1
|
Xue H, Qiu B, Wang H, Jiang P, Sukocheva O, Fan R, Xue L, Wang J. Stereotactic Ablative Brachytherapy: Recent Advances in Optimization of Radiobiological Cancer Therapy. Cancers (Basel) 2021; 13:cancers13143493. [PMID: 34298703 PMCID: PMC8304109 DOI: 10.3390/cancers13143493] [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: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Brachytherapy (BT), a type of focal anti-cancer radiotherapy, delivers a highly focused radiation dose to localized tumors, sparing surrounding normal tissues. Recent technological advances have helped to increase the accuracy of BT and, thus, improve BT-based cancer treatment. Stereotactic ablative brachytherapy (SABT) was designed to improve the ablative effect of radiation, which was achieved via improved image guidance, and calculation of ablative dose, shorter treatment duration, and better organ preservation. Recently collected data characterized SABT as having the potential to cure various early-stage cancers. The method provides higher tumor control rate levels that were previously achievable only by surgical resection. Notably, SABT is suitable for application with unresectable malignancies. However, the pathological assessment of SABT irradiated tumors is limited due to difficulties in specimen acquisition. Prostate, lung, liver, and gynecological cancers are the most commonly reported SABT-treated malignancies. This study will give an overview of SABT, focusing on the advances in SABT optimization, and provide insights on the future benefits of the combined application of SABT with cancer immunotherapies.
Collapse
Affiliation(s)
- Hui Xue
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
| | - Olga Sukocheva
- Discipline of Health Sciences, College of Nursing and Health Sciences, Flinders University of South Australia, Bedford Park, SA 5042, Australia;
| | - Ruitai Fan
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China;
| | - Lixiang Xue
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
- Correspondence: (L.X.); (J.W.); Tel.: +86-13701076310 (L.X.); +86-13701076310 (J.W.)
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China; (H.X.); (B.Q.); (H.W.); (P.J.)
- Correspondence: (L.X.); (J.W.); Tel.: +86-13701076310 (L.X.); +86-13701076310 (J.W.)
| |
Collapse
|
2
|
Qiu B, Jiang P, Ji Z, Huo X, Sun H, Wang J. Brachytherapy for lung cancer. Brachytherapy 2020; 20:454-466. [PMID: 33358847 DOI: 10.1016/j.brachy.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022]
Abstract
Brachytherapy (BT) is a minimally invasive anticancer radiotherapeutic modality where the tumor is directly irradiated via a radioactive source that is precisely implanted in or adjacent to the tumor. BT for lung cancer may be conducted in the form of endobronchial BT and radioactive seed implantation (RSI-BT), mainly for nonsmall cell lung cancer (NSCLC). For patients with early-stage lung cancer who are not suitable for surgery or external beam radiotherapy (EBRT), BT may be used as an alternative treatment, and curative results could be achieved in certain patients with cancer confined to the trachea lumen. For patients with locally advanced/metastatic lung cancer, BT could be selectively applied alone or as a boost to EBRT, which could improve the local tumor control and patient's survival. In addition, BT is also useful as a salvage treatment in select patients with locally recurrent/residual lung cancer that failed other treatments (e.g., surgery, chemotherapy, and EBRT). However, clinical outcomes are mainly obtained from retrospective studies. Prospective studies are limited and needed. In recent years, the introduction of modern image guidance, novel radioactive seeds, BT treatment planning systems (BT-TPS), after-loading technique, and three-dimensional printing template (3D-PT) assistance, among others, have potentially improved the clinical outcomes of BT. However, a comprehensive review of BT with newly published literature was lacking. This review is to discuss BT for NSCLC based on recent literature published in PubMed.
Collapse
Affiliation(s)
- Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China; Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xiaodong Huo
- Department of Thoracic Surgery, Tianjin Medical University 2nd Hospital, Department of Oncology, Tianjin Medical University 2nd Hospital, Tianjin, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
3
|
Pikin O, Vasuikevich A, Alexandrov O, Toneev E. Bronchial stump re-resection for lung cancer recurrence after left pneumonectomy. Indian J Thorac Cardiovasc Surg 2020; 37:105-107. [PMID: 33442216 DOI: 10.1007/s12055-020-01030-y] [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: 06/30/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022] Open
Abstract
We report a rare case of curative bronchial stump re-resection after left-side pneumonectomy. A 65-year-old male was operated 2 years prior to current admission for centrally located non-small cell lung cancer, followed by 4 cycles of platinum-based chemotherapy. In 2 years after treatment, a local endobronchial recurrence was diagnosed in the bronchial stump. The patient was operated via sternothoracotomy approach and successful complete re-resection of the left main bronchus was provided after pericardiotomy and re-amputation of pulmonary vessel stumps. Postoperative period was uneventful.
