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International Journal of Radiation... Mar 2017Radiation therapy (RT) is a crucial component of cancer care, used in the treatment of over 50% of cancer patients. Patients undergoing image guided RT or brachytherapy... (Review)
Review
Radiation therapy (RT) is a crucial component of cancer care, used in the treatment of over 50% of cancer patients. Patients undergoing image guided RT or brachytherapy routinely have inert RT biomaterials implanted into their tumors. The single function of these RT biomaterials is to ensure geometric accuracy during treatment. Recent studies have proposed that the inert biomaterials could be upgraded to "smart" RT biomaterials, designed to do more than 1 function. Such smart biomaterials include next-generation fiducial markers, brachytherapy spacers, and balloon applicators, designed to respond to stimuli and perform additional desirable functions like controlled delivery of therapy-enhancing payloads directly into the tumor subvolume while minimizing normal tissue toxicities. More broadly, smart RT biomaterials may include functionalized nanoparticles that can be activated to boost RT efficacy. This work reviews the rationale for smart RT biomaterials, the state of the art in this emerging cross-disciplinary research area, challenges and opportunities for further research and development, and a purview of potential clinical applications. Applications covered include using smart RT biomaterials for boosting cancer therapy with minimal side effects, combining RT with immunotherapy or chemotherapy, reducing treatment time or health care costs, and other incipient applications.
Topics: Artificial Intelligence; Biocompatible Materials; Brachytherapy; Fiducial Markers; Humans; Nanoparticles; Radiotherapy, Image-Guided
PubMed: 28126309
DOI: 10.1016/j.ijrobp.2016.10.034 -
Journal of Vascular Surgery May 2002Ongoing advances in peripheral endovascular technology have been met with disappointing results because of restenosis within the treated vessel. In particular, stent... (Review)
Review
Ongoing advances in peripheral endovascular technology have been met with disappointing results because of restenosis within the treated vessel. In particular, stent balloon angioplasty of peripheral vessels has yet to achieve patency rates that approximate conventional treatment in the long term. Recent advances in stent, balloon, and wire construction include the incorporation of radioactive substances in an attempt to ameliorate the inflammatory response provoked by typical endovascular manipulation, a technique termed vascular brachytherapy. gamma- and beta-isotopes and external beam radiation target the very cell population whose activity results in the development of neointimal hyperplasia. Although most clinical research examining the efficacy of vascular brachytherapy has emerged from the coronary artery literature, the use of vascular brachytherapy also has been examined in the peripheral arterial tree and has shown promising results. Current data indicate that vascular brachytherapy is a safe and accessible adjunctive endovascular maneuver that may improve the short-term patency rate of peripheral endovascular applications. The effects on long-term patency rates remain indeterminate compared to conventional therapy.
Topics: Brachytherapy; Humans; Peripheral Vascular Diseases; Vascular Patency
PubMed: 12021726
DOI: 10.1067/mva.2002.123751 -
Journal of Thoracic Disease Nov 2021Airway complications (ACs) after lung transplantation remain an important source of morbidity and mortality despite significant advances in the surgical technics,... (Review)
Review
Airway complications (ACs) after lung transplantation remain an important source of morbidity and mortality despite significant advances in the surgical technics, leading to increased cost, and decrease quality of life. The incidences of ACs after lung transplantation range from 2% to 33%, even though most transplant centers have reported rates in the range of 7% to 8%. However, the reported rate of ACs has been inconsistent as a result of a lack of standardized airway definitions and grading protocols before the recent 2018 International Society for Heart and Lung Transplantation (ISHLT) proposed consensus guidelines on ACs after lung transplantation. The ACs include stenosis, perioperative and postoperative bronchial infections, bronchial necrosis and dehiscence, excess granulation tissue, and tracheobronchomalacia (TBM). Anastomosis infection, necrosis, or dehiscence typically develops within the first month after lung transplantation. The most frequent AC after lung transplantation is bronchial stenosis. Several risk factors have been proposed to the development of ACs after lung transplantation, including surgical anastomosis techniques, hypoperfusion, infections, donor and recipient factors, immunosuppression agents, and organ preservation. ACs might be prevented by early recognition of the airway pathology, using advance medical management, and interventional bronchoscopy procedures. Balloon bronchoplasty, cryotherapy, laser photo resection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents placement are the most frequent interventional bronchoscopic procedures utilized for the management of ACs.
