Brachytherapy最新文献

{"title":"Choosing between the best, the easiest and the most usual: Three different dose prescription methods for HDR vaginal-cuff brachytherapy planning in postoperative endometrial cancer.","authors":"Faegheh Noorian, Antonio Herreros, Rosa Abellana, Clara Baltrons, Cristian Candela-Juan, Eduard Agulló-Roca, Faranak Noorian, Ángeles Rovirosa","doi":"10.1016/j.brachy.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.03.005","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate and compare dosimetry parameters of three planning methods in high-dose-rate vaginal cuff brachytherapy (VCB) using cylinders for postoperative endometrial cancer (PEC).</p><p><strong>Material and methods: </strong>Two hundred seventeen patients were treated with 3D-based VCB for PEC, with the dose prescribed at 5 mm from the applicator surface. Three planning methods were retrospectively compared: T1-arm: point-based optimization at 5 mm from the applicator surface; T2-arm: volume-based optimization; T3-arm: graphical optimization. We evaluated the coverage index (CI), conformity index (COIN), D90 to clinical target volume (CTV) and dose to the organs at risk (OAR).</p><p><strong>Statistics: </strong>Descriptive analysis, Chi-square test, Student`s t-test, GEE model, linear regression model.</p><p><strong>Results: </strong>The mean CI was greater than 0.9 in all treatment arms. The T2-arm provided the highest COIN value while T1-arm provided the highest CI value. The T3-arm delivered the lowest doses to the vaginal CTV, rectum and bladder. The linear regression model suggested that in the T3-arm, COIN showed improvement at the expense of CI and achieving a balance between CI and COIN may be more feasible when administering the T2-arm.</p><p><strong>Conclusion: </strong>The T2-arm may be considered a general optimization method since it provides a better COIN within an acceptable D90 to the CTV. However, the T3-arm is easier in daily practice and could be more beneficial for patients who are more likely to develop late complications in OAR. More studies are needed to clarify the correlation of late complications with planning methods and dosimetry variables.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086908","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":"Twice daily template-based interstitial brachytherapy for gynecologic cancers: What is the optimal dose?","authors":"Ria Mulherkar, David Grimm, Paniti Sukumvanich, Madeleine Courtney-Brooks, Michelle Boisen, Jessica Berger, Sarah Taylor, Jamie Lesnock, Shannon Rush, Allison Garrett, Haider Mahdi, John Comerci, Alexander Olaiwaye, Robert Edwards, Elangovan Doraisamy, Michael Hajduk, Christopher J Houser, Hayeon Kim, John Austin Vargo","doi":"10.1016/j.brachy.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.03.002","url":null,"abstract":"<p><strong>Introduction: </strong>Several factors of template-based interstitial brachytherapy in gynecologic cancers, including large tumor size, invasion into adjacent organs or fistula, dose heterogeneity, and twice daily fractionation cause inherent dose-escalation effects, potentially increasing toxicity. This study reports a single-institutional dose escalation experience in twice daily template-based interstitial brachytherapy treatments to demonstrate tumor control and toxicity outcomes, with the hypothesis that with image-based planning dose-escalation with interstitial brachytherapy is safe and efficacious.</p><p><strong>Methods: </strong>Patients treated with template-based interstitial brachytherapy at our institution from 2006 to 2022 were identified. Over time, HDR brachytherapy boost dose at our institution has been dose-escalated from 18.75 Gy in 5 fractions to 27.5 Gy in 5 fractions. Local control and survival outcomes were analyzed using the Kaplan-Meier method and log-rank test to compare between groups. Formal tumor control probability (TCP) analysis was performed using logistic dose-response modeling.</p><p><strong>Results: </strong>214 patients were identified with median follow-up of 28.1 months (IQR 8.2-58.7). Total HDR dose correlated significantly with local and locoregional control when analyzed as a continuous variable, and when dichotomized around median dose of 25 Gy (p = 0.024). TCP analysis showed a dose-response effect between HR CTV D90 and local control in the entire cohort, and separately in cervical and vaginal cancer subsets. The actuarial 5-year incidence of grade 3 or worse toxicity was 6.1%, and there was no significant association between toxicity and total HDR dose or HR CTV D90.</p><p><strong>Conclusion: </strong>In patient treated with twice-daily template-based interstitial brachytherapy for gynecologic cancers brachytherapy dose correlates with local control with no significant association between brachytherapy dose and toxicity, thus suggesting room for dose-escalation.