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CA: a Cancer Journal For Clinicians 1995Brachytherapy is one of the oldest techniques of radiation therapy for prostate cancer. However, its use has been controversial due to mixed results with older implant... (Review)
Review
Brachytherapy is one of the oldest techniques of radiation therapy for prostate cancer. However, its use has been controversial due to mixed results with older implant techniques and the availability of different treatment methods. New methods of brachytherapy based on improved technology and increased understanding of radiobiology hold promise for consistently improved results. This article describe the various methods of prostate brachytherapy and reviews the clinical results for these methods.
Topics: Brachytherapy; Humans; Male; Prostatic Neoplasms; Prostheses and Implants; Radioisotopes
PubMed: 7743420
DOI: 10.3322/canjclin.45.3.165 -
The European Respiratory Journal Jul 2006Cryotherapy, brachytherapy and photodynamic therapy (PDT) are three different methods proposed in the endoluminal treatment of lung cancers. The current article presents... (Review)
Review
Cryotherapy, brachytherapy and photodynamic therapy (PDT) are three different methods proposed in the endoluminal treatment of lung cancers. The current article presents an overview of the specific indications and limits of each technique. These three methods were first proposed with palliative intent in inoperable patients with centrally located lung cancers. Now, the best indication is a curative intent in early stage lung cancers. Of the three, cryotherapy is the cheapest method. It induces cell necrosis in a 3-mm radius around the probe, and is suitable for treatment of superficial tumours. However, clinical trials are limited. In contrast, many clinical studies have confirmed the efficacy of PDT in treatment of superficial lung cancers. Brachytherapy can cure more aggressive tumours with deeper invasion into the bronchial wall. Unfortunately, no comparative studies have been published. Each of these methods induces a delayed tumour necrosis, and thus neither is indicated in the treatment of obstructive tumours with acute dyspnoea. In many situations, these methods should be complementary, particularly cryotherapy and brachytherapy or PDT and brachytherapy. The combination of these endoscopic methods with chemotherapy should be widely tested to promote the adjuvant role of the endoscopic methods in the treatment of lung cancers.
Topics: Animals; Brachytherapy; Cryotherapy; Humans; Lung Neoplasms; Photochemotherapy; Treatment Outcome
PubMed: 16816349
DOI: 10.1183/09031936.06.00014006 -
Asian Pacific Journal of Cancer... Sep 2023Brachytherapy is used in 17 radiotherapy facilities In Kazakhstan. Each institution has an individual quality control (QC) program in place to ensure the safe and...
OBJECTIVE
Brachytherapy is used in 17 radiotherapy facilities In Kazakhstan. Each institution has an individual quality control (QC) program in place to ensure the safe and accurate delivery of the treatment dose to the patient. The main objective of this paper is to explore current approaches to quality control of brachytherapy in Kazakhstan and reduce potential discrepancies in testing frequency and tolerance limits by identifying a set of basic quality control requirements.
MATERIALS AND METHODS
A detailed brachytherapy quality control questionnaire was provided to 17 radiotherapy institutions for completion. A separate questionnaire was sent to two institutions associated with brachytherapy. Questions addressed safety aspects, radiation parameters, total time spent on quality control, and available imaging systems for dose determination. The results of the survey were compared with the recommendations set found in international brachytherapy quality control documents.
RESULTS
The results of the questionnaires revealed significant differences in the frequency and methods of testing. For example, only two of the 17 centers have at least some kind of quality assurance program for brachytherapy treatment. Only five centers have equipment with the help of which dosimetric control can be performed, and only two centers have local medical physicists performing this control. One of the centers is checked quarterly, while the other is checked only once a year. In the remaining 15 centers, dosimetric control is performed by specialists who recharge the source without providing any document or protocol. There were also significant differences in the amount of time spent on quality control, mostly related to the variety of approaches to quality control and differences in the availability of resources. Almost all centers (15 of 17) rely only on inspections from the radionuclide source supplier and do not monitor the dosimetric and mechanical parameters of the facility at all.
