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Hitova-Topkarova D, Payakova V, Kostova-Lefterova D, Ivanova M, Vasileva-Slaveva M, Yordanov A. Electronic brachytherapy for gynecological cancers - a systematic review. Rep Pract Oncol Radiother 2023; 28:79-87. [PMID: 37122914 PMCID: PMC10132201 DOI: 10.5603/rpor.a2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/21/2022] [Indexed: 05/02/2023] Open
Abstract
Background The purpose of this manuscript is to provide an in-depth literature review of the management of endometrial and cervical cancers with electronic brachytherapy. Materials and methods An extensive literature search was performed and 9 articles were selected based on preset criteria. Results The reviewed studies provided dosimetric and clinical results. Patient populations were diverse and prescribed doses varied. When treatment plans were compared to those using cobalt 60 (60Co) and iridium 192 (192Ir) sources researchers found lower or equivalent doses in organs at risk while the doses at the applicator surface were significantly higher for electronic brachytherapy. In the eligible studies, a total of 72 patients received treatment with AxxentXoft vaginal applicator, 29 were treated with the Intrabeam vaginal applicator, and 8 with AxxentXoft cervical applicator. Conclusions All authors found that electronic brachytherapy was safe and well tolerated as higher mucosal doses did not present as adverse clinical effects. Electronic brachytherapy for gynecological cancers has the potential to achieve equivalent tumor control while minimizing bowel and urinary toxicity thus improving the quality of life. More clinical data is needed to stratify patients who would benefit the most.
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Affiliation(s)
| | - Virginia Payakova
- Department of Radiation Oncology, Medical University — Pleven, Pleven, Bulgaria
| | - Desislava Kostova-Lefterova
- Department of Radiation Oncology, Medical University — Pleven, Pleven, Bulgaria
- National Cardiology Hospital, Sofia, Bulgaria
- Aleksandrovska University Hospital, Sofia, Bulgaria
| | - Mirela Ivanova
- Department of Radiation Oncology, Medical University — Pleven, Pleven, Bulgaria
| | - Mariela Vasileva-Slaveva
- Department of Breast Surgery, Shterev Hospital, Sofia, Bulgaria
- Research Institute, University Pleven, Pleven, Bulgaria
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, Pleven, Bulgaria
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Feasibility of electronic brachytherapy in cervix cancer-A dosimetric comparison of different brachytherapy techniques. Brachytherapy 2022; 21:389-396. [PMID: 35246391 DOI: 10.1016/j.brachy.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION This study analyzes cases in which electronic brachytherapy (eBT) led to acceptable treatment plans in cervical cancer. Findings were compared with dosimetry values obtained in 192Ir-based treatments according to the high-risk clinical target volume (HR-CTV) and the disease stage. MATERIAL AND METHODS We retrospectively analyzed 48 patients with cervical cancer from two centers. The patients were treated with 192Ir based on MRI. It was possible to use interstitial needles via an Utrecht-type applicator. Dosimetry was simulated using eBT and the parameters D90 and D98 (HR-CTV) and D2cc, D1cc, and D0.1cc (bladder, rectum, and sigmoid colon) were evaluated. The Mann-Whitney U test was used for comparison. The overall cohort of patients was analyzed, as were the sub-cohorts based on stage (FIGO stages I+IIA, IIB and III-IV). Finally, the dosimetry of the eBT plans was evaluated, and the plans obtained were classified as "good", "acceptable", or "poor". RESULTS Statistically significant differences were found between the eBT and 192Ir plans for D98 (HR-CTV), D1cc and D0.1cc (bladder), and D1cc and D0.1cc (sigmoid colon). A total of 31 cases (64.6%) were considered good, seven (14.6%) were considered acceptable, and 10 (20.8%) were considered poor. For volumes <30 cc, all the plans were good or acceptable; for volumes >30 cc, 54.3% were good, and 71.4% were good or acceptable. By stage, eBT plans for patients with stage IB-IIA disease were good in 100%, whereas those for patients with stage IIB were good in 70.6% and III-IV disease were good in 50%. CONCLUSIONS eBT provides appropriate dosimetry for treatment of cervical cancer in selected cases.
