Brachytherapy最新文献

{"title":"Gastrointestinal and genitourinary toxicity following high dose rate vaginal cuff brachytherapy for endometrial cancer.","authors":"Niki Tselepidakis, Ruyun Jin, Bethany Horton, Wendy Zheng, Einsley Marie Janowski, Kara Romano","doi":"10.1016/j.brachy.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.02.005","url":null,"abstract":"<p><strong>Purpose: </strong>There are currently no organs at risk dose constraints for adjuvant HDR vaginal cuff brachytherapy (VBT). This study evaluates OAR dosimetry and the association with acute and chronic gastrointestinal (GI) or genitourinary (GU) toxicity.</p><p><strong>Methods: </strong>Patients treated at a single institution with VBT of 21 Gray (Gy) in 3 fractions (Fx) prescribed to 5 mm depth twice weekly and CT-based 3D planning were reviewed. OAR doses (D2cc, D1cc, and D0.1cc) were recorded. Acute and chronic toxicities were graded by Common Terminology Criteria for Adverse Events v5.0. Boxplot and Wilcoxon-Mann-Whitney tests compared dose thresholds.</p><p><strong>Results: </strong>177 patients with stage I-IV endometrial cancer received a mean D2cc to rectum, sigmoid, small bowel, and bladder of 5.7 Gy (range: 2.8-8.7), 3.3 Gy (0.6-9.3), 3.8 Gy (0.0-9.1), and 5.4 Gy (2.0-8.2). Overall, 6.2% (n = 11) and 7.3% (n = 13) of patients experienced acute GI and GU toxicity of any grade. 14.7% (n = 26) and 14.7% (n = 26) of patients experienced chronic GI and GU toxicity of any grade, respectively. There were two grade 3 toxicities include one chronic GI and one acute GU. No dosimetric factors were identified that correlated with a higher likelihood of acute or chronic toxicity.</p><p><strong>Conclusions: </strong>The overall rate of GI and GU toxicity following VBT of 21 Gy in 3 Fx is low, and there are no dosimetric parameters that correlate with toxicity. The optimal dose fractionation schedule that balances high local control with minimal toxicity is yet to be determined.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and dosimetric analysis of reirradiation of oral cavity and oropharyngeal cancers with high-dose-rate brachytherapy.","authors":"Christina Phuong, Lisa Ni, Manju Sharma, J Adam M Cunha, Sue S Yom, I-Chow Hsu, Jason W Chan","doi":"10.1016/j.brachy.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.02.002","url":null,"abstract":"<p><strong>Purpose: </strong>This study sought to evaluate the outcomes and toxicities from oral cavity (OC) and oropharynx (OP) high-dose-rate brachytherapy (HDRBT) for re-irradiation (reRT) of head and neck squamous cell carcinoma (HNSCC).</p><p><strong>Methods: </strong>Patients who previously received curative-intent external beam radiotherapy for primary HNSCC and were treated with OC/OP reRT with HDRBT from January 2000 to December 2021 were included. Patients were selected by a multidisciplinary tumor board to be appropriate candidates for HDRBT for one of two reRT indications: (1) definitive reRT or (2) postoperative reRT. Survival outcomes were estimated using the Kaplan-Meier method. Efficacy and toxicity outcomes were analyzed for the entire cohort and separately based on reRT indication.</p><p><strong>Results: </strong>27 patients were evaluated with a median follow up of 20 (IQR 12-41) mo. 14 (52%) and 13 (48%) patients were treated for a recurrent or second primary OC and OP HNSCC, respectively. Median dose of prior EBRT was 68.4 (IQR 60-70) Gy. Median interval between completion of EBRT to HDRBT reRT was 42 (IQR 14-85) mo. Median target volume was 16 (IQR 10-29) cc; median D90% was 31 (IQR 30-36) Gy. In cohorts A and B, 2-year LC/late grade ≥3 toxicity were 70%/57% and 60%/15%, respectively.</p><p><strong>Conclusions: </strong>HDRBT for reRT of small (<4 cm), recurrent, or second primary OC/OP HNSCC provided LC and late grade ≥3 toxicity rates similar to historical outcomes with EBRT reRT.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Tailored Anal canal Radiotherapy (HIT-ART): Long term results of MR image-guided interventional radiotherapy (brachytherapy) boost.","authors":"Luca Tagliaferri, Stefania Manfrida, Bruno Fionda, Nicola Dinapoli, Brunella Barbaro, Viola De Luca, Elisa Placidi, Roberta Bertolini, Fabio Marazzi, Valentina Lancellotta, Vincenzo Frascino, Alessio Giuseppe Morganti, Maria Antonietta Gambacorta","doi":"10.1016/j.brachy.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.01.006","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to investigate the outcomes in terms of survival, treatment compliance and toxicity in a cohort of patients treated with personalized chemoradiation (RCT) followed by image guided Interventional Radiotherapy (IG-IRT), stratified by clinical baseline stage and treatment response.