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Radiation Oncology (London, England) Apr 2014To assess the safety and usefulness of neutron brachytherapy (NBT) as an adjuvant in the treatment of patients with gastroesophageal junction adenocarcinoma (GEJAC) with... (Comparative Study)
Comparative Study
The safety and usefulness of neutron brachytherapy and external beam radiation in the treatment of patients with gastroesophageal junction adenocarcinoma with or without chemotherapy.
PURPOSE
To assess the safety and usefulness of neutron brachytherapy (NBT) as an adjuvant in the treatment of patients with gastroesophageal junction adenocarcinoma (GEJAC) with external beam radiation (EBRT), with or without chemotherapy.
METHODS AND MATERIALS
In total, 197 patients with localized, advanced GEJAC received EBRT and NBT with or without chemotherapy. Radiotherapy consisted of external irradiation to a total dose of 40-54 Gy (median 50 Gy) and brachytherapy to 8-25 Gy (median 20 Gy) in two to five fractions. In total, 88 patients received chemotherapy that consisted of two cycles of a regimen with CDDP and 5FU from days l-4. The cycles were administered on days 1 and 29. MMC was given alone in bolus injection on day 1 each week. The cycles were administered on days 1, 8, 15 and 22.
RESULTS
The duration of follow-up ranged from six to 106 months (median 30.4 months). The median survival time for the 197 patients was 13.3 months, and the one, two, three- and five-year rates for overall survival were 57.1%, 35.1%, 23.0% and 9.2%, respectively. For acute toxicity, no incidences of fistula and massive bleeding were observed during this treatment period. In total, 159 (80.7%) patients developed Grade 2 hematologic toxicity and 146 (74.1%) patients developed Grade ≥ 2 esophagitis. The median times of incidence of fistula and bleeding were 9.5 (3-27.3) months and 12.7 (5-43.4) months, respectively. The incidence of severe, late complications was related to higher NBT dose/f (20-25 Gy/5 F) and higher total dose(≥70 Gy). In total, 75.2% of the patients resumed normal swallowing and 2.0% had some residual dysphagia (non-malignant) requiring intermittent dilatation.
CONCLUSION
A combination of EBRT and NBT with the balloon type applicator was feasible and well tolerated. Better local-regional control and overall survival cannot achieved by a higher dose, and in contrast, a higher dose caused more severe esophageal injury.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Brachytherapy; Carcinoma, Squamous Cell; Cisplatin; Dose Fractionation, Radiation; Esophageal Neoplasms; Esophagogastric Junction; Female; Fluorouracil; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Staging; Neutrons; Prognosis; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Safety; Survival Rate
PubMed: 24774780
DOI: 10.1186/1748-717X-9-99 -
Methodist DeBakey Cardiovascular Journal Apr 2013The complex pathophysiology response to injury of the lower-extremity arteries has prompted the development of several unique balloon technologies to overcome initial... (Review)
Review
The complex pathophysiology response to injury of the lower-extremity arteries has prompted the development of several unique balloon technologies to overcome initial technical failures and short-term intimal hyperplasia. Cryoplasty alters the cellular and mechanical properties of the vessel wall during angioplasty. Cutting balloons incise the wall, preventing elastic recoil and allowing expansion of the lumen at a lower pressure, thus limiting barotrauma. Drug-eluting balloons actively transfer inhibitory compounds to the wall during the initial therapy, while brachytherapy balloons allow for localized delivery of radiation to inhibit the proliferative response seen after angioplasty. These platforms provide unique means to enhance immediate and short-term results and also reduce stent usage in the lower extremity.
Topics: Angioplasty, Balloon; Brachytherapy; Cardiovascular Agents; Cryotherapy; Drug Carriers; Equipment Design; Hemodynamics; Humans; Lower Extremity; Peripheral Arterial Disease; Regional Blood Flow; Treatment Outcome; Vascular Access Devices
PubMed: 23805337
DOI: 10.14797/mdcj-9-2-69 -
Journal of Contemporary Brachytherapy Apr 2019Organs at risk (OARs), which are very close to a clinical target volume (CTV), can compromise effective tumor irradiation. The present study investigated the feasibility...
