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Lalos F, Flühs D, Guberina M, Bornfeld N, Stuschke M, Sauerwein W, Bechrakis NE. Tumor- and Radiation-Related Complications after Ruthenium-106 Brachytherapy in Small to Medium Uveal Melanomas (Part 1). Klin Monbl Augenheilkd 2024. [PMID: 38354842 DOI: 10.1055/a-2268-0985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
PURPOSE The purpose of this study was to analyze tumor-related complications after ruthenium-106 brachytherapy in patients with uveal melanoma, with respect to local tumor control, insufficient radiation response, enucleation, and metastasis rate. PATIENTS/METHODS AND MATERIALS This retrospective study included 608 patients treated consecutively with ruthenium-106 brachytherapy between January 2008 and December 2010 at the Department of Ophthalmology, University Hospital Essen. The occurrence of radiation-induced results was analyzed by estimating the risk by applying the Kaplan-Meier method, i.e., the "time to event" analysis. The Cox model test was used for the univariate and multivariate risk factor analyses. The median follow-up was 51 months after primary treatment. RESULTS Tumor recurrence was found in 21 patients (3.5%) and repeated treatment due to insufficient effect after the initial ruthenium-106 brachytherapy was performed in 40 patients (6.6%). The 5-year cumulative risk of recurrence was 4.0% and that of insufficient effect was 7.3%. Thirteen patients (2.1%) underwent a secondary enucleation; 8 because of a local recurrence and 5 because of severe post-brachytherapy complications. The cumulative enucleation risk was 2.3% after 5 years and 2.9% after 10 years, corresponding to eye preservation of 97.7 and 97.1%, respectively. In forty-two patients (7.2%), metastatic disease was diagnosed during the follow-up. The metastatic rate as calculated by the Kaplan-Meier method was 9.0, and 13.1% at 5 and 10 years, respectively. CONCLUSION Our study demonstrated that ruthenium-106 brachytherapy is an excellent treatment option for achieving local tumor control and eye preservation in well-selected patients. The metastatic rate is in agreement with that of previous studies analyzing small to medium size uveal melanomas.
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Affiliation(s)
- Fotios Lalos
- Department of Ophthalmology, University Hospital of Essen, Germany
| | - Dirk Flühs
- Department of Radiotherapy, University Hospital of Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, University Hospital of Essen, Germany
| | - Norbert Bornfeld
- Department of Ophthalmology, University Hospital of Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University Hospital of Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site University Hospital Essen, Essen, Germany
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Nakamura S, Murakami N, Suzuki S, Ito K, Takemori M, Nakayama H, Kaga K, Chiba T, Iijima K, Takahashi K, Goka T, Itami J, Okamoto H, Igaki H. Monte Carlo simulation of tilted contact plaque brachytherapy placement for juxtapapillary retinoblastoma. Radiat Oncol 2022; 17:16. [PMID: 35073956 PMCID: PMC8785594 DOI: 10.1186/s13014-022-01986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background The 106-Ruthenium contact plaque applicator is utilized for the treatment of intraocular tumor within a thickness of less than 6 mm. If anything obstructs the placement of the plaque applicator, the treatment is generally difficult because the applicator has to be temporarily located just on the opposite side of the retinal tumor. Furthermore, the plaque applicator edge of approximately 1 mm does not contain 106Ru, estimating the delivered radiation dose for eccentric tumor is challenging because the lateral dose profile is inadequately provided by the manufacture’s certification. This study aims to simulate tumor coverage of the tilted applicator placement for treating an infant with juxtapapillary retinoblastoma and to achieve the effective treatment. Case presentation We present an infant with retinoblastoma whose tumor involved macular and was invading just temporal side of the optic disc. Additionally, posterior staphyloma was induced by a series of previous treatments, making it more difficult to treat the standard plaque placement. Thus, the applicator type of CCA was intentionally tilted to the eyeball and the distance between the posterior edge of the applicator and the eyeball had to be then equal to or more than 2 mm based on the dose distribution of the applicator calculated using Monte Carlo simulation to minimize damage to surrounding tissues while covering the tumor. It was then comparable to the certification and previous reports. Based on the acquired dose distribution, the optimal placement of the applicator was derived from varying the distance between the applicator’s edge and the eyeball, and the distance was then determined to be 2 mm. In this case, the minimum dose rate in the tumor was 25.5 mGy/min, and the time required to deliver the prescribed dose was 26.2 h. Therefore, the tilted 106Ru plaque applicator placement could deliver the required dose for the treatment. The physical examination revealed no active tumor as a result of the treatment. Conclusions Optimizing the placement of the 106Ru plaque applicator, it was possible to guarantee that the prescribed dose will be delivered to the tumor even if the standard placement is not possible for the juxtapapillary tumor.