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047227","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":"A dosimetric evaluation of ureteric doses with and without ureter as avoidance organ in patients treated with MR hybrid brachytherapy for cervical cancer.","authors":"Harjot Kaur Bajwa, Sushil Beriwal, Rajesh Natte, Racharla Chandra Kumar, Rampally Kumar, Suresh Chaudhari","doi":"10.1016/j.brachy.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.02.007","url":null,"abstract":"<p><strong>Purpose: </strong>Ureteric stenosis is a known complication with radiotherapy with studies showing correlation of ureteric dose with stenosis. This study was done to assess the dose delivered to the ureters with and without ureter as avoidance organ in cervical cancer patients treated with hybrid brachytherapy.</p><p><strong>Material and methods: </strong>Cervical cancer patients treated with EBRT and MR hybrid brachytherapy were retrospectively analyzed. They were treated without ureter contoured as organ at risk. The right and left ureters were retrospectively contoured on T2 weighted MRI images. Dose to 0.1cc volume of ureter was documented.</p><p><strong>Results: </strong>26 patients treated with hybrid brachytherapy were analyzed. The median HRCTV volume was 23.9cc. The median HRCTV D90 & GTV D98 EQD2 were 91.09Gy (IQR 92.36-87.28) and 104.67Gy (IQR 113.90-95.04) respectively. The median D2cc for bladder, rectum and sigmoid were 75.46Gy, 58.10Gy and 61.3Gy EQD2 respectively. The mean minimum distance of the left ureter from HRCTV was 3.2mm (IQR 6.75-1) & right ureter was 2.3mm (IQR 8-0). The mean D_0.1cc to the left ureter was 75.16Gy EQD2 (IQR 88.28-58.20) and to the right ureter was 69.73Gy EQD2 (IQR 76.77-56.01). The ureter D_0.1cc exceeded 77Gy in 13/26 patients. Replanning and reducing needle loading near the ureter resulted in reduction of ureter 0.1cc dose to less than 77Gy in all but 2 patients, without compromising the HRCTV coverage.</p><p><strong>Conclusion: </strong>The ureter is at risk of receiving high doses when we use hybrid applicator. MR planning to delineate the ureter and careful optimization of needles can result in significant reduction of ureter dose with similar target coverage.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045015","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 HDR brachytherapy for cervical cancer in LMIC: Audit of a single institution experience in Lagos, Nigeria.","authors":"Adedayo Joseph, Chika Nwachukwu, Bolanle Adegboyega, Omolola Salako, Temitope Andero, Adewumi Alabi, Azeezat Ajose, Samuel Adeneye, Nusirat Adedewe, Abdallah Kotkat, Aishat Oladipo, Omoruyi Credit Irabor, Muhammad Habeebu, David Puthoff, Adedayo Onitilo, Wilfred Ngwa, Onyinye Balogun","doi":"10.1016/j.brachy.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>The first 3D high-dose-rate brachytherapy (3D-HDR-BT) program for gynecological cancers in Lagos, Nigeria, was launched in August 2021. A retrospective audit of the pilot program was conducted to report the institution's initial experience in treating cervical cancer within the framework of the American Brachytherapy Society (ABS) guidelines.</p><p><strong>Methods and materials: </strong>24 patients were audited and divided into 2 groups: Group A, which included the first twelve (who had been treated within 3 months of the program launch), and Group B, which included the next twelve (who received treatment over a subsequent period of 5 months).</p><p><strong>Results: </strong>The average age was 58.04 years, with the most common stage at presentation being FIGO Stage IIB (50%). Squamous cell carcinoma was the prevalent histologic type (87.5% of cases). The predominant EBRT regimen was 1.8Gy x 25 fractions in 66.67% of patients. For brachytherapy, 62.5% received the 8Gy x 3 fractions regimen. All patients received weekly concurrent chemotherapy with external beam radiation, with the majority getting cisplatin monotherapy during external beam radiotherapy (EBRT). The mean dose to D90 of the HR-CTV was 77.48 ± 6.95Gy and 88.93 ± 4.20Gy in Group A and B patients, respectively. A comparative assessment revealed significant improvement in HRCTV D90 doses for Group B patients.</p><p><strong>Conclusion: </strong>We report evident improvement in HRCTV D90 doses with increasing numbers and duration of practice, indicating that team proficiency improves with an increasing number of patients treated. Future studies will focus on overall survival and local control rates among patients treated on the program.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033999","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":"Hands-on training using human cadavers: An educational method for head and neck brachytherapy.","authors":"Monali Swain, Ashwini Budrukkar, Elena Dizendorf, Suman Ghosh, Uday Bhat, Sarbani Ghosh Laskar, Samarpita Mohanty, Anuj Kumar, Shwetabh Sinha, Rituraj Upreti, Shrikant Kale, Priyadarshini Sahoo, Jai Prakash Agarwal","doi":"10.1016/j.brachy.