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Cureus Apr 2024Intraductal papillary neoplasm of the bile duct (IPNB) represents a relatively nascent pathological entity, recognized as a precancerous condition within the spectrum of...
Intraductal papillary neoplasm of the bile duct (IPNB) represents a relatively nascent pathological entity, recognized as a precancerous condition within the spectrum of cholangiocarcinoma. Surgical intervention is advocated for all patients with IPNB due to their susceptibility toward obstructive jaundice, cholangitis, and the heightened likelihood of malignant transformation. Nonetheless, the efficacy of radiation therapy for IPNB cases that are either inoperable or refractory remains inadequately substantiated. Herein, we present a case study of an IPNB patient who declined surgery, and a commendable local control was accomplished solely through the implementation of brachytherapy utilizing Ir-192. A septuagenarian Japanese man presented at our medical institution with the chief complaint of jaundice and was subsequently diagnosed with IPNB. The IPNB lesion extensively spanned from the lower intrapancreatic bile duct to the right (extending to B5/B8) and left bile ducts (up to just before B4). The patient underwent weekly endoscopic retrograde cholangiopancreatography (ERCP) sessions. The prescribed treatment regimen encompassed 36 Gy/6 Fr high-dose-rate brachytherapy (HDR-BT) administered once per week during ERCP, with each treatment session adhering to a timeframe not exceeding two hours. Two months following the initiation of treatment, a biliary endoscopy demonstrated complete resolution of the tumor lesion and amelioration of jaundice. The only observed acute adverse event was grade 2 hepatic dysfunctions. To the best of our knowledge, this represents the first documented instance of HDR-BT employed in IPNB management, suggesting its potential as a viable alternative for inoperable or refractory IPNB cases.
PubMed: 38745812
DOI: 10.7759/cureus.58254 -
Acta Otorhinolaryngologica Italica :... May 2024Management of recurrent head and neck cancer (HNC) is challenging. One option in previously irradiated patients is re-irradiation using interventional radiotherapy...
OBJECTIVE
Management of recurrent head and neck cancer (HNC) is challenging. One option in previously irradiated patients is re-irradiation using interventional radiotherapy (IRT), the modern form of brachytherapy. Re-irradiation using IRT can be delivered as an exclusive strategy for salvage or through a postoperative or perioperative approach after salvage surgery. The aim of the present study is to analyse a bicentric Italian series focusing on the use of IRT as a re-irradiation modality and assess the resulting evidence concerning oncologic outcomes and morbidity.
METHODS
This is a retrospective study performed in two referral centres in Italy: Policlinico Universitario Agostino Gemelli in Rome and Azienda Ospedaliera Universitaria in Sassari. All patients who had previously received a full course of external beam RT and have been re-irradiated using high-dose-rate IRT between December 2010 and June 2023 were included. Patients were retreated either by a combination of surgery and perioperative (either endocavitary or interstitial) IRT or by exclusive interstitial IRT.
RESULTS
Thirty-four patients were included in the present series, 2 of whom underwent more than one IRT re-irradiation. Notably, no patient reported specific IRT-related toxicities. Median follow-up, excluding patients who died of HNC, was 24.5 months. Two-year local relapse-free survival was 26%, disease-specific survival 39.1%, and overall survival 36.6%.
CONCLUSIONS
The present series is the largest reported experience of re-irradiation by IRT for HNC in Italy. The very low rate of toxicity confirms IRT as the safest re-irradiation modality. It is noteworthy to underline that IRT is a multidisciplinary strategy based on the close cooperation between surgeons and radiation oncologists during every phase, from the recommendation of treatment and implantation in the operating theatre, to its prescription and dose painting.
Topics: Humans; Retrospective Studies; Male; Middle Aged; Head and Neck Neoplasms; Female; Aged; Neoplasm Recurrence, Local; Brachytherapy; Re-Irradiation; Treatment Outcome; Adult; Italy; Aged, 80 and over
PubMed: 38745514
DOI: 10.14639/0392-100X-suppl.1-44-2024-N2824 -
Journal of Radiation Research May 2024Hyaluronate gel injection (HGI) in the rectovaginal septum and vesicovaginal septum is effective in the setting of high-dose-rate image-guided adaptive brachytherapy...
