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10 pages, 1739 KiB

Open AccessArticle

Dose Contribution to the Regional Lymph-Node Metastases and Point B from Intracavity and Interstitial Hybrid Brachytherapy in Locally Advanced Cervical Cancer

by Yoichi Muramoto, Naoya Murakami, Noriyuki Okonogi, Jun Takatsu, Kotaro Iijima, Tatsuya Inoue, Kanade Kato, Tatsuki Karino, Kanako Kojima, Masaki Oshima, Yasuo Kosugi, Terufumi Kawamoto, Takashi Hirayama, Kazunari Fujino, Yasuhisa Terao and Naoto Shikama

Cancers 2024, 16(13), 2384; https://doi.org/10.3390/cancers16132384 - 28 Jun 2024

Viewed by 907

Abstract

Purpose: Analyzing dose distributions to regional lymph-node metastases (RLNMs) in locally advanced cervical cancer (LACC) patients undergoing intracavitary and interstitial hybrid brachytherapy (IC/IS). Methods: Dose distributions of eleven LACC patients with 38 RLNMs, and who received 38 IC/IS sessions were analyzed in EQD [...] Read more.

Purpose: Analyzing dose distributions to regional lymph-node metastases (RLNMs) in locally advanced cervical cancer (LACC) patients undergoing intracavitary and interstitial hybrid brachytherapy (IC/IS). Methods: Dose distributions of eleven LACC patients with 38 RLNMs, and who received 38 IC/IS sessions were analyzed in EQD₂, considering RLNM positions and ipsilateral interstitial needles; these RLNMs, excepting the para-aortic region, were classified into four groups. Results: RLNMs had a median of two ipsilateral interstitial needles per session. Significant differences were observed in total RLNM D₉₀, depending on whether the position was cranial or caudal of the uterine base (85.5 vs. 378.9 cGy, p < 0.0001), and whether the RLNM D₉₀ was associated with a number of ipsilateral interstitial needles between 0–1 or 2 or more (68.4 vs. 112.2 cGy, p = 0.006) per session. At each session, Group 1 RLNMs (cranial of the uterine base, 0–1 ipsilateral interstitial needle) had a mean D₉₀ of 21.1 cGy; Group 2 (cranial, 2 or more), 73.8; Group 3 (caudal, 0–1), 94.7; and Group 4 (caudal, 2 or more), 136.1. Conclusion: RLNMs located caudal of the uterine base associated with two or more ipsilateral interstitial needles in IC/IS had a higher dose contribution, which should be considered when calculating the RLNMs’ dose of external beam boost irradiation. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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13 pages, 2505 KiB

Open AccessArticle

Prognostic Factors Analysis of Metastatic Recurrence in Cervical Carcinoma Patients Treated with Definitive Radiotherapy: A Retrospective Study Using Mixture Cure Model

by Xiaxian Ou, Jing You, Baosheng Liang, Xiaofan Li, Jiangjie Zhou, Fengyu Wen, Jingyuan Wang, Zhengkun Dong and Yibao Zhang

Cancers 2023, 15(11), 2913; https://doi.org/10.3390/cancers15112913 - 25 May 2023

Viewed by 1662

Abstract

Objectives: This study aims to identify prognostic factors associated with metastatic recurrence-free survival of cervical carcinoma (CC) patients treated with radical radiotherapy and assess the cure probability of radical radiotherapy from metastatic recurrence. Methods: Data were from 446 cervical carcinoma patients with radical [...] Read more.