First report on extended distance between tumor lesion and adjacent organs at risk using interventionally applied balloon catheters: a simple procedure to optimize clinical target volume covering effective isodose in interstitial high-dose-rate brachytherapy of liver malignomas.
PURPOSE
Organs at risk (OARs), which are very close to a clinical target volume (CTV), can compromise effective tumor irradiation. The present study investigated the feasibility and safety of a novel approach, in particular, the extent of the dosimetric effect of distancing CTV from adjacent OARs by means of interventionally applied balloon catheters.
MATERIAL AND METHODS
Patients with peripheral hepatic malignancies, in whom the critical proximity of an OAR to the CTV in the assessment by contrast-enhanced magnetic resonance imaging (MRI) scans and the preplanning process were included. Additionally, patients underwent placement of an interventional balloon catheter during computed tomography (CT)-guided application of interstitial brachytherapy (iBT) catheters inserted into the tissue between hepatic capsule and adjacent OAR. The virtual position of an OAR without balloon catheter was anticipated and contoured in addition to contouring of CTV and OAR. The calculated dose values for CTV as well as 1 cc of the relevant OAR (D) with and without balloon were recorded. The D of the realized irradiation plan was statistically compared to the D of the virtually contoured OARs.
RESULTS
In 31 cases, at least one balloon catheter was administered. The mean D of the OAR in the group with balloon(s) was 12.6 Gy compared with 16 Gy in the virtual cohort without the device, therefore significantly lower ( < 0.001). Overall, there were no acute complications. Severe (> 2 CTCAEv4.03) late complications observed in 3/31 (9.6%) patients during follow-up period after brachytherapy were most certainly not due to the balloon application. Side effects were probably associated with pre-existing serious diseases and potentially additional local late effects of the irradiation in general rather than with the balloon catheters.
CONCLUSIONS
The distancing of the adjacent OARs allows a higher D value of CTV, therefore allowing for more efficient local control.
PubMed: 31139224
DOI: 10.5114/jcb.2019.84798 -
Journal of Vascular Surgery Nov 2016This review summarizes the available evidence and analyzes the current trends on treatments for carotid in-stent restenosis (ISR) after carotid artery stenting (CAS). (Review)
Review
OBJECTIVE
This review summarizes the available evidence and analyzes the current trends on treatments for carotid in-stent restenosis (ISR) after carotid artery stenting (CAS).
METHODS
An update of a 2010 review of the literature (which included 20 articles) was conducted using PubMed and Embase. All studies published from inception until January 2016 reporting original data on ISR treatments were included. Treatment trends before and after 2005 were compared.
RESULTS
We found 22 new articles reporting ISR treatments in 138 patients, of which two (case series) were published before 2005. With the inclusion of the 20 articles of the 2010 report (n = 96 patients), a total of 42 articles were included (23 case reports and 19 case series) reporting 239 interventions for ISR in 234 patients. Of these 42 studies, 14 (including 10 case series) were published before 2005. The interventions were percutaneous transluminal angioplasty (PTA) in 136, repeat CAS in 51, carotid endarterectomy in 39, carotid artery bypass in 10, or brachytherapy in 3. Compared with the articles published before 2005, PTA with regular balloon remains the most practiced treatment (26% before 2005, 40% after 2005). PTA with drug-coated balloons started after 2005. Carotid endarterectomy with stent removal was the second most reported treatment before 2005 but moved to the third place of reported interventions after 2005 owing to an increase in repeat CAS treatment. Of the treated patients, 140 were asymptomatic, 72 were symptomatic, and for 22 the symptomology was unclear. ISR treatment averaged 18 months after CAS, and the follow-up thereafter was 16 months. Treatment for recurrent ISR was performed in 48 of 239 treated arteries, mostly after PTA (n = 35) and repeat CAS (n = 8).
CONCLUSIONS
The available evidence for ISR treatment is still limited owing to methodologic heterogeneity; therefore, no recommendation on the optimal intervention can be provided. Although PTA is the common treatment for ISR, recurrent ISR seems to limit the durability, leading to recurrent interventions and cost implications. A uniform definition for ISR is needed with a standardized workup to compare the treatment options based on individual patient data analysis. Drug-eluting techniques are emerging and may become the preferred treatment option, but long-term follow-up is needed to evaluate their efficacy. Further study and understanding of the effect of drug-eluting technologies on the brain and neurologic function is warranted.