Hyaluronate gel injection (HGI) in the rectovaginal septum and vesicovaginal septum is effective in the setting of high-dose-rate image-guided adaptive brachytherapy (IGABT) for cervical cancer. We aimed to retrospectively investigate optimal conditions for HGI to achieve optimal dose distribution with a minimum number of HGI. We classified 50 IGABT plans of 13 patients with cervical cancer who received IGABT both with and without HGI in the rectovaginal septum and vesicovaginal septum into the following two groups: plan with (number of plans = 32) and plan without (number of plans = 18) HGI. The irradiation dose parameters of high-risk clinical target volume (CTVHR) and organs at risk per fraction were compared between these groups. We also developed the adjusted dose score (ADS), reflecting the overall irradiation dose status for four organs at risk and CTVHR in one IGABT plan and investigated its utility in determining the application of HGI. HGI reduced the maximum dose to the most exposed 2.0 cm3 (D2.0 cm3) of the bladder while increasing the minimum dose covering 90% of CTVHR and the percentage of CTVHR receiving 100% of the prescription dose in one IGABT plan without causing any associated complications. An ADS of ≥2.60 was the optimum cut-off value to decide whether to perform HGI. In conclusion, HGI is a useful procedure for improving target dose distribution while reducing D2.0 cm3 in the bladder in a single IGABT plan. The ADS can serve as a useful indicator for the implementation of HGI.
PubMed: 38739893
DOI: 10.1093/jrr/rrae031 -
International Journal of Molecular... Apr 2024Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired... (Review)
Review
Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients' QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.
Topics: Humans; Keloid; Cicatrix, Hypertrophic; Combined Modality Therapy; Quality of Life
PubMed: 38731893
DOI: 10.3390/ijms25094674 -
Journal of Medical Case Reports May 2024Mesonephric adenocarcinoma is an extremely rare subtype of uterine cervical cancer that is associated with a poor prognosis and for which a standardized treatment...
BACKGROUND
Mesonephric adenocarcinoma is an extremely rare subtype of uterine cervical cancer that is associated with a poor prognosis and for which a standardized treatment protocol has not been established. Carbon ion radiotherapy (CIRT) is an emerging radiotherapy modality that has been shown to have a favorable anti-tumor effect, even for tumors resistant to conventional photon radiotherapy or chemotherapy. However, there is no report on CIRT outcomes for mesonephric adenocarcinoma of the uterine cervix.
CASE PRESENTATION
We treated a 47-year-old Japanese woman with mesonephric adenocarcinoma of the uterine cervix (T2bN0M0 and stage IIB according to the 7th edition of the Union for International Cancer Control and International Federation of Gynecology and Obstetrics, respectively) with CIRT combined with brachytherapy and concurrent chemotherapy. CIRT consisted of whole pelvic irradiation and boost irradiation to the gross tumor; 36.0 Gy (relative biological effectiveness [RBE]) in 12 fractions and 19.2 Gy (RBE) in 4 fractions, respectively, performed once a day, four times per week. Computed tomography-based image-guided adaptive brachytherapy was performed after completion of CIRT, for which the D (i.e., the dose prescribed to 90% of the target volume) for the high-risk clinical target volume was 20.4 Gy in a total of 3 sessions in 2 weeks. A weekly cisplatin (40 mg/m) dose was administered concomitantly with the radiotherapy for a total of five courses. From 4 months post-CIRT, the patient developed metastasis of the lung, with a total of 10 lung metastases over 70 months; these lesions were treated on each occasion by photon stereotactic body radiotherapy and/or systemic therapy. At 8 years from initial treatment (i.e., 2 years after the last treatment), the patient is alive without any evidence of recurrence and maintains a high quality of life.
CONCLUSIONS
This is the first report of CIRT for treatment of mesonephric adenocarcinoma of the uterine cervix. The present case indicates the potential efficacy of CIRT in combination with brachytherapy for treatment of this disease.
Topics: Humans; Female; Middle Aged; Uterine Cervical Neoplasms; Adenocarcinoma; Heavy Ion Radiotherapy; Brachytherapy; Treatment Outcome; Chemoradiotherapy
PubMed: 38720351
DOI: 10.1186/s13256-024-04548-6 -
Nan Fang Yi Ke Da Xue Xue Bao = Journal... Apr 2024To investigate the dosimetric difference between manual and inverse optimization in 3-dimensional (3D) brachytherapy for gynecologic tumors.
OBJECTIVE
To investigate the dosimetric difference between manual and inverse optimization in 3-dimensional (3D) brachytherapy for gynecologic tumors.
METHODS
This retrospective study was conducted among a total of 110 patients with gynecologic tumors undergoing intracavitary combined with interstitial brachytherapy or interstitial brachytherapy. Based on the original images, the brachytherapy plans were optimized for each patient using Gro, IPSA1, IPSA2 (with increased volumetric dose limits on the basis of IPSA1) and HIPO algorithms. The dose-volume histogram (DVH) parameters of the clinical target volume (CTV) including V, V, V, D, D and CI, and the dosimetric parameters D, D, and D for the bladder, rectum, and sigmoid colon were compared among the 4 plans.