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Sharifzadeh M, Chiniforoush TA, Sadeghi M. Design and optimizing a novel ocular plaque brachytherapy with dual-core of 103Pd and 106Ru. Phys Med 2021; 91:99-104. [PMID: 34742099 DOI: 10.1016/j.ejmp.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022] Open
Abstract
In recent decades, eye plaques of brachytherapy have been extensively used as primary treatment as well as a complementary treatment for ocular cancer. The purpose of this study is the development of the eye plaque brachytherapy throughout a new design of eye plaque by combining the COMS plaque and the CCB BEBIG plaque loaded by IRA1-103Pd and 106Ru, respectively. A new dual-core plaque with a diameter of 20 mm was designed in the way that the BEBIG plaque with a diameter of 20 mm loaded by 106Ru plate is attached to the COMS plaque with a diameter of 20 mm loaded by 24 of IRA1-103Pd seeds. Dose calculations for the new plaque were performed by using the MCNP5 code. Dose calculations of dual-core plaque including 103Pd seeds (gamma) and 106Ru plate (beta) were separately done for the sake of MCNP constraints in gamma and beta particle transfer simultaneously. The new dual-core plaque delivers a much higher dose rate to the tumor compared with every single plaque, while the dose rate reached to healthy tissues is slightly higher than each plaque separately. Of course, this is acceptable because the treatment time reduces and subsequently the error in radiation therapy reduces.
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Affiliation(s)
- Mohsen Sharifzadeh
- Radiation Application Research School, Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
| | - Tayebeh A Chiniforoush
- Department of Medical Radiation Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mahdi Sadeghi
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, P.O. Box: 14155-6183 Tehran, Iran.
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Miras Del Río H, Ortiz Lora A, Bertolet Reina A, Terrón León JA. A Monte Carlo dose calculation system for ophthalmic brachytherapy based on a realistic eye model. Med Phys 2021; 48:4542-4559. [PMID: 34250607 DOI: 10.1002/mp.15045] [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: 01/18/2021] [Revised: 05/11/2021] [Accepted: 06/03/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE There is a growing trend towards the adoption of model-based calculation algorithms (MBDCAs) for brachytherapy dose calculations which can properly handle media and source/applicator heterogeneities. However, most of dose calculations in ocular plaque therapy are based on homogeneous water media and standard in-silico ocular phantoms, ignoring non-water equivalency of the anatomic tissues and heterogeneities in applicators and patient anatomy. In this work, we introduce EyeMC, a Monte Carlo (MC) model-based calculation algorithm for ophthalmic plaque brachytherapy using realistic and adaptable patient-specific eye geometries and materials. METHODS We used the MC code PENELOPE in EyeMC to model Bebig IsoSeed I25.S16 seeds in COMS plaques and 106 Ru/106 Rh applicators that are coupled onto a customizable eye model with realistic geometry and composition. To significantly reduce calculation times, we integrated EyeMC with CloudMC, a cloud computing platform for radiation therapy calculations. EyeMC is equipped with an evaluation module that allows the generation of isodose distributions, dose-volume histograms, and comparisons with Plaque Simulator three-dimensional dose distribution. We selected a sample of patients treated with 125 I and 106 Ru isotopes in our institution, covering a variety of different type of plaques, tumor sizes, and locations. Results from EyeMC were compared to the original plan calculated by the TPS Plaque Simulation, studying the influence of heterogeneous media composition as well. RESULTS EyeMC calculations for Ru plaques agreed well with manufacturer's reference data and data of MC simulations from Hermida et al. (2013). Significant deviations, up to 20%, were only found in lateral profiles for notched plaques. As expected, media composition significantly affected estimated doses to different eye structures, especially in the 125 I cases evaluated. Dose to sclera and lens were found to be about 12% lower when considering real media, while average dose to tumor was 9% higher. 106 Ru cases presented a 1%-3% dose reduction in all structures using real media for calculation, except for the lens, which showed an average dose 7.6% lower than water-based calculations. Comparisons with Plaque Simulator calculations showed large differences in dose to critical structures for 106 Ru notched plaques. 125 I cases presented significant and systematic dose deviations when using the default calculation parameters from Plaque Simulator version 5.3.8., which were corrected when using calculation parameters from a custom physics model for carrier-attenuation and air-interface correction functions. CONCLUSIONS EyeMC is a MC calculation system for ophthalmic brachytherapy based on a realistic and customizable eye-tumor model which includes the main eye structures with their real composition. Integrating this tool into a cloud computing environment allows to perform high-precision MC calculations of ocular plaque treatments in short times. The observed variability in eye anatomy among the selected cases justifies the use of patient-specific models.