PubMed: 34992847
DOI: 10.21037/jtd-20-2696 -
Radiation Oncology (London, England) Jan 2017Literature was reviewed to assess the physical aspects governing the present and emerging technologies used in intraoperative radiation therapy (IORT). Three major... (Review)
Review
Literature was reviewed to assess the physical aspects governing the present and emerging technologies used in intraoperative radiation therapy (IORT). Three major technologies were identified: treatment with electrons, treatment with external generators of kV X-rays and electronic brachytherapy. Although also used in IORT, literature on brachytherapy with radioactive sources is not systematically reviewed since an extensive own body of specialized literature and reviews exists in this field. A comparison with radioactive sources is made in the use of balloon catheters for partial breast irradiation where these are applied in almost an identical applicator technique as used with kV X-ray sources. The physical constraints of adaption of the dose distribution to the extended target in breast IORT are compared. Concerning further physical issues, the literature on radiation protection, commissioning, calibration, quality assurance (QA) and in-vivo dosimetry of the three technologies was reviewed. Several issues were found in the calibration and the use of dosimetry detectors and phantoms for low energy X-rays which require further investigation. The uncertainties in the different steps of dose determination were estimated, leading to an estimated total uncertainty of around 10-15% for IORT procedures. The dose inhomogeneity caused by the prescription of electrons at 90% and by the steep dose gradient of kV X-rays causes additional deviations from prescription dose which must be considered in the assessment of dose response in IORT.
Topics: Humans; Intraoperative Period; Radiation Oncology; Radiotherapy; Radiotherapy Dosage
PubMed: 28193241
DOI: 10.1186/s13014-016-0754-z -
JACC. Cardiovascular Interventions Jun 2016
Topics: Angioplasty, Balloon, Coronary; Brachytherapy; Coronary Restenosis; Humans; Stents
PubMed: 27339843
DOI: 10.1016/j.jcin.2016.04.033 -
Przeglad Menopauzalny = Menopause Review Mar 2014Breast conserving surgery (BCS) with following external beam radiation therapy (EBRT) of the conserved breast has become widely accepted in the last decades for the... (Review)
Review
Breast conserving surgery (BCS) with following external beam radiation therapy (EBRT) of the conserved breast has become widely accepted in the last decades for the treatment of early invasive breast cancer. The standard technique of EBRT after BCS is to treat the whole breast up to a total dose of 42.5 to 50 Gy. An additional dose is given to treated volume as a boost to a portion of the breast. In the early stage of breast cancer, research has shown that the area requiring radiation treatment to prevent the cancer from local recurrence is the breast tissue that surrounds the area where the initial cancer was removed. Accelerated partial breast irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1-2 cm margin rather than the whole breast and as a result allows accelerated delivery of the radiation dose in four to five days. There has been a growing interest for APBI and various approaches have been developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy (3D-EBRT) and intra-operative radiation therapy (IORT). Balloon-based brachytherapy approaches include MammoSite, Axxent electronic brachytherapy, Contura, hybrid brachytherapy devices. Another indication for breast brachytherapy is reirradiation of local recurrence after mastectomy. Published results of brachytherapy are very promising. We discuss the current status, indications, and technical aspects of breast cancer brachytherapy.
PubMed: 26327829
DOI: 10.5114/pm.2014.41090 -
European Urology Oct 2021Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are... (Meta-Analysis)
Meta-Analysis
CONTEXT
Urethral stricture disease (USD) is initially managed with minimally invasive techniques such as urethrotomy and urethral dilatation. Minimally invasive techniques are associated with a high recurrence rate, especially in recurrent USD. Adjunctive measures, such as local drug injection, have been used in an attempt to reduce recurrence rates.
OBJECTIVE
To systematically review evidence for the efficacy and safety of adjuncts used alongside minimally invasive treatment of USD.
EVIDENCE ACQUISITION
A systematic review of the literature published between 1990 and 2020 was conducted in accordance with the PRISMA checklist.
