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Gimeno-Morales M, Motisi L, Rodriguez-Spiteri N, Martínez-Regueira F, Worthington T, Therapist R, Strnad V, Hannoun-Levi JM, Gutierrez C. Post- versus intra-operative implant for breast cancer interstitial brachytherapy: How to choose? J Contemp Brachytherapy 2024; 16:72-83. [PMID: 38584881 PMCID: PMC10993897 DOI: 10.5114/jcb.2024.135635] [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: 12/05/2023] [Accepted: 01/20/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Breast brachytherapy (BB) represents an important radiation therapy modality in modern breast cancer treatments. Currently, BB is mainly used for accelerated partial breast irradiation (APBI), local boost after whole breast radiation therapy (WBRT), and as salvage re-irradiation after second lumpectomy (APBrl). Two multi-catheter interstitial brachytherapy (MIB) techniques can be offered: intra-operative (IOB) and post-operative (POB) brachytherapy. The aim of this article was to summarize current available data on these two different brachytherapy approaches for breast cancer. Material and methods A literature search was performed, and different experiences published by BB expert teams were analyzed and compared. These two different brachytherapy approaches for breast cancer have also been presented and discussed during meetings of the GEC-ESTRO BCWG. In addition, expert recommendations were defined. Results A comprehensive description and practical comparison of both the techniques, i.e., IOB and POB, considering the latest available published data were presented. Different technical, logistic, and clinical aspects of both the methods were thoroughly examined and analyzed. This detailed comparison of the two breast brachytherapy techniques was supported by scientific data from extensive experience of experts, facilitating an objective analysis that, to our knowledge, has not been previously published. Conclusions Based on the comprehensive analysis of both the brachytherapy techniques available, this article serves as a valuable resource to guide breast teams in selecting the optimal BB technique (POB or IOB), considering hospital environment, multi-disciplinary collaboration, and patient logistics.
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Affiliation(s)
- Marta Gimeno-Morales
- Department of Radiation Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
| | - Laura Motisi
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
| | - Natalia Rodriguez-Spiteri
- Department of Breast Surgical Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Tucker Worthington
- Department of Radiation Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
- Department of Breast Surgical Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d’Azur, Nice, France
- Department of Radiation Oncology, Institut Català d’Oncologia, Barcelona, Spain
| | - Radiation Therapist
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Jean Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d’Azur, Nice, France
| | - Cristina Gutierrez
- Department of Radiation Oncology, Institut Català d’Oncologia, Barcelona, Spain
| | - On behalf of Working Group Breast Cancer of GEC ESTRO
- Department of Radiation Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Zürich University Hospital, Zürich, Switzerland
- Department of Breast Surgical Oncology, Cancer Center Clinica Universidad de Navarra, Pamplona, Spain
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University of Côte d’Azur, Nice, France
- Department of Radiation Oncology, Institut Català d’Oncologia, Barcelona, Spain
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Yousif YAM, Osman AFI, Halato MA. A review of dosimetric impact of implementation of model-based dose calculation algorithms (MBDCAs) for HDR brachytherapy. Phys Eng Sci Med 2021; 44:871-886. [PMID: 34142317 DOI: 10.1007/s13246-021-01029-8] [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: 11/26/2020] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
To obtain dose distributions more physically representative to the patient anatomy in brachytherapy, calculation algorithms that can account for heterogeneity are required. The current standard AAPM Task Group No 43 (TG-43) dose calculation formalism has some clinically relevant dosimetric limitations. Lack of tissue heterogeneity and scattered dose corrections are the major weaknesses of the TG-43 formalism and could lead to systematic dose errors in target volumes and organs at risk. Over the last decade, model-based dose calculation algorithms (MBDCAs) have been clinically offered as complementary algorithms beyond the TG43 formalism for high dose rate (HDR) brachytherapy treatment planning. These algorithms provide enhanced dose calculation accuracy by using the information in the patient's computed tomography images, which allows modeling the patient's geometry, material compositions, and the treatment applicator. Several researchers have investigated the implementation of MBDCAs in HDR brachytherapy for dose optimization, but moving toward using them as primary algorithms for dose calculations is still lagging. Therefore, an overview of up-to-date research is needed to familiarize clinicians with the current status of the MBDCAs for different cancers in HDR brachytherapy. In this paper, we review the MBDCAs for HDR brachytherapy from a dosimetric perspective. Treatment sites covered include breast, gynecological, lung, head and neck, esophagus, liver, prostate, and skin cancers. Moreover, we discuss the current status of implementation of MBDCAs and the challenges.