</p><p><strong>Methods and materials: </strong>We analyzed patients with histologically proven squamous anal carcinoma treated using intensity modulated radiation therapy (IMRT) with curative intent, and IRT boost. External beam radiation was delivered using personalized IMRT technique with a simultaneous-integrated boost (SIB) to deliver 45 to 55 Gy in 25 fractions according to clinical stage. After the end of the RCT patients underwent clinical and imaging re-evaluation, and according to initial stage of disease and tumor response, a radiotherapy boost was administered through IG-IRT, performing MRI with IRT applicator on site (trans-anal position) and defining GTV on MRI imaging. All patients' treatments and outcomes data were collected by an internal database. The endpoints were in terms of overall treatment time (OTT), toxicity, clinical complete response (cCR), locoregional failure (LRF), colostomy free survival, overall survival (OS) and disease-free survival (DFS). Univariate survival analysis with Kaplan- Meier curves was performed to allow between-group comparison.</p><p><strong>Results: </strong>73 patients treated between February 2012 and January 2023 were included in the analysis. 72.6 % were female, with a median age of 65.4 years (range 39.1-89). 62 were staged T2-T4 (T2 42.5.5%, T3 19.2%, T4 27.4%) and 50 (68.5%) had positive nodes. Combined RCT was administered mainly using mitomycin C and 5-fluorouracil. The mean dose received by patients was 50 Gy; after a median time of 43 days (range 9-128) a sequential boost dose was delivered in 1-2 fractions (median dose of 4 Gy). OTT median was 85 days (range 44-225). The median follow-up period was 50.6 months. LRF was 17.8%, and at 3 and 5 years LC was 80.1% and 77.2%, CFS was 80.5 and 77.8%, DFS was 79.3% and 75.9% and OS 95.1%, 84.3% and 61.4% at 10 years. Moreover, we verified that OS was higher in patients who had an OTT lower than 93 days. Toxicity was acceptable: 45.2% of patients experienced a G1-G2 abdominal discomfort (only 5.5% had G3).</p><p><strong>Conclusions: </strong>Our experience confirms that MR Image Guided Interventional Radiotherapy boost is a feasible treatment option with a significant impact on outcomes.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of 3D image-guided brachytherapy for penile cancer: Impact of urethral dose on long-term morbidity.","authors":"Samir Achkar, Mouhamadou Bachir, Rémi Bourdais, Manon Kissel, Tony Felefly, Alexandre Escande, Sophie Espenel, Roger Sun, Cyrus Chargari","doi":"10.1016/j.brachy.2024.02.007","DOIUrl":"https://doi.org/10.1016/j.brachy.2024.02.007","url":null,"abstract":"<p><strong>Purpose: </strong>Interstitial brachytherapy is a conservative treatment approach for localized penile glans cancer. We report our experience with pulse dose rate interstitial brachytherapy (PDR-BT) in the treatment of penile cancer and evaluated urethral dose-volume constraints for clinical practice.</p><p><strong>Methods and materials: </strong>Medical records of patients treated with PDR-BT for localized squamous cell carcinoma of the glans penis in our institution between July 2008 and February 2019 were reviewed. All patients underwent posthectomy followed by CT-guided PDR-BT. Urethral doses were calculated and predictors of urethral stenosis among various clinical and dosimetric characteristics were examined.</p><p><strong>Results: </strong>65 patients were identified. Eight patients (12%) presented initially with inguinal lymph node metastasis. The median brachytherapy dose was 60 Gy (37-65 Gy). The median number of pulses was 150 pulses (87-175 pulses). With a median follow-up of 37 months (3-120 months), 12 patients (18.4%) had tumor local relapse. Three-year overall survival (OS) and disease-free survival (DFS) rates were 88.2% (95%CI: 79.7-97.7%) and 74.4% (95%CI: 63.9-86.6%) respectively. Twelve patients (20%) presented grade 2 painful ulceration resolving spontaneously and 13 patients (21.5%) experienced grade 2 meatal stenosis. No clinical or dosimetric factors correlated with painful ulceration were identified. The risk of meatal stenosis correlated with distal urethra D0.1cc (p = 0.0016) and D0.2cc (p = 0.0019) in multivariate analysis. The optimal cutoff for these constraints were 82 Gy (HR = 0.12, 95%CI: 0.04-0.38) and 79 Gy (HR = 0.19, 95%CI: 0.06-0.56) for D0.1 cc and D0.2 cc respectively.