CONCLUSION
Based on the results of the survey and comparison with international recommendations, a set of basic requirements for brachytherapy quality control is needed.
Topics: Humans; Brachytherapy; Kazakhstan; Radiation Oncology; Radiometry; Quality Control; Radiotherapy Dosage
PubMed: 37774065
DOI: 10.31557/APJCP.2023.24.9.3133 -
Radiotherapy and Oncology : Journal of... May 2022Wound healing complications (WHC), osteoradionecrosis (ORN), and nerve damage (ND) are common adverse effects in adult patients with soft tissue sarcomas of the...
Dose volume histogram constraints in patients with soft tissue sarcomas of the extremities and the superficial trunk treated with surgery and perioperative HDR brachytherapy.
BACKGROUND
Wound healing complications (WHC), osteoradionecrosis (ORN), and nerve damage (ND) are common adverse effects in adult patients with soft tissue sarcomas of the extremities and the superficial trunk treated with surgery and perioperative high dose rate brachytherapy (PHDRB) alone or combined with external beam radiotherapy (EBRT).
RATIONALE
Analysis of the treatment factors contributing to these complications can potentially minimize their occurrence and severity.
PATIENTS
A total of 169 patients enrolled in two parallel prospective studies were included in this analysis. Previously Unirradiated cases (Group 1; n = 139) were treated with surgical resection, 16-24 Gy of PHDRB and 45 Gy of EBRT. Adjuvant chemotherapy was given to selected patients with high-grade tumors. Previously irradiated cases (Group 2; n = 30) were treated with surgical resection and 32-40 Gy of PHDRB without further EBRT.
METHODS
Patient factors, tumor factors, surgical factors, PHDRB factors and EBRT factors were analyzed using Cox univariate and multivariate analysis.
RESULTS
In Previously Unirradiated cases, WHC, ORN and ND occurred in 38.8%, 5.0% and 19.4%. Multivariate analysis indicated that WHC increased with CTV size (p = 0.02) and CTV Physical dose (p = 0.02). ORN increased with Bone EQD2 ≥ 67 Gy(p = 0.01) and ND was more frequent in patients with TVDVH-based dose (tissue volume encompassed by the 100% isodose) ≥ 84 Gy (p < 0.01). In Previously Irradiated cases, WHC, ORN and ND occurred in 63.3%, 3.3% and 23.3%. Multivariate analysis showed that WHC was more frequent in patients with SkinLifetime EQD2 ≥ 84 Gy (p = 0.01) and ND was more frequent after CTV Physical Doses ≥ 40 Gy (p < 0.01).
CONCLUSIONS
WHC in Previously Unirradiated patients can be minimized by using a more conservative CTV definition together with a meticulous implant technique and planning aimed to minimize hyperdose CTV areas. In Previously Irradiated patients WHC may be mimimized considering Lifetime EQD2 Skin doses. ORN can be reduced by using the Bone EQD2 constraint. ND occurs more frequently in patients with large tumors receiving high treated volume doses, but no specific constraints can be recommended due to the lack of peripheral nerve definition during brachytherapy planning.
Topics: Adult; Brachytherapy; Extremities; Humans; Osteoradionecrosis; Prospective Studies; Radiotherapy Dosage; Sarcoma; Soft Tissue Neoplasms
PubMed: 35227732
DOI: 10.1016/j.radonc.2022.02.025 -
Radiotherapy and Oncology : Journal of... May 2022To report disease-free survival (DFS) for volume-based and point-A based brachytherapy (BT) in locally advanced cervical cancer. (Meta-Analysis)
Meta-Analysis
BACKGROUND & PURPOSE
To report disease-free survival (DFS) for volume-based and point-A based brachytherapy (BT) in locally advanced cervical cancer.
