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Bilski M, Korab K, Stąpór-Fudzińska M, Ponikowska J, Brzozowska A, Sroka Ł, Wojtyna E, Sroka S, Szlag M, Cisek P, Napieralska A. HDR brachytherapy versus robotic-based and linac-based stereotactic ablative body radiotherapy in the treatment of liver metastases - A dosimetric comparison study of three radioablative techniques. Clin Transl Radiat Oncol 2024; 48:100815. [PMID: 39070028 PMCID: PMC11279445 DOI: 10.1016/j.ctro.2024.100815] [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: 04/20/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose The aim of our study was to compare dosimetric aspects of three radioablation modalities - direct high-dose-rate brachytherapy (HDR-BT) and virtually planned stereotactic body radiation therapy performed on CyberKnife (SBRTck) and Elekta Versa HD LINAC (SBRTe) applied in patients with liver metastases. Material and methods We selected 30 patients with liver metastases, who received liver interstitial HDR-BT and virtually prepared plans for SBRTck and SBRTe. In all the cases, the prescribed dose was a single fraction of 25 Gy. Treatment delivery time, doses delivered to PTV and organs at risk, as well as conformity indices, were calculated and compared. Results The longest median treatment delivery time was observed in SBRTck in contrast to HDR-BT and SBRTe which were significantly shorter and comparable. HDR-BT plans achieved better coverage of PTV (except for D98%) in contrast to SBRT modalities. Between both SBRT modalities, SBRTck plans resulted in better dose coverage in Dmean, D50%, and D90% values compared to SBRTe without difference in D98%. The SBRTe was the most advantageous considering the PCI and R100%. SBRTck plans achieved the best HI, while R50% value was comparable between SBRTe and SBRTck. The lowest median doses delivered to uninvolved liver volume (V5Gy, V9.1Gy) were achieved with HDR-BT, while the difference between SBRT modalities was insignificant. SBRT plans were better regarding more favourable dose distribution in the duodenum and right kidney, while HDR-BT achieved lower doses in the stomach, heart, great vessels, ribs, skin and spinal cord. There were no significant differences in bowel and biliary tract dose distribution between all selected modalities. Conclusions HDR-BT resulted in more favourable dose distribution within PTVs and lower doses in organs at risk, which suggests that this treatment modality could be regarded as an alternative to other local ablative therapies in carefully selected patients' with liver malignancies. Future studies should further address the issue of comparing treatment modalities in different liver locations and clinical scenarios.
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Affiliation(s)
- Mateusz Bilski
- Radiotherapy Department, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Saint John’s Cancer Center, Lublin, Poland
- Radiotherapy Department, Saint John’s Cancer Center, Lublin, Poland
| | - Katarzyna Korab
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Małgorzata Stąpór-Fudzińska
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Julia Ponikowska
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Agnieszka Brzozowska
- Department of Medical Mathematics and Statistics with e-Health Laboratory, Medical University of Lublin, Lublin, Poland
| | - Łukasz Sroka
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Ewa Wojtyna
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Sylwia Sroka
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Marta Szlag
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Paweł Cisek
- Radiotherapy Department, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Saint John’s Cancer Center, Lublin, Poland
| | - Aleksandra Napieralska
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology in Gliwice and Kraków, Poland
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Ümütlü MR, Öcal O, Puhr-Westerheide D, Fabritius MP, Wildgruber M, Deniz S, Corradini S, Rottler M, Walter F, Rogowski P, Seidensticker R, Philipp AB, Rössler D, Ricke J, Seidensticker M. Efficacy and Safety of Local Liver Radioablation in Hepatocellular Carcinoma Lesions within and beyond Limits of Thermal Ablation. Dig Dis 2024; 42:461-472. [PMID: 38781948 DOI: 10.1159/000538788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION CT-guided interstitial brachytherapy (iBT) radiotherapy has been established in the treatment of liver tumors. With iBT, hepatocellular carcinoma (HCC) lesions can be treated beyond the limits of thermal ablation (i.e., size and location). However, a comprehensive analysis of the efficacy of iBT in patients within and beyond thermal ablation limits is lacking. MATERIALS AND METHODS A total of 146 patients with 216 HCC lesions have been analyzed retrospectively. Clinical and imaging follow-up data has been collected. Lesions were evaluated in terms of suitability for thermal ablation or not. The correlation between local tumor control (LTC), time to progression (TTP), overall survival (OS), and clinical and imaging parameters have been evaluated using univariable and multivariable Cox regression analyses. RESULTS LTC rates at 12 months, 24 months, and 36 months were 87%, 75%, and 73%, respectively. 65% of lesions (n = 141) were not suitable for radiofrequency ablation (RFA). The median TTP was 13 months, and the median OS was not reached (3-year OS rate: 70%). No significant difference in LTC, TTP, or OS regarding RFA suitability existed. However, in the overall multivariable analysis, lesion diameter >5 cm was significantly associated with lower LTC (HR: 3.65, CI [1.60-8.31], p = 0.002) and shorter TTP (HR: 2.08, CI [1.17-3.70], p = 0.013). Advanced BCLC stage, Child-Pugh Stage, and Hepatitis B were associated with shorter OS. CONCLUSION iBT offers excellent LTC rates and OS in local HCC treatment regardless of the limits of thermal ablation, suggesting further evidence of its alternative role to thermal ablation in patients with early-stage HCC.
