1
|
Benkhaled S, Diakité K, Jullian N, Poeta S, Vandekerkhove C, Van Houtte P, Van Gestel D, De Caluwé A. Boost modalities in cervical cancer: dosimetric comparison between intracavitary BT vs. intracavitary + interstitial BT vs. SBRT. Radiat Oncol 2023; 18:105. [PMID: 37381016 DOI: 10.1186/s13014-023-02295-4] [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: 12/19/2022] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
PURPOSE / OBJECTIVE This study compares the dosimetric plans of three distinct boost modalities in cervical cancer (CC): intracavitary (IC) with tandem/ovoids brachytherapy (BT), IC + interstitial (IS) BT, and Stereotactic-Body-Radiotherapy (SBRT). The aim is to determine the dosimetric impact in terms of target coverage and organ at risk (OAR) doses. MATERIALS AND METHODS 24 consecutive IC + IS BT boost treatment plans were retrospectively identified. For each plan included, two additional plans were created: IC-BT and SBRT. Importantly, no planning target volume (PTV) or planning (organ at) risk volume (PRV) margins were generated, therefore all structures were identical for any boost modality. Two different normalizations were performed: (1) Normalization to the target: prescription of 7.1 Gy to the D90% (defined as the minimum dose covering 90%) of the high-risk clinical target volume (HR-CTV); (2) Normalization to the OARs. HR-CTV coverage and OARs sparing were compared. The equivalent doses in 2 Gy fractions (EQD2) of EBRT and BT for CTV-HR and OARs were calculated using the linear-quadratic model with α/β of 10 (EQD210) and 3 (EQD23), respectively RESULTS: A total of 72 plans were investigated. In the first normalization, the mean EQD23-D2cc (defined as the minimal dose of the 2 cc) of OAR was significantly higher in the IC-BT plans, and the bladder D2cc hard constraint could not be reached. IC + IS BT leads to a 1 Gy mean absolute decrease of bladder EQD23-D2cc (relative dose: -19%), allowing to reach the hard constraint. SBRT (without PTV) delivers the lowest EQD23-D2cc to the OAR. In the second normalization, IC-BT provides a significantly lower dose to the EQD210-D90% (6.62 Gy) and cannot achieve the coverage goal. SBRT (without PTV) yields the highest dose to the D90% of HR-CTV and a significantly lower EQD210-D50% and D30%. CONCLUSION The key dosimetric benefit of BT over SBRT without PTV is a significantly higher D50% and D30% in the HR-CTV, which increases the local and conformal dose to the target. IC + IS BT vs. IC-BT provides significantly better target coverage and a lower dose to the OARs, making it the preferred boost modality in CC.
Collapse
Affiliation(s)
- Sofian Benkhaled
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, UNIL-CHUV, Lausanne, Switzerland
| | - Kadiatou Diakité
- Department of Radiation-Oncology, National Center for Medical Oncology and Radiotherapy Alassane, Abidjan, Ivory Coast
| | - Nicolas Jullian
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
| | - Sara Poeta
- Department of Medical-Physics, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Christophe Vandekerkhove
- Department of Medical-Physics, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | - Paul Van Houtte
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium
| | - Alex De Caluwé
- Institut Jules Bordet, Department of Radiation-Oncology, Université Libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
2
|
Kut C, Kao T, Morcos M, Kim Y, Boctor E, Viswanathan AN. 3D-printed Magnetic Resonance (MR)-based gynecological phantom for image-guided brachytherapy training. Brachytherapy 2022; 21:799-805. [PMID: 36050143 PMCID: PMC10810234 DOI: 10.1016/j.brachy.2022.07.005] [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: 02/15/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 01/16/2023]
Abstract
PURPOSE/OBJECTIVES There is a clinical need to develop anatomic phantoms for simulation-based learning in gynecological brachytherapy. Here, we provide a step-by-step approach to build a life-sized gynecological training phantom based on magnetic resonance imaging (MRI) of an individual patient. Our hypothesis is that this phantom can generate convincing ultrasound (US) images that are similar to patient scans. METHODS Organs-at-risk were manually segmented using patient scans (MRI). The gynecological phantom was constructed using positive molds from 3D printing and polyvinyl chloride (PVC) plastisol. Tissue texture/acoustic properties were simulated using different plastic softener/hardener ratios and microbead densities. Nine readers (residents) were asked to evaluate 10 cases (1 ultrasound image per case) and categorize each as a "patient" or "phantom" image. To evaluate whether the phantom and patient images were equivalent, we used a multireader, multicase equivalence study design with two composite null hypotheses with proportion (pr) at H01: pr ≤ 0.35 and H02: pr ≥ 0.65. Readers were also asked to review US videos and identify the insertion of an interstitial needle into the pelvic phantom. Computed Tomography (CT) and magnetic resonance (MR) images of the phantom were acquired for a feasibility study. RESULTS Readers correctly classified "patient" and "phantom" scans at pr = 53.3% ± 6.2% (p values 0.013 for H01 and 0.054 for H02, df = 5.96). Readers reviewed US videos and identified the interstitial needle 100% of the time in transabdominal view, and 78% in transrectal view. The phantom was CT and MR safe. CONCLUSIONS We have outlined a manufacturing process to create a life-sized, gynecological phantom that is compatible with multi-modality imaging and can be used to simulate clinical scenarios in image-guided brachytherapy procedures.
Collapse
Affiliation(s)
- Carmen Kut
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Tracy Kao
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL
| | - Marc Morcos
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Younsu Kim
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Emad Boctor
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
| |
Collapse
|
3
|
Major T, Fröhlich G, Ágoston P, Polgár C, Takácsi-Nagy Z. The value of brachytherapy in the age of advanced external beam radiotherapy: a review of the literature in terms of dosimetry. Strahlenther Onkol 2021; 198:93-109. [PMID: 34724086 PMCID: PMC8789711 DOI: 10.1007/s00066-021-01867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/03/2021] [Indexed: 12/29/2022]
Abstract
Brachytherapy (BT) has long been used for successful treatment of various tumour entities, including prostate, breast and gynaecological cancer. However, particularly due to advances in modern external beam techniques such as intensity-modulated radiotherapy (IMRT), volume modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT), there are concerns about its future. Based on a comprehensive literature review, this article aims to summarize the role of BT in cancer treatment and highlight its particular dosimetric advantages. The authors conclude that image-guided BT supported by inverse dose planning will successfully compete with high-tech EBRT in the future and continue to serve as a valuable modality for cancer treatment.
Collapse
Affiliation(s)
- Tibor Major
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary. .,Department of Oncology, Semmelweis University, Budapest, Hungary.
| | - Georgina Fröhlich
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Faculty of Science, Eötvös Loránd University, Budapest, Hungary
| | - Péter Ágoston
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Polgár
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Zoltán Takácsi-Nagy
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
4
|
Chargari C, Renard S, Espenel S, Escande A, Buchheit I, Ducassou A, Peiffert D, Hannoun-Lévi JM. [Can stereotactic body radiotherapy replace brachytherapy for locally advanced cervical cancer? French society for radiation oncology statement]. Cancer Radiother 2020; 24:706-713. [PMID: 32753238 DOI: 10.1016/j.canrad.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022]
Abstract
Brachytherapy is part of the treatment of locally advanced cervical cancers, accounting for about half of the total delivered dose. The benefit of dose escalation is the most important in advanced cases or if the tumor has responded poorly. The use of interstitial implantations makes it possible to reach doses of the order of 85 to 90Gy (including external beam radiotherapy contribution) in most patients, through image-guided approaches. Brachytherapy delivery is one of the quality criteria for patient care. To date, no data allow us to consider as an alternative the use of external boost through intensity-modulated or stereotactic body radiotherapy. Indeed, the doses delivered to the tumor and the capacity to spare normal tissues remains lower, as compared to what is permitted by brachytherapy. It is therefore appropriate for centers that do not have access to the technique to establish networks with centers where brachytherapy is performed, to allow each patient to have access to the technique. It is also necessary to promote brachytherapy teaching. The issue of reimbursement will be crucial in the coming years to maintain expertise that is today insufficiently valued in its financial aspects, but has a very high added value for patients.