MATERIALS & METHODS
We conducted a meta-analysis of studies assessing the effects of point-A and volume-based brachytherapy on 3-year DFS. Studies including stage I-IVA cervical cancer patients were included if standard treatment of concomitant chemo-radiotherapy and high-dose- or pulsed dose rate BT was delivered. The primary outcome was 3-year DFS, and secondary outcomes were 3-year local control (LC), 3-year overall survival (OS) and late toxicity. A random-effects subgroup meta-analysis was done.
RESULTS
In total, 5499 studies were screened, of which 24 studies with 5488 patients were eligible. There was significant heterogeneity among point-A studies (1538 patients) (I = 82%, p < 0.05) relative to volume-based studies (3950 patients) (I = 58, p = 0.01). The 3-year DFS for point-A and volume-based studies were 67% (95% CI 60%-73%) and 79% (95% CI 76%-82%) respectively (p = 0.001). Three-year LC for point-A and volume-based studies were 86% (95% CI 81%-90%) and 92% (91%-94%) respectively (p = 0.01). The difference in 3-year OS (72% vs. 79%, p = 0.12) was not statistically significant. The proportion of prospectively enrolled patients was 23% for point-A studies and 33% for volume-based studies. There was no difference in late grade 3 or higher gastrointestinal (3% vs. 4%, p = 0.76) genitourinary toxicities (3% vs. 3% p = 0.45) between the two groups.
CONCLUSION
Volume-based BT results in superior 3-year DFS and 3-year LC. In the absence of randomized trials, this meta-analysis provides the best evidence regarding transition to 3D planning.
Topics: Brachytherapy; Disease-Free Survival; Female; Humans; Progression-Free Survival; Radiotherapy Dosage; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 35259419
DOI: 10.1016/j.radonc.2022.02.038 -
Health and Quality of Life Outcomes Jan 2018Patient-reported health-related quality of life (HRQOL) differs between treatment options for prostate carcinoma. Long-term HRQOL data in brachytherapy series are... (Review)
Review
Quality of life after low-dose rate-brachytherapy for prostate carcinoma - long-term results and literature review on QLQ-C30 and QLQ-PR25 results in published brachytherapy series.
BACKGROUND
Patient-reported health-related quality of life (HRQOL) differs between treatment options for prostate carcinoma. Long-term HRQOL data in brachytherapy series are scarce. Therefore, we analyzed prostate-specific and general HRQOL in patients treated with brachytherapy for prostate carcinoma after long-term follow-up.
METHODS
Two hundred ninety-six patients with prostate carcinoma were treated with brachytherapy (01/1998-11/2003). General and prostate-specific HRQOL were measured using EORTC-QLQ-C30 and EORTC-QLQ-PR25, respectively. Patients were asked to complete the questionnaires after a median follow-up of 141 (119-181) months. QLQ-C30 results were compared to the German reference population. QLQ-PR25 results were compared to an earlier follow-up after a median of 51 months (no published QLQ-PR25 reference population for comparison). Additionally, a literature review on HRQOL data in brachytherapy series was performed.
RESULTS
One hundred six (35.8%) patients were lost to follow-up, 70 (23.6%) had died. 120 (40.5%) patients were contacted. 80 questionnaires were returned (27% of the original cohort; 91% of alive patients were ≥70 years). Sexual activity declined over time (mean scores: 40.5 vs. 45.5; p = 0.006), hormonal treatment-related symptoms, problems associated with incontinence aids, and burden of obstructive urinary symptoms did not differ significantly compared to the 51-month follow-up. General HRQOL was numerically better in our cohort as compared to the German reference population (> 16% relative difference for both age strata; < 70 and ≥70 years).
CONCLUSIONS
Our results indicate that symptom-burden after long-term follow-up and associated prostate-specific HRQOL remains relatively stable from 51 to 141 months. General HRQOL in surviving patients was numerically better compared to the reference population.