</p><p><strong>Conclusions: </strong>This institutional experience shows that 3D PDR-BT could be a valid option for penile preservation. Dosimetric constraints for late distal urethral toxicity were identified.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraluminal brachytherapy using ¹²⁵I seed strand combined with PTBD and Hepatic arterial infusion chemotherapy for unresectable Bismuth-Corlette III and IV stage hilar cholangiocarcinoma.","authors":"Zi-Han Zhang, Min Li, Hui-Yi Sun, Fei-Hang Wang, Min-Jie Yang, Zhi-Ping Yan, Fu-You Li, Ling-Xiao Liu","doi":"10.1016/j.brachy.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.brachy.2024.12.004","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of ¹²⁵I seed strand combined with percutaneous transhepatic biliary drainage (PTBD) and hepatic arterial infusion chemotherapy (HAIC) for unresectable Bismuth-Corlette III and IV stage hilar cholangiocarcinoma (HCCA).</p><p><strong>Methods: </strong>From January 2018 to December 2021, a total of 128 Bismuth-Corlette III and IV stage HCCA patients with obstructive jaundice were included in this single-center retrospective study. Forty-eight patients underwent ¹²⁵I seed strand combined with PTBD and HAIC (group A). The mean intended dose (r = 10 mm; z = 0; 240 days) in group A was 63.8 ± 0.6 Gy. Eighty cases underwent PTBD plus HAIC (group B). Median overall survival (OS) and median bile duct patency time (BDPT) were compared between the two groups.</p><p><strong>Results: </strong>In the propensity-score matched (PSM) cohort, the median OS and median BDPT were significantly longer in group A than in group B (44 PSM pairs; OS, 13.6 ± 0.4 vs. 8.7 ± 1.4 months, p < 0.001; BDPT, 12.1 ± 0.5 vs. 6.4 ± 0.7 months, p < 0.001). Multivariate analysis revealed that the treatment regimen was an independent prognostic factor of OS. There were no serious complications related to ¹²⁵I seed strand implantation.</p><p><strong>Conclusions: </strong>¹²⁵I seed strand combined with PTBD and HAIC for unresectable Bismuth-Corlette III and IV stage HCCA is safe and effective.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The NorCal brachytherapy waste audit: A simple, validated, toolkit for clinician led waste reduction.","authors":"Claire C Baniel, Katie E Lichter, Melissa A Frick, Jaclyn Wu, Eniola Oladipo, Yufan Fred Wu, Aneesh SwamyS, I-Chow Hsu, Nicolas Prionas, Erik S Blomain, Elizabeth A Kidd, Mark K Buyyounouski, Glenn Rosenbluth, Osama Mohamad, Hilary P Bagshaw","doi":"10.1016/j.brachy.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.01.002","url":null,"abstract":"<p><strong>Purpose: </strong>The healthcare system is resource intensive, and many opportunities exist to reduce medical waste. Brachytherapists performing inherently resource intensive procedures are well poised to initiate the transition to sustainable, climate-smart care. The authors developed a quality improvement-based (QI) NorCal Brachytherapy Waste Audit Toolkit to guide medical waste reduction in brachytherapy procedures and provide climate health education.</p><p><strong>Methods and materials: </strong>The NorCal Brachytherapy Waste Audit Toolkit was validated through brachytherapy waste audits conducted at 2 neighboring hospitals between 2021 and 2023. Waste was categorized into biohazardous waste, nonbiohazardous waste, and anesthesia waste and was weighed and cataloged after each procedure using a standard template by auditors not involved in the brachytherapy case. Findings were analyzed for key drivers of waste production and high impact interventions were selected.</p><p><strong>Results: </strong>Postaudit results demonstrate biohazardous waste reduction of greater than 50%, elimination of over 90% improper biohazardous waste sorting, cost savings ($4.22/kg) and a reduction in landfill waste by over 20%. The Toolkit was made public online and over 18 months, was accessed by 34 distinct individuals from 21 healthcare organizations across 7 countries and led to waste reduction projects in multiple specialties including radiation oncology, emergency medicine, and pediatrics.</p><p><strong>Conclusion: </strong>A QI-based NorCal Brachytherapy Waste Audit Toolkit may help radiation oncologists and healthcare teams beyond radiation oncology reduce waste and contribute toward environmentally sustainable healthcare.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HDR brachytherapy salvage for nodular prostate fossa recurrence: A mechanistic review and initial report of clinical outcomes.","authors":"Lauren M Andring, Rebecca F Krc, Elleana Paradise, Brandon Li, Arjit Baghwala, Brian Miles, Raj Satkunasivam, Dharam Kaushik, Ramiro Pino, Bin S Teh, E Brian Butler, Andrew M Farach","doi":"10.1016/j.brachy.