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GEC ESTRO ACROP consensus recommendations for contact brachytherapy for rectal cancer. Clin Transl Radiat Oncol 2022; 33:15-22. [PMID: 35243017 PMCID: PMC8885383 DOI: 10.1016/j.ctro.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 12/19/2022] Open
Abstract
CXB appears to be an efficacious technique for rectal cancer treatment and may allow rectal preservation in selected patients. These GEC ESTRO ACROP recommendations recommend dose schemes in for rectal CXB. These recommendations advise reporting of tumour depth to enable future refinement of dose prescription and target definition. The routine collection and publication of outcome data including patient reported outcomes (PROs) is recommended.
Purpose To issue consensus recommendations for contact X-Ray brachytherapy (CXB) for rectal cancer covering pre-treatment evaluation, treatment, dosimetric issues and follow-up. These recommendations cover CXB in the definitive and palliative setting. Methods Members of GEC ESTRO with expertise in rectal CXB issued consensus-based recommendations for CXB based on literature review and clinical experience. Levels of evidence according to the Oxford Centre for Evidence based medicine guidance are presented where possible. Results The GEC ESTRO ACROP consensus recommendations support the use of CXB to increase the chances of clinical complete remission and cure for patients who are elderly with high surgical risk, surgically unfit or refusing surgery. For palliative treatment, the use of CXB is recommended for symptomatic relief and disease control. The use of CXB in an organ-preservation setting in surgically fit patients is recommended within the setting of a clinical trial or registry. Conclusions The GEC ESTRO ACROP recommendations for CXB are provided. Recommendations towards standardisation of reporting and prescription are given. Practitioners are encouraged to follow these recommendations and to develop further clinical trials to examine this treatment modality and increase the evidence base for its use. The routine collection of outcomes both clinical and patient-reported is also encouraged.
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Bellezzo M, Fonseca GP, Voncken R, Verrijssen AS, Van Beveren C, Roelofs E, Yoriyaz H, Reniers B, Van Limbergen EJ, Berbée M, Verhaegen F. Advanced design, simulation, and dosimetry of a novel rectal applicator for contact brachytherapy with a conventional HDR 192Ir source. Brachytherapy 2020; 19:544-553. [PMID: 32386884 DOI: 10.1016/j.brachy.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Dose escalation yields higher complete response to rectal tumors, which may enable the omission of surgery. Dose escalation using 50 kVp contact x-ray brachytherapy (CXB) allow the treatment of a selective volume, resulting in low toxicity and organs-at-risk preservation. However, the use of CXB devices is limited because of its high cost and lack of treatment planning tools. Hence, the MAASTRO applicator (for HDR 192Ir sources) was developed and characterized by measurements and Monte Carlo simulations to be a cost-effective alternative to CXB devices. METHODS AND MATERIALS A cylindrical applicator with lateral shielding was designed to be used with a rectoscope using its tip as treatment surface. Both the applicator and the rectoscope have a slanted edge to potentially allow easier placement against tumors. The applicator design was achieved by Monte Carlo modeling and validated experimentally with film dosimetry, using the Papillon 50 (P50) device as reference. RESULTS The applicator delivers CXB doses in less than 9 min using a 20375 U source for a treatment area of approximately 20 × 20 mm2 at 2 mm depth. Normalized at 2 mm, the dose falloff for depths of 0 mm, 5 mm, and 10 mm are 130%, 70%, and 43% for the P50 and 140%, 67%, and 38% for the MAASTRO applicator, respectively. CONCLUSIONS The MAASTRO applicator was designed to use HDR 192Ir sources to deliver a dose distribution similar to those of CXB devices. The applicator may provide a cost-effective solution for endoluminal boosting with clinical treatment planning system integration.
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Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - An-Sofie Verrijssen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Celine Van Beveren
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hélio Yoriyaz
- Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Callaghan CM, Adams Q, Flynn RT, Wu X, Xu W, Kim Y. Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques. Int J Radiat Oncol Biol Phys 2019; 105:206-221. [DOI: 10.1016/j.ijrobp.2019.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/27/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
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Bellezzo M, Baeza JA, Voncken R, Reniers B, Verhaegen F, Fonseca GP. Mechanical evaluation of the Bravos afterloader system for HDR brachytherapy. Brachytherapy 2019; 18:852-862. [PMID: 31327634 DOI: 10.1016/j.brachy.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The Bravos afterloader system was released by Varian Medical Systems in October of 2018 for high-dose-rate brachytherapy with 192Ir sources, containing new features such as the CamScale (a new device for daily quality assurance and system recalibration), channel length verification, and different settings for rigid and flexible applicators. This study mechanically evaluated the Bravos system precision and accuracy for clinically relevant scenarios, using dummy sources. METHODS AND MATERIALS The system was evaluated after three sets of experiments: (1) The CamScale was used to verify inter- and intra-channel dwelling variability and system calibration; (2) A high-speed camera was used to verify the source simulation cable movement inside a transparent quality assurance device, where dwell positions, dwell times, transit times, speed profiles, and accelerations were measured; (3) The source movement inside clinical applicators was captured with an imaging panel while being exposed to an external kV source. Measured and planned dwell positions and times were compared. RESULTS Maximum deviations between planned and measured dwell positions and times for the source cable were 0.4 mm for the CamScale measurements and 0.07 seconds for the high-speed camera measurements. Mean dwell position deviations inside clinical applicators were below 1.2 mm for all applicators except the ring that required an offset correction of 1 mm to achieve a mean deviation of 0.4 mm. CONCLUSIONS Features of the Bravos afterloader system provide a robust and precise treatment delivery. All measurements were within manufacturer specifications.
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Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - José A Baeza
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Devic S, Bekerat H, Garant A, Vuong T. Optimization of HDRBT boost dose delivery for patients with rectal cancer. Brachytherapy 2019; 18:559-563. [DOI: 10.1016/j.brachy.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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Berbée M, Verrijssen AS, Buijsen J, Verhaegen F, Van Limbergen EJ. The role of external beam and endoluminal radiation boosting in rectal cancer. COLORECTAL CANCER 2019. [DOI: 10.2217/crc-2019-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology & Developmental Biology, Maastricht University Medical Center, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - An-Sofie Verrijssen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology & Developmental Biology, Maastricht University Medical Center, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Jeroen Buijsen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology & Developmental Biology, Maastricht University Medical Center, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology & Developmental Biology, Maastricht University Medical Center, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Evert Jan Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology & Developmental Biology, Maastricht University Medical Center, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
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