Topics: Aged; Angioplasty, Balloon; Brachytherapy; Carotid Stenosis; Endarterectomy, Carotid; Humans; Middle Aged; Recurrence; Retreatment; Stents; Time Factors; Treatment Outcome; Vascular Grafting
PubMed: 27776704
DOI: 10.1016/j.jvs.2016.07.106 -
International Journal of Hyperthermia :... 2020Hyperthermia (HT) has been shown to improve clinical response to radiation therapy (RT) for cancer. Synergism is dramatically enhanced if HT and RT are combined...
AIM
Hyperthermia (HT) has been shown to improve clinical response to radiation therapy (RT) for cancer. Synergism is dramatically enhanced if HT and RT are combined simultaneously, but appropriate technology to apply treatments together does not exist. This study investigates the feasibility of delivering HT with RT to a 5-10mm annular rim of at-risk tissue around a tumor resection cavity using a temporary thermobrachytherapy (TBT) balloon implant.
METHODS
A balloon catheter was designed to deliver radiation from High Dose Rate (HDR) brachytherapy concurrent with HT delivered by filling the balloon with magnetic nanoparticles (MNP) and immersing it in a radiofrequency magnetic field. Temperature distributions in brain around the TBT balloon were simulated with temperature dependent brain blood perfusion using numerical modeling. A magnetic induction system was constructed and used to produce rapid heating (>0.2°C/s) of MNP-filled balloons in brain tissue-equivalent phantoms by absorbing 0.5 W/ml from a 5.7 kA/m field at 133 kHz.
RESULTS
Simulated treatment plans demonstrate the ability to heat at-risk tissue around a brain tumor resection cavity between 40-48°C for 2-5cm diameter balloons. Experimental thermal dosimetry verifies the expected rapid and spherically symmetric heating of brain phantom around the MNP-filled balloon at a magnetic field strength that has proven safe in previous clinical studies.
CONCLUSIONS
These preclinical results demonstrate the feasibility of using a TBT balloon to deliver heat simultaneously with HDR brachytherapy to tumor bed around a brain tumor resection cavity, with significantly improved uniformity of heating over previous multi-catheter interstitial approaches. Considered along with results of previous clinical thermobrachytherapy trials, this new capability is expected to improve both survival and quality of life in patients with glioblastoma multiforme.
Topics: Brachytherapy; Brain Neoplasms; Feasibility Studies; Heating; Humans; Hyperthermia, Induced; Magnetite Nanoparticles; Quality of Life
PubMed: 33047639
DOI: 10.1080/02656736.2020.1829103 -
Oncology (Williston Park, N.Y.) Oct 2003This is a period of rapid developments in radiotherapy for malignant disease. New methods of targeting tumors with computed tomography (CT) virtual simulation, magnetic... (Review)
Review
This is a period of rapid developments in radiotherapy for malignant disease. New methods of targeting tumors with computed tomography (CT) virtual simulation, magnetic resonance imaging (MRI), and positron-emission tomography (PET) fusion provide the clinician with information heretofore unknown. Linear accelerators (linacs) with multileaf collimation (MLC) have replaced lead-alloy blocks. Indeed, new attachments to the linacs allow small, pencil beams of radiation to be emitted as the linac gantry rotates around the patient, conforming to three-dimensional (3D) targets as never before. Planning for these delivery systems now takes the form of "inverse planning," with CT information used to map targets and the structures to be avoided. In the area of brachytherapy, techniques utilizing the 3D information provided by the new imaging modalities have been perfected. Permanent seed prostate implants and high-dose-rate (HDR) irradiation techniques targeting bronchial, head and neck, biliary, gynecologic, and other anatomic targets are now commonplace radiotherapy tools. CT-guided permanent seed implants are being investigated, and a new method of treating early breast cancer with HDR brachytherapy via a balloon catheter placed in the lumpectomized cavity is coming to the forefront. Newer modalities for the treatment of malignant and benign disease using stereotactic systems and body radiosurgery are being developed. Targeted radionuclides using microspheres that contain radioemitters and other monoclonal antibody systems tagged with radioemitters have been recently approved for use by the Food and Drug Administration.