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Affiliation(s)
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Zhu J, Wang C, Teng S, Lu J, Lyu P, Zhang P, Xu J, Lu L, Teng GJ. Embedding expertise knowledge into inverse treatment planning for low-dose-rate brachytherapy of hepatic malignancies. Med Phys 2024; 51:348-362. [PMID: 37475484 DOI: 10.1002/mp.16627] [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: 12/29/2022] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Leveraging the precision of its radiation dose distribution and the minimization of postoperative complications, low-dose-rate (LDR) permanent seed brachytherapy is progressively adopted in addressing hepatic malignancies. PURPOSE The present study endeavors to devise a sophisticated treatment planning system (TPS) to optimize LDR brachytherapy for hepatic lesions. METHODS Our TPS encompasses four integral modules: multi-organ segmentation, seed distribution initialization, puncture pathway selection, and inverse dose planning. By amalgamating an array of deep learning models, the segmentation module proficiently labels 17 discrete abdominal targets within the images. We introduce a knowledge-based seed distribution initialization methodology that discerns the most analogous tumor shape in the reference treatment plan from the knowledge base. Subsequently, the seed distribution from the reference plan is transmuted to the current case, thus establishing seed distribution initialization. Furthermore, we parameterize the puncture needles and seeds, while concurrently constraining the puncture needle angle through the employment of a virtual puncture panel to augment planning algorithm efficiency. We also presented a user interface that includes a range of interactive features, seamlessly integrated with the treatment planning generation function. RESULTS The multi-organ segmentation module, which is trained by 50 cases of in-house CT scans and 694 cases of publicly available CT scans, achieved average Dice of 0.80 and Hausdorff distance of 5.2 mm in testing datasets. The results demonstrate that knowledge-based initialization exhibits a marked enhancement in expediting the convergence rate. Our TPS also demonstrates a dominant advantage in dose-volume-histogram criteria and execution time in comparison to commercial TPS. CONCLUSION The study proposes an innovative treatment planning system for low-dose-rate permanent seed brachytherapy for hepatic malignancies. We show that the generated treatment plans meet clinical requirement.
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Affiliation(s)
- Jianjun Zhu
- Hanglok-Tech Co., Ltd., Hengqin, China
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | | | | | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | | | | | - Jun Xu
- Nanjing University of Information Science & Technology, Nanjing, China
| | - Ligong Lu
- Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, Guangdong, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Yadawa N, Shahi UP, Mandal A, Verma A, Kumari K, Aggrawal LM, Jaiswal I, Mourya A, Jaiswal AK, Srivastava P. Percutaneous high-dose-rate interstitial brachytherapy for non-resectable, chemo resistant malignant lesion of lung and liver. J Cancer Res Ther 2023; 19:S807-S814. [PMID: 38384060 DOI: 10.4103/jcrt.jcrt_1351_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/17/2022] [Indexed: 02/23/2024]
Abstract
PURPOSE To explore the feasibility and efficacy of interstitial brachytherapy application for nonresectable and chemo-resistant malignant liver and lung lesions. MATERIALS AND METHODS Percutaneous high-dose-rate interstitial brachytherapy (HDR ISBT) was applied in nine lesions of seven middle-aged patients with advanced carcinoma (five patients with liver lesion and two patients with lung lesion). All patients were surgically ineligible. All patients had already received systemic chemotherapy. Under computed tomography (CT) guidance (for lung lesion) or ultrasonography (USG) guidance (for liver lesion), a single stainless steel brachytherapy needle was inserted percutaneously in patients with lesion size ≤4 centimeter (cm) and multiple needles were inserted in patients of lesion size >4cm. A single dose of 15 Gy to 20 Gy with HDR ISBT was prescribed at the periphery of the lesion. The needles were removed just after treatment. Patients were kept under observation for 24 h after treatment. RESULTS The median size of the lesion was 6.5 cm. In all the cases of liver lesion, more than 75% shrinkage of tumor volume in follow-up at 6 mo was observed. It was more than 50% for lung lesion. None of the patients had developed significant complications as on the median follow up period of 15 mo (ranges 3-27 mo). CONCLUSIONS Percutaneous CT-guided high-dose-rate interstitial brachytherapy is a minimally invasive, safe, and feasible treatment option with minimal complication for inoperable, chemo resistant, advanced cancers with encouraging treatment outcomes.