Objectives: This study aims to identify prognostic factors associated with metastatic recurrence-free survival of cervical carcinoma (CC) patients treated with radical radiotherapy and assess the cure probability of radical radiotherapy from metastatic recurrence. Methods: Data were from 446 cervical carcinoma patients with radical radiotherapy for an average follow up of 3.96 years. We applied a mixture cure model to investigate the association between metastatic recurrence and prognostic factors and the association between noncure probability and factors, respectively. A nonparametric test of cure probability under the framework of a mixture cure model was used to examine the significance of cure probability of the definitive radiotherapy treatment. Propensity-score-matched (PSM) pairs were generated to reduce bias in subgroup analysis. Results: Patients in advanced stages (p = 0.005) and those with worse treatment responses in the 3rd month (p = 0.004) had higher metastatic recurrence rates. Nonparametric tests of the cure probability showed that 3-year cure probability from metastatic recurrence was significantly larger than 0, and 5-year cure probability was significantly larger than 0.7 but no larger than 0.8. The empirical cure probability by mixture cure model was 79.2% (95% CI: 78.6–79.9%) for the entire study population, and the overall median metastatic recurrence time for uncured patients (patients susceptible to metastatic recurrence) was 1.60 (95% CI: 1.51–1.69) years. Locally advanced/advanced stage was a risk factor but non-significant against the cure probability (OR = 1.078, p = 0.088). The interaction of age and activity of radioactive source were statistically significant in the incidence model (OR = 0.839, p = 0.025). In subgroup analysis, compared with high activity of radioactive source (HARS), low activity of radioactive source (LARS) significantly contributed to a 16.1% higher cure probability for patients greater than 53 years old, while cure probability was 12.2% lower for the younger patients. Conclusions: There was statistically significant evidence in the data showing the existence of a large amount of patients cured by the definitive radiotherapy treatment. HARS is a protective factor against metastatic recurrence for uncured patients, and young patients tend to benefit more than the elderly from the HARS treatment. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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14 pages, 2772 KiB

Open AccessArticle

A User-Friendly System for Mailed Dosimetric Audits of ¹⁹²Ir or ⁶⁰Co HDR Brachytherapy Sources

by Laura Oliver-Cañamás, Javier Vijande, Cristian Candela-Juan, Jose Gimeno-Olmos, Mª Carmen Pujades-Claumarchirant, Juan J. Rovira-Escutia, Facundo Ballester and Jose Perez-Calatayud

Cancers 2023, 15(9), 2484; https://doi.org/10.3390/cancers15092484 - 26 Apr 2023

Cited by 1 | Viewed by 1435

Abstract

Objectives: The main goal of this work is to design and characterize a user-friendly methodology to perform mailed dosimetric audits in high dose rate (HDR) brachytherapy for systems using either Iridium-192 (¹⁹²Ir) or Cobalt-60 (⁶⁰Co) sources. Methods: A solid [...] Read more.

Objectives: The main goal of this work is to design and characterize a user-friendly methodology to perform mailed dosimetric audits in high dose rate (HDR) brachytherapy for systems using either Iridium-192 (¹⁹²Ir) or Cobalt-60 (⁶⁰Co) sources. Methods: A solid phantom was designed and manufactured with four catheters and a central slot to place one dosimeter. Irradiations with an Elekta MicroSelectron V2 for ¹⁹²Ir, and with a BEBIG Multisource for ⁶⁰Co were performed for its characterization. For the dose measurements, nanoDots, a type of optically stimulated luminescent dosimeters (OSLDs), were characterized. Monte Carlo (MC) simulations were performed to evaluate the scatter conditions of the irradiation set-up and to study differences in the photon spectra of different ¹⁹²Ir sources (Microselectron V2, Flexisource, BEBIG Ir2.A85-2 and Varisource VS2000) reaching the dosimeter in the irradiation set-up. Results: MC simulations indicate that the surface material on which the phantom is supported during the irradiations does not affect the absorbed dose in the nanoDot. Generally, differences below 5% were found in the photon spectra reaching the detector when comparing the Microselectron V2, the Flexisource and the BEBIG models. However, differences up to 20% are observed between the V2 and the Varisource VS2000 models. The calibration coefficients and the uncertainty in the dose measurement were evaluated. Conclusions: The system described here is able to perform dosimetric audits in HDR brachytherapy for systems using either ¹⁹²Ir or ⁶⁰Co sources. No significant differences are observed between the photon spectra reaching the detector for the MicroSelectron V2, the Flexisource and the BEBIG ¹⁹²Ir sources. For the Varisource VS2000, a higher uncertainty is considered in the dose measurement to allow for the nanoDot response. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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9 pages, 680 KiB

Open AccessArticle

Dose Distribution of High Dose-Rate and Low Dose-Rate Prostate Brachytherapy at Different Intervals—Impact of a Hydrogel Spacer and Prostate Volume

by Hathal Haddad, Horst Hermani, Herbert Hanitzsch, Albert Heidrich and Michael Pinkawa

Cancers 2023, 15(5), 1396; https://doi.org/10.3390/cancers15051396 - 22 Feb 2023

Cited by 1 | Viewed by 2137

Abstract

The study aimed to compare the dose distribution in permanent low-dose-rate brachytherapy (LDR-BT) and high-dose-rate brachytherapy (HDR-BT), specifically focusing on the impact of a spacer and prostate volume. The relative dose distribution of 102 LDR-BT patients (prescription dose 145 Gy) at different intervals [...] Read more.