Collapse
Affiliation(s)
- C Chargari
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - S Renard
- Département d'oncologie radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - S Espenel
- Département d'oncologie radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - A Escande
- Département d'oncologie radiothérapie, centre Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille, France
| | - I Buchheit
- Département d'oncologie radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - A Ducassou
- Département d'oncologie radiothérapie, institut Claudius-Regaud, 1, avenue Joliot-Curie, 31059 Toulouse, France
| | - D Peiffert
- Département d'oncologie radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - J-M Hannoun-Lévi
- Département d'oncologie radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France
| |
Collapse
|
5
|
Carrasco N, Chimeno J, Adrià-Mora M, Pérez-Calatayud MJ, Ibáñez B, Carmona V, Celada F, Gimeno J, Lliso F, Pérez-Calatayud J. Inter-observer and intra-observer variability in reporting vaginal dose points for cervical cancer in high-dose-rate brachytherapy. J Contemp Brachytherapy 2020; 12:139-146. [PMID: 32395138 PMCID: PMC7207226 DOI: 10.5114/jcb.2020.94494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The ICRU 89 recommends reporting a set of vaginal dose points for cervical cancer treatments in order to quantify the goodness of implant. This vaginal dose reporting method for combined external beam radiotherapy and brachytherapy has been adopted by the EMBRACE II study protocol. Large variations in dose between patients and centers have been reported. The aim of this study was to determine possible discrepancies with consensus observers from the same institution. Therefore, the inter- and intra-observer variability were analyzed. MATERIAL AND METHODS For five patients, five experienced observers reported dose at the proposed vaginal points twice. The effect of inter- and intra-observer variations on total dose was analyzed by estimating biologically equivalent dose EQD2 (α/β = 3 Gy). Coefficient of variation (CV) was used to provide a measure of data dispersion as a proportion to the mean. RESULTS The maximum inter-observer deviation among all patients and all points ranged from 0.5 Gy to 24.1 Gy in EQD2. The higher inter-observer discrepancies were found at points at 3 o'clock and at 6 o'clock, with respect to ovoids. In case of the maximum intra-observer deviation, it ranged from 0.5 Gy to 14.2 Gy, with higher deviation points at 12 o'clock and 9 o'clock, with respect to ovoids. CONCLUSIONS There is a need to ensure consistency in vaginal points reporting. The impact of the dosimetric inter- and intra-observer variability should also be considered when dealing with dose tolerances and limits due to the potential dose gradient.