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Affiliation(s)
- Nandlal Yadawa
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Uday P Shahi
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Abhijit Mandal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis, IMS BHU Varanasi, Uttar Pradesh, India
| | - Kiran Kumari
- Department of Radiodiagnosis, DMCH, Darbhanga, Bihar, India
| | - Lalit M Aggrawal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Isha Jaiswal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Ankur Mourya
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Anil K Jaiswal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Pammy Srivastava
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
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Correlation of chemokines and growth factors with radiation-induced liver injury after interstitial high dose rate (HDR) brachytherapy of liver metastases. J Cancer Res Clin Oncol 2022; 148:2815-2826. [PMID: 35596772 PMCID: PMC9470622 DOI: 10.1007/s00432-022-04041-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 11/06/2022]
Abstract
Background Locoregional therapies, as imaging-guided tumor-directed procedures, are emerging treatment strategies in the management of primary and secondary liver malignancies such as e.g. colorectal cancer liver metastases. As one of those, irradiation-based interstitial high dose rate brachytherapy (iBT) of liver metastases bears a risk of developing focal radiation-induced liver injury (fRILI). Since little is known about biological factors involved in hepatic dysfunction after irradiation, the aim of this study was to identify factors, that may play a role in the underlying mechanism of fRILI, and that potentially may serve as biomarkers for post-therapeutic fRILI to improve specific management and treatment of patients. Methods Twenty-two patients with hepatic malignancies (tumor patients, TP) underwent iBT with total ablative doses of radiation to the target volume ranging from e.g. 15 to 25 Gy. Hepatobiliary magnetic resonance imaging (MRI) was performed 6 weeks after iBT to quanitify fRILI. Blood samples were taken before (pre) and 6 weeks after (post) iBT from TP, and from ten healthy volunteers (HV controls) for the analyses of humoral mediators: monocyte chemoattractant protein-1 (MCP-1), chemokine (C-X3-C motif) ligand 1 (CX3CL1), vascular endothelial growth factor (VEGF) and beta-nerve growth factor (beta-NGF) using the Multi-Analyte Flow Assay via flow cytometry. Correlation analyses between the humoral mediators (pre and post iBT) with the tumor volume and fRILI were performed. Results While MCP-1 and CX3CL1 tended to decrease in TP vs. HV, VEGF was significantly decreased in TP vs. HV pre and post iBT (p < 0.05). Beta-NGF levels were significantly increased in TP vs. HV pre and post iBT (p < 0.05). Baseline circulating levels of MCP-1, VEGF and beta-NGF have shown significant positive correlations with the hepatic tumor volume (p < 0.05). Circulating levels of humoral mediators before treatment did not correlate with fRILI, while CX3CL1 and VEGF after iBT have shown significant positive correlations with fRILI (p < 0.05). Conclusion Tumor volume and threshold dose of irradiation damage correlated positively with MCP-1 and VEGF as well as NGF and CX3CL, respectively. Thus, investigation of biological mediators in blood samples from tumor patients may provide an appropriate tool to predict fRILI after interstitial HDR brachytherapy of liver metastases.
