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Jin N, Meng F, Zhu L, Xing L, Lin Q, Zhang H. Multimodal image-guided surgical robot versus 3D-printed template for brachytherapy of malignant tumours in the skull base and deep facial region: a clinical comparative study. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00368-0. [PMID: 39317561 DOI: 10.1016/j.ijom.2024.09.002] [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: 09/21/2023] [Revised: 09/02/2024] [Accepted: 09/10/2024] [Indexed: 09/26/2024]
Abstract
This study compared a multimodal image-guided robot and three-dimensionally (3D) printed templates for implanting iodine-125 (I125) radioactive seeds in patients with malignant tumours in the skull base and deep facial region. Seventeen patients who underwent I125 radioactive seed implantation between December 2018 and December 2019 were included. The operation time, intraoperative blood loss, and accuracy of seed implantation were compared between the multimodal image-guided robot-assisted implantation (experimental) group (n = 7) and 3D-printed template-assisted implantation (control) group (n = 10). In total, 291 seeds were implanted in the experimental group and 436 in the control group; the mean error of seed implantation accuracy was 1.95 ± 0.13 mm and 1.90 ± 0.08 mm, respectively (P = 0.309). The preparation time was 26.13 ± 5.28 min in the experimental group and 0 min in the control group, while the average operation time was 34.44 ± 6.39 min versus 43.70 ± 6.06 min, respectively. The intraoperative blood loss was 4.96 ± 1.76 ml (experimental) versus 8.97 ± 2.99 ml (control) (P = 0.123). Multimodal image-guided robot-assisted I125 radioactive seed implantation met the clinical requirements for treating malignant tumours in the skull base and deep facial regions.
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Affiliation(s)
- N Jin
- Medical School of Chinese PLA, Beijing, China; Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - F Meng
- Medical School of Chinese PLA, Beijing, China; Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - L Zhu
- Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - L Xing
- Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Q Lin
- Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - H Zhang
- Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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Guinot JL, Bacorro W, Budrukkar A, Bussu F, Gonzalez-Perez V, Jaberi R, Martinez-Monge R, Rembielak A, Rovirosa A, Strnad V, Takácsi-Nagy Z, Tagliaferri L. GEC-ESTRO recommendations for head & neck cancer brachytherapy (interventional radiotherapy): 2nd update with focus on HDR and PDR. Radiother Oncol 2024; 201:110533. [PMID: 39284416 DOI: 10.1016/j.radonc.2024.110533] [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: 08/19/2024] [Accepted: 09/04/2024] [Indexed: 10/20/2024]
Abstract
Modern brachytherapy (BT) is playing an important role in the multidisciplinary treatment of Head and Neck (H&N) cancer, as an organ- and function-preserving therapy. Low-dose-rate (LDR) technology has been replaced by modern remote afterloading and stepping source equipment using pulsed dose rate (PDR) or high dose rate (HDR) sources, improved image guidance and 3D treatment planning systems. This is an update of the previous GEC-ESTRO recommendations for H&N tumors, mainly applied to squamous carcinomas. Indications, results and recommended doses for different tumor sites are presented according to the published studies.
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Affiliation(s)
- J L Guinot
- Department of Radiation Oncology, Foundation Instituto Valenciano de Oncologia IVO, Valencia, Spain.
| | - W Bacorro
- Department of Radiation Oncology, University of Santo Tomas Hospital - Benavides Cancer Institute, Manila, Philippines
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - F Bussu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Italia
| | - V Gonzalez-Perez
- Department of Radiation Physics, Foundation Instituto Valenciano de Oncologia IVO, Valencia, Spain
| | - R Jaberi
- Department of Radiation Physics, Radiation Oncology Research Centre (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - R Martinez-Monge
- Department of Radiation Oncology, Clínica Universidad de Navarra Cancer Center, Pamplona, Spain
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
| | - A Rovirosa
- Radiation Oncology Department, Hospital Clínic-Universitat de Barcelona, Fonaments Clinics Dpt, Faculty of Medicine, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - V Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Z Takácsi-Nagy
- Centre of Radiotherapy, National Tumorbiology Laboratory, National Institute of Oncology, Department of Oncology, Semmelweis University, Budapest, Hungary
| | - L Tagliaferri
- Gemelli ART (Advaced Radiation Therapy), Department of Diagnostic Imaging and Radiotherapy - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, RomeDepartment of Radiation Oncology, Fondazione Policlinico Universitario A, Gemelli IRCCS, Roma, Italia
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Dahake SB, Uke A, Luharia A, Luharia M, Mishra GV, Mahakalkar C. Interdisciplinary Approach Toward Reirradiation of Cancer Patients. Cureus 2024; 16:e65750. [PMID: 39211649 PMCID: PMC11361461 DOI: 10.7759/cureus.65750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
As systemic therapies, alongside radiation, for cancer treatment continue to evolve, the radiation oncology community is facing an increasing number of reirradiation (re-RT) of tumor sites subject to recurrences. There are multiple factors associated with choosing re-RT as a treatment option for a previously irradiated site. The factors include the site of previous radiotherapy (RT), the current extent of the disease, the nature of recurrence, the technique used for previous irradiation, and the previous RT details including dose and dose fractionation. There is a persistent heterogeneity in the workflow and decision-making in cancer care centers worldwide. The current review is an attempt to dive into the practices of decision-making for re-RT, interdisciplinary attention given to the re-RT patients, and acceptable doses to the organ at risk (OAR) deduced from the understanding of previous RT and radiobiology of the tumor and sites evidence of better techniques for effective execution.
