BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.06.010
Gil'ad N. Cohen , Xiuxiu He , Michael Trager , Maria F. Chan , Jeonghoon Park , Antonio L. Damato , David Aramburu Nunez
{"title":"Commissioning considerations for the Bravos high-dose-rate afterloader: Towards improving treatment delivery accuracy","authors":"Gil'ad N. Cohen , Xiuxiu He , Michael Trager , Maria F. Chan , Jeonghoon Park , Antonio L. Damato , David Aramburu Nunez","doi":"10.1016/j.brachy.2024.06.010","DOIUrl":"10.1016/j.brachy.2024.06.010","url":null,"abstract":"<div><h3>BACKGROUND And PURPOSE</h3><div>The upgrade of major equipment can be disruptive to clinical operations and introduce risk as policy and procedures need to adapt to new technical possibilities and constraints. We describe here the transition from GammaMed<em>Plus</em>-iX to Bravos in a busy brachytherapy clinic, involving four afterloaders across two sites.</div></div><div><h3>MATERIAL And METHODS</h3><div>Our clinic employs three high-dose-rate remote afterloaders in four dedicated treatment vaults at the main site and a fourth afterloader at a regional location. Of more than 600 new HDR treatment plans performed annually, most are planned and treated intraoperatively. Most treatments are for prostate cancer, followed by GYN, intraoperative brachytherapy, GI, and other sites. Applicators used include vendor-provided applicators as well as third party applicators and in-house 3D-printed devices to provide interstitial, intracavitary, intraluminal, and surface treatments. All applicators were commissioned according to recommended guidelines. The choice of tolerances and the design of new procedures were informed by current guidelines and leveraged new HDR afterloader functionalities. A review of clinical operations in the 4 months postupgrade was conducted to evaluate the feasibility of new tolerances and the effectiveness of new procedures.</div></div><div><h3>RESULTS</h3><div>The procedures outlined improved and standardized afterloader QA and treatment protocols with clear actionable steps for staff to follow to ensure treatments are delivered as planned. Re-commissioning of applicators yielded results similar to those previously reported by other investigators. A review of initial treatment data revealed that in one case, due to the implementation of tight tolerances, obstruction near the tip of the channel was detected and corrected prior to treatment. It confirms that the implementation of the tolerances adopted is feasible and effective in flagging treatment deviations.</div></div><div><h3>CONCLUSION</h3><div>Enhanced procedures and QA processes were implemented successfully. We established clear actionable steps to follow by staff to ensure that treatments are delivered accurately.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 705-711"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903961","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":"Comprehensive commissioning of a cone beam CT imaging ring for treatment of HDR GYN patients","authors":"Cullen Boyle, Firas Mourtada, Rani Anne, Shuying Wan, Yingxuan Chen, Yevgeniy Vinogradskiy, Reza Taleei","doi":"10.1016/j.brachy.2024.07.008","DOIUrl":"10.1016/j.brachy.2024.07.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>A new mobile cone beam computed tomography (CBCT) imaging ring (IRm, Elekta, v2.10.6, Veenendaal, Netherlands) has recently been proposed for brachytherapy to improve procedure efficiency. We describe the commissioning process and end-to-end tests for GYN HDR brachytherapy employing IRm CBCT imaging.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Commissioning included imaging isocenter test, 3D image quality, 2D imaging quality, image dose, and tube characteristics. CIRS HDR GYN phantom and Venezia CT/MR gynecological applicator were used to perform end-to-end (E2E) tests and optimize workflow. Venezia applicator and four interstitial needles were inserted into the phantom and IRm CBCT images were acquired. Phantom and applicator were scanned with CT scanner (Siemens SOMATOM go.Open Pro) using department's pelvis imaging protocol. MR imaging was performed using 0.35T MR Linac TRUFI pulse sequence. CBCT images were registered to CT and MR using rigid registration to assess image quality and applicator geometry fidelity.</div></div><div><h3>RESULTS</h3><div>All physics tests passed within acceptance tolerances. Registration of CBCT images to MR and CT scans was acceptable for applicator placement. Applicator registration of CBCT images to CT demonstrated excellent agreement of most distal source dwell position (<1 mm). Slice thickness was also measured to be 1.25 mm, within 0.5 mm of its nominal value.</div></div><div><h3>CONCLUSION</h3><div>Based on E2E and commissioning results, IRm is an appropriate tool for brachytherapy treatment planning. This study demonstrated good image quality in GYN phantom and Venezia applicator using the IRm. Distal source dwell position agreement between CBCT and CT was acceptable for clinical use.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 687-697"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303356","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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.08.255
J.V. Panetta, I. Veltchev, E. Horwitz, M. Hallman, K. Wong, R.A. Price, C.M.C. Ma
{"title":"Overview of treatment plan quality in a high dose rate prostate brachytherapy workflow","authors":"J.V. Panetta, I. Veltchev, E. Horwitz, M. Hallman, K. Wong, R.A. Price, 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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.07.004
C.K. Matrosic , S. Kronenberg , H. Demirci , J.A. Hayman , H. Han , C. Lee
{"title":"A novel 3D-printed brachytherapy applicator and Monte Carlo model for the treatment of conjunctival tumors","authors":"C.K. Matrosic , S. Kronenberg , H. Demirci , J.A. Hayman , H. Han , 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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.07.006
Taylor Dear , Jodi Chiu , Harley Meirovich , Amie Malkin , Razan Amjad , David D'Souza , Jeannie Callum , Eric Leung , Kate Kelly , Alejandro Lazo-Langner , Ziad Solh
{"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 , Jodi Chiu , Harley Meirovich , Amie Malkin , Razan Amjad , David D'Souza , Jeannie Callum , Eric Leung , Kate Kelly , Alejandro Lazo-Langner , 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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.07.003
Genevieve Loos , James P Buteau , Justin Oh , Sylvia Van Dyk , David Chang , Declan G Murphy , Michael S Hofman , Scott Williams , Sarat Chander
{"title":"PSMA PET/CT patterns of recurrence after mono-brachytherapy in men with low and intermediate prostate cancer and subsequent management","authors":"Genevieve Loos , James P Buteau , Justin Oh , Sylvia Van Dyk , David Chang , Declan G Murphy , Michael S Hofman , Scott Williams , 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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.06.006
Christopher L. Deufel, Eric E. Brost, Justine M. Dupere, Ivy A. Petersen, Michael G. Haddock, Allison E. Garda
{"title":"EMVision: An electromagnetic tracking guidance system for accurate placement of interstitial brachytherapy applicators","authors":"Christopher L. Deufel, Eric E. Brost, Justine M. Dupere, Ivy A. Petersen, Michael G. Haddock, 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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.03.004
Dominic Rafie, David Beyer, Kyle Schmanke, Frank Rafie
{"title":"Determination of the optimal time for planning SAVI brachytherapy for APBI","authors":"Dominic Rafie, David Beyer, Kyle Schmanke, 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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.06.004
Chengjun Feng, Xiaomin Wen, Shiting Li, Li Hua, Shaojun Chen
{"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, Xiaomin Wen, Shiting Li, Li Hua, 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> < 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> < 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}
BrachytherapyPub Date : 2024-11-01DOI: 10.1016/j.brachy.2024.06.005
Alexander Lukez , Brian L. Egleston , Peter L. Lee , Krisha J. Howell , Jeremy G. Price
{"title":"National Cancer Database analysis of radiation therapy consolidation modality and dose for inoperable endometrial cancer","authors":"Alexander Lukez , Brian L. Egleston , Peter L. Lee , Krisha J. Howell , 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}