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Krivoshapkin A, Gaytan A, Abdullaev O, Salim N, Sergeev G, Marmazeev I, Cesnulis E, Killeen T, Tyuryn V, Kiselev R, Syomin P, Spallone A. Prospective comparative study of intraoperative balloon electronic brachytherapy versus resection with multidisciplinary adjuvant therapy for recurrent glioblastoma. Surg Neurol Int 2021; 12:517. [PMID: 34754567 PMCID: PMC8571379 DOI: 10.25259/sni_494_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/30/2021] [Indexed: 12/16/2022] Open
Abstract
Background Intraoperative balloon electronic brachytherapy (IBEB) may provide potential benefit for local control of recurrent cerebral glioblastomas (GBMs). Methods This is a preliminary report of an open-label, prospective, comparative cohort study conducted in two neurosurgical centers with ongoing follow-up. At recurrence, patients at one center (n = 15) underwent reresection with IBEB while, at the second center (n = 15), control subjects underwent re-resection with various accepted second-line adjuvant chemoradiotherapy options. A comparative analysis of overall survival (OS) and local progression-free survival (LPFS) following re-resection was performed. Exploratory subgroup analysis based on postoperative residual contrast-enhanced volume status was also done. Results In the IBEB group, median LPFS after re-resection was significantly longer than in the control group (8.0 vs. 6.0 months; log rank χ2 = 4.93, P = 0.026, P < 0.05). In addition, the median OS after second resection in the IBEB group was also significantly longer than in the control group (11.0 vs. 8.0 months; log rank χ2 = 4.23, P = 0.04, P < 0.05). Conclusion These hypothesis-generating results from a small cohort of subjects suggest putative clinical benefit in OS and LPFS associated with maximal safe re-resection of recurrent GBM with IBEB versus re-resection and standard adjuvant therapy, a hypothesis that deserves further testing in an appropriately powered clinical trial.
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Affiliation(s)
- Aleksey Krivoshapkin
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - Aleksey Gaytan
- Department of Neurosurgery, Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Orkhan Abdullaev
- Department of Neurosurgery, European Medical Center, Moscow, Russian Federation
| | - Nidal Salim
- Department of Neurosurgery, European Medical Center, Moscow, Russian Federation
| | - Gleb Sergeev
- Department of Neurosurgery, European Medical Center, Moscow, Russian Federation
| | - Ilya Marmazeev
- Department of Neurosurgery, European Medical Center, Moscow, Russian Federation
| | - Evaldas Cesnulis
- Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
| | - Tim Killeen
- Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland
| | - Vladimir Tyuryn
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - Roman Kiselev
- Department of Neurosurgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Pavel Syomin
- Department of Neurosurgery, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Aldo Spallone
- Department of Neurosurgery, European Medical Center, Moscow, Russian Federation
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Hoisak JDP, Manger R, Dragojević I. Benchmarking failure mode and effects analysis of electronic brachytherapy with data from incident learning systems. Brachytherapy 2021; 20:645-654. [PMID: 33353846 DOI: 10.1016/j.brachy.2020.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/12/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Failure modes and effects analysis (FMEA) is a prospective risk assessment tool for identifying failure modes in equipment or processes and informing the design of quality control systems. This work aims to benchmark the performance of FMEAs for electronic brachytherapy (eBT) of the skin and for breast by comparing predicted versus actual failure modes reported in multiple incident learning systems (ILS). METHODS AND MATERIALS Two public and our institution's internal ILS were queried for Xoft Axxent eBT-related events over 9 years. The failure modes and Risk Priority Numbers (RPNs) were taken from FMEAs previously performed for Xoft eBT of nonmelanoma skin cancer and breast intraoperative radiation therapy (IORT). For each event, the treatment site and primary failure mode was compared with the failure modes and RPNs from that site's FMEA. RESULTS 49 events involving Xoft eBT were identified. Thirty-one (63.3%) involved breast IORT, and 18 (36.7%) involved the skin. Three events could not be linked to an FMEA failure mode. In 87.7% of events, the primary failure mode ranked in the FMEA top 10 by RPNs. In 83.3% of skin events, the failure modes ranked in the top 10 by RPN or severity. In 90.3% of IORT events, the failure modes ranked within the top 10 by RPN or severity. CONCLUSIONS Evaluating FMEA failure modes against ILS data demonstrates that FMEA is effective at predicting failure modes but can be dependent on user experience. ILS data can improve FMEA by identifying potential failure modes and suggesting realistic occurrence, detectability, and severity values.