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Scafa D, Muedder T, Holz JA, Koch D, Nour Y, Garbe S, Gonzalez-Carmona MA, Feldmann G, Vilz TO, Köksal M, Giordano FA, Schmeel LC, Sarria GR. Dosimetric Comparison of Intraoperative Radiotherapy and SRS for Liver Metastases. Front Oncol 2021; 11:767468. [PMID: 34926271 PMCID: PMC8674179 DOI: 10.3389/fonc.2021.767468] [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: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose/Objectives To perform a dosimetric comparison between kilovoltage intraoperative radiotherapy (IORT) and stereotactic radiosurgery (SRS) simulating both deep-inspiration breath-hold (DIBH) and free-breathing (FB) modalities for patients with liver metastases. Methods/Materials Diagnostic computed tomographies (CT) of patients carrying one or two lesions <4 cm and who underwent surgery were retrospectively screened and randomly selected for the study. For DIBH-SRS, a gross target volume (GTV) plus planning target volume (PTV) were delineated. For FB-SRS, a GTV plus an internal target volume (ITV) and PTV were defined. Accounting for the maximal GTV diameters, a modified GTV (GTV-IORT) was expanded circumferentially to simulate a resection cavity. The best suitable round-applicator size was thereafter selected. All treatment plans were calculated homogeneously to deliver 40 Gy. Doses delivered to organs at risk (OAR) and target volumes were compared for IORT vs. both SRS modalities. Results Eight patients encompassing 10 lesions were included in the study. The mean liver volume was 2,050.97 cm3 (SD, 650.82), and the mean GTV volume was 12.23 cm3 (SD, 12.62). As for target structures, GTV-IORT [19.44 cm3 (SD, 17.26)] were significantly smaller than both PTV DIBH-SRS [30.74 cm3 (SD, 24.64), p = 0.002] and PTV FB-SRS [75.82 cm3 (SD, 45.65), p = 0.002]. The median applicator size was 3 cm (1.5–4.5), and the mean IORT simulated delivery time was 45.45 min (SD, 19.88). All constraints were met in all modalities. Liver V9.1 showed significantly smaller volumes with IORT [63.39 cm3 (SD, 35.67)] when compared to DIBH-SRS [150.12 cm3 (SD, 81.43), p = 0.002] or FB-SRS [306.13 cm3 (SD, 128.75), p = 0.002]. No other statistical or dosimetrically relevant difference was observed for stomach, spinal cord, or biliary tract. Mean IORT D90 was 85.3% (SD, 6.05), whereas D95 for DIBH-SRS and FB-SRS were 99.03% (SD, 1.71; p = 0.042) and 98.04% (SD, 3.46; p = 0.036), respectively. Conclusion Kilovoltage IORT bears the potential as novel add-on treatment for resectable liver metastases, significantly reducing healthy liver exposure to radiation in comparison to SRS. Prospective clinical evidence is required to confirm this hypothesis.
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Affiliation(s)
- Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Thomas Muedder
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Jasmin A Holz
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Younéss Nour
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Georg Feldmann
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Tim O Vilz
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - Mümtaz Köksal
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
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Roussakis Y, Anagnostopoulos G. Physical and Dosimetric Aspects of the Iridium-Knife. Front Oncol 2021; 11:728452. [PMID: 34858815 PMCID: PMC8630660 DOI: 10.3389/fonc.2021.728452] [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: 06/21/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
The three-dimensional iridium-192 (192Ir) high-dose-rate (HDR) brachytherapy manifests itself as a high-precision, hypofractionated, dose-escalating, minimally invasive method in the armamentarium of contemporary radiation oncology clinical applications. In this study, the physical aspects of the 192Ir radionuclide are presented. Its dosimetric application in HDR brachytherapy for different anatomical sites (prostate, gynecological malignancies, liver, and intrathoracic tumors) as well as the corresponding dosimetric comparison with the stereotactic body radiation therapy (SBRT) techniques based on a representative selection of dosimetric publications is reviewed and illustrated.
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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.
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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
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Appalanaido GK, Shukor SA, Fan AS, Chong SE, Hussin H, Karim NKA, Meng LV, Aziz MZA. Palliative brachytherapy to axilla and hypopharynx in elderly patient with hypopharyngeal squamous cell carcinoma - case report. REPORTS OF PRACTICAL ONCOLOGY AND RADIOTHERAPY : JOURNAL OF GREATPOLAND CANCER CENTER IN POZNAN AND POLISH SOCIETY OF RADIATION ONCOLOGY 2021; 26:647-653. [PMID: 34434581 DOI: 10.5603/rpor.a2021.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022]
Abstract
Brachytherapy (BT) is an important local treatment of tumor and it can be applied to different anatomical sites either in a curative or palliative setting. BT can deliver large dose of radiation to the tumor while sparing the surrounding normal tissue which translates into a better therapeutic ratio compared to external beam radiotherapy. However, the evidence for the use of brachytherapy in the palliative setting is lacking in the literature. In this case report, we describe the brachytherapy technique and outcome of a patient with squamous cell carcinoma of the hypopharynx who underwent palliative brachytherapy to the hypopharynx and metastatic tumor at the right axilla.