Topics: Aged; Aged, 80 and over; Brachytherapy; Erectile Dysfunction; Humans; Longitudinal Studies; Male; Middle Aged; Patient Reported Outcome Measures; Prostatic Neoplasms; Quality of Life; Radiotherapy Dosage; Statistics, Nonparametric; Surveys and Questionnaires; Time Factors; Urinary Incontinence
PubMed: 29357874
DOI: 10.1186/s12955-018-0844-8 -
Bulletin Du Cancer Dec 2012Curietherapy, more commonly named brachytherapy, is one of the oldest irradiation techniques used for prostate cancer. Prostate brachytherapy evolved according to the... (Review)
Review
Curietherapy, more commonly named brachytherapy, is one of the oldest irradiation techniques used for prostate cancer. Prostate brachytherapy evolved according to the scientific and technological progress. After a historical reminder of the evolution of prostate brachytherapy, different technical aspects are discussed: low-dose rate brachytherapy using permanent or temporary implants, high-dose rate brachytherapy as well as new imaging modalities. Prostate brachytherapy indications are listed regarding to the evidence-based medicine data for low, intermediate and high risks prostate cancers. Potential indications and new research programs (focal therapy, high-dose rate, single-dose brachytherapy) are also presented.
Topics: Brachytherapy; Evidence-Based Medicine; Humans; Iodine Radioisotopes; Male; Palladium; Prostatic Neoplasms; Radiation Protection; Radioisotopes; Radiotherapy Dosage; Risk
PubMed: 23228827
DOI: 10.1684/bdc.2012.1668 -
Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer.Cancer Treatment Reviews Jul 2016We review radiation therapy (RT) options available for prostate cancer, including external beam (EBRT; with conventional fractionation, hypofractionation, stereotactic... (Comparative Study)
Comparative Study Review
We review radiation therapy (RT) options available for prostate cancer, including external beam (EBRT; with conventional fractionation, hypofractionation, stereotactic body RT [SBRT]) and brachytherapy (BT), with an emphasis on the outcomes, toxicities, and contraindications for therapies. PICOS/PRISMA methods were used to identify published English-language comparative studies on PubMed (from 1980 to 2015) that included men treated on prospective studies with a primary endpoint of patient outcomes, with ⩾70 patients, and ⩾5year median follow up. Twenty-six studies met inclusion criteria; of these, 16 used EBRT, and 10 used BT. Long-term freedom from biochemical failure (FFBF) rates were roughly equivalent between conventional and hypofractionated RT with intensity modulation (evidence level 1B), with 10-year FFBF rates of 45-90%, 40-60%, and 20-50% (for low-, intermediate-, and high-risk groups, respectively). SBRT had promising rates of BF, with shorter follow-up (5-year FFBF of >90% for low-risk patients). Similarly, BT (5-year FFBF for low-, intermediate-, and high-risk patients have generally been >85%, 69-97%, 63-80%, respectively) and BT+EBRT were appropriate in select patients (evidence level 1B). Differences in overall survival, distant metastasis, and cancer specific mortality (5-year rates: 82-97%, 1-14%, 0-8%, respectively) have not been detected in randomized trials of dose escalation or in studies comparing RT modalities. Studies did not use patient-reported outcomes, through Grade 3-4 toxicities were rare (<5%) among all modalities. There was limited evidence available to compare proton therapy to other modalities. The treatment decision for a man is usually based on his risk group, ability to tolerate the procedure, convenience for the patient, and the anticipated impact on quality of life. To further personalize therapy, future trials should report (1) race; (2) medical comorbidities; (3) psychiatric comorbidities; (4) insurance status; (5) education status; (6) marital status; (7) income; (8) sexual orientation; and (9) facility-related characteristics.
