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Zhang S, Zeng N, Yang J, He J, Zhu F, Liao W, Xiong M, Li Y. Advancements of radiotherapy for recurrent head and neck cancer in modern era. Radiat Oncol 2023; 18:166. [PMID: 37803477 PMCID: PMC10559506 DOI: 10.1186/s13014-023-02342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023] Open
Abstract
Head and neck cancer is a kind of cancer which can be eradicated from radical radiation therapy. However, with best efforts, nearly 40% patients will experience locoregional recurrence. Locoregional recurrence is the main cause of cancer-related death in head and neck cancers, so local treatments play a key role in improving progression free survival. In the last decades, radiation techniques have been tremendously developed, highly conformal radiation techniques such as intensity-modulated radiotherapy, stereotactic body radiation therapy, brachytherapy and proton or heavy ion radiation therapy have their unique radiobiological advances. Although reirradiation is widely used in clinical practice, but little is known when comparing the different techniques. In this review, we will provide a comprehensive overview of the role of reirradiation in recurrent head and neck cancers including radiation techniques, patient selection, overall clinical benefits, and toxicities.
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Affiliation(s)
- Shu Zhang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Ni Zeng
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jiangping Yang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jinlan He
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Fubin Zhu
- Department of Oncology, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China
| | - Wenjun Liao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Sichuan Cancer Hospital& Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Maoqi Xiong
- West China Clinical Skills Training Center, West China School of Medicine, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Yan Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
- Lung Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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Bhalavat R, Budrukkar A, Laskar SG, Sharma D, Mukherji A, Chandra M, Mahantshetty U, Pareek V, Bauskar P, Saraf S. Brachytherapy in head and neck malignancies: Indian Brachytherapy Society (IBS) recommendations and guidelines. J Contemp Brachytherapy 2020; 12:501-511. [PMID: 33299441 PMCID: PMC7701929 DOI: 10.5114/jcb.2020.100385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 07/21/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Brachytherapy (BT) forms major treatment modality in squamous cell carcinoma of head and neck cancers (HNC). However, there is a dearth of literature and guidelines for the use in various indications. High-dose-rate brachytherapy (HDR-BT) in Indian scenario is an important treatment modality, and the recommendations in this guidelines aim to provide the necessary recommendations for the use of HDR-BT for uniform application across the country in patients with HNC. MATERIAL AND METHODS A panel consisting of members of the Indian Brachytherapy Society (IBS), based on their clinical experience was invited. The process involved defining important steps, precautions, target volumes and indications, thorough literature review, and discussion with fellow members. The guidelines were established and formulated the recommendations for HDR-BT based on available evidences and individual experience for sites, relevant to Indian settings. RESULTS The IBS recommends the use of HDR brachytherapy as a part of treatment of head and neck tumors. The scope of these guidelines and recommendations included practical suggestions, ensuring efficient use of brachytherapy treatment as radical with external beam radiotherapy (EBRT) boost, palliative and adjuvant as definitive, or re-radiation as salvage for HNC in India. The IBS has made specific site-wise recommendations for previously untreated and recurrent HNC patients on their selection criteria, implant techniques, target volume definition, and HDR treatment parameters, such as time, dose rate, total dose, and fractionation schedules. Limited experience exists with HDR-BT in patients with head and neck cancers in India and across the globe. CONCLUSIONS IBS provided a consensus statement and guidelines for the head and neck brachytherapy and believed that these recommendations will overcome the fear of practicing radiation oncologists. This should generate interest amongst students and will help radiation oncologists all across the country to use the art of brachytherapy carefully in HNC patients, with better curative and salvage options.