Collapse
Affiliation(s)
- Nuria Carrasco
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - Jose Chimeno
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - Mar Adrià-Mora
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | | | - Blanca Ibáñez
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - Vicente Carmona
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - Francisco Celada
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - Jose Gimeno
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - Françoise Lliso
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| | - José Pérez-Calatayud
- Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
| |
Collapse
|
6
|
彭 清, 彭 应, 朱 金, 蔡 明, 周 凌. [Accuracy of different image registration methods in image-guided adaptive brachytherapy for cervical cancer]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1344-1348. [PMID: 30514683 PMCID: PMC6744129 DOI: 10.12122/j.issn.1673-4254.2018.11.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the accuracy of different methods for image registration in image-guided adaptive brachytherapy (IGABT) for cervical cancer. METHODS The last treatment planning CT images (CT1) and the first treatment planning CT images (CT2) were acquired from 15 patients with cervical cancer and registered with different match image qualities (retained/removed catheter source in images) and different match regions [target only (S Group)/ interested organ structure (M Group)/body (L Group)] in Velocity3.2 software. The dice similarity coefficient (DSC) between the clinical target volumes (CTV) of the CT1 and CT2 images (CTVCT1 and CTVCT2, respectively) and between the organs-at-risk (OAR) of the two imaging datasets (OARCT1 and OARCT2, respectively) were used to evaluate the image registration accuracy. RESULTS The auto-segmentation volume of the catheter source using Velocity software based on the CT threshold was the closest to the actual volume within the CT value range of 1700-1800 HU. In the retained group, the DSC for the OARs of was better than or equal to that of the removed group, and the DSC value of the rectum was significantly improved (P < 0.05). For comparison of different match regions, the high-risk target volume (HRCTV) and the low-risk target volume (IRCTV) had the best precision for registration of the target area, which was significantly greater than that of M group and L group (P < 0.05). The M group had better registration accuracy of the target area and the best accuracy for the OARs. The DSC values of the bladder and rectum were significantly better than those of the other two groups (P < 0.05). CONCLUSIONS The CT value range of 1700-1800 HU is optimal for automatic image segmentation using Velocity software. Automatic segmentation and shielding the volume of the catheter source can improve the image quality. We recommend the use of interested organ structures regions for image registration in image-guided adaptive brachytherapy for cervical cancer.
Collapse
Affiliation(s)
- 清河 彭
- 南方医科大学生物医学工程学院,广东 广州 510515School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 应林 彭
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 金汉 朱
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 明章 蔡
- 中山大学肿瘤防治中心//华南肿瘤学国家实验室//肿瘤医学协同创新中心,广东 广州 510060Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China
| | - 凌宏 周
- 南方医科大学生物医学工程学院,广东 广州 510515School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
7
|
Image guided high-dose-rate brachytherapy versus volumetric modulated arc therapy for head and neck cancer: A comparative analysis of dosimetry for target volume and organs at risk. Radiol Oncol 2018; 52:461-467. [PMID: 30422804 PMCID: PMC6287174 DOI: 10.2478/raon-2018-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/06/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to present dosimetric comparison of image guided high-dose-rate brachytherapy (IGBT) with volumetric modulated arc therapy (VMAT) for head and neck cancer regarding conformity of dose distribution to planning target volume (PTV) and doses to organs at risk (OARs). Patients and methods Thirty-eight consecutive patients with T1-4 mobile tongue, floor of mouth and base of tongue cancer treated with IGBT were selected. For these patients additional VMAT treatment plans were also prepared using identical computed tomography data. OARs and PTV related parameters (e.g. V98, D0.1cm3, Dmean, etc.) were compared. Results Mean V98 of the PTV was 90.2% vs. 90.4% (p > 0.05) for IGBT and VMAT, respectively. Mean D0.1cm3 to the mandible was 77.0% vs. 85.4% (p < 0.05). Dmean to ipsilateral and contralateral parotid glands was 4.6% vs. 4.6% and 3.0% vs. 3.9% (p > 0.05). Dmean to ipsilateral and contralateral submandibular glands was 16.4% vs. 21.9% (p > 0.05) and 8.2% vs. 16.9% (p < 0.05), respectively. Conclusions Both techniques showed excellent target coverage. With IGBT dose to normal tissues was lower than with VMAT. The results prove the superiority of IGBT in the protection of OARs and the important role of this invasive method in the era of new external beam techniques.