Collapse
Affiliation(s)
- Oleg Pikin
- Moscow Oncology Research Institute of P.A. Herzen, Moscow, Russia
| | - Andrey Vasuikevich
- Department of Thoracic Surgery, Burdenko Central Military Hospital, Hospital Street, 3, Moscow, Russia
| | - Oleg Alexandrov
- Moscow Oncology Research Institute of P.A. Herzen, Moscow, Russia
| | - Evgeniy Toneev
- Department of Thoracic Surgery, Regional Cancer Centre, 12 th September Street, 90, Ulianovsk, Russia
| |
Collapse
|
4
|
Analysis of dose distribution between contemporary and standard planning in high-dose-rate endobronchial brachytherapy based on three-dimensional imaging. J Contemp Brachytherapy 2019; 11:462-468. [PMID: 31749856 PMCID: PMC6854859 DOI: 10.5114/jcb.2019.89194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 08/28/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose The treatment planning (TP) in high-dose-rate (HDR) endobronchial brachytherapy (EB) can be based on various forms of imaging. In the case of lung cancer, one-dimensional or two-dimensional imaging is standard. The dose coverage of the target (planning target volume – PTV) and organs at risk (OAR) is unknown, because the doses are calculated on the basis of the dose points. In modern brachytherapy, TP can be based on three-dimensional (3D) images. A plan created in this way contains information about the dose distribution in the PTV and OAR. Treatment plans based on standard planning (SP) and contemporary planning (CP) may differ in dose distribution in the patient’s body. Those differences between SP and CP may have an effect on the dose distribution in PTV, OAR and follow-up. Material and methods The study involved a group of 31 patients prospectively treated with advanced, inoperable, non-small cell lung cancer. As many as 76 treatment fractions were analyzed. Firstly, the coverage of the PTV parameter in 2D and 3D for V85, V100 and V115 was analyzed. Secondly, the dosage that OAR would take in was evaluated. In the cases of the heart, spinal cord and esophagus, the examined dosage equaled D0.1cm3, D1cm3 and D2cm3 for each of the structures. Also, heart D20 was examined as well as D5 for the healthy lung. Results The median dose to the target volume was on average 43.33% higher for V85 with the contemporary planning method when compared to standard planning, with statistical significance. This came with the cost of an OAR mean dose increase of 1 Gy in D0.1cm3 for the heart. Conclusions Contemporary TP in EB allows one to adjust the dose distribution for individual clinical situations and allows one to improve clinical target volume (CTV) coverage, increase doses to the OAR and increase overall survival. The use of new methods of treatment plans in EB has significantly increased the follow-up to 21 months in a treated group of patients.
Collapse
|
5
|
Dhillon S, Bansal S, Sindhwani G, Gupta M, Nautiyal V, Saini S, Ahmad M. Clinical and endoscopic response to high dose rate endobronchial brachytherapy in malignant lung tumors: A single centre experience. South Asian J Cancer 2018; 7:267-269. [PMID: 30430099 PMCID: PMC6190393 DOI: 10.4103/sajc.sajc_29_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The aim of the study was to evaluate the short-term clinical, endoscopic response, and acute toxicities in endobronchial cancer treated with high-dose-rate endobronchial brachytherapy (HDR-EB). Materials and Methods Thirty patients of advanced endobronchial cancers were treated with HDR-EB. Brachytherapy was delivered at a depth of 1 cm from the source axis at weeks 1, 2, and 3 with 7 Gy per fraction. All patients were evaluated before treatment and at 1 month after completion of therapy. Using Speiser's scoring criteria, the severity of symptoms (dyspnea, cough, hemoptysis, and postobstructive pneumonia) and degree of obstruction were graded. Results Symptomatic response for cough, dyspnea, and hemoptysis was seen in 88%, 75%, and 96%, respectively, with a significant P value (<0.05). Obstructive pneumonia was resolved in 94% of patients. Endoscopic response in terms of degree of obstruction was seen in 84% of patients. Acute toxicities in the form of radiation bronchitis were seen in 32% of patients, whereas 8% of patients experienced esophagitis. Bronchospasm was seen in one patient during treatment. Conclusion HDR brachytherapy is a highly effective, safe, convenient therapy in alleviating symptoms of endobronchial obstruction with endoscopic response in the majority of cases. Thus, HDR-BT is a promising treatment for palliation of patients presenting with symptoms of endobronchial obstruction with an acceptable rate of complications.