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.brachy.2024.12.006","url":null,"abstract":"<p><strong>Purpose: </strong>Biochemical recurrence (BCR) occurs in approximately 30% of men after upfront prostatectomy (RP) for prostate cancer. Salvage fossa brachytherapy offers a promising local treatment option. Here we describe a salvage technique and report initial outcomes.</p><p><strong>Materials and methods: </strong>Patients with local BCR and no evidence of distant metastases were included. Clinical, toxicity and dosimetry were collected.</p><p><strong>Results: </strong>At a single institution, 23 patients completed prostate fossa brachytherapy salvage. Seven patients had received prior pelvic EBRT for an initial recurrence after RP and received HDR BT as definitive treatment for a second local recurrence. The remaining 16 patients were treated with combination EBRT + BT for initial recurrence after RP. Median age was 69 and PSA prior to salvage was 1.12 ng/mL. Ten patients (43.5%) received androgen directed therapy at the time of salvage, and 13 (56.5%) received local therapy only. After median follow up of 12 months, the median PSA decreased to 0.1 ng/mL. Eight patients (34.8%) remain on ADT. All patients have local disease control. Three patients developed locoregional failures, and two developed distant metastases. There were 17 (73.9%) acute grade 1 GU toxicities, two acute grade 2 GU toxicities (8.7%), and a single grade 3 (4.3%) GU toxicity. There were 6 acute grade 1 GI toxicities (26.1%), and a single patient with late grade 3 GU toxicity (4.3%). No grade 4 or higher toxicities were reported.</p><p><strong>Conclusions: </strong>This study found prostate bed BT to be safe and feasible for patients with nodular prostate fossa recurrences in both the initial salvage and salvage reirradiation setting. On preliminary follow up, PSA control rates are acceptable.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the value of an EM tracking quality assurance system for pretreatment verification of needle digitization accuracy in ultrasound-based prostate HDR brachytherapy.","authors":"Christopher L Deufel, Eric E Brost, Justine M Dupere, Jessica M Wilson, Mark R Waddle, Bradley J Stish","doi":"10.1016/j.brachy.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.01.003","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and deploy an electromagnetic (EM) tracking-based platform for pretreatment, patient-specific quality assurance of brachytherapy applicator digitization, with the goals of intercepting human errors and quantifying treatment planning dose uncertainties.</p><p><strong>Methods: </strong>An EM tracking platform, EMQA, was developed for patient-specific quality assurance of HDR treatment plan needle reconstructions. EMQA compared needle geometry between a manually digitized clinical HDR treatment plan and EM-tracked positions. Pretreatment quality assurance (QA) was performed for 25 implants (20 patients). Distance and dose metric differences were reported. Factors influencing accuracy were analyzed, including radial distance from the ultrasound probe and EM field generator (EFG), needle 'shadowing' artifacts, needle depth adjustments using exposed needle length protruding from the implant template, and TRUS calibrated speed of sound, v_{SoundEffective}.</p><p><strong>Results: </strong>Needle digitization differences between the clinical plan and EM tracking had a magnitude (mean ± standard deviation [minimum, maximum]) of 0.46 ± 0.36 (0.002, 2.19) millimeters for the needle depths and 0.62 ± 0.44 (0.01, 3.26) millimeters for needle shafts. Dose metric differences (% of Rx) for PTV, CTV, bladder, rectum, and urethra were <1.7% on average, but differences >5% were observed in two patients. Accuracy was notably worse for locations shadowed by more than one needle, decreased with distance from the probe and EFG, and was optimal for v_{SoundEffective}=1570 m/s.</p><p><strong>Conclusion: </strong>Clinical evaluation of an EMQA platform demonstrated the potential to intercept errors in the digital reconstruction of ultrasound-based prostate HDR brachytherapy needles prior to radiation delivery, which may be due to poor image quality or human error. Manual needle digitization accuracy was typically submillimeter, however errors as great as 3 mm were observed. The adoption of EMQA as standard of care is expected to reduce the potential for mistreatment.