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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 -
Journal of Applied Clinical Medical... Nov 2018A large number of surveys have been sent to the medical physics community addressing many clinical topics for which the medical physicist is, or may be, responsible....
A large number of surveys have been sent to the medical physics community addressing many clinical topics for which the medical physicist is, or may be, responsible. Each survey provides an insight into clinical practice relevant to the medical physics community. The goal of this study was to create a summary of these surveys giving a snapshot of clinical practice patterns. Surveys used in this study were created using SurveyMonkey and distributed between February 6, 2013 and January 2, 2018 via the MEDPHYS and MEDDOS listserv groups. The format of the surveys included questions that were multiple choice and free response. Surveys were included in this analysis if they met the following criteria: more than 20 responses, relevant to radiation therapy physics practice, not single-vendor specific, and formatted as multiple-choice questions (i.e., not exclusively free-text responses). Although the results of free response questions were not explicitly reported, they were carefully reviewed, and the responses were considered in the discussion of each topic. Two-hundred and fifty-two surveys were available, of which 139 passed the inclusion criteria. The mean number of questions per survey was 4. The mean number of respondents per survey was 63. Summaries were made for the following topics: simulation, treatment planning, electron treatments, linac commissioning and quality assurance, setup and treatment verification, IMRT and VMAT treatments, SRS/SBRT, breast treatments, prostate treatments, brachytherapy, TBI, facial lesion treatments, clinical workflow, and after-hours/emergent treatments. We have provided a coherent overview of medical physics practice according to surveys conducted over the last 5 yr, which will be instructive for medical physicists.
Topics: Brachytherapy; Health Physics; Humans; Neoplasms; Particle Accelerators; Practice Patterns, Physicians'; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Surveys and Questionnaires; Workflow
PubMed: 30272385
DOI: 10.1002/acm2.12464 -
The British Journal of Radiology Sep 2014This article reviews recent developments in primary standards for the calibration of brachytherapy sources, with an emphasis on the currently most common photon-emitting... (Review)
Review
This article reviews recent developments in primary standards for the calibration of brachytherapy sources, with an emphasis on the currently most common photon-emitting radionuclides. The introduction discusses the need for reference dosimetry in brachytherapy in general. The following section focuses on the three main quantities, i.e. reference air kerma rate, air kerma strength and absorbed dose rate to water, which are currently used for the specification of brachytherapy photon sources and which can be realized with primary standards from first principles. An overview of different air kerma and absorbed dose standards, which have been independently developed by various national metrology institutes over the past two decades, is given in the next two sections. Other dosimetry techniques for brachytherapy will also be discussed. The review closes with an outlook on a possible transition from air kerma to absorbed dose to water-based calibrations for brachytherapy sources in the future.
Topics: Air; Brachytherapy; Calibration; Humans; Photons; Radioisotopes; Radiometry; Water
PubMed: 24814696
DOI: 10.1259/bjr.20140176 -
Clinical & Translational Oncology :... Jan 2022The aim of this study was to compare accelerated partial breast irradiation (APBI) with multicatheter interstitial brachytherapy (BT) and whole breast irradiation (WBI),... (Comparative Study)
Comparative Study
PURPOSE
The aim of this study was to compare accelerated partial breast irradiation (APBI) with multicatheter interstitial brachytherapy (BT) and whole breast irradiation (WBI), in terms of toxicity, aesthetic result, quality of life and survival, in clinical practice.
MATERIALS AND METHODS
A comparative study of two prospectively recorded cohorts of 76 breast cancer patients who complied with the recommendations of GEC-ESTRO for APBI was conducted. The main objective was toxicity, quality of life measured through validated questionnaires and the aesthetic results. Secondary objectives were overall survival and disease-free survival.
RESULTS
Seventy-six stage I/II breast cancer patients, with a mean age of 66 years entered the study. APBI group showed less acute G1-2 dermatitis (51.4 vs 94.9%, p < 0.001) and late hyperpigmentation (0 vs 17.9%, p = 0.04). There were no differences in aesthetic results, both assessed by the patient herself and by the doctor. Statistically significant differences in measures of quality of life were observed in favour of the APBI, both in EORTC QLQ-BR23 and body image scale questionnaires. With a median follow-up of 72 months (6 years), the estimated overall survival at 5 and 10 years was 96.8 and 77.7%, respectively, and disease-free survival at 5 and 10 years was 91.1 and 69.4%, respectively, without statistically significant differences between groups.
DISCUSSION
APBI is an attractive alternative in candidate patients with initial breast cancer, with benefits in acute toxicity and quality of life and fewer visits to the hospital, without compromising tumor control or survival.