Topics: Brachytherapy; Dose Fractionation, Radiation; Humans; Male; Prostatic Neoplasms; Radiosurgery; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 27347670
DOI: 10.1016/j.ctrv.2016.06.006 -
Technology in Cancer Research &... Jun 2004Brachytherapy has the advantage of delivering a high dose to the tumor while sparing the surrounding normal tissues. With proper case selection and delivery technique,... (Review)
Review
Brachytherapy has the advantage of delivering a high dose to the tumor while sparing the surrounding normal tissues. With proper case selection and delivery technique, high-dose-rate (HDR) brachytherapy has great promise, because it eliminates radiation exposure, allows short treatment times, and can be performed on an outpatient basis. Additionally, use of a single-stepping source, allows optimization of dose distribution by varying the dwell time at each dwell position. However, when HDR brachytherapy is used, the treatments must be executed carefully, because the short treatment times do not allow any time for correction of errors, and mistakes can result in harm to patients. Hence, it is very important that all personnel involved in HDR brachytherapy be well trained and be constantly alert. It is expected that the use of HDR brachytherapy will greatly expand over the next decade and that refinements will occur primarily in the integration of imaging (computed tomography, magnetic resonance imaging, intraoperative ultrasonography) and optimization of dose distribution. It is anticipated that better tumor localization and normal tissue definition will help to optimize dose distribution to the tumor and reduce normal tissue exposure. The development of well-controlled randomized trials addressing issues of efficacy, toxicity, quality of life, and costs-versus-benefits will ultimately define the role of HDR brachytherapy in the therapeutic armamentarium.
Topics: Brachytherapy; Breast Neoplasms; Bronchial Neoplasms; Combined Modality Therapy; Female; Head and Neck Neoplasms; Humans; Male; Neoplasms; Palliative Care; Practice Guidelines as Topic; Radiotherapy Dosage; Sarcoma; Uterine Cervical Neoplasms
PubMed: 15161320
DOI: 10.1177/153303460400300305 -
JCO Global Oncology Sep 2021To evaluate the clinical outcomes in patients with cervical cancer with limited residual disease at brachytherapy (BT) treated with point-based dose prescription.
Point-Based Brachytherapy in Cervical Cancer With Limited Residual Disease: A Low- and Middle-Income Country Experience in the Era of Magnetic Resonance-Guided Adaptive Brachytherapy.
PURPOSE
To evaluate the clinical outcomes in patients with cervical cancer with limited residual disease at brachytherapy (BT) treated with point-based dose prescription.
METHODS
Patients with locally advanced squamous cell carcinoma of the cervix treated with computed tomography (CT)-based intracavitary BT were considered for analysis. Patients with good response to external beam radiotherapy and limited residual disease suitable for intracavitary BT alone were included. Postapplication CT scans were performed before each fraction and individual plans were made for each session. The dose per fraction was 9Gy high dose rate, prescribed to point-A. Two sessions were planned, 1 week apart. The organs at risk were contoured, and cumulative dose-volume histograms were computed. Local control, pelvic control, disease-free survival, and overall survival were evaluated and late toxicities were documented.
RESULTS
Four hundred ninety patients were included. Overall, 79.8% had International Federation of Gynecology and Obstetrics (FIGO) stage IB2 to IIB disease and 20.2% had stage III to IVA disease. Median dose at point A (EQD2) was 74.4 Gy (interquartile range [IQR] 72.3-74.5 Gy) and median D (EQD2) for bladder, rectum, and sigmoid were 82.5 Gy (IQR, 65.5-90.8 Gy), 66.5 Gy (IQR, 60.7-75.7 Gy), and 54.1 Gy (IQR, 50.5-77.3 Gy), respectively. At a median follow-up of 62 (IQR, 33-87) months, the 5-year local and pelvic control rates were 90.1% and 88.3%, respectively. The 5-year disease-free survival was 80% and overall survival was 88%. Rates of grade 3-4 bladder and rectosigmoid toxicities were 6.93% and 4.08%, respectively.
CONCLUSION
In patients with limited residual disease at BT, point-based dose prescription with CT planning results in good local control and acceptable toxicity. In a resource-constrained setting, patients may be triaged to receive point-based BT or magnetic resonance imaging-guided adaptive BT depending on the extent of residual disease.
Topics: Brachytherapy; Female; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Radiotherapy Dosage; Uterine Cervical Neoplasms
PubMed: 34843375
DOI: 10.1200/GO.21.00147