Brachytherapy最新文献

{"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}

{"title":"GSOR08 Presentation Time: 5:35 PM","authors":"Mayank Patel MD MBA ,&nbsp;Samyukta Jhavar BS ,&nbsp;Gaurav Gomber BS ,&nbsp;Anne Hubbard MBA ,&nbsp;Ann Klopp MD PhD ,&nbsp;Andrew Farach MD ,&nbsp;Michelle Ludwig MD MPH PhD","doi":"10.1016/j.brachy.2024.08.054","DOIUrl":"10.1016/j.brachy.2024.08.054","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy is a critical component of definitive cervical cancer treatment. Timely access to treatment has shown an improved survival benefit. Texas is the second largest state by size and population in the US. Here we explore the geographic availability of brachytherapy (BT) centers in the state.</div></div><div><h3>Materials and Methods</h3><div>We queried publicly available data on cervical cancer incidence and mortality between 2010-2020 from the Texas Cancer Registry. Available BT centers were compiled from the Texas Department of State Health Services (DSHS) Radiation Control Program and verified by direct contact with each treating institution. Number of BT units per 1,000 new cases was calculated as an index of BT availability.</div></div><div><h3>Results</h3><div>The state currently has 48 institutions actively treating cervical cancer with definitive tandem &amp; ring/ovoid intracavitary BT. Texas DSHS geographically divided the state into 11 public health regions (PHR) to support and coordinate the local health needs of the entire state. PHR 8 located in the south-central region has the lowest availability of centers (1.23 centers/1,000 new cases), while PHR 1 in the north region has the highest availability (8.73 centers/1,000 new cases). The overall Texas incidence rate, mortality rate, and BT availability is 9.4 per 100,000 (US rate 7.7), 2.8 per 100,000 (US rate 2.6), and 3.43 per 1,000 new cases, respectively. In Texas, it is estimated that 45% of cases are diagnosed with locally advanced disease. The overall state locally advanced incidence rate is 4.2 cases per 100,000 population, which is 55% higher than the national locally advanced incidence rate of 2.7. Annually, 31% of all cervical cancer patients diagnosed in Texas die from the disease, as compared to only 10% nationally. On the county level, Henderson County has the highest mortality rate (5.8 deaths per 100,000 population) and no BT availability. Hidalgo County located on the southern border has the highest incidence (500) and deaths (157) of rural counties. Fort Bend County has the highest absolute incidence (263) and deaths (90) for a county without any BT centers. Angelina County has the highest incidence rate (15.9 per 100,000) with a non-zero death rate (3.9 per 100,000).</div></div><div><h3>Conclusions</h3><div>Compared to national rates, Texas has a higher overall incidence rate of cervical cancer overall and locally advanced cervical cancer highlighting the need for widespread access to BT services across the state. Herein, we review cervical cancer incidence rates, mortality rates, and access to intracavitary BT centers by county and PHR to identify BT deserts across the state. This analysis identifies the highest at-risk populations and opportunities for improved BT access. There is an existing need for expanded geographic access to high-quality BT centers and well-trained brachytherapists across Texas.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S45-S46"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527138","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":"MSOR10 Presentation Time: 8:45 AM","authors":"Yhana Chavis DO,&nbsp;Kristin Walker MD MBA,&nbsp;Allen Luk MD,&nbsp;Daniel Leach MD,&nbsp;Kara Romano MD,&nbsp;Einsley Janowski MD PhD","doi":"10.1016/j.brachy.2024.08.072","DOIUrl":"10.1016/j.brachy.2024.08.072","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Brachytherapy (BT) boost is the standard of care technique for locally advanced cervical cancer (LACC) and a critical component of curative treatment. Overall treatment time strongly correlates with local control, with evidence indicating that completion of chemoradiation within 8 weeks is important for clinical outcomes. Socioeconomic and racial factors are also known to contribute to disparities in BT access and have been linked to worsened survival. The aim of our study is to explore factors impacting timely completion of BT treatment amongst LACC patients treated at a single academic institution that serves a large catchment area in the state of Virginia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients diagnosed with LACC receiving their BT at the University of Virginia (UVA) between 2004 and 2021 were identified. Patient demographics and additional characteristics were recorded, including: insurance and employment status, alcohol and/or drug use disorder, and distance from UVA Cancer Center. Based on proven prognostic factors for local control of LACC, the cut off of 56 days to complete treatment was used for stratification, looking at demographic differences between those groups who received timely or prolonged therapy completion. The means for each demographic were compared using standard error and simple unpaired t-tests.