Topics: Brachytherapy; Humans; Magnetic Resonance Imaging; Neoplasms; Radiotherapy; Stereotaxic Techniques; Tomography, Emission-Computed; Tomography, X-Ray Computed
PubMed: 14606366
DOI: No ID Found -
Journal of Contemporary Brachytherapy Dec 2022To compare the rectal and bladder doses using two different vaginal packing techniques among uterine cervical cancer patients receiving high-dose-rate (HDR)...
PURPOSE
To compare the rectal and bladder doses using two different vaginal packing techniques among uterine cervical cancer patients receiving high-dose-rate (HDR) intracavitary brachytherapy (ICBT).
MATERIAL AND METHODS
Forty-five patients with cervical cancer were randomized to receive two sessions of ICBT using tandem and ring applicator (Varian), following completion of pelvic external beam radiotherapy treatment. The procedure was performed with vaginal balloon plus gauze packing or vaginal gauze packing alone, each of which was used in one of two sessions. Sequence of the type of vaginal packing was chosen with computer-generated block randomization. A HDR dose of 8.5 Gy was prescribed to point A in all patients. Volumetric dose parameters, such as D, D, D, and D of the rectum and bladder were compared between the two techniques of vaginal packing.
RESULTS
The mean age of patients was 51 years. Majority (88%) of patients had locally advanced stages of cancer at baseline (stage IIB or more). Rectal doses were significantly less in combined packing technique (D: 7.52 Gy vs. 9.02 Gy, = 0.01; D: 6.46 Gy vs. 7.42 Gy, < 0.01; D: 5.91 Gy vs. 6.7 Gy, < 0.01; D: 5.29 Gy vs. 5.97 Gy, < 0.01). Bladder doses were higher in the combined packing technique (D: 11.20 Gy vs. 10.76 Gy, = 0.18; D: 9.64 Gy vs. 9.32 Gy, = 0.56; D: 8.64 Gy vs. 8.36 Gy, = 0.55; D: 7.56 vs. 7.33 Gy, = 0.55).
CONCLUSIONS
Combined vaginal packing resulted in statistically significant reduction in rectal radiation dose compared with standard vaginal gauze packing in high-dose-rate brachytherapy of cervix cancer using tandem and ring applicators.
PubMed: 36819474
DOI: 10.5114/jcb.2022.123975 -
Journal of Radiation Oncology Sep 2015The aim of this study is to define the maximal safe radiation dose to guide further study of the GliaSite balloon brachytherapy (GSBT) system in untreated newly...
Outcome of Adult Brain Tumor Consortium (ABTC) prospective dose-finding trials of I-125 balloon brachytherapy in high-grade gliomas: challenges in clinical trial design and technology development when MRI treatment effect and recurrence appear similar.
OBJECTIVES
The aim of this study is to define the maximal safe radiation dose to guide further study of the GliaSite balloon brachytherapy (GSBT) system in untreated newly diagnosed glioblastoma (NEW-GBM) and recurrent high-grade glioma (REC-HGG). GBST is a balloon placed in the resection cavity and later filled through a subcutaneous port with liquid I-125 Iotrex, providing radiation doses that diminish uniformly with distance from the balloon surface.
METHODS
The Adult Brain Tumor Consortium initiated prospective dose-finding studies to determine maximum tolerated dose in NEW-GBM treated before standard RT or after surgery for REC-HGG. Patients were inevaluable if there was progression before the 90-day posttreatment toxicity evaluation point.
RESULTS
Ten NEW-GBM patients had the balloon placed, and 2/10 reached the 90 day timepoint. Five REC-HGG enrolled and two were assessable at the 90-day evaluation endpoint. Imaging progression occurred before 90-day evaluation in 7/12 treated patients. The trials were closed as too few patients were assessable to allow dose escalation, although no dose-limiting toxicities (DLTs) were observed. Median survival from treatment was 15.3 months (95 % CI 7.1-23.6) for NEW-GBM and 12.8 months (95 % CI 4.2-20.9) for REC-HGG.