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Affiliation(s)
- Yousif A M Yousif
- Department of Radiation Oncology, North West Cancer Centre-Tamworth Hospital, Tamworth, Australia.
| | - Alexander F I Osman
- Department of Medical Physics, Al-Neelain University, 11121, Khartoum, Sudan.
| | - Mohammed A Halato
- Department of Medical Physics, Al-Neelain University, 11121, Khartoum, Sudan
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Palled SR, Radhakrishna NK, Manikantan S, Khanum H, Venugopal BK, Vishwanath L. Dosimetric comparison of manual forward planning with uniform dwell times versus volume-based inverse planning in interstitial brachytherapy of cervical malignancies. Rep Pract Oncol Radiother 2020; 25:851-855. [PMID: 32982589 DOI: 10.1016/j.rpor.2020.08.005] [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: 03/26/2020] [Revised: 05/31/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022] Open
Abstract
Aim Dosimetic comparison of manual forward planning(MFP) with inverse planning(IP) for interstitial brachytherapy(ISBT) in cervical carcinoma. Background Brachytherapy planning by MFP is more reliable but time-consuming method, whereas IP has been explored more often for its ease and rapidness. The superiority of either is yet to be established. Methodology Two plans were created on data sets of 24 patients of cervical carcinoma who had undergone ISBT, one by MFP with uniform dwell times and another IP on BrachyVision 13.7 planning system with a dose prescription of 600 cGy. Isodose shaper was used for improving conformity & homogeneity. Dosimetric parameters for target and organs at risk (OARs) were recorded. Conformity index (COIN), dose homogeneity index (DHI), overdose index (OI), Coverage index (CI) and dose nonuniformity ratio (DNR) were calculated. Results Mean high risk clinical target volume: 73.05(±20.7)cc, D90: 5.51 Gy vs. 5.6 Gy (p = 0.017), V100: 81.77 % vs. 83.74 % (p = 0.002), V150: 21.7 % vs. 24.93 % (p = 0.002), V200: 6.3 % vs. 6.4 % (p=0.75) for IP and MFP, respectively. CI: 0.81(IP) and 0.83(MFP) (p = 0.003); however, COIN was 0.79 for both plans. D2cc of OARs was statistically better with IP (bladder 54.7 % vs. 56.1 %, p = 0.03; rectum 63 % vs. 64.7 %, (p = 0.0008). Conclusion Both MFP and IP are equally acceptable dosimetrically. With higher dose achieved to the target, for a similar OAR dose, MFP provides greater user flexibility of dwell positions within the target as well as better optimization. Isodose shaper may be carefully used for fine tuning. Larger sample sizes and clinical correlation will better answer the superiority of one over the other.
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Affiliation(s)
- Siddanna R Palled
- Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | | | - Senthil Manikantan
- Medical Physicist, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Hashmath Khanum
- Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Bindu K Venugopal
- Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Lokesh Vishwanath
- Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
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Does inverse planning improve plan quality in interstitial high-dose-rate breast brachytherapy? J Contemp Brachytherapy 2020; 12:166-174. [PMID: 32395141 PMCID: PMC7207228 DOI: 10.5114/jcb.2020.94584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To investigate the effect of input parameters for an inverse optimization algorithm, and dosimetrically evaluate and compare clinical treatment plans made by inverse and forward planning in high-dose-rate interstitial breast implants. Material and methods By using a representative breast implant, input parameters responsible for target coverage and dose homogeneity were changed step-by-step, and their optimal values were determined. Then, effects of parameters on dosimetry of normal tissue and organs at risk were investigated. The role of dwell time modulation restriction was also studied. With optimal input parameters, treatment plans of forty-two patients were re-calculated using an inverse optimization algorithm (HIPO). Then, a pair-wise comparison between forward and inverse plans was performed using dose-volume parameters. Results To find a compromise between target coverage and dose homogeneity, we recommend using weight factors in the range of 70-90 for minimum dose, and in the range of 10-30 for maximum dose. Maximum dose value of 120% with a weight factor of 5 is recommended for normal tissue. Dose constraints for organs at risk did not play an important role, and the dwell time gradient restriction had only minor effect on target dosimetry. In clinical treatment plans, at identical target coverage, the inverse planning significantly increased the dose conformality (COIN, 0.75 vs. 0.69, p < 0.0001) and improved the homogeneity (DNR, 0.35 vs. 0.39, p = 0.0027), as compared to forward planning. All dosimetric parameters for non-target breast, ipsilateral lung, ribs, and heart were significantly better with inverse planning. The most exposed small volumes for skin were less in HIPO plans, but without statistical significance. Volume irradiated by 5% was 173.5 cm3 in forward and 167.7 cm3 in inverse plans (p = 0.0247). Conclusions By using appropriate input parameters, inverse planning can provide dosimetrically superior dose distributions over forward planning in interstitial breast implants.