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Affiliation(s)
- Héctor Miras Del Río
- Department of Medical Physics, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Antonio Ortiz Lora
- Department of Medical Physics, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alejandro Bertolet Reina
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Koyuncu N, Reyhancan İA. Dose evaluation of 142Pr radioisotope by Monte Carlo method in eye brachytherapy. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.109150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Zaragoza FJ, Eichmann M, Flühs D, Timmermann B, Brualla L. Monte Carlo Computation of Dose-Volume Histograms in Structures at Risk of an Eye Irradiated with Heterogeneous Ruthenium-106 Plaques. Ocul Oncol Pathol 2020; 6:353-359. [PMID: 33123529 DOI: 10.1159/000508113] [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: 01/02/2020] [Accepted: 04/18/2020] [Indexed: 11/19/2022] Open
Abstract
Background/Aims The aim of this work is to compare Monte Carlo simulated absorbed dose distributions obtained from <sup>106</sup>Ru eye plaques, whose heterogeneous emitter distribution is known, with the common homogeneous approximation. The effect of these heterogeneities on segmented structures at risk is analyzed using an anthropomorphic phantom. Methods The generic CCA and CCB, with a homogeneous emitter map, and the specific CCA1364 and CCB1256 <sup>106</sup>Ru eye plaques are modeled with the Monte Carlo code PENELOPE. To compare the effect of the heterogeneities in the segmented volumes, cumulative dose-volume histograms are calculated for different rotations of the aforementioned plaques. Results For the cornea, the CCA with the equatorial placement yields the lowest absorbed dose rate while for the CCA1364 in the same placement the absorbed dose rate is 33% higher. The CCB1256 with the hot spot oriented towards the cornea yields the maximum dose rate per unit of activity while it is 44% lower for the CCB. Conclusions Dose calculations based on a homogeneous distribution of the emitter substance yield the lowest absorbed dose in the analyzed structures for all plaque placements. Treatment planning based on such calculations may result in an overdose of the structures at risk.
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Affiliation(s)
| | - Marion Eichmann
- Fakultät Physik, Technische Universität Dortmund, Dortmund, Germany
| | - Dirk Flühs
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Center Essen (WPE), Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,Department of Particle Therapy, University Hospital Essen, Essen, Germany
| | - Lorenzo Brualla
- West German Proton Therapy Center Essen (WPE), Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,University Hospital Essen, Essen, Germany
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Itta F, Liuzzi R, Farella A, Porri G, Pacelli R, Conson M, Oliviero C, Buonanno F, Breve M, Cennamo G, Clemente S, Cella L. Personalized treatment planning in eye brachytherapy for ocular melanoma: Dosimetric analysis on ophthalmic structure at risk. Phys Med 2020; 76:285-293. [DOI: 10.1016/j.ejmp.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/21/2022] Open
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8
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Thomson RM, Furutani KM, Kaulich TW, Mourtada F, Rivard MJ, Soares CG, Vanneste FM, Melhus CS. AAPM recommendations on medical physics practices for ocular plaque brachytherapy: Report of task group 221. Med Phys 2020; 47:e92-e124. [PMID: 31883269 DOI: 10.1002/mp.13996] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/12/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
The American Association of Physicists in Medicine (AAPM) formed Task Group 221 (TG-221) to discuss a generalized commissioning process, quality management considerations, and clinical physics practice standards for ocular plaque brachytherapy. The purpose of this report is also, in part, to aid the clinician to implement recommendations of the AAPM TG-129 report, which placed emphasis on dosimetric considerations for ocular brachytherapy applicators used in the Collaborative Ocular Melanoma Study (COMS). This report is intended to assist medical physicists in establishing a new ocular brachytherapy program and, for existing programs, in reviewing and updating clinical practices. The report scope includes photon- and beta-emitting sources and source:applicator combinations. Dosimetric studies for photon and beta sources are reviewed to summarize the salient issues and provide references for additional study. The components of an ocular plaque brachytherapy quality management program are discussed, including radiation safety considerations, source calibration methodology, applicator commissioning, imaging quality assurance tests for treatment planning, treatment planning strategies, and treatment planning system commissioning. Finally, specific guidelines for commissioning an ocular plaque brachytherapy program, clinical physics practice standards in ocular plaque brachytherapy, and other areas reflecting the need for specialized treatment planning systems, measurement phantoms, and detectors (among other topics) to support the clinical practice of ocular brachytherapy are presented. Expected future advances and developments for ocular brachytherapy are discussed.