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;124 patients with LACC, FIGO stage IB2 to IV were included Median age of our cohort at time of treatment was 49.8 years. 50% of patients were employed, 42% were unemployed, and 8% had unknown employment status. 79% of patients had listed insurance, 11% had no insurance, and 10% had unknown insurance information. Racial demographics were 74% white, 15% black, 9% Hispanic, 2% Asian, and &lt;1% unidentified. 4% of patients had a history of incarceration, 3% of patients had a known history of or current drug abuse, and 2 of the above patients had both factors. Out of the 124 patients, 24 patients completed concurrent chemoradiation and BT beyond 56 days. The statistically significant social barriers identified in this group included employment, insurance status, and drug use. Employed patients completed treatment on an average of 49.7 ± 1.1 days (range 36-79), compared to 51.44 days ± 1.5 days (range 34-87) for unemployed patients &lt;em&gt;(p&lt;/em&gt; = 0.0135). Insured patients completed their treatment within 50.6 ± 0.9 days (range 43-71), compared to 59.14 ± 1.9 days (range 34-87) for uninsured, (&lt;em&gt;p&lt;/em&gt; = 0.035). On average, white, Hispanic, and black women completed treatment in 50.9 ± 1.02 days, 48.9 ± 1.58 days, and 54.0 ± 2.5 days, respectively (&lt;em&gt;p&lt;/em&gt;=0.20 for white versus black cohorts). Average completion time was 50.6 ± 0.9 (range 34-87) in the non-incarcerated group compared to 55 ± 5 days (range 47-70) in the incarcerated group, &lt;em&gt;p&lt;/em&gt; =0.32, and average completion time was 50.3 ± 0.9 days (range 34-87) in the non-drug use compared to 65.5 ± 2.1 day","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S55-S56"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526902","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":"MSOR12 Presentation Time: 5:55 PM","authors":"Felipe Castro Canovas MD, DRCPSC,&nbsp;Carlos Herrera Castillo MSc,&nbsp;Eduardo Carrasco Solis MSc,&nbsp;Yesenia Miranda Tunque MD,&nbsp;Luis Gamarra Delgado MD,&nbsp;Indranit Revilla Coz MD,&nbsp;Gustavo Lasteros Ayma MD,&nbsp;Juan Manuel Trejo Mena MD,&nbsp;Herbert Cardenas Del Carpio MD,&nbsp;Paola Fuentes-Rivera Carmelo MD,&nbsp;Alberto Lachos Davila MD,&nbsp;Adela Heredia Zelaya MD,&nbsp;Karinthia Ballon Cervantes MD","doi":"10.1016/j.brachy.2024.08.046","DOIUrl":"10.1016/j.brachy.2024.08.046","url":null,"abstract":"<div><h3>Purpose</h3><div>This single-institution proof of concept and early experience on an innovative workflow for the creation of custom applicators for high dose rate (HDR) skin brachytherapy and skin bolus in low to middle-income countries, where access to CT simulation or dedicated surface scanners is sparse, we utilized geometry mapping technology found in many readily available smartphones as an alternative to other design methods, reducing the number of CT-simulations needed from two to one, improving access to custom applicators for more patients. We now report our skin brachytherapy early experience.</div></div><div><h3>Materials and Methods</h3><div>In selected consenting patients with indication for skin brachytherapy or EBRT, a smartphone front camera system (e.g. Apple iPhone X or newer with TrueDepth camera) was used to capture the skin surface with capturing software (Apple iOS - Heges 3D Scanner by Marek Simonik), then exported to a computer-aided design software to blueprint the applicator (Meshmixer and Fusion 360 Autodesk on Apple MacOS or Microsoft Windows). The applicator was then 3D printed in-house using a fused deposition modeling printer (Flashforge Adventure 3) with polylactic Acid (PLA) material. The applicator completed a quality assurance examination and then fitted to the patient for a single CT simulation for planning (SagiPlan®), quality assurance and treatment delivery with a Cobalt - 60 after loader (SagiNova®). Follow-up was conducted per standard institutional protocol, and Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE) was used to report toxicities.