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Radiotherapy and Oncology : Journal of... May 2009To overcome the barriers to BCT, methods of PBI in the setting of breast conservation have been explored. The method of PBI with the longest published follow-up is... (Review)
Review
To overcome the barriers to BCT, methods of PBI in the setting of breast conservation have been explored. The method of PBI with the longest published follow-up is multi-catheter interstitial brachytherapy. Balloon-based brachytherapy with the MammoSite brachytherapy applicator was designed to simplify the brachytherapy procedure for PBI, enhance the reproducibility of the dosimetry, and improve patient comfort. The rates of local recurrence following PBI with the MammoSite applicator have been low, but there are few published reports and follow-up has been relatively short. The cosmetic outcomes and toxicity of MammoSite PBI are comparable to those seen after multicatheter-based PBI. Additional methods of balloon brachytherapy, including Xoft and SenoRx Contura have been developed. Finally, long-term follow-up after PBI is important for the welfare of individual patients and in order to establish the efficacy, late toxicity and cosmetic outcomes of this technique.
Topics: Brachytherapy; Breast Neoplasms; Esthetics; Female; Humans; Mastectomy, Segmental; Patient Selection; Radiotherapy Dosage; Radiotherapy, Conformal; Randomized Controlled Trials as Topic
PubMed: 19167123
DOI: 10.1016/j.radonc.2008.12.014 -
Brachytherapy 2021Coronary artery disease leads to stenosis of the major cardiac vessels, resulting in ischemia and infarction. Percutaneous intervention (PCI) with balloon angioplasty...
BACKGROUND
Coronary artery disease leads to stenosis of the major cardiac vessels, resulting in ischemia and infarction. Percutaneous intervention (PCI) with balloon angioplasty can re-open stenosed vessels. Drug eluting stents (DES) and intravascular brachytherapy (IVBT) and drug-coated balloons (DCBs) are proven to decrease the likelihood of another restenosis after PCI, but neither is completely effective. Due to the limited long-term effectiveness of IVBT or DCB used separately for salvage PCI, we combined the two in some poor prognosis patients.
METHODS
Combined IVBT+DCB was intended for a total of 36 patients from 2015-2020. PCI with some combination of ballooning, laser and directional/rotational atherectomy was used to maximally open the stenotic region prior to IVBT+DCB. Beta-radiation brachytherapy for all patients was done with a Novoste Beta-Cath. Lutonix 4.0 x 40 mm paclitaxel-coated balloons (Bard, Murray Hill, NJ) were employed.
RESULTS
Overall survival at two years was 88%. Nine patients had follow-up angiograms, all for cardiac symptoms. Time from IVBT+DCB to follow-up angiography ranged from 4 to 33 months. The average months PCI-free interval before brachy therapy was 11.1 mos (95% CI 1.03-23.25) versus 23.3 mos after VBT (23.3 95% CI 12.3-32.3). The mean difference was 11.2 mos (95% CI 1.06-21.4, p < 0.031). None of the follow-up angiographic procedures displayed evidence of what could be interpreted as radiation damage.
CONCLUSIONS
In this uncontrolled series, IVBT plus DCB appeared to lengthen the ISR-free interval relative to what had been achieved prior to the combined intervention. We view these results as mildly encouraging, worthy of further study.
Topics: Brachytherapy; Coronary Restenosis; Humans; Percutaneous Coronary Intervention; Pharmaceutical Preparations; Stents; Treatment Outcome
PubMed: 34226148
DOI: 10.1016/j.brachy.2021.04.002 -
Expert Review of Medical Devices May 2009Multiple institutions have explored accelerated partial breast irradiation (APBI). The method of APBI with the longest reported follow-up is multicatheter interstitial... (Review)
Review
Multiple institutions have explored accelerated partial breast irradiation (APBI). The method of APBI with the longest reported follow-up is multicatheter interstitial brachytherapy. Balloon brachytherapy was introduced to simplify the APBI procedure. The MammoSite device was the first breast brachytherapy device designed for the treatment of APBI to hit the market. The MammoSite catheter was adopted rapidly in both academic and community settings and has led to a great increase in the number of patients undergoing the APBI procedure. We introduce and describe five additional breast brachytherapy devices.
Topics: Animals; Brachytherapy; Breast Neoplasms; Catheterization; Female; Humans
PubMed: 19419289
DOI: 10.1586/erd.09.6 -
International Journal of Radiation... Jul 2019To propose a novel high-dose-rate brachytherapy applicator for balloon-based dynamic modulated brachytherapy (DMBT) for accelerated partial breast irradiation (APBI) and...
PURPOSE
To propose a novel high-dose-rate brachytherapy applicator for balloon-based dynamic modulated brachytherapy (DMBT) for accelerated partial breast irradiation (APBI) and to demonstrate its dosimetric advantage compared to the widely used Contura applicator.