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Dosimetric comparison of inverse optimisation methods versus forward optimisation in HDR brachytherapy of breast, cervical and prostate cancer. Strahlenther Onkol 2019; 195:991-1000. [PMID: 31482321 PMCID: PMC6811387 DOI: 10.1007/s00066-019-01513-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/08/2019] [Indexed: 11/29/2022]
Abstract
Objective Dosimetric comparison of HIPO (hybrid inverse planning optimisation) and IPSA (inverse planning simulated annealing) inverse and forward optimisation (FO) methods in brachytherapy (BT) of breast, cervical and prostate cancer. Methods At our institute 38 breast, 47 cervical and 50 prostate cancer patients treated with image-guided interstitial high-dose-rate BT were selected. Treatment plans were created using HIPO and IPSA inverse optimisation methods as well as FO. The dose–volume parameters of different treatment plans were compared with Friedman ANOVA and the LSD post-hoc test. Results IPSA creates less dose coverage to the target volume than HIPO or FO: V100 was 91.7%, 91% and 91.9% for HIPO, IPSA and FO plans (p = 0.1784) in breast BT; 90.4%, 89.2% and 91% (p = 0.0045) in cervical BT; and 97.1%, 96.2% and 97.7% (p = 0.0005) in prostate BT, respectively. HIPO results in more conformal plans: COIN was 0.72, 0.71 and 0.69 (p = 0.0306) in breast BT; 0.6, 0.47 and 0.58 (p < 0.001) in cervical BT; and 0.8, 0.7 and 0.7 (p < 0.001) in prostate BT, respectively. In breast BT, dose to the skin and lung was smaller with HIPO and FO than with IPSA. In cervical BT, dose to the rectum, sigmoid and bowel was larger using IPSA than with HIPO or FO. In prostate BT, dose to the urethra was higher and the rectal dose was smaller using FO than with inverse methods. Conclusion In interstitial breast and prostate BT, HIPO results in comparable dose–volume parameters to FO, but HIPO plans are more conformal. In cervical BT, HIPO produces dosimetrically acceptable plans only when more needles are used. The dosimetric quality of IPSA plans is suboptimal and results in unnecessary larger active lengths.
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Breast: Hungarian Experience and European Trend. Brachytherapy 2019. [DOI: 10.1007/978-981-13-0490-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Image guided high-dose-rate brachytherapy versus volumetric modulated arc therapy for head and neck cancer: A comparative analysis of dosimetry for target volume and organs at risk. Radiol Oncol 2018; 52:461-467. [PMID: 30422804 PMCID: PMC6287174 DOI: 10.2478/raon-2018-0042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/06/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to present dosimetric comparison of image guided high-dose-rate brachytherapy (IGBT) with volumetric modulated arc therapy (VMAT) for head and neck cancer regarding conformity of dose distribution to planning target volume (PTV) and doses to organs at risk (OARs). Patients and methods Thirty-eight consecutive patients with T1-4 mobile tongue, floor of mouth and base of tongue cancer treated with IGBT were selected. For these patients additional VMAT treatment plans were also prepared using identical computed tomography data. OARs and PTV related parameters (e.g. V98, D0.1cm3, Dmean, etc.) were compared. Results Mean V98 of the PTV was 90.2% vs. 90.4% (p > 0.05) for IGBT and VMAT, respectively. Mean D0.1cm3 to the mandible was 77.0% vs. 85.4% (p < 0.05). Dmean to ipsilateral and contralateral parotid glands was 4.6% vs. 4.6% and 3.0% vs. 3.9% (p > 0.05). Dmean to ipsilateral and contralateral submandibular glands was 16.4% vs. 21.9% (p > 0.05) and 8.2% vs. 16.9% (p < 0.05), respectively. Conclusions Both techniques showed excellent target coverage. With IGBT dose to normal tissues was lower than with VMAT. The results prove the superiority of IGBT in the protection of OARs and the important role of this invasive method in the era of new external beam techniques.