Collapse
Affiliation(s)
- Sneha Dhillon
- Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
| | - Saurabh Bansal
- Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
| | - Girish Sindhwani
- Department of Pulmonary Medicine, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
| | - Meenu Gupta
- Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
| | - Vipul Nautiyal
- Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
| | - Sunil Saini
- Department of Surgery Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
| | - Mushtaq Ahmad
- Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
| |
Collapse
|
6
|
Skowronek J. Current status of brachytherapy in cancer treatment - short overview. J Contemp Brachytherapy 2017; 9:581-589. [PMID: 29441104 PMCID: PMC5808003 DOI: 10.5114/jcb.2017.72607] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 01/21/2023] Open
Abstract
Cancer incidence and mortality depend on a number of factors, including age, socio-economic status and geographical location, and its prevalence is growing around the world. Most of cancer treatments include external beam radiotherapy or brachytherapy. Brachytherapy, a type of radiotherapy with energy from radionuclides inserted directly into the tumor, is increasingly used in cancer treatment. For cervical and skin cancers, it has become a standard therapy for more than 100 years as well as an important part of the treatment guidelines for other malignancies, including head and neck, skin, breast, and prostate cancers. Compared to external beam radiotherapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time directly to the altered tissue area with the advantage of a rapid fall-off in dose, and consequently, sparing of adjacent organs. As a result, the patient is able to complete the treatment earlier, and the risks of occurrence of another cancer are lower than in conventional radiotherapy treatment. Brachytherapy has increased its use as a radical or palliative treatment, and become more advanced with the spread of pulsed-dose-rate and high-dose-rate afterloading machines; the use of new 3D/4D planning systems has additionally improved the quality of the treatment. The aim of the present study was to present short summaries of current studies on brachytherapy for the most frequently diagnosed tumors. Data presented in this manuscript should help especially young physicians or physicists to explore and introduce brachytherapy in cancer treatments.
Collapse
Affiliation(s)
- Janusz Skowronek
- Brachytherapy Department, Greater Poland Cancer Center
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
7
|
Ma C, Xu X, Zhang R, Qin S, Zhou J. Computed tomography-guided intraluminal brachytherapy in recurrent bronchogenic carcinoma: A clinical trial in a small group. PRECISION RADIATION ONCOLOGY 2017. [DOI: 10.1002/pro6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chenying Ma
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Xiaoting Xu
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Ruting Zhang
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Songbing Qin
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Juying Zhou
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| |
Collapse
|
8
|
High Dose Rate Brachytherapy as a Treatment Option in Endobronchial Tumors. LUNG CANCER INTERNATIONAL 2016; 2016:3086148. [PMID: 27493804 PMCID: PMC4963588 DOI: 10.1155/2016/3086148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/19/2016] [Indexed: 12/26/2022]
Abstract
Purpose. To report our experience with high dose rate endobronchial brachytherapy (HDR-EBBT) and to assess its efficacy and tolerability with possibility of its use in selected cases with curative intent. Method. Retrospective review of patients with endobronchial tumors treated at our institution in 2007–2013 with HDR-EBBT. Subjective response and treatment related toxicity were extracted from patients' records. Clinical response was evaluated by chest CT +/− bronchoscopy 2-3 months after treatment. Local control (LC) and overall survival (OS) were analyzed. Results. Overall 23 patients were identified. Ten patients were treated with curative intent, in 8 of them HDR-EBBT was combined with external beam radiotherapy. Short term palliation was as follows: dyspnea (13/15), cough (12/14), and hemoptysis (3/3). Seventeen patients were evaluated, of whom 9 (53%) showed complete response. Four patients developed local failure (only 1 of them treated with curative intent) and were salvaged with HDR-EBBT (n = 1), chemotherapy (n = 2), and laser (n = 1). Among patients treated with curative intent, the 2-year LC and OS were 89% and 67%, respectively, and 2 out of 4 deaths were cancer-related. Late toxicity included bronchial stenosis (n = 1). Only 1 patient had fatal hemoptysis and postmortem examination indicated local recurrence. Conclusion. HDR-EBBT is promising treatment with tolerable complication if used in properly selected patients.