Topics: Aged; Brachytherapy; Breast Neoplasms; Catheters; Disease-Free Survival; Female; Humans; Middle Aged; Quality of Life; Radiotherapy; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 34213744
DOI: 10.1007/s12094-021-02664-z -
Anales Del Sistema Sanitario de Navarra 2009Brachytherapy consists in the administration of radiation in intimate contact with the tumour, with a low exposure of neighbouring healthy tissues. Its use began in the... (Review)
Review
Brachytherapy consists in the administration of radiation in intimate contact with the tumour, with a low exposure of neighbouring healthy tissues. Its use began in the early XX century and it has developed since then: different radioisotopes, systems of remote treatment, computer programs making individual dose calculation possible. In recent years there have been changes affecting two aspects of brachytherapy. In the first place, the incorporation of imaging techniques such as echography, computerised tomography (CT) and magnetic resonance (MR), indispensable for diagnosis and tumoural staging. Their use when the implant is being done helps in guiding and carrying out the operation with greater precision. In the second place, the use of CT, MR and echography makes better coverage of the tumour possible, or reduces the dose to healthy organs. They are used in inverse planning systems, which carry out dose calculation on the basis of the doses to be administered to the tumour and healthy organs. In these planning programs it is possible to make calculations more rapidly, taking account of the placement of the source at each moment in time. This technique, called real-time planning, is starting to show advantages in the treatment of prostate cancer. Incorporation of imaging techniques and improvements in calculation systems mean that brachytherapy is currently playing an important role in treating cancer of the prostate, cervix, breast, head and neck tumours, bronchial tubes or oesophagus.
Topics: Brachytherapy; Diagnostic Imaging; Humans; Neoplasms; Radiotherapy, Computer-Assisted
PubMed: 19738659
DOI: 10.23938/ASSN.0177 -
Urologic Oncology Dec 2022Long-term conventional high-dose radiation therapy can lead to retroperitoneal fibrosis and nerve damage in patients with advanced ureteral carcinoma (UC). The purpose...
BACKGROUND
Long-term conventional high-dose radiation therapy can lead to retroperitoneal fibrosis and nerve damage in patients with advanced ureteral carcinoma (UC). The purpose of this study is to evaluate the safety and efficacy of nephrostomy combined with iodine-125 seed strand (ISS) brachytherapy for the treatment of UC.
MATERIALS AND METHODS
Twenty-one patients with UC were treated with nephrostomy combined with ISS brachytherapy. The following parameters were recorded: technical success rate, procedure time, complications, mean D90 (dose delivered to the 90% gross tumor volume), organ at risk (OAR) dose, local control rate (LCR), ureteral patency (UP), local tumor progression (LTP), and overall survival (OS). The hydronephrosis score (HS), visual analog score (VAS), Karnofsky score and maximum diameter (MD) were compared before and 8 weeks after the operation.
RESULTS
The technical success rate was 100%, with a mean procedure time of 54.6 min. Three cases (14.5%) had bladder implant metastasis but no other major complications, such as ureteral perforation, infection, or severe bleeding, occurred. The mean D90 and OAR doses were 50.7 and 3.8 Gy, respectively. LCR was 100% with 28.6% UP at the 8-week evaluation. During the mean follow-up of 16.6 months, LTP occurred in 4 cases (19.1%), and the median OS was 25.0 months (95% CI 21.3-28.5). The HS, VAS, Karnofsky score and MD showed significant changes (all P < 0.01).
CONCLUSION
UC can be safely and effectively treated by nephrostomy combined with ISS brachytherapy, a viable option for patients who cannot undergo or refuse surgical resection.
Topics: Humans; Brachytherapy; Iodine Radioisotopes; Carcinoma; Urinary Bladder; Radiotherapy Dosage; Treatment Outcome
PubMed: 36216664
DOI: 10.1016/j.urolonc.2022.08.009 -
International Journal of Radiation... Jul 2023To evaluate overall severe late morbidity (grade ≥3) in patients with locally advanced cervical cancer treated with chemo-radiation therapy and magnetic resonance...
Overall Severe Morbidity After Chemo-Radiation Therapy and Magnetic Resonance Imaging-Guided Adaptive Brachytherapy in Locally Advanced Cervical Cancer: Results From the EMBRACE-I Study.
PURPOSE
To evaluate overall severe late morbidity (grade ≥3) in patients with locally advanced cervical cancer treated with chemo-radiation therapy and magnetic resonance image guided adaptive brachytherapy within the prospective EMBRACE-I study, and to compare the results with published literature after standard radiograph based brachytherapy (BT).