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Affiliation(s)
- Rowan M Thomson
- Carleton Laboratory for Radiotherapy Physics, Physics Department, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Keith M Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Theodor W Kaulich
- Department of Medical Physics, University of Tübingen, 72074, Tübingen, Germany
| | - Firas Mourtada
- Department of Radiation Oncology, Christiana Care Hospital, Newark, DE, 19713, USA
| | - Mark J Rivard
- Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | | | | | - Christopher S Melhus
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA, 02111, USA
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9
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Radiotherapy for Diseases of the Eye. Radiat Oncol 2020. [DOI: 10.1007/978-3-319-52619-5_137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Hashemi S, Aghamiri MR, Kahani M, Jaberi R. Investigation of gold nanoparticle effects in brachytherapy by an electron emitter ophthalmic plaque. Int J Nanomedicine 2019; 14:4157-4165. [PMID: 31239674 PMCID: PMC6560204 DOI: 10.2147/ijn.s205814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background: During decades, all improvements and developments in radiation therapy technologies have been focused on its main goal: maximize the dose in the tumor and minimize it in surrounding normal tissues. Recently, scientists have some approaches to nanoparticles, especially gold nanoparticles (GNPs), for dose localization. Purpose: Herein, the effect of GNPs in combination with electron brachytherapy in a model of eye tumor has been investigated. Materials and methods: Monte Carlo simulation was utilized and a complete anatomical model of the eye, a tumor with 5 mm thick, and a type of Ruthenium-106 beta emitter ophthalmic plaque were simulated. Simulation results have been validated by a Plexiglas eye phantom and film dosimetry, experimentally. Results: The results showed using GNPs causes the dose amplification in 2 mm from the plaque surface which the higher concentration has the higher enhancement. At more distances, Dose Enhancement Factors (DEFs) have the negative amounts, so that total delivered dose to the tumor has decreased with increasing of Au concentrations and the dose of organ at risk like sclera has increased. Conclusion: Therefore, using of GNPs along with a 106Ru/106Rh ocular plaque, as an electron emitter source, is a good choice only for superficial lesions, and it is not recommended for deeper tumors due to the parameters of radiation treatment and delivered dose to the tissues.
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Affiliation(s)
- S Hashemi
- Radiation Medicine Engineering Department, Shahid Beheshti University, Tehran, Iran
| | - MR Aghamiri
- Radiation Medicine Engineering Department, Shahid Beheshti University, Tehran, Iran
| | - M Kahani
- Radiation Medicine Engineering Department, Shahid Beheshti University, Tehran, Iran
| | - R Jaberi
- Cancer Institute, Imam Khomeini Hospital, Tehran, Iran
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Zaragoza FJ, Eichmann M, Flühs D, Wittig A, Sauerwein W, Brualla L. Monte Carlo Simulation of the Treatment of Uveal Melanoma Using Measured Heterogeneous 106Ru Plaques. Ocul Oncol Pathol 2018; 5:276-283. [PMID: 31367591 DOI: 10.1159/000492599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/31/2018] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Ruthenium plaques are used for the treatment of ocular tumors. The aim of this work is the comparison between simulated absorbed dose distributions tallied in an anthropomorphic phantom, obtained from ideal homogeneous plaques, and real eye plaques in which the actual heterogeneous distribution of <sup>106</sup>Ru was measured. The placement of the plaques with respect to the tumor location was taken into consideration to optimize the effectiveness of the treatment. Methods The generic CCA and CCB, and the specific CCA1364 and CCB1256 <sup>106</sup>Ru eye plaques were modeled with the Monte Carlo code PENELOPE. To compare the suitability of each treatment for an anterior, equatorial and posterior tumor location, cumulative dose-volume histograms for the tumors and structures at risk were calculated. Results Eccentric placements of the plaques, taking into account the inhomogeneities of the emitter map, can substantially reduce the dose delivered to structures at risk while maintaining the prescribed dose at the tumor apex. Conclusions The emitter map distribution of the plaque and the computerized tomography of the patient used in a Monte Carlo simulation allow an accurate determination of the plaque position with respect to the tumor with the potential to reduce the dose to sensitive structures.