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Affiliation(s)
- Rajendra Bhalavat
- Department of Radiation Oncology, Jupiter Lifelines Hospital, Thane, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, India
| | | | - Dayanand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Mukherji
- Department of Radiation Oncology, Mahamana Pandit Madanmohan Malviya Cancer Center and Homi Bhabha Cancer Hospital, Varanasi, India
| | - Manish Chandra
- Department of Radiation Oncology, Jupiter Lifelines Hospital, Thane, India
| | | | - Vibhay Pareek
- Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India
| | - Pratibha Bauskar
- Department of Radiation Oncology, Jupiter Lifelines Hospital, Thane, India
| | - Sonali Saraf
- Department of Oncoanesthesia, Jupiter Lifelines Hospital, Thane, India
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Evaluation of the accuracy of computer-assisted techniques in the interstitial brachytherapy of the deep regions of the head and neck. Brachytherapy 2019; 18:217-223. [DOI: 10.1016/j.brachy.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/14/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
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Ricchetti F, Barra S, Agostinelli S, Vagge S, Marcenaro M, Corvò R. Feasibility of helical tomotherapy for radical dose retreatment in pelvic area: A report of 4 cases. TUMORI JOURNAL 2018; 97:492-7. [DOI: 10.1177/030089161109700413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background To retrospectively determine acute toxicity and local control in patients with recurrence after definitive radiotherapy for prostate, bladder and rectal carcinoma. Methods Between September 2009 and March 2010, 4 patients with a prior history of pelvic radiotherapy were treated with helical tomotherapy. The prior course of radiotherapy was given for prostate cancer in 2 patients, bladder carcinoma in 1 patient and rectal carcinoma in 1 patient. The median prescribed dose of the prior course of radiotherapy was 6320 cGy (range, 5000–7600), and the median elapsed time between the first and second course was 17 months (range, 4–73). The total prescribed dose for tomotherapy retreatment was 60 Gy in 3 patients and 50 Gy in 1 patient. Hormone therapy was administered to 2 patients before and during radiation. No patient underwent surgical resection. Results The cumulative mean dose to the rectum ranged from 3813 to 6058 cGy; cumulative rectal maximum dose to 1 cc ranged from 6475 to 8780 cGy. Regarding the bladder, the cumulative mean dose was between 4384 and 7612 cGy; cumulative maximum dose to 1 cc ranged from 7560 to 9790 cGy. All patients completed the re-irradiation course. Acute genitourinary toxicity (RTOG scale) was grade 0 in 3 patients and grade 1 in 1 patient; acute gastrointestinal toxicity was grade 0 in 3 patients and grade 1 in 1 patient. With a median follow-up of 9 months (range, 7–12), late toxicity was G0 in all patients. Three patients showed partial response with computed tomography or magnetic resonance imaging, and 1 had a PSA decrease. Conclusions Re-irradiation with helical tomotherapy was well tolerated, with low rates of acute and late toxicity. It can be therefore considered a useful tool to improve local control in patients previously treated with radiotherapy. However, a larger number of patients and a longer follow-up are required to assess retreatment safety.
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Affiliation(s)
- Francesco Ricchetti
- Department of Radiation Oncology, National Institute for Cancer Research, Genoa
| | - Salvina Barra
- Department of Radiation Oncology, National Institute for Cancer Research, Genoa
| | - Stefano Agostinelli
- Department of Medical Physics, National Institute for Cancer Research, Genoa
| | - Stefano Vagge
- Department of Radiation Oncology, National Institute for Cancer Research, Genoa
| | - Michela Marcenaro
- Department of Radiation Oncology, National Institute for Cancer Research, Genoa
| | - Renzo Corvò
- Department of Radiation Oncology, National Institute for Cancer Research, Genoa
- University of Genoa, Genoa, Italy
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Li L, Yang J, Li X, Wang X, Ren Y, Fei J, Xi Y, Sun R, Ma J. (125)I Seed Permanent Implantation as a Palliative Treatment for Stage III and IV Hypopharyngeal Carcinoma. Clin Exp Otorhinolaryngol 2016; 9:185-91. [PMID: 27440132 PMCID: PMC4996106 DOI: 10.21053/ceo.2015.00213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 08/03/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the feasibility and safety of percutaneous (125)I seed permanent implantation for advanced hypopharyngeal carcinoma from toxicity, tumor response, and short-term outcome. METHODS (125)I seeds implant procedures were performed under computed tomography for 34 patients with advanced hypopharyngeal carcinoma. We observed the local control rate, overall survival, and acute or late toxicity rate. RESULTS In the 34 patients (stage III, n=6; stage IV, n=28), the sites of origin were pyriform sinus (n=29) and postcricoid area (n=5). All patients also received one to four cycles of chemotherapy after seed implantation. The post-plan showed that the actuarial D90 of (125)I seeds ranged from 90 to 158 Gy (median, 127 Gy). The mean follow-up was 12.3 months (range, 3.4 to 43.2 months). The local control was 2.1-31.0 months with a median of 17.7 months (95% confidence interval [CI], 13.4 to 22.0 months). The 1-, 2-, and 3-year local controls were 65.3%, 28.6%, and 9.5% respectively. Twelve patients (35%) died of local recurrence, fourteen patients (41%) died of distant metastases, and three patients (9%) died of recurrence and metastases at the same time. Five patients (15%) still survived to follow-up. At the time of analysis, the median survival time was 12.5 months (95% CI, 9.5 to 15.4 months). The 1-, 2-, and 3-year overall survival rates were 55.2%, 20.3%, and 10.9%, respectively. Five patients (15%) experienced grade 3 toxic events and nine patients (26%) have experienced grade 2 toxic events. CONCLUSION This review shows relatively low toxicity for interstitial (125)I seed implantation in the patients with advanced stage hypopharyngeal cancer. The high local control results suggest that (125)I seed brachytherapy implant as a salvage or palliative treatment for advanced hypopharyngeal carcinoma merit further investigation.