METHODS AND MATERIALS
From 2008 to 2015 the EMBRACE-I study enrolled 1416 patients. Morbidity was assessed (Common Terminology Criteria for Adverse Events version 3.0) every 3 months the 1st year, every 6 months the second and third year, and yearly thereafter and 1251 patients had available follow-up on late morbidity. Morbidity events (grade 3-5) were summarized as the maximum grade during follow-up (crude incidence rates) and actuarial estimates at 3 and 5 years. To compare with the published literature on standard radiograph based BT, Common Terminology Criteria for Adverse Events scores from the EMBRACE-I study were retrospectively converted into a corresponding score in the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer system.
RESULTS
In total, 534 severe events occurred in 270 patients; 429 events were grade 3 and 105 were grade 4 events. Actuarial estimates for grade ≥3 gastrointestinal (GI), genitourinary (GU), vaginal and fistula events at 5 years were 8.5% (95% confidence interval [CI], 6.9%-10.6%), 6.8% (95% CI, 5.4%-8.6%), 5.7% (95% CI, 4.3%-7.6%), and 3.2% (95% CI, 2.2%-4.5%), respectively. The 5-year actuarial estimate for organ-related events (GI, GU, vaginal, or fistula) was 18.4% (95% CI, 16.0%-21.2%). The 5-year actuarial estimate when aggregating all G≥3 endpoints (GI, GU, vaginal, fistulas, and non-GI/GU/vaginal) was 26.6% (95% CI, 23.8%-29.6%). Thirteen patients had a treatment-related death, 8 of which were associated with GI morbidity.
CONCLUSIONS
This report assesses severe morbidity from the largest prospective study on chemo-radiation therapy and image guided adaptive brachytherapy for locally advanced cervical cancer to date. Severe late morbidity was limited per endpoint and organ category, but considerable when aggregated across organs and all endpoints. The late morbidity results in the EMBRACE-I study compare favorably with published literature on standard radiograph based BT for GI morbidity, vaginal morbidity, and fistulas.
Topics: Female; Humans; Brachytherapy; Uterine Cervical Neoplasms; Prospective Studies; Retrospective Studies; Chemoradiotherapy; Morbidity; Vagina; Magnetic Resonance Imaging; Radiotherapy Dosage
PubMed: 36641039
DOI: 10.1016/j.ijrobp.2023.01.002 -
Asian Pacific Journal of Cancer... Dec 2019Endometrial cancer (EC) is a leading cause of female cancer in developed countries. The total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic... (Comparative Study)
Comparative Study
INTRODUCTION
Endometrial cancer (EC) is a leading cause of female cancer in developed countries. The total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymph node dissection is the primary management of endometrial cancer. Afterwards vaginal brachytherapy can be preferred either alone or combined with external beam radiotherapy to avoid the vault recurrence. This study was to assess the in-house multichannel applicator for HDR vaginal brachytherapy and dosimetric compression with the single channel applicator through DVHs. The main objective of this study was to design and development of an in-house multichannel applicator for HDR vaginal brachytherapy and dosimetric compression with the single channel applicator through DVHs.
MATERIALS AND METHODS
The multichannel applicator is a solid cylinder with 3 cm diameter, 13 cm length. It has a central channel surrounded by eight channels with a periphery arrangement in a single circle. We randomly selected eleven patients with endometrial carcinoma and 7Gy/per fraction of HDR dose was prescribed to CTV. Retrospectively, two 3D inverse treatment plans were created for each patient, with single channel loading and multichannel loading and the dose distribution of both plans could be compared. CTV coverage, rectum and bladder doses were compared.
RESULTS
The DVH analysis showed statistically significant difference between single and multichannel plan, that is for D95 of CTV (p=0.008), D100 of CTV (p=0.004) and 2cc of CTV (p=0.003). The p value for 1cc, 2cc and V70 are 0.003, 0.003 and 0.003 for rectum. On the other hand, bladder DVHs showed large difference between single and multichannel plan yet it is not statistically significant, and the p values for 1cc, 2cc and V 80 are 0.012, 0.009 and 0.225.
CONCLUSION
The authors conclude that in house multichannel applicator with 3D inverse treatment planning techniques improves the dosimetric advantage over single channel applicators.
Topics: Adult; Aged; Brachytherapy; Endometrial Neoplasms; Equipment Design; Female; Follow-Up Studies; Humans; Hysterectomy; Middle Aged; Organs at Risk; Prognosis; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Vaginal Neoplasms
PubMed: 31870125
DOI: 10.31557/APJCP.2019.20.12.3805