Collapse
|
8
|
Richart J, Carmona-Meseguer V, García-Martínez T, Herreros A, Otal A, Pellejero S, Tornero-López A, Pérez-Calatayud J. Review of strategies for MRI based reconstruction of endocavitary and interstitial applicators in brachytherapy of cervical cancer. Rep Pract Oncol Radiother 2018; 23:547-561. [PMID: 30534019 PMCID: PMC6277512 DOI: 10.1016/j.rpor.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/04/2018] [Accepted: 06/23/2018] [Indexed: 12/14/2022] Open
Abstract
Brachytherapy plays an essential role in the curative intent management of locally advanced cervical cancer. The introduction of the magnetic resonance (MR) as a preferred image modality and the development of new type of applicators with interstitial components have further improved its benefits. The aim of this work is to review the current status of one important aspect in the cervix cancer brachytherapy procedure, namely catheter reconstruction. MR compatible intracavitary and interstitial applicators are described. Considerations about the use of MR imaging (MRI) regarding appropriate strategies for applicator reconstruction, technical requirements, MR sequences, patient preparation and applicator commissioning are included. It is recommendable to perform the reconstruction process in the same image study employed by the physician for contouring, that is, T2 weighted (T2W) sequences. Nevertheless, a clear identification of the source path inside the catheters and the applicators is a challenge when using exclusively T2W sequences. For the intracavitary component of the implant, sometimes the catheters may be filled with some substance that produces a high intensity signal on MRI. However, this strategy is not feasible for plastic tubes or titanium needles, which, moreover, induce magnetic susceptibility artifacts. In these situations, the use of applicator libraries available in the treatment planning system (TPS) is useful, since they not only include accurate geometrical models of the intracavitary applicators, but also recent developments have made possible the implementation of the interstitial component. Another strategy to improve the reconstruction process is based on the incorporation of MR markers, such as small pellets, to be used as anchor points. Many institutions employ computed tomography (CT) as a supporting image modality. The registration of CT and MR image sets should be carefully performed, and its uncertainty previously assessed. Besides, an important research work is being carried out regarding the use of ultrasound and electromagnetic tracking technologies.
Collapse
Affiliation(s)
- José Richart
- Hospital Clínica Benidorm, Medical Physics Department, Alicante, Spain
| | - Vicente Carmona-Meseguer
- Hospital La Fe-IRIMED, Department of Radiation Oncology, Medical Physics Section, Valencia, Spain
| | | | - Antonio Herreros
- Hospital Clínic, Department of Radiation Oncology, Medical Physics Section, Barcelona, Spain
| | - Antonio Otal
- Hospital Arnau de Vilanova, Medical Physics Department, Lleida, Spain
| | - Santiago Pellejero
- Complejo Hospitalario de Navarra, Medical Physics Department, Pamplona, Spain
| | - Ana Tornero-López
- Hospital Dr. Negrín, Medical Physics Department, Las Palmas de Gran Canaria, Spain
| | - José Pérez-Calatayud
- Hospital La Fe-IRIMED, Department of Radiation Oncology, Medical Physics Section, Valencia, Spain
| |
Collapse
|
9
|
Fumagalli I, Haie-Méder C, Chargari C. 3D brachytherapy for cervical cancer: New optimization ways. Cancer Radiother 2018; 22:345-351. [DOI: 10.1016/j.canrad.2017.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 01/14/2023]
|
10
|
Brito Delgado A, Cohen D, Eng T, Stanley D, Shi Z, Charlton M, Gutiérrez A. Modeling the target dose fall-off in IMRT and VMAT planning techniques for cervical SBRT. Med Dosim 2018; 43:1-10. [DOI: 10.1016/j.meddos.2017.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 10/18/2022]
|
11
|
Al Feghali KA, Elshaikh MA. Why brachytherapy boost is the treatment of choice for most women with locally advanced cervical carcinoma? Brachytherapy 2016; 15:191-9. [DOI: 10.1016/j.brachy.2015.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/23/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
|
12
|