RESULTS
Among the 4 plans, Gro optimization took the longest time, followed by HIPO, IPSA2 and IPSA1 optimization. The mean D, D, and V of HIPO plans were significantly higher than those of Gro and IPSA plans, and D and V of IPSA1, IPSA2 and HIPO plans were higher than those of Gro plans ( < 0.05), but the CI of the 4 plans were similar ( > 0.05). For the organs at risk (OARs), the HIPO plan had the lowest D of the bladder and rectum; the bladder absorbed dose of Gro plans were significantly greater than those of IPSA1 and HIPO ( < 0.05). The D and D of the rectum in IPSA1, IPSA2 and HIPO plans were better than Gro ( < 0.05). The D and D of the sigmoid colon did not differ significantly among the 4 plans.
CONCLUSION
Among the 4 algorithms, the HIPO algorithm can better improve dose coverage of the target and lower the radiation dose of the OARs, and is thus recommended for the initial plan optimization. Clinically, the combination of manual optimization can achieve more individualized dose distribution of the plan.
Topics: Humans; Brachytherapy; Female; Retrospective Studies; Genital Neoplasms, Female; Radiotherapy Dosage; Algorithms; Radiotherapy Planning, Computer-Assisted; Radiometry
PubMed: 38708512
DOI: 10.12122/j.issn.1673-4254.2024.04.20 -
Cancer Diagnosis & Prognosis 2024Radiotherapy plays a key role in the treatment of gynecological cancer. Modern radiotherapy techniques with external beams (e-RT) are applied in a broad spectrum of...
BACKGROUND/AIM
Radiotherapy plays a key role in the treatment of gynecological cancer. Modern radiotherapy techniques with external beams (e-RT) are applied in a broad spectrum of gynecological cancer cases. However, high radiation doses, affecting normal tissue adjacent to cancer, represent the main disadvantage of e-RT regimens. For this reason, brachytherapy (BT), an internal beam-based technique (i-RT), is suggested following e-RT. Our purpose was to compare e-RT plans using volumetric-modulated arc therapy (VMAT) with those using 3D conformal techniques (3D-CRT) and compare BT plans guided by 3D or 2D imaging based on the potential corresponding toxicity levels.
MATERIALS AND METHODS
In this preliminary, non-randomized comparative retrospective study, 15 females suffering gynecological cancer were enrolled. Modern e-RT and i-RT (BT) techniques were applied.
RESULTS
Concerning e-RT, D95/D99/rectum 2cc/bladder 2cc and small intestine 2cc were measured and compared; in i-RT, rectum 2cc/bladder 2cc were measured and compared. The median dose to the planning target volume in VMAT was 97.4 Gy compared with 92.9 Gy in 3D-CRT. Τhe rectum received almost 5 Gy less in VMAT compared to 3D-CRT (median of 43.5 Gy vs. 48.6 Gy; p=0.001). In the bladder, dose differences were minimal, while the small intestine received 47.6 Gy in VMAT (p=0.001). Regarding 3D-BT, the rectum received 63.1 Gy compared with 49.9 Gy (p=0.009) in 2D-BT. Concerning the bladder, mean 2D-BT and 3D-BT doses were 71.9 and 65 Gy, respectively, differing non-significantly.
CONCLUSION
VMAT was found to be superior to 3D-CRT, especially in dose distribution, volume coverage and protection of critical organs. Similarly, 3D-BT should be preferred over 2D-BT due to critical advantages.
PubMed: 38707738
DOI: 10.21873/cdp.10331 -
Cancer Diagnosis & Prognosis 2024Malignant airway obstruction (MAO) secondary to tumor growth occurs in nearly a third of patients with lung cancer and portends a very poor prognosis if untreated....
BACKGROUND
Malignant airway obstruction (MAO) secondary to tumor growth occurs in nearly a third of patients with lung cancer and portends a very poor prognosis if untreated. Treatment options include bronchoscopic intervention with tumor debulking, stent placement, endobronchial brachytherapy, or palliative radiotherapy.
CASE REPORT
This is a report of a 74-year-old woman with a medical history of metastatic lung adenocarcinoma, hospitalized for dyspnea, hemoptysis, and chest pain with a radiographic finding of MAO on chest X-ray and computed tomography. Patient underwent radiation with a total dose of 13 Gy in two once-weekly fractions of 6.5 Gy per fraction. Three days after the end of radiation treatment, chest X-ray showed a completely right lung re-expansion without atelectasis. Two weeks after radiotherapy treatment, the patient was discharged from hospital without pulmonary symptoms.
CONCLUSION
A different fractionation with a lower equivalent dose in 2 Gy fraction compared to literature data showed efficacy in resolving MAO with excellent local control in the first three months of follow-up.