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Affiliation(s)
- Jeremy D P Hoisak
- Department of Radiation Medicine & Applied Sciences, UC San Diego, La Jolla, CA.
| | - Ryan Manger
- Department of Radiation Medicine & Applied Sciences, UC San Diego, La Jolla, CA
| | - Irena Dragojević
- Department of Radiation Medicine & Applied Sciences, UC San Diego, La Jolla, CA
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Lozares S, Font JA, Gandía A, Campos A, Flamarique S, Ibáñez R, Villa D, Alba V, Jiménez S, Hernández M, Casamayor C, Vicente I, Hernando E, Rubio P. In vivo dosimetry in low-voltage IORT breast treatments with XR-RV3 radiochromic film. Phys Med 2021; 81:173-181. [PMID: 33465753 DOI: 10.1016/j.ejmp.2020.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The objectives of the study were to establish a procedure for in vivo film-based dosimetry for intraoperative radiotherapy (IORT), evaluate the typical doses delivered to organs at risk, and verify the dose prescription. MATERIALS AND METHODS In vivo dose measurements were studied using XR-RV3 radiochromic films in 30 patients with breast cancer undergoing IORT using the Axxent® device (Xoft Inc.). The stability of the radiochromic films in the energy ranges used was verified by taking measurements at different depths. The stability of the scanner response was tested, and 5 different calibration curves were constructed for different beam qualities. Six pieces of film were placed in each of the 30 patients. All the pieces were correctly sterilized and checked to ensure that the process did not affect the outcome. All calibration and dose measurements were analyzed using the Radiochromic.com software application. RESULTS The doses were measured for 30 patients. The doses in contact with the applicator (prescription zone) were 19.8 ± 0.9 Gy. In the skin areas, the doses were as follows: 1-2 cm from the applicator, 1.86 ± 0.77 Gy; 2-5 cm, 0.73 ± 0.14 Gy; and greater than 5 cm, 0.28 ± 0.17 Gy. The dose delivered to the pectoral muscle (tungsten shielding disc) was 0.51 ± 0.27 Gy. CONCLUSIONS The study demonstrated the viability of XR-RV3 films for in vivo dose measurement in the dose and energy ranges applied in a complex procedure, such as breast IORT. The doses in organs at risk were far below the tolerances for cases such as those studied.
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Affiliation(s)
- Sergio Lozares
- Medical Physics Department. Miguel Servet University Hospital Zaragoza, Spain.
| | - Jose A Font
- Medical Physics Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Almudena Gandía
- Medical Physics Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Arantxa Campos
- Radiation Oncology Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Sonia Flamarique
- Radiation Oncology Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Reyes Ibáñez
- Radiation Oncology Department. Miguel Servet University Hospital Zaragoza, Spain
| | - David Villa
- Medical Physics Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Verónica Alba
- Medical Physics Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Sara Jiménez
- Medical Physics Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Mónica Hernández
- Medical Physics Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Carmen Casamayor
- Endocrine, Bariatric and Breast Surgery Unit. General and Digestive Surgery Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Isabel Vicente
- Breast Unit. Gynaecology Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Ernesto Hernando
- Endocrine, Bariatric and Breast Surgery Unit. General and Digestive Surgery Department. Miguel Servet University Hospital Zaragoza, Spain
| | - Patricia Rubio
- Breast Unit. Gynaecology Department. Miguel Servet University Hospital Zaragoza, Spain
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Mourya A, Aggarwal LM, Choudhary S. Evolution of Brachytherapy Applicators for the Treatment of Cervical Cancer. J Med Phys 2021; 46:231-243. [PMID: 35261493 PMCID: PMC8853448 DOI: 10.4103/jmp.jmp_62_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/07/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022] Open
Abstract
Brachytherapy applicators have come a long way since Danlos developed early intracavitary applicators to treat cervical cancer patients. Therefore, this review will help in the neoteric designs of intracavitary applicators. A detailed literature survey of the gynecological brachytherapy applicators from the era of preloading to conceptual intensity-modulated brachytherapy applicators has been carried out. Depending on the extent of the disease and patient anatomy, the selection of brachytherapy applicators plays a pivotal role in the treatment of cervical cancer. Furthermore, the selection of the applicators is also based on the imaging modalities to be used for applicator reconstruction and treatment planning. Dose acceleration in the target and reduction in nearby organs at risk can be optimized using an applicator having the capabilities of intensity-modulated brachytherapy. Now, three-dimensional printed applicators are used for patient-specific tailor-made treatment and they are fast replacing the old conventional applicators. Newer advancements in technology have greatly influenced the neoteric designs of intracavitary brachytherapy applicators.