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Affiliation(s)
- Gokula Kumar Appalanaido
- Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, Pulau Pinang, Malaysia
| | | | | | - Soon Eu Chong
- Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, Pulau Pinang, Malaysia
| | - Hasma Hussin
- Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, Pulau Pinang, Malaysia
| | - Noor Khairiah A Karim
- Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, Pulau Pinang, Malaysia
| | - Leow Voon Meng
- Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, Pulau Pinang, Malaysia
| | - Mohd Zahri Abdul Aziz
- Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, Pulau Pinang, Malaysia
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Yoon SM, Suh R, Abtin F, Moghanaki D, Genshaft S, Kamrava M, Drakaki A, Liu S, Venkat P, Lee A, Chang AJ. Outcomes with multi-disciplinary management of central lung tumors with CT-guided percutaneous high dose rate brachyablation. Radiat Oncol 2021; 16:99. [PMID: 34098977 PMCID: PMC8186067 DOI: 10.1186/s13014-021-01826-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Centrally located lung tumors present treatment challenges given their proximity to mediastinal structures including the central airway, esophagus, major vessels, and heart. Therapeutic options can be limited for medically inoperable patients, particularly if they have received previous thoracic radiotherapy. High dose rate (HDR) brachyablation was developed to improve the therapeutic ratio for patients with central lung tumors. The purpose of this study is to report initial safety and efficacy outcomes with this treatment for central lung malignancies. METHODS From September 2015 to August 2019, a total of 25 patients with 37 pulmonary tumors were treated with percutaneous HDR brachyablation. Treatment was delivered by a multi-disciplinary team of interventional radiologists, pulmonologists, and radiation oncologists. Twenty-three patients received a median dose of 21.5 Gy (range 15-27.5) in a single fraction, whereas two patients received median dose of 24.75 Gy (range 24-25.5) over 2-3 fractions. Tumor local control (LC) was evaluated by Response Evaluation Criteria in Solid Tumors v1.1. Treatment-related toxicities were graded by Common Terminology Criteria for Adverse Events v5.0, with adverse events less than 90 days defined as acute, and those occurring later were defined as late. LC, progression-free survival (PFS), and overall survival (OS) rates were estimated by the Kaplan-Meier method. RESULTS Of 37 treated tumors, 88% were metastatic. Tumor location was central and ultra-central in 24.3% and 54.1%, respectively. Average tumor volume was 11.6 cm3 (SD 12.4, range 0.57-62.8). Median follow-up was 19 months (range 3-48). Two-year LC, PFS, and OS were 96.2%, 29.7%, and 65.5%, respectively. Thirteen of 39 (33.3%) catheter implantation procedures were associated with trace minor pneumothorax requiring no intervention, 1 (2.5%) procedure with minor radiographic pulmonary hemorrhage, and 4 (10.3%) with major pneumothorax requiring chest tube insertions. All procedural complications resolved within 24 h from treatment. Acute grade 1-2 toxicity was identified in 4 patients, whereas none developed late toxicity beyond 90 days of follow-up. CONCLUSION Percutaneous HDR brachyablation is a safe and promising treatment option for centrally located primary and metastatic lung tumors. Future comparisons with stereotactic body radiotherapy and other ablative techniques are warranted to expand multi-disciplinary management options.
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Affiliation(s)
- Stephanie M Yoon
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA
| | - Robert Suh
- Department of Radiology Thoracic Interventional Services, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Fereidoun Abtin
- Department of Radiology Thoracic Interventional Services, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Drew Moghanaki
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA.,Department of Radiation Oncology, Veterans Affairs Greater Los Angeles, Los Angeles, CA, 90073, USA
| | - Scott Genshaft
- Department of Radiology Thoracic Interventional Services, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Alexandra Drakaki
- Department of Hematology and Medical Oncology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Sandy Liu
- Department of Hematology and Medical Oncology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA
| | - Alan Lee
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA
| | - Albert J Chang
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA.
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11
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Duque AS, van Wagenberg T, Seidensticker M, Streitparth F, Walter F, Parodi K, Verhaegen F, Ricke J, Belka C, Paiva Fonseca G, Corradini S, Landry G. Validation of the collapsed cone algorithm for HDR liver brachytherapy against Monte Carlo simulations. Brachytherapy 2021; 20:936-947. [PMID: 34001415 DOI: 10.1016/j.brachy.2021.03.018] [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: 11/22/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To validate the collapsed cone (CC) algorithm against Monte Carlo (MC) simulations for model-based dose calculations in high-dose-rate (HDR) liver brachytherapy. METHODS AND MATERIALS Doses for liver brachytherapy treatment plans of 10 cases were retrospectively recalculated with a model-based approach using Monte Carlo n-Particle Code (MCNP) 6 (Dm,m-MC) and Oncentra Brachy ACE (Dm,m-ACE). Tissue segmentation consisted of assigning uniform compositions and mass densities to predefined Hounsfield Unit (HU) thresholds. Resulting doses were compared according to dose volume histogram parameters typical for clinical routine. These included the percentage liver volume receiving 5 Gy (V5Gy) or 10 Gy (V10Gy), the maximum dose to one cubic centimeter (D1cc) of organs at risk, the clinical target volume (CTV) fractions receiving 150% (V150), 100% (V100), 95% (V95) and 90% (V90) of the prescribed dose and the absolute doses to 95% (D95) and 90% (D90) of the CTV volumes. RESULTS Doses from Oncentra Brachy ACE agreed well with MC simulations. Differences were seen far from the source, in low-density regions and bone structures. Median percentage deviations were 1.1% for the liver V5Gy and 0.4% for the liver V10Gy, with deviations of largest magnitude amounting to 2.2% and 1.0%, respectively. Organs at risk had median deviations ranging from 0.3% to 1.5% for D1cc, with outliers ranging up to 4.6%. CTV volume parameter deviations ranged between -1.5% and 0.5%, dose parameter deviations ranged mostly between -2% and 1%, with two outliers at -4.0% and -3.4% for a small CTV.