The study aimed to compare the dose distribution in permanent low-dose-rate brachytherapy (LDR-BT) and high-dose-rate brachytherapy (HDR-BT), specifically focusing on the impact of a spacer and prostate volume. The relative dose distribution of 102 LDR-BT patients (prescription dose 145 Gy) at different intervals was compared with the dose distribution of 105 HDR-BT patients (232 HDR-BT fractions with prescription doses of 9 Gy, n = 151, or 11.5 Gy, n = 81). A hydrogel spacer (10 mL) was only injected before HDR-BT. For the analysis of dose coverage outside the prostate, a 5 mm margin was added to the prostate volume (PV+). Prostate V100 and D90 of HDR-BT and LDR-BT at different intervals were comparable. HDR-BT was characterized by a considerably more homogenous dose distribution and lower doses to the urethra. The minimum dose in 90% of PV+ was higher for larger prostates. As a consequence of the hydrogel spacer in HDR-BT patients, the intraoperative dose at the rectum was considerably lower, especially in smaller prostates. However, prostate volume dose coverage was not improved. The dosimetric results well explain clinical differences between these techniques reported in the literature review, specifically comparable tumor control, higher acute urinary toxicity rates in LDR-BT in comparison to HDR-BT, decreased rectal toxicity after spacer placement, and improved tumor control after HDR-BT in larger prostate volumes. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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14 pages, 3123 KiB

Open AccessArticle

High-Dose-Rate Brachytherapy as an Organ-Sparing Treatment for Early Penile Cancer

by Denisa Pohanková, Igor Sirák, Milan Vošmik, Linda Kašaová, Jakub Grepl, Petr Paluska, Lukáš Holub, Jiří Špaček, Miroslav Hodek, Martin Kopeček and Jiří Petera

Cancers 2022, 14(24), 6248; https://doi.org/10.3390/cancers14246248 - 19 Dec 2022

Cited by 5 | Viewed by 4696

Abstract

Background: Low-dose-rate brachytherapy is an effective organ-sparing treatment for patients with early-stage penile cancer. However, only limited data are available on the role of high-dose-rate brachytherapy (HDR-BT) in this clinical setting. Methods: Between 2002 and 2020, 31 patients with early penile cancer were [...] Read more.

Background: Low-dose-rate brachytherapy is an effective organ-sparing treatment for patients with early-stage penile cancer. However, only limited data are available on the role of high-dose-rate brachytherapy (HDR-BT) in this clinical setting. Methods: Between 2002 and 2020, 31 patients with early penile cancer were treated at our center with interstitial HDR BT at a dose of 18 × 3 Gy twice daily. A breast brachytherapy template was used for the fixation of stainless hollow needles. Results: The median follow-up was 117.5 months (range, 5–210). Eight patients (25.8%) developed a recurrence; of these, seven were salvaged by partial amputation. Six patients died of internal comorbidities or a second cancer. The probability of local control at 5 and 10 years was 80.7% (95% CI: 63.7–97.7%) and 68.3% (95% CI: 44.0–92.6%), respectively. Cause-specific survival was 100%. Only one case of radiation-induced necrosis was observed. The probability of penile sparing at 5 and 10 years was 80.6% (95% CI: 63.45–97.7%) and 62.1% (95% CI: 34.8–89.4%), respectively. Conclusions: These results show that HDR-BT for penile cancer can achieve results comparable to LDR-BT with organ sparing. Despite the relatively large patient cohort—the second largest reported to date in this clinical setting—prospective data from larger samples are needed to confirm the role of HDR-BT in penile cancer. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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Review

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16 pages, 756 KiB

Open AccessReview

Plaque Radiotherapy for Ocular Melanoma

by George Naveen Thomas, I-Ling Chou and Lingam Gopal

Cancers 2024, 16(19), 3386; https://doi.org/10.3390/cancers16193386 - 3 Oct 2024

Viewed by 562

Abstract

Plaque radiotherapy is an effective treatment modality for medium-sized ocular tumors such as uveal melanoma. The authors review the available literature and concisely summarize the current state of the art of ophthalmic plaque brachytherapy. The choice of radioisotope, which includes Ruthenium-106 and Iodine-125, [...] Read more.