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.02.004","url":null,"abstract":"<p><strong>Purpose: </strong>To report the impact of didactic lectures with hands-on cadaveric training for head and neck brachytherapy (BT) as part of a teaching course.</p><p><strong>Materials and methods: </strong>The 1st BT teaching course under Elekta BrachyAcademy for head and neck cancer (HNC) and breast cancer was conducted at Tata Memorial Hospital, Mumbai, India. Didactic lectures with cadaveric workshop and hands-on training for planning procedure were taught to the participants. Both precourse survey and postcourse evaluation were conducted.</p><p><strong>Results: </strong>Total 33 radiation oncologists (ROs) and seven medical physicists were trained. The major goals of participating in the master course were to increase confidence in performing brachytherapy and to begin practicing it, as indicated by 23 and 20 responses, respectively. Nine ROs were already doing the BT for HNC, 18 participants were willing to start HN BT procedure within 1year from the training course and five participants did not have the necessary equipment in the postcourse evaluation, 95% and 94% of participants acknowledged adequate coverage of the scope of the topic and the clarity of the content, respectively, as very good or good (5 or 4) in a scale of 5. The training course met the expectation of 94% of the participants. The hands-on training on cadavers for buccal mucosa cancer was considered as very good by 96% of participants and was most useful and needed. One participant insisted on the lacuna of systematic training program for BT in India.</p><p><strong>Conclusions: </strong>Didactic training with hands-on procedure led to increase in confidence and appears to be one of the suitable methods for training HN BT.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055176","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":"A novel technique for the quality assurance of dwell positions for ovoid applicators using 2D optical imaging.","authors":"Jette Borg, Akbar Beiki-Ardakani, Hedi Mohseni, Maryam Golshan, Alexandra Rink, Robert A Weersink","doi":"10.1016/j.brachy.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.03.003","url":null,"abstract":"<p><strong>Purpose: </strong>We propose a new method for commissioning lunar ovoid applicators in high dose rate gynecology brachytherapy based on 2D optical scintillating imaging of the applicators.</p><p><strong>Methods: </strong>Treatment plans were generated for 22 mm and 26 mm diameter Venezia applicators, using four to eight dwell positions in each ovoid. Images of the applicator dwell positions were acquired using a pinhole apparatus combined with scintillating material and optical camera. Images were acquired for individual dwell positions and processed to identify pixel locations with peak signal intensity. Catheter dwell positions were used to register pixel locations in the optical images and absolute coordinates of the applicator in the treatment planning system. Errors were calculated using the standard deviation in the Euclidean distance between measured and expected ovoid dwell positions. Measurements were repeated three times, including repositioning the applicator on the measurement system.</p><p><strong>Results: </strong>Imaging of each applicator required between 20 and 25 min for all dwell positions. Catheter registration errors were 0.14 ± 0.09 mm and 0.21 ± 0.04 mm for the 26 and 22 mm applicators, respectively. Average differences between the imaged and planned ovoid dwell positions were 0.48 ± 0.14 mm and 0.48 ± 0.16 mm for the 26 and 22 mm applicators, respectively. The maximum difference between the measured and planned ovoid positions was 0.7 mm and 1.3 mm measured for the 26 and 22 mm applicators, respectively. These uncertainties are lower than our clinical tolerance of 2.0 mm.</p><p><strong>Conclusions: </strong>2D-Scintillating imaging of lunar ovoid applicator dwell positions is feasible, accurate and faster than previous methods used at our center.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055218","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":"Primary vaginal cancer treated with high-dose rate brachytherapy and intraprocedural magnetic resonance imaging.","authors":"Ulysses G Gardner, Keara English, Michael Roumeliotis, Serena Mao, Todd McNutt, Mohammad Rezaee, Junghoon Lee, Akila N Viswanathan","doi":"10.1016/j.brachy.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.03.001","url":null,"abstract":"<p><strong>Purpose: </strong>To report outcomes among primary vaginal cancer patients treated definitively with either external beam radiation therapy plus high-dose rate (HDR) brachytherapy (EBRT-BT) or BT (BT) alone with placement of interstitial catheters under magnetic resonance imaging (MRI) guidance.