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Affiliation(s)
- Anna Sophie Duque
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany
| | - Teun van Wagenberg
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Max Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Florian Streitparth
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Munich, Germany
| | - Gabriel Paiva Fonseca
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching, Germany.
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12
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Walter F, Nierer L, Rottler M, Duque AS, Weingandt H, Well J, Shpani R, Landry G, Seidensticker M, Streitparth F, Ricke J, Belka C, Corradini S. Comparison of liver exposure in CT-guided high-dose rate (HDR) interstitial brachytherapy versus SBRT in hepatocellular carcinoma. Radiat Oncol 2021; 16:86. [PMID: 33957941 PMCID: PMC8103624 DOI: 10.1186/s13014-021-01812-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background In unresectable hepatocellular carcinoma several local ablative treatments are available. Among others, radiation based treatments such as stereotactic body radiotherapy (SBRT) and high-dose rate interstitial brachytherapy (HDR BT) have shown good local control rates. Methods We conducted a dose comparison between actually performed HDR BT versus virtually planned SBRT to evaluate the respective clinically relevant radiation exposure to uninvolved liver tissue. Moreover, dose coverage and conformity indices were assessed. Results Overall, 46 treatment sessions (71 lesions, 38 patients) were evaluated. HDR BT was applied in a single fraction with a dose prescription of 1 × 15 Gy. D98 was 17.9 ± 1.3 Gy, D50 was 41.8 ± 8.1 Gy. The SBRT was planned with a prescribed dose of 3 × 12.5 Gy (65%-Isodose), D98 was 50.7 ± 3.1 Gy, D2 was 57.0 ± 2.3 Gy, and D50 was 55.2 ± 2.3 Gy. Regarding liver exposure Vliver10GyBT was compared to Vliver15.9GySBRT, Vliver16.2GySBRT (EQD2 equivalent doses), and Vliver20GySBRT (clinically relevant dose), all results showed significant differences (p < .001). In a case by case analysis Vliver10GyBT was smaller than Vliver20GySBRT in 38/46 cases (83%). Dmean of the liver was significantly smaller in BT compared to SBRT (p < .001). GTV volume was correlated to the liver exposure and showed an advantage of HDR BT over SBRT in comparison of clinically relevant doses, and for EQD2 equivalent doses. The advantage was more pronounced for greater liver lesions The Conformity Index (CI) was significantly better for BT, while Healthy Tissue Conformity Index (HTCI) and Conformation Number (CN) showed an advantage for SBRT (p < .001). Conclusion HDR BT can be advantageous in respect of sparing of normal liver tissue as compared to SBRT, while providing excellent target conformity.
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Affiliation(s)
- Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Anna Sophie Duque
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Helmut Weingandt
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Justus Well
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Roel Shpani
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
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13
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Appalanaido GK, Bahajjaj SIBZA, Shukor SA, Ahmad MZ, Francis HCH. Case Report-Staged brachytherapy achieving complete metabolic response in unresectable oligometastatic colorectal cancer to the liver. Oxf Med Case Reports 2021; 2021:omab016. [PMID: 33948189 PMCID: PMC8081016 DOI: 10.1093/omcr/omab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/03/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Liver is the most common site for metastasis from colorectal cancer (CRC). Non-surgical treatment options for oligometastatic CRC confined to the liver which represents an intermediate state in the metastatic cascade are fast expanding. Currently, several liver-directed local therapeutic options are available, such as hepatic arterial infusion (HAI) therapy, radio-frequency ablation (RFA), transarterial chemoembolization (TACE), stereotactic body radiotherapy and high dose rate brachytherapy (HDRBT). Many factors such as patient's fitness, liver function (LF), tumour size, location of the tumour in the liver and scheduling of systemic therapy need to be considered when selecting patients for surgery or local liver-directed therapy. This case report illustrates a successful local treatment with staged HDRBT for a large and unresectable, liver only oligometastatic disease from CRC. This patient underwent 4 cycles of chemotherapy (FOLFOX 4) followed by primary tumour resection and first stage of HDRBT to liver for a residual 14 cm tumour after the chemotherapy. After completing a further 4 cycles of chemotherapy with the same regimen, the tumour remained stable at 8 cm. She underwent a second stage of HDRBT to the same lesion and a repeat PET-CT scan done 8 weeks after the second HDRBT showed complete metabolic response. To our knowledge, this is the largest CRC metastatic liver lesion that has been successfully treated with HDRB.