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Affiliation(s)
- Lei Li
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jie Yang
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaojiang Li
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoli Wang
- Radiation Therapy Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanxin Ren
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jimin Fei
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yan Xi
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruimei Sun
- Head and Neck Tumor Research Center, No. 3 Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Ma
- Department of ENT, Kunming City Children's Hospital, Kunming, China
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Balgobind BV, Koedooder K, Ordoñez Zúñiga D, Dávila Fajardo R, Rasch CRN, Pieters BR. A review of the clinical experience in pulsed dose rate brachytherapy. Br J Radiol 2015; 88:20150310. [PMID: 26290399 DOI: 10.1259/bjr.20150310] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumour locations. We found 66 articles reporting on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumour sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases, HDR resembles PDR brachytherapy by the use of multifractionated low-fraction dose.
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Affiliation(s)
- Brian V Balgobind
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Kees Koedooder
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Diego Ordoñez Zúñiga
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | | | - Coen R N Rasch
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
| | - Bradley R Pieters
- 1 Department of Radiation Oncology, Academic Medical Center, Amsterdam, Netherlands
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Kovács G. Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachytherapy. J Contemp Brachytherapy 2015; 6:404-16. [PMID: 25834586 PMCID: PMC4300360 DOI: 10.5114/jcb.2014.47813] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/29/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022] Open
Abstract
Intensity modulated brachytherapy (IMBT) is a modern development of classical interventional radiation therapy (brachytherapy), which allows the application of a high radiation dose sparing severe adverse events, thereby further improving the treatment outcome. Classical indications in head and neck (H&N) cancers are the face, the oral cavity, the naso- and oropharynx, the paranasal sinuses including base of skull, incomplete resections on important structures, and palliation. The application type can be curative, adjuvant or perioperative, as a boost to external beam radiation as well as without external beam radiation and with palliative intention. Due to the frequently used perioperative application method (intraoperative implantation of inactive applicators and postoperative performance of radiation), close interdisciplinary cooperation between surgical specialists (ENT-, dento-maxillary-facial-, neuro- and orbital surgeons), as well interventional radiotherapy (brachytherapy) experts are obligatory. Published results encourage the integration of IMBT into H&N therapy, thereby improving the prognosis and quality of life of patients.
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Affiliation(s)
- György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck/University Hospital Schleswig-Holstein Campus Lübeck, Germany
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Zhu L, Jiang Y, Wang J, Ran W, Yuan H, Liu C, Qu A, Yang R. An investigation of 125I seed permanent implantation for recurrent carcinoma in the head and neck after surgery and external beam radiotherapy. World J Surg Oncol 2013; 11:60. [PMID: 23496973 PMCID: PMC3607919 DOI: 10.1186/1477-7819-11-60] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 02/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A preliminary assessment was conducted of the feasibility, efficacy, and morbidity of 125I seed implantation for recurrent head and neck carcinoma after surgery and external beam radiotherapy. METHODS Nineteen patients with recurrent head and neck carcinomas underwent 125I seed implantation under ultrasound or computed tomography guidance. The actuarial D90 of 125I seed implantation ranged from 90 to 160 Gy (median, 131 Gy). The follow-up period ranged from 3 to 44 months (median, 11 months). RESULTS The median local control was 24 months (95% confidence interval, 10.2 to 37.8). The one- year, two-year and three-year local controls were 73.3%, 27.5% and 27.5%, respectively, whereas the one-year, two-year and three-year survival rates were 53.0%, 18.2% and 18.2%, respectively, and the median survival was 13 months (95% confidence interval, 6.6 to 19.4). A total of 26.3% of patients (5/19) died of local recurrence and 21.1% of patients (4/19) died of metastases. One suffered from a grade 1 skin reaction. CONCLUSIONS 125I seed implantation is feasible and safe as a salvage treatment for patients with recurrent head and neck cancers. The high local control results and low morbidity merits further investigation.