Collapse
|
9
|
Stewart A, Parashar B, Patel M, O'Farrell D, Biagioli M, Devlin P, Mutyala S. American Brachytherapy Society consensus guidelines for thoracic brachytherapy for lung cancer. Brachytherapy 2015; 15:1-11. [PMID: 26561277 DOI: 10.1016/j.brachy.2015.09.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/28/2015] [Accepted: 09/02/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To update brachytherapy recommendations for pretreatment evaluation, treatment, and dosimetric issues for thoracic brachytherapy for lung cancer. METHODS AND MATERIALS Members of the American Brachytherapy Society with expertise in thoracic brachytherapy updated recommendations for thoracic brachytherapy based on literature review and clinical experience. RESULTS The American Brachytherapy Society consensus guidelines recommend the use of endobronchial brachytherapy for disease palliation in patients with central obstructing lesions, particularly in patients who have previously received external beam radiotherapy. The use of interstitial implants after incomplete resection may improve outcomes and provide enhanced palliation. Early reports support the use of CT-guided intratumoral volume implants within clinical studies. The use of brachytherapy routinely after sublobar resection is not generally recommended, unless within the confines of a clinical trial or a registry. CONCLUSIONS American Brachytherapy Society recommendations for thoracic brachytherapy are provided. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality to increase the evidence base for its use.
Collapse
Affiliation(s)
- A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK.
| | - B Parashar
- Department of Stich Radiation Oncology, Weill Cornell Medical College, New York, NY
| | - M Patel
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, TX
| | - D O'Farrell
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - M Biagioli
- Florida Hospital Cancer Institute, Department of Radiation Oncology, H.Lee Moffitt Cancer Center, Tampa, FL
| | - P Devlin
- Dana Faber Cancer Centre, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - S Mutyala
- Department of Radiation Medicine, St. Joseph's Hospital and Medical Center, University of Arizona Cancer Center at Dignity Health, Phoenix, AZ
| |
Collapse
|
10
|
A total EQD2 greater than 85 Gy for trachea and main bronchus D2cc being associated with severe late complications after definitive endobronchial brachytherapy. J Contemp Brachytherapy 2015; 7:363-8. [PMID: 26622242 PMCID: PMC4663210 DOI: 10.5114/jcb.2015.54968] [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: 06/16/2015] [Accepted: 09/06/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose The endobronchial brachytherapy (EBBT) is an established treatment method for tumors of the tracheobronchial system, however, little is known about the tolerance dose for organ at risk (OAR) in EBBT. The purpose of this study is to analyze patients with superficial bronchial carcinoma treated with definitive EBBT, and to investigate a relationship between late complications and dose for OAR. Material and methods Endobronchial brachytherapy was performed 6 Gy per fraction for three to four fractions with or without external beam radiation therapy (EBRT). For the purpose of dosimetric analysis, the wall of the lower respiratory tract (LRT: trachea, main bronchus, and lobar bronchiole), trachea, and main bronchus (TMB) was extracted. D0.5cc, D1cc, and D2cc of LRT and TMB were calculated in each EBBT session and added together. V100, V150, and V200 of LRT were also calculated. Results Between March 2008 and April 2014, EBBT was performed in 14 patients for curative intent. The 2-year overall survival (OS), progression-free survival (PFS), and local recurrence free survival (LRFS) was 82.1%, 77.9%, and 91.7%, respectively. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014). Conclusions It was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT.
Collapse
|
11
|
Brachytherapy in the treatment of lung cancer - a valuable solution. J Contemp Brachytherapy 2015; 7:297-311. [PMID: 26622233 PMCID: PMC4643732 DOI: 10.5114/jcb.2015.54038] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 11/17/2022] Open
Abstract
The majority of patients with lung cancer are diagnosed with clinically advanced disease. Many of these patients have a short life expectancy and are treated with palliative aim. Because of uncontrolled local or recurrent disease, patients may have significant symptoms such as: cough, dyspnea, hemoptysis, obstructive pneumonia, or atelectasis. Brachytherapy is one of the most efficient methods in overcoming difficulties in breathing that is caused by endobronchial obstruction in palliative treatment of bronchus cancer. Efforts to relieve this obstructive process are worthwhile, because patients may experience improved quality of their life (QoL). Brachytherapy plays a limited but specific role in definitive treatment with curative intent in selected cases of early endobronchial disease as well as in the postoperative treatment of small residual peribronchial disease. Depending on the location of the lesion, in some cases brachytherapy is a treatment of choice. This option is fast, inexpensive, and easy to perform on an outpatient basis. Clinical indications, different techniques, results, and complications are presented in this work.
Collapse
|