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Affiliation(s)
- Gokula Kumar Appalanaido
- Department of Radiotherapy & Oncology, Advanced Medical & Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Syadwa Abdul Shukor
- Department of Radiotherapy & Oncology, Sarawak General Hospital, Kuching, Malaysia
| | - Muhammad Zabidi Ahmad
- Department of Radiology, Advanced Medical & Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Ho Cho Hao Francis
- Department of Radiation Oncology, National University Cancer Institute Singapore
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14
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Feasibility and Early Clinical Experience of Online Adaptive MR-Guided Radiotherapy of Liver Tumors. Cancers (Basel) 2021; 13:cancers13071523. [PMID: 33810244 PMCID: PMC8037065 DOI: 10.3390/cancers13071523] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/13/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the feasibility and early results of online adaptive MR-guided radiotherapy (oMRgRT) of liver tumors. METHODS We retrospectively examined consecutive patients with primary or secondary liver lesions treated at our institution using a 0.35T hybrid MR-Linac (Viewray Inc., Mountain View, CA, USA). Online-adaptive treatment planning was used to account for interfractional anatomical changes, and real-time intrafractional motion management using online 2D cine MRI was performed using a respiratory gating approach. Treatment response and toxicity were assessed during follow-up. RESULTS Eleven patients and a total of 15 lesions were evaluated. Histologies included cholangiocarcinomas and metastases of neuroendocrine tumors, colorectal carcinomas, sarcomas and a gastrointestinal stroma tumor. The median BED10 of the PTV prescription doses was 84.4 Gy (range 59.5-112.5 Gy) applied in 3-5 fractions and the mean GTV BED10 was in median 147.9 Gy (range 71.7-200.5 Gy). Online plan adaptation was performed in 98% of fractions. The median overall treatment duration was 53 min. The treatment was feasible and successfully completed in all patients. After a median follow-up of five months, no local failure occurred and no ≥ grade two toxicity was observed. OMRgRT resulted in better PTV coverage and fewer OAR constraint violations. CONCLUSION Early results of MR-linac based oMRgRT for the primary and secondary liver tumors are promising. The treatment was feasible in all cases and well tolerated with minimal toxicity. The technique should be compared to conventional SBRT in further studies to assess the advantages of the technique.
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15
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Rashid A, Pinkawa M, Haddad H, Hermani H, Temming S, Schäfer A, Bischoff P, Kovács A. Interstitial single fraction brachytherapy for malignant pulmonary tumours. Strahlenther Onkol 2021; 197:416-422. [PMID: 33725134 DOI: 10.1007/s00066-021-01758-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Interstitial brachytherapy for pulmonary tumours is an alternative to stereotactic radiotherapy, allowing high conformity despite it being an invasive technique. The aim of the study was the analysis of dose distribution, toxicity and tumour response rates. METHODS In the years 2014-2019, 27 patients with pulmonary tumours received 36 interstitial brachytherapies with Ir-192: 11 patients with non-small cell lung cancer, 16 patients with pulmonary metastases of other entities. RESULTS Patients were treated with a median (interquartile range) prescription dose of 20 (20-26) Gy in a single fraction. Mean lung dose to the ipsilateral lung was 2.8 (1.6-4.7) Gy. Maximum doses to the heart, oesophagus, thoracic wall and spinal cord were 2.4 (1.8-4.6) Gy, 2.0 (1.2-6.2) Gy, 12.6 (8.0-18.2) Gy and 1.5 (0.6-3.9) Gy. Median survival after treatment was 15 months, with a 1- and 2‑year local control of 84% and 60%. Median overall survival after initial cancer diagnosis was 94 months; 2 years following brachytherapy, 75% of patients with colorectal cancer vs. 37% with other histologies were alive; p = 0.14. In 69% (n = 25), brachytherapy could be performed without acute complications. A self-limiting bleeding occurred in 8% (n = 3), fever in 3% (n = 1), pneumothorax in 17% (n = 6), and pulmonary failure in 3% (n = 1). Patients with > 20 Gy in 95% of planning target volume had higher pneumothorax rates needing intervention (31% vs. 5%, p = 0.04). CONCLUSIONS Interstitial brachytherapy for pulmonary tumours is a highly conformal therapy with minimal doses to the organs at risk. For the majority of patients, treatment can be performed without relevant complications in a single fraction with a satisfactory local control.