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Affiliation(s)
| | - Marion Eichmann
- Fakultät Physik, Technische Universität Dortmund, Dortmund, Germany
| | - Dirk Flühs
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
| | - Andrea Wittig
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Jena, Germany
| | | | - Lorenzo Brualla
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
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Stöckel E, Eichmann M, Flühs D, Sommer H, Biewald E, Bornfeld N, Spaan B, Sauerwein W. Dose Distributions and Treatment Margins in Ocular Brachytherapy with 106Ru Eye Plaques. Ocul Oncol Pathol 2017; 4:122-128. [PMID: 30320093 DOI: 10.1159/000479558] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/14/2017] [Indexed: 11/19/2022] Open
Abstract
Brachytherapy with 106Ru eye plaques is the most common treatment modality for small to medium-sized uveal melanomas in Europe. So far, no standardized or widely accepted dose prescription protocol for the irradiation of intraocular tumors with 106Ru eye plaques has been defined. For 125I plaques, the minimum dose required for tumor control should be at least 85 Gy. Concerning 106Ru plaques, the dose prescriptions at the University Hospital of Essen foresees minimum doses of 700 Gy to the tumor base and 130 Gy to the tumor apex. These dose prescriptions are expected to ensure sufficient treatment margins. We apply these dose prescriptions to different eye plaque types and tumor sizes and discuss the resulting treatment margins. These investigations are based on Monte Carlo simulations of dose distributions of 3 different eye plaque types. The treatment margin in apical direction has an expansion of at least 0.8 mm for all investigated eye plaques. For symmetrically formed eye plaques, the treatment margin at the base of the tumor goes beyond the visible edge of the plaque. This study focuses on the shape of 85-Gy isodose lines and on treatment margins for different eye plaque types and tumor sizes and shall help exchange knowledge for ocular brachytherapy.
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Affiliation(s)
- Erik Stöckel
- Fakultät Physik, Technische Universität Dortmund, Dortmund, Germany
| | - Marion Eichmann
- Fakultät Physik, Technische Universität Dortmund, Dortmund, Germany
| | - Dirk Flühs
- Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
| | - Holger Sommer
- Fakultät Physik, Technische Universität Dortmund, Dortmund, Germany
| | - Eva Biewald
- Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, Germany
| | - Norbert Bornfeld
- Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, Germany
| | - Bernhard Spaan
- Fakultät Physik, Technische Universität Dortmund, Dortmund, Germany
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Hermida-López M, Brualla L. Technical Note: Monte Carlo study of106Ru/106Rh ophthalmic plaques including the106Rh gamma spectrum. Med Phys 2017; 44:2581-2585. [DOI: 10.1002/mp.12248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- Marcelino Hermida-López
- NCTeam, Strahlenklinik; Universitätsklinikum Essen; Hufelandstraße 55 D-45122 Essen Germany
- Servei de Física i Protecció Radiològica; Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona Pg. Vall d’Hebron; 119-129 08035 Barcelona Spain
| | - Lorenzo Brualla
- NCTeam, Strahlenklinik; Universitätsklinikum Essen; Hufelandstraße 55 D-45122 Essen Germany
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Zaragoza FJ, Eichmann M, Flühs D, Sauerwein W, Brualla L. Monte Carlo Estimation of Absorbed Dose Distributions Obtained from Heterogeneous 106Ru Eye Plaques. Ocul Oncol Pathol 2017; 3:204-209. [PMID: 29071271 DOI: 10.1159/000456717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/12/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The distribution of the emitter substance in 106Ru eye plaques is usually assumed to be homogeneous for treatment planning purposes. However, this distribution is never homogeneous, and it widely differs from plaque to plaque due to manufacturing factors. METHODS By Monte Carlo simulation of radiation transport, we study the absorbed dose distribution obtained from the specific CCA1364 and CCB1256 106Ru plaques, whose actual emitter distributions were measured. The idealized, homogeneous CCA and CCB plaques are also simulated. RESULTS The largest discrepancy in depth dose distribution observed between the heterogeneous and the homogeneous plaques was 7.9 and 23.7% for the CCA and CCB plaques, respectively. In terms of isodose lines, the line referring to 100% of the reference dose penetrates 0.2 and 1.8 mm deeper in the case of heterogeneous CCA and CCB plaques, respectively, with respect to the homogeneous counterpart. CONCLUSIONS The observed differences in absorbed dose distributions obtained from heterogeneous and homogeneous plaques are clinically irrelevant if the plaques are used with a lateral safety margin of at least 2 mm. However, these differences may be relevant if the plaques are used in eccentric positioning.