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D-printed template design to improve ¹²⁵I seed plaque assembly accuracy for uveal brachytherapy.","authors":"Kaitlyn Calabresi, Jacqueline Emrich, Sara Belko, Robert Pugliese, Lydia Komarnicky-Kocher, Firas Mourtada","doi":"10.1016/j.brachy.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.01.004","url":null,"abstract":"<p><strong>Purpose: </strong>To demonstrate the utility of a QA program for seed localization, and to design a 3D-printed template to improve the accuracy of seed placement on custom-built ¹²⁵I eye plaques for uveal brachytherapy.</p><p><strong>Methods and materials: </strong>A seed localization analysis tool (SLAT) was developed in MATLAB to detect variations in seed placement relative to a treatment plan. A flexible seed placement template (3D-FSPT) was designed in CAD and printed using a Formlabs Form-3 3D printer. The 3D-FSPT and SLAT were tested using 3D-printed model eye plaques with nonradioactive seeds arranged following clinically-relevant treatment plans. Five clinical plaques were also evaluated.</p><p><strong>Results: </strong>SLAT detected submillimeter scale variations in seed position with 2.3% error relative to the plan's seed coordinates, and with an uncertainty of ± 0.01 mm. The average seed displacement on the model plaques with free-handed seed placement was 1.31 mm (SD = 0.61), and the average seed orientation difference was 5.27 degrees (SD = 4.77). The average seed displacement on the clinical plaques was 0.77 mm (SD = 0.42), and the average seed orientation difference was 4.41 degrees (SD = 3.00). For the clinical plaques, changes in dosimetry to the tumor apex and critical eye structures were within acceptable tolerances. Seed displacement (mm) (p < 0.001) and seed orientation differences (degrees) (p = 0.008) were significantly lower using the template to guide seed placement on the model plaques compared to free-handed seed placement.</p><p><strong>Conclusions: </strong>The feasibility of a 3D-FSPT and SLAT is demonstrated for improving seed placement accuracy relative to a treatment plan.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D-printed needle guides for cervical cancer brachytherapy: Optimized dosimetry and improved local control outcomes.","authors":"Santino Butler, Thomas Niedermayr, Elizabeth A Kidd","doi":"10.1016/j.brachy.2025.01.001","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.01.001","url":null,"abstract":"<p><strong>Purpose: </strong>We previously designed three-dimensionally-printed needle guides (3D-NG) for cervical cancer brachytherapy, which improved procedure efficiency and tumor coverage while achieving similar organs at risk (OAR) sparing compared to non-3D-printed techniques (non-3D). The subject of this study was whether 3D-NG can help improve local control and other brachytherapy outcomes.</p><p><strong>Methods: </strong>This single institution cohort study includes 130 patients who underwent definitive external-beam radiotherapy and high-dose-rate intracavitary +/- interstitial brachytherapy from February 2017 to July 2023. 3D-NG were implemented for all cases after December 2019 (N = 77). Non-3D included applicator-only/no-needles (N = 28) or freehand-placed needles (N = 25).</p><p><strong>Results: </strong>Median follow-up was 24 months. 3D-NG, versus non-3D, achieved higher mean D90 (+5.2 Gy, p < 0.001), D98 (+4.3 Gy, p < 0.001), and V100_average (+5.9%, p < 0.001)-with greater improvement for larger tumors (high-risk[HR]-CTV>30 cubic-centimeters[cc]) (P_interaction<0.10 for all). Maximum D2cc for all OAR were comparable between 3D-NG and non-3D (p > 0.05). 2-year LF was lower with 3D-NG compared to non-3D (8.2% vs. 22.0%; aHR 0.31, p = 0.036)-and compared to freehand-needles alone (8.2% vs. 20.6%, p < 0.001 [log-rank])-particularly among cases with higher cumulative HR-CTV dose (D90 >85 Gy; p_interaction = 0.013) and lower HR-CTV volume (≤30 cc; p_interaction = 0.048). 2-year LF was also lower with concurrent cisplatin (aHR 0.20, p = 0.001) and ≥40% decrease in tumor diameter after EBRT (aHR 0.16, p = 0.010); but higher among minority race (aHR 4.21, p = 0.06).</p><p><strong>Conclusions: </strong>3D-NG for cervix brachytherapy were associated with improved 2-year LF compared to non-3D/freehand-needles, with higher achievement of EMBRACE II goals for D90 and D98, with similar OAR doses. This study highlights the potential for 3D-NG to simplify needle insertion while simultaneously improving needle position, dosimetry, and disease control outcomes.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}