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Affiliation(s)
- Ali Rashid
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany.
| | - Hathal Haddad
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany
| | - Horst Hermani
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany
| | - Susanne Temming
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany
| | - Andreas Schäfer
- Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany
| | - Peter Bischoff
- Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany
| | - Attila Kovács
- Department of Interventional and Diagnostic Radiology and Neuroradiology, MediClin Robert Janker Klinik, Villenstr. 8, 53129, Bonn, Germany
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16
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MRI-guided stereotactic radiation therapy for hepatocellular carcinoma: a feasible and safe innovative treatment approach. J Cancer Res Clin Oncol 2021; 147:2057-2068. [PMID: 33398447 DOI: 10.1007/s00432-020-03480-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) in early stages benefits from local ablative treatments such as radiofrequency ablation (RFA) or transarterial chemoembolization (TACE). In this context, radiotherapy (RT) has shown promising results but has not been thoroughly evaluated. Magnetic resonance-guided RT (MRgRT) may represent a paradigm shifting improvement in stereotactic body radiotherapy (SBRT) for liver tumors. METHODS We retrospectively evaluated HCC patients treated on a hybrid low-tesla MRgRT unit. A total biologically effective dose (BED) > 100 Gy was delivered in 5 consecutive fractions, respecting the appropriate organs-at-risk constraints. Hybrid MR scans were used for treatment planning and cine MR was used for delivery gating. Patients were followed up for toxicity and treatment-response assessment. RESULTS Ten patients were enrolled, with a total of 12 lesions. All the lesions were irradiated with no interruptions. Six patients had already performed previous local therapies. Median follow-up after SBRT was 6.5 months (1-25). Two cases of acute toxicity were reported (G ≤ 2 according to CTCAE v4.0). At the time of the analysis, 90% of the population presented local control. Child-Pugh before and after treatment remained unchanged in all but one patient. CONCLUSION MRgRT is a feasible and safe option showing favorable toxicity profile for HCC treatment.
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17
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Mohindra P, Beriwal S, Kamrava M. Proposed brachytherapy recommendations (practical implementation, indications, and dose fractionation) during COVID-19 pandemic. Brachytherapy 2020; 19:390-400. [PMID: 32423787 PMCID: PMC7252026 DOI: 10.1016/j.brachy.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA.
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18
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Duque AS, Corradini S, Kamp F, Seidensticker M, Streitparth F, Kurz C, Walter F, Parodi K, Verhaegen F, Ricke J, Belka C, Fonseca GP, Landry G. The dosimetric impact of replacing the TG-43 algorithm by model based dose calculation for liver brachytherapy. Radiat Oncol 2020; 15:60. [PMID: 32151255 PMCID: PMC7063719 DOI: 10.1186/s13014-020-01492-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/13/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To compare treatment plans for interstitial high dose rate (HDR) liver brachytherapy with 192Ir calculated according to current-standard TG-43U1 protocol with model-based dose calculation following TG-186 protocol. METHODS We retrospectively evaluated dose volume histogram (DVH) parameters for liver, organs at risk (OARs) and clinical target volumes (CTVs) of 20 patient cases diagnosed with hepatocellular carcinoma (HCC) or metastatic colorectal cancer (mCRC). Dose calculations on a homogeneous water geometry (TG-43U1 surrogate) and on a computed tomography (CT) based geometry (TG-186) were performed using Monte Carlo (MC) simulations. The CTs were segmented based on a combination of assigning TG-186 recommended tissues to fixed Hounsfield Unit (HU) ranges and using organ contours delineated by physicians. For the liver, V5Gy and V10Gy were analysed, and for OARs the dose to 1 cubic centimeter (D1cc). Target coverage was assessed by calculating V150, V100, V95 and V90 as well as D95 and D90. For every DVH parameter, median, minimum and maximum values of the deviations of TG-186 from TG-43U1 were analysed. RESULTS TG-186-calculated dose was found to be on average lower than dose calculated with TG-43U1. The deviation of highest magnitude for liver parameters was -6.2% of the total liver volume. For OARs, the deviations were all smaller than or equal to -0.5 Gy. Target coverage deviations were as high as -1.5% of the total CTV volume and -3.5% of the prescribed dose. CONCLUSIONS In this study we found that TG-43U1 overestimates dose to liver tissue compared to TG-186. This finding may be of clinical importance for cases where dose to the whole liver is the limiting factor.
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Affiliation(s)
- Anna Sophie Duque
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany.,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, Garching, 85748, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany
| | - Max Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, Munich, 81377, Germany
| | - Florian Streitparth
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, Munich, 81377, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany.,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, Garching, 85748, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, Garching, 85748, Germany
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Dr. Tanslaan 12, Maastricht, 6229 ET, The Netherlands
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, Munich, 81377, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany.,German Cancer Consortium (DKTK), Munich, Germany
| | - Gabriel Paiva Fonseca
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Dr. Tanslaan 12, Maastricht, 6229 ET, The Netherlands
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Germany. .,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, Garching, 85748, Germany.
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