Plaque radiotherapy is an effective treatment modality for medium-sized ocular tumors such as uveal melanoma. The authors review the available literature and concisely summarize the current state of the art of ophthalmic plaque brachytherapy. The choice of radioisotope, which includes Ruthenium-106 and Iodine-125, depends on the intended treatment duration, tumor characteristics, and side effect profiles. Ophthalmic plaques may be customized to allow for the delivery of a precise radiation dose by adjusting seed placement and plaque shape to minimize collateral tissue radiation. High dose rate (HDR) brachytherapy, using beta (e.g., Yttrium-90) and photon-emitting sources (e.g., Ytterbium-169, Selenium-75), allows for rapid radiation dose delivery, which typically lasts minutes, compared to multiple days with low-dose plaque brachytherapy. The efficacy of Ruthenium-106 brachytherapy for uveal melanoma varies widely, with reported local control rates between 59.0% and 98.0%. Factors influencing outcomes include tumor size, thickness, anatomical location, and radiation dose at the tumor apex, with larger and thicker tumors potentially exhibiting poorer response and a higher rate of complications. Plaque brachytherapy is effective for selected tumors, particularly uveal melanoma, providing comparable survival rates to enucleation for medium-sized tumors. The complications of plaque brachytherapy are well described, and many of these are treatable. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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22 pages, 2350 KiB

Open AccessReview

Brachytherapy in Brain Metastasis Treatment: A Scoping Review of Advances in Techniques and Clinical Outcomes

by Sandra Leskinen, Netanel Ben-Shalom, Jason Ellis, David Langer, John A. Boockvar, Randy S. D’Amico and A. Gabriella Wernicke

Cancers 2024, 16(15), 2723; https://doi.org/10.3390/cancers16152723 - 31 Jul 2024

Viewed by 924

Abstract

Brain metastases pose a significant therapeutic challenge in the field of oncology, necessitating treatments that effectively control disease progression while preserving neurological and cognitive functions. Among various interventions, brachytherapy, which involves the direct placement of radioactive sources into or near tumors or into [...] Read more.

Brain metastases pose a significant therapeutic challenge in the field of oncology, necessitating treatments that effectively control disease progression while preserving neurological and cognitive functions. Among various interventions, brachytherapy, which involves the direct placement of radioactive sources into or near tumors or into the resected cavity, can play an important role in treatment. Current literature describes brachytherapy’s capacity to deliver targeted, high-dose radiation while minimizing damage to adjacent healthy tissues—a crucial consideration in the choice of treatment modality. Furthermore, advancements in implantation techniques as well as in the development of different isotopes have expanded its efficacy and safety profile. This review delineates the contemporary applications of brachytherapy in managing brain metastases, examining its advantages, constraints, and associated clinical outcomes, and provides a comprehensive understanding of advances in the use of brachytherapy for brain metastasis treatment, with implications for improved patient outcomes and enhanced quality of life. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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16 pages, 3320 KiB

Open AccessReview

Comparative Analysis of 60Co and 192Ir Sources in High Dose Rate Brachytherapy for Cervical Cancer

by Aiping Wen, Xianliang Wang, Bingjie Wang, Chuanjun Yan, Jingyue Luo, Pei Wang and Jie Li

Cancers 2022, 14(19), 4749; https://doi.org/10.3390/cancers14194749 - 29 Sep 2022

Cited by 5 | Viewed by 3103

Abstract

High-dose-rate (HDR) brachytherapy (BT) is an essential treatment for cervical cancer, one of the most prevalent gynecological malignant tumors. In HDR BT, high radiation doses can be delivered to the tumor target with the minimum radiation doses to organs at risk. Despite the [...] Read more.

High-dose-rate (HDR) brachytherapy (BT) is an essential treatment for cervical cancer, one of the most prevalent gynecological malignant tumors. In HDR BT, high radiation doses can be delivered to the tumor target with the minimum radiation doses to organs at risk. Despite the wide use of the small HDR 192Ir source, as the technique has improved, the HDR 60Co source, which has the same miniaturized geometry, has also been produced and put into clinical practice. Compared with 192Ir (74 days), 60Co has a longer half-life (5.3 years), which gives it a great economic advantage for developing nations. The aim of the study was to compare 60Co and 192Ir sources for HDR BT in terms of both dosimetry and clinical treatment. The results of reports published on the use of HDR BT for cervical cancer over the past few years as well as our own research show that this treatment is safe and it is feasible to use 60Co as an alternative source. Full article

(This article belongs to the Special Issue Advances in Brachytherapy in the Treatment of Tumors)

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