CONCLUSION
These trials failed to determine a maximum tolerated dose (MTD) for further testing as early imaging changes, presumed to be progression, were common and interfered with the assessment of treatment-related toxicity. The survival outcomes in these and other related studies, although based on small populations, suggest that GSBT may be worthy of further study using clinical and survival endpoints, rather than standard imaging results. The implications for local therapy development are discussed.
PubMed: 27695605
DOI: 10.1007/s13566-015-0210-y -
The British Journal of Radiology Jul 2015This article proposes a combination of californium-252 ((252)Cf) brachytherapy, boron neutron capture therapy (BNCT) and an intracavitary moderator balloon catheter...
OBJECTIVE
This article proposes a combination of californium-252 ((252)Cf) brachytherapy, boron neutron capture therapy (BNCT) and an intracavitary moderator balloon catheter applied to brain tumour and infiltrations.
METHODS
Dosimetric evaluations were performed on three protocol set-ups: (252)Cf brachytherapy combined with BNCT (Cf-BNCT); Cf-BNCT with a balloon catheter filled with light water (LWB) and the same set-up with heavy water (HWB).
RESULTS
Cf-BNCT-HWB has presented dosimetric advantages to Cf-BNCT-LWB and Cf-BNCT in infiltrations at 2.0-5.0 cm from the balloon surface. However, Cf-BNCT-LWB has shown superior dosimetry up to 2.0 cm from the balloon surface.
CONCLUSION
Cf-BNCT-HWB and Cf-BNCT-LWB protocols provide a selective dose distribution for brain tumour and infiltrations, mainly further from the (252)Cf source, sparing the normal brain tissue.
ADVANCES IN KNOWLEDGE
Malignant brain tumours grow rapidly and often spread to adjacent brain tissues, leading to death. Improvements in brain radiation protocols have been continuously achieved; however, brain tumour recurrence is observed in most cases. Cf-BNCT-LWB and Cf-BNCT-HWB represent new modalities for selectively combating brain tumour infiltrations and metastasis.
Topics: Boron Neutron Capture Therapy; Brachytherapy; Brain Neoplasms; Californium; Catheterization; Humans; Phantoms, Imaging; Radiometry; Radiotherapy Dosage
PubMed: 25927876
DOI: 10.1259/bjr.20140829 -
BMC Research Notes Feb 2023In this study, it was aimed to evaluate the functionality to deliver different prescription dose except 20 Gy for the Xoft Axxent Ebt (electronic Brachytherapy) system...
PURPOSE
In this study, it was aimed to evaluate the functionality to deliver different prescription dose except 20 Gy for the Xoft Axxent Ebt (electronic Brachytherapy) system and analyzing the system in terms of radiation dosimetry in water and 0.9% isotonic Sodium Chloride (NaCl) solution.
MATERIALS AND METHODS
In the Xoft Axxent eBT, different prescription dose in single fraction were calculated for different balloon applicator volumes based on source position and irradiation times. EBT-XD Gafchromic film was calibrated at 6MV photon energy. A balloon applicator filled with 0.9% isotonic NaCl solution was used to deliver a radiation dose of 20 Gy, 16 Gy, 10 Gy on the applicator surface. Then the balloon applicator was filled with water and the same measurements were repeated. Finally, the balloon applicator was irradiated by positioning it at different distances in the water phantom to simulate the isodose contour.
RESULTS
At the time the balloon applicator was filled with water and 0,9% NaCl solution, the difference between the planned dose and the absorbed dose was ~ 2% vs. 15% for 30 cc, ~ 5% vs. 14% for 35 cc and ~ 3,5% vs. 10% for 40 cc respectively. Finally, the absorbed dose at a distance of 1 cm from the applicator surface was measured as 9.63 Gy.
CONCLUSION
In this study, it was showed that different prescription dose could be possible to deliver in the Xoft Axxent eBT system based on the standard plan. In addition, the absorbed dose was higher than the planned dose depending on the effective atomic number of NaCl solution comparing to water due to photoelectric effect in low energy photons. By measuring the dose distributions at different distances from the balloon applicator surface, the absorbed dose in tissue equivalent medium was determined and the isodose contours characteristics was simulated.
Topics: X-Rays; Sodium Chloride; Radiography; Saline Solution; Water; Radiation Dosage
PubMed: 36855193
DOI: 10.1186/s13104-023-06287-1