</p><p><strong>Methods: </strong>Retrospective review of 41 patients treated for primary vaginal cancer from 2016 to 2022. Kaplan-Meier (KM) estimates were generated for disease-free survival (DFS), local control (LC), and overall survival (OS).</p><p><strong>Results: </strong>Median follow-up was 28 months (range 2-82 months). A total of 36 patients had EBRT-BT, 5 had BT alone. Forty patients had template interstitial and 1 had a multichannel cylinder. Among patients who received EBRT-BT, median total D90 EQD2 was 68.3 Gray (Gy) (range 56.6-91.5 Gy); BT only, median 40.3 Gy (range 38.1-86.3 Gy). No patient experienced local only failure. Relapse occurred in 12 patients treated with EBRT-BT versus 1 with BT alone group. For the EBRT-BT cohort versus BT only cohort, 2-year OS was 81% versus 60%, DFS 61% versus 40%, and LC was 94% versus 80%, respectively. For the entire cohort, 2-year OS was 67%, and median OS was 5 years. The 2-year DFS was 57% and 2-year LC was 93%. The most common any grade acute treatment-related toxicity were grade 1 vaginal pain and stenosis. Grade 3 acute and late toxicities were minimal.</p><p><strong>Conclusions: </strong>MRI-guided HDR BT for primary vaginal cancer yields high rates of local control with limited toxicities. Lower rates of distant control indicate the need for newer options such as immunotherapy or other systemic agents.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797268","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 impact of inherent dose heterogeneity of brachytherapy on calculating iso-effective dose-fractionation regimens for nonmelanoma skin cancers.","authors":"Arezoo Karimi, Nahid Chegeni, Farshid Mahmoudi, Seyed Masoud Rezaeijo, Ali Bagheri","doi":"10.1016/j.brachy.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.02.001","url":null,"abstract":"<p><strong>Purpose: </strong>Utilizing equivalent uniform biologically effective dose (EUBED) concept to calculate iso-effective dose-fractionation regimens in nonmelanoma skin cancer high-dose-rate (HDR) brachytherapy (BT) to address dose heterogeneity and comparing it with the simple form of biologically effective dose (BED) formula.</p><p><strong>Methods and materials: </strong>Two hypothetical HDR BT treatment plans were created for surface and interstitial techniques. Then iso-effective dose-fractionation regimens were calculated (with both EUBED and BED equations) to prescribe a total EQD2₁₀ (equivalent dose in 2 Gy fractions with α/β = 10Gy) of 56, 60 and 65 Gy to the planning target volume (PTV) over a range of five to fifteen fractions. Three different treatment schedules were considered: two and three fraction per week for surface BT and two times a day for interstitial BT. If the treatment duration exceeded 1 month (T_k = 28 days), tumor repopulation was taken into account. Other radiobiological parameters used were α/β = 10Gy, α = 0.3Gy^-1, and T_p = 4 days. Finally, the dose per fraction calculated in the EUBED method was compared with the simple form of the BED formula.</p><p><strong>Results: </strong>The BED formula, compared to the EUBED equation, may lead to less than 5% overestimation in the calculated dose per fraction. This difference is more noticeable in surface BT compared to interstitial implants, especially when prescribing lower total doses, when the total treatment duration in surface BT approaches 28 days, and when using more fractionated interstitial BT treatment regimens.</p><p><strong>Conclusions: </strong>Based on the findings of this study, dose distribution inhomogeneity in nonmelanoma skin cancer HDR brachytherapy has minimal clinical impact on calculating iso-effective dose-fractionation regimens.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782278","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 use of Monte Carlo simulation techniques in brachytherapy: A comprehensive literature review.","authors":"Tirthraj Adhikari, Tomas Montenegro, Jae Won Jung, Courtney Oare, Gabriel Fonseca, Luc Beaulieu, Abdullah Alshreef, Clara Ferreira","doi":"10.1016/j.brachy.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.02.006","url":null,"abstract":"<p><p>Monte Carlo techniques have become crucial in brachytherapy since their introduction in the early 1980s, offering significant improvements in source parameter characterizations, and dose calculations. It provides precise dose distributions by modeling complex radiation interactions and can be determine doses in nonhomogeneous detailed cases. They are not affected by experimental artifacts, unlike traditional detectors, and can distinguish between primary and scatter dose components. However, MC techniques have limitations. They are susceptible to systematic errors and require thorough validation against experimental data, despite generally showing smaller standard deviations. Additionally, MC simulations can be computationally intensive and depend heavily on