EVIDENCE SYNTHESIS
A total of 26 studies were included in the systematic review, from which 13 different adjuncts were identified, including intralesional injection (triamcinolone, n = 135; prednisolone, n = 58; mitomycin C, n = 142; steroid-mitomycin C-hyaluronidase, n = 103, triamcinolone-mitomycin C-N-acetyl cysteine, n = 50; platelet-rich plasma, n = 44), intraluminal instillation (mitomycin C, n = 20; hyaluronic acid and carboxymethylcellulose, n = 70; captopril, n = 37; 192-iridium brachytherapy, n = 10), application via a lubricated catheter (triamcinolone, n = 124), application via a coated balloon (paclitaxel, n = 106), and enteral application (tamoxifen, n = 30; deflazacort, n = 36). Overall, 13 randomised controlled trials were included in the meta-analysis. Use of any adjunct was associated with a lower rate of USD recurrence (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27-0.50; p < 0.001) compared to no adjunct use. Of all the adjuncts, mitomycin C was associated with the lowest rate of USD recurrence (intralesional injection: OR 0.23, 95% CI 0.11-0.48; p < 0.001; intraluminal injection: OR 0.11, 95% CI 0.02-0.61; p = 0.01). Urinary tract infection (2.9-14%), bleeding (8.8%), and extravasation (5.8%) were associated with steroid injection; pruritis of the urethra (61%) occurred after instillation of captopril; mild gynaecomastia (6.7%) and gastrointestinal side effects (6.7%) were associated with oral tamoxifen.
CONCLUSIONS
Adjuncts to minimally invasive treatment of USD appear to lower the recurrence rate and are associated with a low adjunct-specific complication rate. However, the studies included were at high risk of bias. Mitomycin C is the adjunct supported by the highest level of evidence.
PATIENT SUMMARY
We reviewed studies on additional therapies (called adjuncts) to minimally invasive treatments for narrowing of the urethra in men. Adjuncts such as mitomycin C injection result in a lower recurrence rate compared to no adjunct use. The use of adjuncts appeared to be safe and complications are uncommon; however, the studies were small and of low quality.
Topics: Captopril; Humans; Injections, Intralesional; Male; Mitomycin; Recurrence; Tamoxifen; Triamcinolone; Urethra; Urethral Stricture
PubMed: 34275660
DOI: 10.1016/j.eururo.2021.06.022 -
Journal of Contemporary Brachytherapy Jun 2009Breast conserving surgery (BCS) with postoperative radiotherapy has been a standard treatment of early stage breast cancer for the last 30 years. Interstitial... (Review)
Review
Breast conserving surgery (BCS) with postoperative radiotherapy has been a standard treatment of early stage breast cancer for the last 30 years. Interstitial brachytherapy has been used as a boost therapy after whole breast external beam radiotherapy (EBRT), and recently, it's been investigated in selected patients as a possible technique of a single radiotherapy modality (partial breast irradiation, PBI) after tumorectomy. Further clinical studies are required to define the most appropriate candidates for breast brachytherapy as a sole modality treatment and to determine the best delivery method of brachytherapy (multicatheter interstitial implant vs. balloon brachytherapy) in such patients.
PubMed: 27795722
DOI: No ID Found -
The Keio Journal of Medicine Sep 2001More than 20 years have passed since percutaneous transluminal coronary angioplasty (PTCA) was introduced for the treatment of coronary artery disease. During the first... (Review)
Review
More than 20 years have passed since percutaneous transluminal coronary angioplasty (PTCA) was introduced for the treatment of coronary artery disease. During the first decade, PTCA outcome had improved significantly. However, acute occlusive complications and restenosis remained as significant limitations of the procedure. During the second decade, new procedures, such as stents and atherectomy (directional coronary atherectomy, and Rotablator) had been introduced and had a significant impact on the outcome of percutaneous coronary intervention (PCI). In addition to the improvements in the equipment, the use of glycoprotein IIb/IIIa inhibitors to prevent platelet aggregation has reduced procedure-related complications. PCI continues to evolve with new developments such as distal protection devices to prevent distal embolism, brachytherapy and drug-eluting stents to prevent restenosis. These new technologies may play a significant role in expanding the applications of PCI in the future.
Topics: Angioplasty, Balloon, Coronary; Atherectomy, Coronary; Coronary Angiography; Coronary Disease; Humans; Recurrence; Stents
PubMed: 11594037
DOI: 10.2302/kjm.50.152