Attitude and practice of brachytherapy in India: a study based on the survey amongst attendees of Annual Meeting of Indian Brachytherapy Society. J Contemp Brachytherapy 2016; 7:462-8. [PMID: 26816503 PMCID: PMC4716124 DOI: 10.5114/jcb.2015.55666] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/12/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We performed a survey amongst attendees of the 4(th) Annual Meeting of Indian Brachytherapy Society to study the patterns of brachytherapy practice and attitude towards brachytherapy use. MATERIAL AND METHODS A 19-point questionnaire was designed and e-mailed to the attendees immediately after the conference. Descriptive analysis of the responses were done and satisfaction index was used as a tool for evaluation of the program effectiveness. Binomial test was used to assess the difference between distributions of responses and Mann-Whitney U test was used to assess the correlation between responses. P value (2-tailed) of < 0.05 was taken significant for all statistical analysis. RESULTS Of a total of 202 attendees, 90 responded to the survey (response rate: 44.5%). Seventy-two percent belonged to an academic institute while 28% belonged to non-academic institutes. Eighty-six percent were radiation oncologists and 10% were medical physicists. Eighty-nine percent respondents used high-dose-rate, 14% - pulse-dose-rate, and 13% used low-dose-rate brachytherapy facility. Orthogonal X-rays, computed tomography, and magnetic resonance imaging was used for brachytherapy planning by 56%, 69%, and 14%, respectively. Ninety-three percent of them thought that lack of training is a hurdle in practicing brachytherapy and 92% opined that brachytherapy dedicated meetings can change their perception about brachytherapy. Seventy percent respondents admitted to make some changes in their practice patterns after attending this meeting. Ninety-seven percent of them would like to attend future meetings and 98% felt the need to include live workshops, hands on demonstrations, and video presentations in the scientific programme. CONCLUSIONS The survey highlights a positive attitude towards increasing brachytherapy use, and may serve as an important guiding tool in designing teaching and training programmes; thus overcoming the hurdles in successful and widespread use of a quality brachytherapy programme at radiotherapy centers.
Collapse
|
13
|
Villalba SR, Sancho JR, Palacin AO, Calatayud JP, Ortega MS. A new template for MRI-based intracavitary/interstitial gynecologic brachytherapy: design and clinical implementation. J Contemp Brachytherapy 2015; 7:265-72. [PMID: 26622229 PMCID: PMC4643734 DOI: 10.5114/jcb.2015.54051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/05/2015] [Accepted: 08/10/2015] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To describe the potential clinical use of a new brachytherapy applicator for gynecological tumors, with special attention to locally advanced cervical carcinoma. This device allows the combination of intracavitary radiotherapy and MRI-compatible transperineal interstitial needles. The design of this template addresses the disadvantages of currently commercially available templates: the inability of the intracavitary component to reach deep into the cervix (MUPIT), and the MRI-incompatibility of these templates (MUPIT and Syed), which necessitates use of CT imaging for the dosimetry. MATERIAL AND METHODS The newly developed Benidorm Template applicator allows titanium needles in a template with straight and angled holes to provide different angles of divergence to be used with currently existing MRI-compatible intrauterine tubes. It can provide total coverage of the craniocaudal and lateral extension of the tumor (intrautherus, parametrial, and paravaginal). This method is mainly indicated in advanced cervical carcinoma with bulky parametrial invasion (medial or distal), with bulky primary disease that responds poorly to external beam radiotherapy extensive paravaginal involvement (tumor thickness greater than 0.5 cm) extending to the middle or lower third of the vagina, or for disease that has invaded the bladder or rectum (stage IVA). RESULTS Between April 2013 until December 2014, we treated 15 patients with locally advanced cervical carcinoma employing the Benidorm Template. The median dose at D90 for the CTV was 79.8 Gy (71.5-89.9 Gy), at D2cc for the bladder it was 77.6 Gy (69.8-90.8 Gy), and at D2cc for the rectum it was 71.9 Gy (58.3-83.7 Gy). Values expressed in EQD2, assuming α/β of 10 for CTV and 3 for OAR. CONCLUSIONS This new applicator allows the use of MRI-based dosimetry, thus providing the advantages of MRI volume definition. As such, it facilitates determination of complete intracavitary and interstitial CTV coverage and the sparing of normal tissues.
Collapse
Affiliation(s)
| | | | | | - Jose Perez Calatayud
- Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante
- Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | |
Collapse
|