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Affiliation(s)
| | - Marion Eichmann
- Fakultät Physik, Technische Universität Dortmund, Dortmund, Germany
| | - Dirk Flühs
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
| | | | - Lorenzo Brualla
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
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Sommer H, Ebenau M, Spaan B, Eichmann M. Monte Carlo simulation of ruthenium eye plaques with GEANT4: influence of multiple scattering algorithms, the spectrum and the geometry on depth dose profiles. Phys Med Biol 2017; 62:1848-1864. [DOI: 10.1088/1361-6560/aa5696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Lymphomas of the ocular adnexa are heterogeneous and demonstrate a wide range of clinical, histological, immunohistochemical and molecular genetic characteristics. AIM The aim of this article is to give an overview of the interdisciplinary diagnostics and individually adapted lymphoma subtype-based therapy. DIAGNOSTICS Depending on the lymphoma localisation, i.e. whether in the eyelid, the conjunctiva or in the orbit, a photograph or a radiological scan is required to record the tumor extent. Visual function is more likely to be impacted when the lymphoma arises in the posterior orbit, close to the optic nerve and imaging diagnostics are therefore necessary. Histological investigations are essential for confirming the lymphoma diagnosis and give information about the particular subtype, which in turn will determine subsequent patient management, Clinical staging investigations for determining the systemic extent of the lymphoma manifestation (e.g. imaging, blood analyses as well as bone marrow biopsy) are mandatory. THERAPY External beam radiation, local and systemic chemotherapy or in some cases antibiotics are treatment options after surgical excision in isolated ocular adnexal lymphoma. The TNM classification of the American Joint Committee on Cancer or the Ann Arbor staging system, as well as the guidelines of the German Society of Hematology and Medical Oncology are all tools to aid the choice of the appropriate individually adapted therapy for systemic disease, which includes psycho-oncological care.
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Asadi S, Vaez-zadeh M, Masoudi SF, Rahmani F, Knaup C, Meigooni AS. Gold nanoparticle-based brachytherapy enhancement in choroidal melanoma using a full Monte Carlo model of the human eye. J Appl Clin Med Phys 2015; 16:344–357. [PMID: 26699318 PMCID: PMC5690168 DOI: 10.1120/jacmp.v16i5.5568] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/15/2015] [Accepted: 04/08/2015] [Indexed: 12/20/2022] Open
Abstract
The effects of gold nanoparticles (GNPs) in 125I brachytherapy dose enhancement on choroidal melanoma are examined using the Monte Carlo simulation technique. Usually, Monte Carlo ophthalmic brachytherapy dosimetry is performed in a water phantom. However, here, the compositions of human eye have been considered instead of water. Both human eye and water phantoms have been simulated with MCNP5 code. These simulations were performed for a fully loaded 16 mm COMS eye plaque containing 13 125I seeds. The dose delivered to the tumor and normal tissues have been calculated in both phantoms with and without GNPs. Normally, the radiation therapy of cancer patients is designed to deliver a required dose to the tumor while sparing the surrounding normal tissues. However, as the normal and cancerous cells absorbed dose in an almost identical fashion, the normal tissue absorbed radiation dose during the treatment time. The use of GNPs in combination with radiotherapy in the treatment of tumor decreases the absorbed dose by normal tissues. The results indicate that the dose to the tumor in an eyeball implanted with COMS plaque increases with increasing GNPs concentration inside the target. Therefore, the required irradiation time for the tumors in the eye is decreased by adding the GNPs prior to treatment. As a result, the dose to normal tissues decreases when the irradiation time is reduced. Furthermore, a comparison between the simulated data in an eye phantom made of water and eye phantom made of human eye composition, in the presence of GNPs, shows the significance of utilizing the composition of eye in ophthalmic brachytherapy dosimetry Also, defining the eye composition instead of water leads to more accurate calculations of GNPs radiation effects in ophthalmic brachytherapy dosimetry.
