA) nadir and experience of PSA bounce after low-dose-rate brachytherapy for prostate cancer predicts clinical failure","authors":"Yasushi Nakai ,&nbsp;Nobumichi Tanaka ,&nbsp;Isao Asakawa ,&nbsp;Kenta Onishi ,&nbsp;Makito Miyake ,&nbsp;Kaori Yamaki ,&nbsp;Kiyohide Fujimoto","doi":"10.1016/j.brachy.2024.09.003","DOIUrl":"10.1016/j.brachy.2024.09.003","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to assess if prostate-specific antigen (PSA) threshold and PSA bounce are associated with oncological control after low-dose-rate brachytherapy (LDR-BT) alone or with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), considering serum testosterone levels.</div></div><div><h3>METHODS</h3><div>This study enrolled 944 prostate cancer patients treated at a single institution with LDR-BT alone or LDR-BT combined with EBRT, with or without ADT. The Fine-Gray hazard model was used to evaluate factors related to clinical failure, including experience of PSA bounce between baseline and 2, 4, or 7 years after LDR-BT and PSA value (0.1, 0.2, or 0.5 ng/mL) with normal testosterone levels at 2, 4, and 7 years after LDR-BT, respectively.</div></div><div><h3>RESULTS</h3><div>Patients with normal testosterone levels and a PSA of 0.2 or 0.5 ng/mL at 2, 4, and 7 years after LDR-BT had a significantly better clinical failure free rate (CFFR) than those with PSA levels &gt;0.2 or &gt;0.5 ng/mL or low testosterone levels. Multivariate analysis revealed that PSA &lt;0.1, 0.2, or 0.5 ng/mL with normal testosterone levels at 2, 4, and 7 years and experience of PSA bounce between baseline and 2 or 4 years after LDR-BT were significantly related to better CFFR.</div></div><div><h3>CONCLUSIONS</h3><div>Patients with normal serum testosterone levels who reached PSA of &lt;0.1, 0.2, or 0.5 ng/mL after LDR-BT, or those who experienced PSA bounce, showed better oncological control.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 727-736"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378713","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":"MPP05 Presentation Time: 4:45 PM","authors":"Grzegorz Bielęda PhD ,&nbsp;Anna Marach MSc ,&nbsp;Adam Chichel MD PhD ,&nbsp;Natalia Langner MSc ,&nbsp;Artur Chyrek MD PhD ,&nbsp;Adam Kluska MD PhD ,&nbsp;Wojciech Burchardt MD PhD ,&nbsp;Grzegorz Zwierzchowski PhD","doi":"10.1016/j.brachy.2024.08.019","DOIUrl":"10.1016/j.brachy.2024.08.019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Contact brachytherapy for non-melanoma skin cancers demonstrates very good treatment results. The main problem is to fit properly a standard applicator to a heavily pleated surface, such as the nasal or orbital region. In order to improve the reproducibility and quality of dose distributions, we have introduced individual custom-designed applicators manufactured on a 3D printer. The purpose of this study was to verify the effect of changing the contoured CTV volume between the pre-plan and the therapeutic plan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;For the study, 95 consecutive treatment plans were qualified for patients treated between 2021 and 2023 with individual contact applicators for skin brachytherapy. After the qualification, on the first visit in brachytherapy department, the patient had fiducial radiological markers surrounding the skin lesion placed and the CT scan performed. On the images, the physician contoured the volume of the CTV and critical organs. Based on the CT images and contours, medical physicist prepared the body of the applicator, the position of the catheters and the optimal source dwell positions in treatment planning system. The proposed dose distribution was consulted with the physician for verification. After approval, the DICOM files were exported to software converting DICOM files to printable stl files and the applicator was printed. At the next visit, the patient was CT scanned with the applicator in place and a treatment plan was prepared, based on the recontoured CTV and critical organs. We compared CTV volume values and dose distribution values in reconstructed critical organs and CTV for the pre-plan and approved treatment plan. We considered CTV volume, V100, V150 and D90. For OARs we compared doses in 0.1, 1 and 2 ccm.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Since the parameters studied did not show conformity to the normal distribution (the Shapiro-Wilk test was used) we applied the Wilcoxon signed-rank test. The compared parameters for the evaluation of the treatment plan appeared to be consistent with each other within the limits assumed for the tests performed (α=0.05), except for the maximum doses in the lenses. The doses in 0.1 cc of lens in the realized plans were found to be statistically significantly lower than in the plans created at the time of applicator design. Left lens pre-plan D0.1 = 12.86% vs 11.48% (p=0,005441) in treatment plan, right lens pre-plan D.01 = 9.67% vs 8.02% (p=0,005694) in treatment plan. During the preparation of the final treatment plans, physicists suspected physicians to contour larger CTV volumes than during the pre-plan and the applicator design. A surprising result of this study was that although not statistically significant but the mean CTV volume in the pre-plan was higher than in the contour made for the final treatment plan (1.69 ccm vs. 1.61 ccm). The main investigator thought before performing the statistics that the relati","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S26"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527065","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}