</div></div><div><h3>Results</h3><div>From July 2023 to January 2024, 05 patients were scanned, 4 patients received a 3D printed custom bolus for EBRT, and 1 patient received a custom HDR skin brachytherapy custom applicator, the one patient treated with HDR brachytherapy is reported, had basal cell carcinoma of the nose, the prescription dose was 40Gy in 10 fractions delivered daily, 100% isodose line encapsulated the PTV, limiting surface dose &lt;150%. Acute grade 1 skin toxicity was observed at the end of treatment, it completely resolved at 3 months. No late toxicity or recurrence was observed at 6 months.</div></div><div><h3>Conclusions</h3><div>This small, early-reported experience with a novel workflow seems faceable and safe, potentially allowing less congestion at the CT Sim, improving access for more patients in low to middle-income countries to custom 3D printed accessories. A larger number of patients and longer follow-ups are needed, report on 3D EBRT bolus results to follow.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S41"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526540","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":"MPP03 Presentation Time: 4:18 PM","authors":"Tamer Soror MD, PhD ,&nbsp;Pierre-Alexander Justenhoven MD ,&nbsp;Anke Leichtle MD, PhD ,&nbsp;Karl-Ludwig Bruchhage MD, PhD ,&nbsp;György Kovács MD, PhD ,&nbsp;Dirk Rades MD, PhD","doi":"10.1016/j.brachy.2024.08.017","DOIUrl":"10.1016/j.brachy.2024.08.017","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Periorificial facial cancer (PFC), characterized by cancer originating from the eyelids, nasal vestibule, lips, and ear lobules, exhibits significantly high global incidence rates. Radical surgery have both functional and aesthetic complications. This retrospective analysis explores the effectiveness of high-dose-rate interventional radiotherapy (HDR-IRT, brachytherapy) combined with organ-preserving surgery for managing PFC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective assessment of patients with PFC and treated with HDR-IRT at our center between 2008 and 2022. Patients underwent a physical examination, tumor biopsy, and head-and-neck CT and/or MRI for locoregional staging. The decision of organ-preserving surgery with HDR-IRT was made by a specialized multidisciplinary tumor board. Organ-preserving surgery ranged from tumor debulking to complete local resection. HDR-IRT catheters were immediately implanted in the operating room, in a parallel arrangement with 8-12 mm spacing. The clinical target volume included the estimated tumor volume and a safety margin (5-15 mm) based on anatomical considerations and nearby critical structures. The prescribed radiation dose was administered twice daily with a minimum six-hour gap between fractions. The median HDR-IRT dose was 40Gy (30-50), the median fraction dose was 4Gy (2.5-5), and the median number of fractions was 10 (8-16). Treatment-related toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 123 patients were identified, with primary sites as follows: 24 (19.5%) eyelids, 58 (47.2%) nasal vestibule, 25 (20.3%) lips, and 16 (13%) ear lobules. The median age was 76 years (37-99), with 60.2% (74/123) males and 39.2% (49/123) females. Sixty-four percent (64.2%) had primary tumors, and 35.8% had recurrent tumors. Among patients with recurrent tumors, 40 had previous surgery, and four were primarily treated with EBRT. Debulking surgery was performed in 16 patients (13%), and neck dissection in 14 patients (11.4%). Among 107 patients undergoing local resection, eight had close surgical margins, 40 had positive margins, and four had macroscopic residuals. T-status included T1 (53.7%), T2 (28.5%), T3 (10.5%), and T4 (7.3%). Six patients had positive neck lymph nodes. Squamous cell carcinoma constituted 61.8%, basal cell carcinoma 30.9%, and other histologies 7.3%. The median follow-up time was 38 months (4-147). During follow-up, 15 local recurrences (12.2%) were documented, with a median time to recurrence of 13 months (5-71). Local recurrence rates by tumor site were as follows: Nose 10/58 (17.2%), eyelid 3/24 (12.5%), lip 1/25 (4%), and ear lobule 1/16 (6.3%). The 5-year local control (LC) rate was 85.3%, with 10-year and 12-year LC rates of 80.8%. Five-year, 10-year, and 12-year disease-free survival (DFS) rates were 87.8%. Five-year distant ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S24-S25"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526617","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}