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Seegenschmiedt MH, Micke O, Muecke R. Radiotherapy for non-malignant disorders: state of the art and update of the evidence-based practice guidelines. Br J Radiol 2015; 88:20150080. [PMID: 25955230 PMCID: PMC4628533 DOI: 10.1259/bjr.20150080] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/16/2015] [Accepted: 05/07/2015] [Indexed: 11/05/2022] Open
Abstract
Every year in Germany about 50,000 patients are referred and treated by radiotherapy (RT) for "non-malignant disorders". This highly successful treatment is applied only for specific indications such as preservation or recovery of the quality of life by means of pain reduction or resolution and/or an improvement of formerly impaired physical body function owing to specific disease-related symptoms. Since 1995, German radiation oncologists have treated non-malignant disorders according to national consensus guidelines; these guidelines were updated and further developed over 3 years by implementation of a systematic consensus process to achieve national upgraded and accepted S2e clinical practice guidelines. Throughout this process, international standards of evaluation were implemented. This review summarizes most of the generally accepted indications for the application of RT for non-malignant diseases and presents the special treatment concepts. The following disease groups are addressed: painful degenerative skeletal disorders, hyperproliferative disorders and symptomatic functional disorders. These state of the art guidelines may serve as a platform for daily clinical work; they provide a new starting point for quality assessment, future clinical research, including the design of prospective clinical trials, and outcome research in the underrepresented and less appreciated field of RT for non-malignant disorders.
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Affiliation(s)
- M H Seegenschmiedt
- Center for Radiotherapy and Radiation Oncology, Strahlenzentrum Hamburg, Hamburg, Germany
| | - O Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | - R Muecke
- Department of Radiotherapy, Lippe Hospital Lemgo, Lemgo, Germany
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
| | - the German Cooperative Group on Radiotherapy for Non-malignant Diseases (GCG-BD)
- Center for Radiotherapy and Radiation Oncology, Strahlenzentrum Hamburg, Hamburg, Germany
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Bielefeld, Germany
- Department of Radiotherapy, Lippe Hospital Lemgo, Lemgo, Germany
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany
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Reinartz G, Eich HT, Pohl F. DEGRO practical guidelines for the radiotherapy of non-malignant disorders - Part IV: Symptomatic functional disorders. Strahlenther Onkol 2014; 191:295-302. [PMID: 25487694 DOI: 10.1007/s00066-014-0789-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/05/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To summarize the updated DEGRO consensus S2e guideline recommendations for the treatment of benign symptomatic functional disorders with low-dose radiotherapy. MATERIALS AND METHODS This overview reports on the role of low-dose radiotherapy in the treatment of functional disorders in cases of heterotopic ossification (HO) and Graves orbitopathy (GO). The most relevant aspects of the DEGRO S2e Consensus Guideline "Radiation Therapy of Benign Diseases 2014" regarding diagnostics, treatment decision, dose prescription, as well as performance of radiotherapy and results are summarized. RESULTS For both indications (HO, GO), retrospective and some prospective analyses have shown remarkable effects in terms of symptom relief. Nevertheless, the level of evidence (LoE) and the grade of recommendation (GR) vary: LoE 1-2 and GR A-B (HO), LoE 2 and GR B (GO). CONCLUSION Low-dose radiotherapy for benign symptomatic functional disorders has proven to be effective, according to different authors, for 25-100 % of the patients studied and therefore it may be a reasonable prophylactic and therapeutic option if noninvasive or invasive methods have been used without persistent success. For HO, a single-fraction dose of 7-8 Gy or fractionated radiation with five fractions of 3.5 Gy is recommended. For GO, single-fraction doses of 0.3-2.0 Gy, and total doses of 2.4-20 Gy/series, applied in one daily fraction are recommended.
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Affiliation(s)
- Gabriele Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany,
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Brualla L, Zaragoza FJ, Sauerwein W. Monte Carlo Simulation of the Treatment of Eye Tumors with (106)Ru Plaques: A Study on Maximum Tumor Height and Eccentric Placement. Ocul Oncol Pathol 2014; 1:2-12. [PMID: 27175356 PMCID: PMC4864522 DOI: 10.1159/000362560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Ruthenium plaques are used for the treatment of ocular tumors. There is, however, a controversy regarding the maximum treatable tumor height. Some advocate eccentric plaque placement, without a posterior safety margin, to avoid collateral damage to the fovea and optic disc, but this has raised concerns about marginal tumor recurrence. There is a need for quantitative information on the spatial absorbed dose distribution in the tumor and adjacent tissues. We have overcome this obstacle using an approach based on Monte Carlo simulation of radiation transport. METHODS CCA and CCB (106)Ru plaques were modeled and their geometry embedded in a computerized tomography scan of the eye of a patient. Different tumor sizes and locations were simulated with the general-purpose Monte Carlo code PENELOPE. RESULTS Cumulative dose-volume histograms were obtained for the tumors and the tissues at risk considered. Plots of isodose lines for both plaques were obtained in a computerized tomography study. CONCLUSIONS Ruthenium eye plaques are an adequate treatment option for tumors up to around 5 mm in height. According to our results, assuming a correct placement of the plaque, a tumor of 6.5 mm apical height is about the maximum size that can be treated safely with the large CCB plaque.