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Affiliation(s)
- Ankur Mourya
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Lalit Mohan Aggarwal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India,Address for correspondence: Lalit Mohan Aggarwal, Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh, India. E-mail:
| | - Sunil Choudhary
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Feasibility of interstitial stepping-source electronic brachytherapy to locally inoperable tumors. J Contemp Brachytherapy 2020; 12:480-486. [PMID: 33299437 PMCID: PMC7701928 DOI: 10.5114/jcb.2020.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Radiotherapy is the mainstay in the treatment of locally inoperable tumors. Interstitial electronic needle-based kilovoltage brachytherapy (EBT) could be an economic alternative to high-dose-rate (HDR) brachytherapy or permanent seed implantation (PSI). In this work, we evaluated if locally inoperable tumors treated with PSI at our institution may be suitable for EBT. Material and methods A total of 10 post-interventional computed tomography (CT) scans of patients, who received PSI and simulated stepping-source EBT applied with Intrabeam system and needle applicator were used. EBT treatment planning software with 3-dimensional image and projection of applicator were applied for designing trajectories and establishing dwell positions. Dwell position doses were summarized, and doses covering 90% of the target volume (D90) achieved with stepping-source EBT were compared to those of PSI. Additionally, conformality of dose distributions and total irradiation time were assessed using conformation number (CN) or conformal index (COIN). Results In all patients, D90 of EBT exceeded the prescribed dose or D90 of PSI on average by 4.7% or 21.3% relative to the prescribed dose, respectively. Mean number of trajectories was 5.0 for EBT and 6.9 for PSI. Average CN/COIN for EBT was 0.69, with a mean irradiation time of 27.8 minutes for standardized dose of 13 Gy. Conclusions Stepping-source EBT allowed for a conformal treatment of inoperable interstitial tumors with similar D90. Fewer trajectories were required for EBT in majority of cases.
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Hopfensperger KM, Adams Q, Kim Y, Wu X, Xu W, Patwardhan K, Thammavong B, Caster J, Flynn RT. Needle-free cervical cancer treatment using helical multishield intracavitary rotating shield brachytherapy with the 169 Yb Isotope. Med Phys 2020; 47:2061-2071. [PMID: 32073669 PMCID: PMC7377278 DOI: 10.1002/mp.14101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the capability of an intracavitary 169 Yb-based helical multishield rotating shield brachytherapy (RSBT) delivery system to treat cervical cancer. The proposed RSBT delivery system contains a pair of 1.25 mm thick platinum partial shields with 45° and 180° emission angles, which travel in a helical pattern within the applicator. METHODS A helically threaded tandem applicator with a 45° tandem curvature containing a helically threaded catheter was designed. A 0.6 mm diameter 169 Yb source with a length of 10.5 mm was simulated. A 37-patient treatment planning study, based on Monte Carlo dose calculations using MCNP5, was conducted with high-risk clinical target volumes (HR-CTVs) of 41.2-192.8 cm3 (average ± standard deviation of 79.9 ± 35.8 cm3 ). All patients were assumed to receive 25 fractions of 1.8 Gy of external beam radiation therapy (EBRT) before receiving 5 fractions of high-dose-rate brachytherapy (HDR-BT). For each patient, 192 Ir-based intracavitary (IC) HDR-BT, 192 Ir-based intracavitary/interstitial (IC/IS) HDR-BT using a hybrid applicator with eight IS needles, and 169 Yb-based RSBT plans were generated. RESULTS For the IC, IC/IS, and RSBT treatment plans, 38%, 84%, and 86% of the plans, respectively, met the planning goal of an HR-CTV D90 (minimum dose to hottest 90%) of 85 GyEQD2 (α/β = 10 Gy). Median (25th percentile, 75th percentile) treatment times for IC, IC/IS, and RSBT were 11.71 (6.62, 15.40) min, 68.00 (45.02, 80.02) min, and 25.30 (13.87, 35.39) min, respectively. 192 Ir activities ranging from 159.1-370 GBq (4.3-10 Ci) and 169 Yb activities ranging from 429.2-999 GBq (11.6-27 Ci) were used, which correspond to the same clinical ranges of dose rates at 1 cm off-source-axis in water. Extra needle insertion and planning time beyond that needed for intracavitary-only approaches was accounted for in the IC/IS treatment time calculations. CONCLUSION 169 Yb-based RSBT for cervical cancer met the HR-CTV D90 goal of 85 Gy in a greater percentage of the patients considered than IC/IS (86% vs 84%, respectively) and can reduce overall treatment time relative to IC/IS. 169 Yb-based RSBT could be used to replace IC/IS in instances where IC/IS treatment is not available, especially in instances when HR-CTV volumes are ≥30 cm3 .
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Affiliation(s)
- Karolyn M Hopfensperger
- Department of Biomedical Engineering, University of Iowa, 1402 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, 52242, USA
| | - Quentin Adams
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, 52242, USA
| | - Weiyu Xu
- Department of Electrical and Computer Engineering, University of Iowa, 4016 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, 52242, USA
| | - Kaustubh Patwardhan
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Joseph Caster
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Ryan T Flynn
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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