accurate input data and models. Recent research, including 1433 publications identified up to October 2024, highlights the ongoing development and application of MC techniques in brachytherapy. Of these, 426 articles met the inclusion criteria for relevance. This comprehensive review aims to help brachytherapy researchers to identify the appropriate MC code depending on the application in BT research. Of the forty-five MC codes used in BT, MCNP is noted as the most widely used MC code due to its robust modeling capabilities in various materials and geometries. AAPM TG-186 and TG-372 reports have recommended the use of model base dose calculation algorithms, since it can offer more accurate dose calculations over TG-43 formalism, particularly in heterogeneous tissues. Despite these recommendations, further research is needed to refine dosimetry for various isotopes, geometry and media. In essence, MC techniques have greatly enhanced the accuracy, precision and flexibility of brachytherapy techniques, though challenges such as systematic errors, heterogeneities corrections, and high computational demands remain. Continued research and development of MC codes and algorithms are essential for advancing the field and improving clinical outcomes.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775173","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":"Long-term rectal patient-reported quality of life outcomes among patients treated with Pd-103 LDR prostate brachytherapy.","authors":"Keara English, Tanmay Singh, Michael Roumeliotis, Ulysses Grant Gardner, Gayane Yenokyan, Emerson Lee, Todd McNutt, Theodore DeWeese, Daniel Y Song","doi":"10.1016/j.brachy.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.brachy.2025.02.003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Rectal toxicity is a dose-limiting side effect of definitive prostate radiation. There are limited long-term data on patient-reported rectal toxicity outcomes following Pd-103 LDR prostate brachytherapy, as well as some recent data suggesting high rates of long-term toxicity from LDR brachytherapy overall. This study reports incidence and predictors of late patient-reported rectal quality of life outcomes after Pd-103 prostate brachytherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This study analyzed a prospectively collected IRB-approved database of men receiving LDR prostate brachytherapy between 12/2004 and 12/2018 at our institution. Patients received either LDR monotherapy or combined with IMRT to prostate and/or pelvic lymph nodes. Outcomes data related to rectal toxicity were evaluated based on Bowel subdomain of the Epic-26 questionnaire, which was routinely given to patients at initial consult and follow up visits. Bowel \"Bother\" score (\"How big a problem have your bowel habits been during the last 4 weeks\") was analyzed for overall bowel function assessment. Patients were grouped into those reporting 'Moderate Problem' or worse and those reporting 'No, Very Small, or Small' problem. In addition, composite Function and Bother scores were analyzed. Statistical analyses assessed the correlation between the V100% (volume of rectum receiving 100% of the prescription dose) and patient Function and Bother QOL scores over time using linear mixed models with random intercept for patient.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;146 patients met criteria and were included in the analyses; 51 (35%) received combined IMRT 45 Gy with Pd-103 (90-100 Gy) and 95 (65%) patients received Pd-103 monotherapy (125 Gy). There were 863 individual responses to the Bowel problem questions completed. Median follow-up with questionnaire data was 4.7 years; 102/146 (70%) patients had follow-up greater than 2 years, and 70/146 (48%) greater than 5 years. Among 814 questionnaires with \"Bother\" question completed, the proportion of patients reporting 'No / Very Small / Small Problem' was 97.3% pretreatment, and 92.5% at last follow-up. Proportion of 'Moderate or Big Problem' responses at any time during follow-up was 4.8%. At last recorded follow-up, Mean Bother score was 89.1 (SD 14.4) in patients receiving IMRT + LDR, n = 48, and 91.2 (SD 13.4), n = 95 in LDR monotherapy patients (p = 0.39). Neither follow-up time nor Prostate V100 were independently associated with Bother score (p = 0.15 and 0.71, respectively). In multivariable linear mixed model, IMRT was not statistically associated with Bother score adjusted for Rectal V100 and follow-up time (p = 0.16), nor was it associated with Epic Function Score (p = 0.6).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients receiving Pd-103 brachytherapy with or without IMRT reported excellent preservation of long-term bowel quality of life. IMRT was not associated with worse bowel outcomes, and bowel s","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775161","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}