METHODS AND MATERIALS
The DMBT balloon device consists of a fixed central channel enabling real-time, in vivo dosimetry and an outer motion-dynamic, adjustable-radius channel capable of moving to any angular position within the balloon. This design allows placement of dwell positions anywhere within the balloon volume, guaranteeing optimal placement and generation of the applicator and treatment plan, respectively. Thirteen clinical treatment plans for patients with early-stage breast cancer receiving APBI after lumpectomy using Contura were retrospectively obtained under institutional review board approval. New treatment plans were created by replacing the Contura with the DMBT device. DMBT plans were limited to 4 angular positions and an outer channel radius of 1.5 cm. The new plans were optimized to limit dose to ribs and skin while maintaining target coverage similar to that of the clinical plan.
RESULTS
Similar target coverage was obtained for the DMBT plans compared with clinical Contura plans. Across all patients the mean (standard deviation) reductions in D0.1 cc to the ribs and skin were 6.70% (6.28%) and 5.13% (6.54%), respectively. A threshold separation distance between the balloon surface and the organ at risk (OAR), below which dosimetric changes of greater than 5% were obtained, was observed to be 12 mm for ribs and skin. When both OARs were far from the balloon, DMBT plans were of similar quality to Contura plans, as expected.
CONCLUSIONS
This study demonstrates the superior ability of the APBI DMBT applicator to spare OARs while achieving target coverage comparable to current treatment plans, especially when in close proximity. The DMBT balloon may enable new modes of dynamic high-dose-rate treatment delivery and allow for ultrahypofractionated dose regimens to be safely used.
Topics: Brachytherapy; Breast Neoplasms; Equipment Design; Female; Humans; Organ Sparing Treatments; Organs at Risk; Postoperative Period; Radiation Injuries; Retrospective Studies
PubMed: 30910767
DOI: 10.1016/j.ijrobp.2019.03.026 -
JACC. Cardiovascular Interventions Jun 2016
Topics: Angioplasty, Balloon, Coronary; Brachytherapy; Coronary Restenosis; Humans; Stents
PubMed: 27339843
DOI: 10.1016/j.jcin.2016.04.033 -
Radiographics : a Review Publication of... 2015The use of accelerated partial breast irradiation (APBI) following breast-conserving surgery is rapidly gaining popularity as an alternative to whole-breast irradiation... (Review)
Review
The use of accelerated partial breast irradiation (APBI) following breast-conserving surgery is rapidly gaining popularity as an alternative to whole-breast irradiation (WBI) in selected patients with early-stage breast cancer. Although data on the long-term effectiveness and safety of APBI accelerated partial breast irradiation are still being gathered, the shorter treatment course and narrowed radiation target of APBI accelerated partial breast irradiation provide an attractive alternative for carefully selected patients. These patients include those with relatively small tumors (≤3 cm), negative or close margins, and negative sentinel lymph nodes. Possible long-term complications include telangiectasia and the development of a palpable mass at the lumpectomy site. Mammographic findings in patients who have undergone APBI accelerated partial breast irradiation are distinct from those in patients who have undergone conventional WBI whole-breast irradiation . The most common post-APBI accelerated partial breast irradiation radiographic findings include formation of seromas at the lumpectomy site, focal parenchymal changes such as increased trabeculation and parenchymal distortion, fat necrosis, and skin changes such as thickening or retraction. Given the continued evolution of breast cancer treatment, it is important that radiologists have a comprehensive understanding of APBI accelerated partial breast irradiation in terms of rationale, patient selection criteria, common postprocedural radiographic findings (and how they differ from post-WBI whole-breast irradiation findings), and advantages and potential complications.
Topics: Brachytherapy; Breast Neoplasms; Female; Humans; Mammography
PubMed: 25590384
DOI: 10.1148/rg.351140131 -
Coronary Artery Disease Sep 2004The Gamma I, START and INHIBIT trials conclusively demonstrate the feasibility, safety and efficacy of intracoronary radiation as the treatment of choice for stent... (Review)
Review
The Gamma I, START and INHIBIT trials conclusively demonstrate the feasibility, safety and efficacy of intracoronary radiation as the treatment of choice for stent restenosis. Further reports confirm this finding and extend the indications. Vascular brachytherapy should be made available for all patients with diffuse stent restenosis. Specific devices such as cutting balloons may improve the procedure but does not seem to have an impact alone on the evolution.