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Affiliation(s)
- Lorenzo Brualla
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
| | - Francisco J. Zaragoza
- Institut de Tècniques Energètiques, Universitat Politècnica de Catalunya, Barcelona, Spain
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Interstitial brachytherapy for eyelid carcinoma. Outcome analysis in 60 patients. Strahlenther Onkol 2014; 190:245-9. [PMID: 24424628 DOI: 10.1007/s00066-013-0495-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/24/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Eyelid cancer is a therapeutic challenge due to the cosmetic and functional implications of this anatomical region and the objectives of therapy are tumor control, functional and cosmetic outcome. AIM The present study was performed to analyze local control, toxicity, functional and cosmetic results in patients with eyelid carcinoma treated by interstitial brachytherapy. MATERIAL AND METHODS In this study 60 patients with eyelid carcinoma were treated by interstitial brachytherapy using iridium ((192)Ir) wires with a linear activity of 1.2-1.7 mCi/cm. The prescription dose was 51-70 Gy (mean 65 Gy, median 66 Gy). RESULTS Of the 60 patients 51 (85.0 %) had received no prior treatment, 4 (6.7 %) had received previous surgery with positive or close margins and 5 (8.3 %) had suffered local recurrence after surgery. Of the tumors 52 (86.7 %) were basal cell carcinoma, 7 (11.7 %) squamous cell carcinoma and 1 (1.7 %) Merkel cell carcinoma. Clinical stage of the 51 previously untreated tumors was 38 T1N0, 12 T2N0 and 1 T3N0. Mean follow-up was 92 months (range 6-253 months). Local control was maintained in 96.7 % of patients. Late effects higher than grade 2 were observed in 3.0 % of cases. Functional and cosmetic outcomes were optimal in 68.4 % of patients. CONCLUSION Interstitial brachytherapy for carcinoma of the eyelid can achieve local control, cosmetic and functional results comparable to those of surgery.
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The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma. Brachytherapy 2013; 13:1-14. [PMID: 24373763 DOI: 10.1016/j.brachy.2013.11.008] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/05/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To present the American Brachytherapy Society (ABS) guidelines for plaque brachytherapy of choroidal melanoma and retinoblastoma. METHODS AND MATERIALS An international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to include 47 radiation oncologists, medical physicists, and ophthalmic oncologists from 10 countries. The ABS-OOTF produced collaborative guidelines, based on their eye cancer-specific clinical experience and knowledge of the literature. This work was reviewed and approved by the ABS Board of Directors as well as within the journal's peer-reivew process. RESULTS The ABS-OOTF reached consensus that ophthalmic plaque radiation therapy is best performed in subspecialty brachytherapy centers. Quality assurance, methods of plaque construction, and dosimetry should be consistent with the 2012 joint guidelines of the American Association of Physicists in Medicine and ABS. Implantation of plaque sources should be performed by subspecialty-trained surgeons. Although there exist select restrictions related to tumor size and location, the ABS-OOTF agreed that most melanomas of the iris, ciliary body, and choroid could be treated with plaque brachytherapy. The ABS-OOTF reached consensus that tumors with gross orbital extension and blind painful eyes and those with no light perception vision are unsuitable for brachytherapy. In contrast, only select retinoblastomas are eligible for plaque brachytherapy. Prescription doses, dose rates, treatment durations, and clinical methods are described. CONCLUSIONS Plaque brachytherapy is an effective eye and vision-sparing method to treat patients with intraocular tumors. Practitioners are encouraged to use ABS-OOTF guidelines to enhance their practice.
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Hermida-López M. Calculation of dose distributions for 12 106
Ru/106
Rh ophthalmic applicator models with the PENELOPE Monte Carlo code. Med Phys 2013; 40:101705. [DOI: 10.1118/1.4820368] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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