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Case report of a dose-volume histogram analysis of rib fracture after accelerated partial breast irradiation: interim analysis of a Japanese prospective multi-institutional feasibility study. J Contemp Brachytherapy 2018; 10:274-278. [PMID: 30038649 PMCID: PMC6052388 DOI: 10.5114/jcb.2018.76983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/22/2018] [Indexed: 01/15/2023] Open
Abstract
We initiated the first multi-institutional prospective study of accelerated partial breast irradiation for early breast cancer in Japan. Our early clinical results showed that the treatment methods were technically reproducible between institutions and showed excellent disease control at a median follow-up of 26 months in our previous report. At present, total 46 patients from six institutions underwent the treatment regimen from October 2009 to December 2011, and the median follow-up time was 60 months (range, 57-67 months). In 46 patients, we experienced one patient who had rib fracture as a late complication. The dose-volume histogram (DVH) result of this patient was analyzed. The D0.01cc, D0.1cc, and D1cc values of the patient were 913, 817, and 664 cGy per fraction, respectively. These values were the highest values in 46 patients. The average D0.01cc, D0.1cc, and D1cc values of the other 45 patients were 546, 500, and 419, respectively, cGy per fraction. From this result, DVH values showing high-dose irradiated volume (D0.01cc, D0.1cc, and D1cc) seem to be a good predictive factor of rib fracture for accelerated partial breast irradiation. However, further investigation is necessary because of the small number of patients investigated.
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Karagiannis E, Leczynski A, Tselis N, Psanis E, Steckenreiter O, Milickovic N, Bon D, Strouthos I, Ferentinos K, Hass P, Gademann G, Baltas D, Zamboglou N. Inverse planning and inverse implanting for breast interstitial brachytherapy. Introducing a new anatomy specific breast interstitial template (ASBIT). Radiother Oncol 2018; 128:421-427. [PMID: 29934109 DOI: 10.1016/j.radonc.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 04/30/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
Abstract
An innovative template, based on thoracic cage surface reconstructions for breast interstitial brachytherapy was developed. Hybrid-inverse-planning-optimisation-based implantations and brachytherapy plans, using three custom anthropomorphic breast phantoms, were utilised for its validation. A user independent, inverse planning and inverse implanting technique is proposed.
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Affiliation(s)
| | - Agnes Leczynski
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Nikolaos Tselis
- Department of Radiation Oncology, Radiotherapy and Oncology, J. W. Goethe University, Frankfurt am Main, Germany
| | - Emmanouil Psanis
- Department of Electrical Engineering and Computer Science, University of Liege, Montefiore Institute, Belgium
| | | | - Natasa Milickovic
- Department of Radiation Oncology, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Dimitra Bon
- Institute of Biostatistic and Mathematical Modeling, J. W. Goethe University, Frankfurt am Main, Germany
| | - Iosif Strouthos
- Department of Radiation Oncology, Medical Center, University of Freiburg, Germany
| | | | - Peter Hass
- Department of Radiation Oncology, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Günther Gademann
- Department of Radiation Oncology, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine and German Cancer Consortium (DKTK), Partner Site, Freiburg, Germany
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus; Department of Radiation Oncology, Radiotherapy and Oncology, J. W. Goethe University, Frankfurt am Main, Germany
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Hellebust T. Place of modern imaging in brachytherapy planning. Cancer Radiother 2018; 22:326-333. [DOI: 10.1016/j.canrad.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/20/2018] [Indexed: 01/07/2023]
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