Topics: Angioplasty, Balloon, Coronary; Beta Particles; Brachytherapy; Coronary Restenosis; Gamma Rays; Graft Occlusion, Vascular; Humans; Prosthesis Implantation; Saphenous Vein; Stents
PubMed: 15346089
DOI: 10.1097/00019501-200409000-00004 -
Journal of Controlled Release :... Oct 2014Brachytherapy is described as the short distance treatment of cancer with a radioactive isotope placed on, in, or near the lesions or tumor to be treated. The main... (Review)
Review
Brachytherapy is described as the short distance treatment of cancer with a radioactive isotope placed on, in, or near the lesions or tumor to be treated. The main advantage of brachytherapy compared with external beam radiation (EBR) is the improved localized delivery of dose to the target volume of interest, thus normal tissue irradiation is reduced. The precise and targeted nature of brachytherapy provides a number of key benefits for the effective treatment of cancer such as efficacy, minimized risk of side effects, short treatment times, and cost-effectiveness. Brachytherapy devices have yielded promising results in preclinical and clinical studies. However, brachytherapy can only be used in localized and relatively small tumors. Although the introduction of new delivery devices allows the treatment of more complex tumor sites, with wider range of dose rate for improving treatment efficacy and reduction of side effects, a better understanding about the safety, efficacy, and accuracy of these systems is required, and further development of new techniques is warranted. Therefore, this review focuses on the delivery devices for brachytherapy and their application in prostate, breast, brain, and other tumor sites.
Topics: Animals; Brachytherapy; Brain; Brain Neoplasms; Breast; Breast Neoplasms; Female; Humans; Male; Neoplasms; Prostate; Prostatic Neoplasms; Treatment Outcome
PubMed: 25008970
DOI: 10.1016/j.jconrel.2014.06.057 -
Current Cardiology Reports Oct 2021The catheter-based coronary intervention has become a well-established therapeutic modality for obstructive coronary artery disease. However, in-stent restenosis remains... (Review)
Review
PURPOSE OF REVIEW
The catheter-based coronary intervention has become a well-established therapeutic modality for obstructive coronary artery disease. However, in-stent restenosis remains a significant limitation of coronary intervention despite the use of newer devices. Intravascular brachytherapy was introduced to treat recurrent in-stent restenosis but only modestly adopted. This review will discuss the mechanism of intracoronary brachytherapy, available clinical evidence of brachytherapy in recurrent in-stent restenosis treatment, and the future of coronary brachytherapy in coronary intervention.
RECENT FINDINGS
Drug-eluting stents have an inherent limitation as they leave a permanent metal layer inside an artery when deployed. Recently, drug-coated balloon technology has emerged to treat coronary artery disease as a combination of balloon angioplasty and local drug delivery without leaving a metal layer behind. Recent European guidelines recommended using drug-coated balloons when treating in-stent restenosis treatment, while the US guidelines have not yet addressed the use of drug-coated balloons in such cases. Coronary brachytherapy is a valuable addition to treat these challenging diseases despite several logistic issues. If there are newer technologies with easier setup, such as drug-coated balloons, coronary brachytherapy resurgence is improbable in the contemporary era, although it may not become obsolete.
Topics: Angioplasty, Balloon, Coronary; Brachytherapy; Coronary Restenosis; Drug-Eluting Stents; Humans; Stents
PubMed: 34599432
DOI: 10.1007/s11886-021-01582-4 -
Biomedical Materials (Bristol, England) Feb 2018A drug-eluting balloon is a non-stent technology in which the effective homogenous delivery of anti-proliferative drugs is processed by the vessel wall through an... (Review)
Review
A drug-eluting balloon is a non-stent technology in which the effective homogenous delivery of anti-proliferative drugs is processed by the vessel wall through an inflated balloon. This is done to restore luminal vascularity in order to treat atherosclerosis, in-stent restenosis and reduce the risk of late thrombosis without implanting a permanent foreign object. The balloon technology relies on the concept of targeted drug delivery, which helps in the rapid healing of the vessel wall and prevents the proliferation of smooth muscle cells. Several drug eluting devices in the form of coated balloons are currently in clinical use, namely DIOR, PACCOCATH, SeQuentPlease and IN.PACT™. The device varies in terms of the material used for making the balloon, the coating techniques, the choice of coated drug and the release pattern of the drug at the site. This review gives an insight into the evolution, rationale and comparison of the marketed drug-eluting balloons. Here, different coating techniques have been analysed for the application and critical analysis of available DEB technologies, and a technical comparison has been done.
Topics: Angioplasty, Balloon; Animals; Atherosclerosis; Brachytherapy; Coated Materials, Biocompatible; Coronary Restenosis; Drug Delivery Systems; Drug-Eluting Stents; Humans; Lasers; Materials Testing; Paclitaxel; Polymers; Prosthesis Design; Sirolimus; Treatment Outcome
PubMed: 29227279
DOI: 10.1088/1748-605X/aaa0aa