PubMed: 38707719
DOI: 10.21873/cdp.10332 -
EJNMMI Radiopharmacy and Chemistry May 2024Radiation nanomedicines are nanoparticles labeled with radionuclides that emit α- or β-particles or Auger electrons for cancer treatment. We describe here our... (Review)
Review
BACKGROUND
Radiation nanomedicines are nanoparticles labeled with radionuclides that emit α- or β-particles or Auger electrons for cancer treatment. We describe here our 15 years scientific journey studying locally-administered radiation nanomedicines for cancer treatment. We further present a view of the radiation nanomedicine landscape by reviewing research reported by other groups.
MAIN BODY
Gold nanoparticles were studied initially for radiosensitization of breast cancer to X-radiation therapy. These nanoparticles were labeled with In to assess their biodistribution after intratumoural vs. intravenous injection. Intravenous injection was limited by high liver and spleen uptake and low tumour uptake, while intratumoural injection provided high tumour uptake but low normal tissue uptake. Further, [In]In-labeled gold nanoparticles modified with trastuzumab and injected iintratumourally exhibited strong tumour growth inhibition in mice with subcutaneous HER2-positive human breast cancer xenografts. In subsequent studies, strong tumour growth inhibition in mice was achieved without normal tissue toxicity in mice with human breast cancer xenografts injected intratumourally with gold nanoparticles labeled with β-particle emitting Lu and modified with panitumumab or trastuzumab to specifically bind EGFR or HER2, respectively. A nanoparticle depot (nanodepot) was designed to incorporate and deliver radiolabeled gold nanoparticles to tumours using brachytherapy needle insertion techniques. Treatment of mice with s.c. 4T1 murine mammary carcinoma tumours with a nanodepot incorporating [Y]Y-labeled gold nanoparticles inserted into one tumour arrested tumour growth and caused an abscopal growth-inhibitory effect on a distant second tumour. Convection-enhanced delivery of [Lu]Lu-AuNPs to orthotopic human glioblastoma multiforme (GBM) tumours in mice arrested tumour growth without normal tissue toxicity. Other groups have explored radiation nanomedicines for cancer treatment in preclinical animal tumour xenograft models using gold nanoparticles, liposomes, block copolymer micelles, dendrimers, carbon nanotubes, cellulose nanocrystals or iron oxide nanoparticles. These nanoparticles were labeled with radionuclides emitting Auger electrons (In, Tc, I, Pd, Pt, Pt), β-particles (Lu, Re, Re, Y, Au, I) or α-particles (Ac, Bi, Pb, At, Ra). These studies employed intravenous or intratumoural injection or convection enhanced delivery. Local administration of these radiation nanomedicines was most effective and minimized normal tissue toxicity.
CONCLUSIONS
Radiation nanomedicines have shown great promise for treating cancer in preclinical studies. Local intratumoural administration avoids sequestration by the liver and spleen and is most effective for treating tumours, while minimizing normal tissue toxicity.
PubMed: 38703297
DOI: 10.1186/s41181-024-00266-y -
Physica Medica : PM : An International... May 2024Diffusing alpha-emitters radiation therapy (DaRT) is a brachytherapy technique using α-particles to treat solid tumours. The high linear energy transfer (LET) and short...
PURPOSE
Diffusing alpha-emitters radiation therapy (DaRT) is a brachytherapy technique using α-particles to treat solid tumours. The high linear energy transfer (LET) and short range of α-particles make them good candidates for the targeted treatment of cancer. Treatment planning of DaRT requires a good understanding of the dose from α-particles and the other particles released in the Ra decay chain.
METHODS
The Geant4 Monte Carlo toolkit has been used to simulate a DaRT seed to better understand the dose contribution from all particles and simulate the DNA damage due to this treatment.
RESULTS
Close to the seed α-particles deliver the majority of dose, however at radial distances greater than 4 mm, the contribution of β-particles is greater. The RBE has been estimated as a function of number of double strand breaks (DSBs) and complex DSBs. A maximum seed spacing of 5.5 mm and 6.5 mm was found to deliver at least 20 Gy RBE weighted dose between the seeds for RBE and RBE respectively.
CONCLUSIONS
The DNA damage changes with radial distance from the seed and has been found to become less complex with distance, which is potentially easier for the cell to repair. Close to the seed α-particles contribute the majority of dose, however the contribution from other particles cannot be neglected and may influence the choice of seed spacing.
Topics: Alpha Particles; Monte Carlo Method; DNA Damage; Radiotherapy Dosage; Radiation Dosage; Relative Biological Effectiveness; Diffusion; Brachytherapy; Humans; Linear Energy Transfer; Radiotherapy Planning, Computer-Assisted; DNA Breaks, Double-Stranded
PubMed: 38701625
DOI: 10.1016/j.ejmp.2024.103367