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Affiliation(s)
- Lihong Zhu
- Department of Radiation Oncology, Peking University 3rd Hospital, No, 49 Huayuan North road, Haidian district, Beijing, 100191, People's Republic of China
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Meng N, Jiang YL, Wang JJ, Ran WQ, Yuan HS, Qu A, Jiang P, Yang RJ. Permanent Implantation of Iodine-125 Seeds as a Salvage Therapy for Recurrent Head and Neck Carcinoma After Radiotherapy. Cancer Invest 2012; 30:236-42. [DOI: 10.3109/07357907.2012.654869] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jiang P, Jiang Y, Wang JJ, Meng N, Ran W, Qu A, Yang R. Percutaneous Ultrasonography-Guided Permanent Iodine-125 Implantation as Salvage Therapy for Recurrent Head and Neck Carcimonas. Cancer Biother Radiopharm 2011; 26:753-7. [PMID: 22133099 DOI: 10.1089/cbr.2010.0844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ping Jiang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, P.R. China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, P.R. China
| | - Jun-jie Wang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, P.R. China
| | - Na Meng
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, P.R. China
| | - Weiqiang Ran
- Department of Ultrasound, Peking University 3rd Hospital, Beijing, P.R. China
| | - Ang Qu
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, P.R. China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, P.R. China
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Reirradiation of head and neck cancer with high-dose-rate brachytherapy: A customizable intraluminal solution for postoperative treatment of tracheal mucosa recurrence. Brachytherapy 2011; 10:154-8. [DOI: 10.1016/j.brachy.2010.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/09/2010] [Accepted: 05/21/2010] [Indexed: 11/21/2022]
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Jiang YL, Meng N, Wang JJ, Jiang P, Yuan HSH, Liu C, Qu A, Yang RJ. CT-guided iodine-125 seed permanent implantation for recurrent head and neck cancers. Radiat Oncol 2010; 5:68. [PMID: 20673340 PMCID: PMC2919543 DOI: 10.1186/1748-717x-5-68] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 07/30/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To investigate the feasibility, and safety of 125I seed permanent implantation for recurrent head and neck carcinoma under CT-guidance. RESULTS A retrospective study on 14 patients with recurrent head and neck cancers undergone 125I seed implantation with different seed activities. The post-plan showed that the actuarial D90 of 125I seeds ranged from 90 to 218 Gy (median, 157.5 Gy). The follow-up was 3 to 60 months (median, 13 months). The median local control was 18 months (95% CI, 6.1-29.9 months), and the 1-, 2-, 3-, and 5- year local controls were 52%, 39%, 39%, and 39%, respectively. The 1-, 2-, 3-, and 5- survival rates were 65%, 39%, 39% and 39%, respectively, with a median survival time of 20 months (95% CI, 8.7-31.3 months). Of all patients, 28.6% (4/14) died of local recurrence, 7.1% (1/14) died of metastases, one patient died of hepatocirrhosis, and 8 patients are still alive to the date of data analysis. CONCLUSION CT-guided 125I seed implantation is feasible and safe as a salvage or palliative treatment for patients with recurrent head and neck cancers.
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Affiliation(s)
- Yu L Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, PR China
| | - Na Meng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, PR China
| | - Jun J Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, PR China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, PR China
| | - Hui SH Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Chen Liu
- Department of Radiology, Peking University Third Hospital, Beijing, 100191, PR China
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, PR China
| | - Rui J Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, PR China
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Krempien R, Hoppe H, Kahrs L, Daeuber S, Schorr O, Eggers G, Bischof M, Munter MW, Debus J, Harms W. Projector-based augmented reality for intuitive intraoperative guidance in image-guided 3D interstitial brachytherapy. Int J Radiat Oncol Biol Phys 2007; 70:944-52. [PMID: 18164834 DOI: 10.1016/j.ijrobp.2007.10.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 10/25/2007] [Accepted: 10/25/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study is to implement augmented reality in real-time image-guided interstitial brachytherapy to allow an intuitive real-time intraoperative orientation. METHODS AND MATERIALS The developed system consists of a common video projector, two high-resolution charge coupled device cameras, and an off-the-shelf notebook. The projector was used as a scanning device by projecting coded-light patterns to register the patient and superimpose the operating field with planning data and additional information in arbitrary colors. Subsequent movements of the nonfixed patient were detected by means of stereoscopically tracking passive markers attached to the patient. RESULTS In a first clinical study, we evaluated the whole process chain from image acquisition to data projection and determined overall accuracy with 10 patients undergoing implantation. The described method enabled the surgeon to visualize planning data on top of any preoperatively segmented and triangulated surface (skin) with direct line of sight during the operation. Furthermore, the tracking system allowed dynamic adjustment of the data to the patient's current position and therefore eliminated the need for rigid fixation. Because of soft-part displacement, we obtained an average deviation of 1.1 mm by moving the patient, whereas changing the projector's position resulted in an average deviation of 0.9 mm. Mean deviation of all needles of an implant was 1.4 mm (range, 0.3-2.7 mm). CONCLUSIONS The developed low-cost augmented-reality system proved to be accurate and feasible in interstitial brachytherapy. The system meets clinical demands and enables intuitive real-time intraoperative orientation and monitoring of needle implantation.
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Affiliation(s)
- Robert Krempien
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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