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Affiliation(s)
- Shweta B Dahake
- Medical Physics, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Uke
- Radiotherapy, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anurag Luharia
- Medical Physics and Radiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Monika Luharia
- Siddhant and Samhita, Ayurveda, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Bussu F, Fionda B, Rigante M, Rizzo D, Loperfido A, Gallus R, De Luca LM, Corbisiero MF, Lancellotta V, Tondo A, D’Aviero A, Mattiucci GC, Kovacs G, Galli J, Tagliaferri L. Interventional radiotherapy (brachytherapy) for re-irradiation of recurrent head and neck malignancies: oncologic outcomes and morbidity. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S28-S36. [PMID: 38745514 PMCID: PMC11098534 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/12/2024] [Indexed: 05/16/2024]
Abstract
Objective Management of recurrent head and neck cancer (HNC) is challenging. One option in previously irradiated patients is re-irradiation using interventional radiotherapy (IRT), the modern form of brachytherapy. Re-irradiation using IRT can be delivered as an exclusive strategy for salvage or through a postoperative or perioperative approach after salvage surgery. The aim of the present study is to analyse a bicentric Italian series focusing on the use of IRT as a re-irradiation modality and assess the resulting evidence concerning oncologic outcomes and morbidity. Methods This is a retrospective study performed in two referral centres in Italy: Policlinico Universitario Agostino Gemelli in Rome and Azienda Ospedaliera Universitaria in Sassari. All patients who had previously received a full course of external beam RT and have been re-irradiated using high-dose-rate IRT between December 2010 and June 2023 were included. Patients were retreated either by a combination of surgery and perioperative (either endocavitary or interstitial) IRT or by exclusive interstitial IRT. Results Thirty-four patients were included in the present series, 2 of whom underwent more than one IRT re-irradiation. Notably, no patient reported specific IRT-related toxicities. Median follow-up, excluding patients who died of HNC, was 24.5 months. Two-year local relapse-free survival was 26%, disease-specific survival 39.1%, and overall survival 36.6%. Conclusions The present series is the largest reported experience of re-irradiation by IRT for HNC in Italy. The very low rate of toxicity confirms IRT as the safest re-irradiation modality. It is noteworthy to underline that IRT is a multidisciplinary strategy based on the close cooperation between surgeons and radiation oncologists during every phase, from the recommendation of treatment and implantation in the operating theatre, to its prescription and dose painting.
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Affiliation(s)
- Francesco Bussu
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Mario Rigante
- UOC Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Rizzo
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Antonella Loperfido
- UOC Otorinolaringoiatria, Dipartimento Testa, Collo e delle Neuroscienze, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Roberto Gallus
- Divisione di Otorinolaringoiatria, Mater Olbia Hospital, Olbia, Italy
| | - Laura Maria De Luca
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Michaele Francesco Corbisiero
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Andrea Tondo
- Divisione di Otorinolaringoiatria, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Andrea D’Aviero
- UO di Radioterapia Oncologica, Mater Olbia Hospital, Olbia, Italy
| | | | - Gyorgy Kovacs
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, Italy
| | - Jacopo Galli
- UOC Otorinolaringoiatria, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
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Fanhao M, Dongsheng X, Nenghao J, Yu S, Huanyu T, Bo Q, Bofu L, Ning Z, Shimin C, Runtao G, Xingguang D, Haizhong Z. Phantom study of a fully automatic radioactive seed placement robot for the treatment of skull base tumours. BMC Oral Health 2024; 24:420. [PMID: 38580965 PMCID: PMC10996177 DOI: 10.1186/s12903-024-04089-w] [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: 01/25/2024] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Interstitial brachytherapy is a form of intensive local irradiation that facilitates the effective protection of surrounding structures and the preservation of organ functions, resulting in a favourable therapeutic response. As surgical robots can perform needle placement with a high level of accuracy, our team developed a fully automatic radioactive seed placement robot, and this study aimed to evaluate the accuracy and feasibility of fully automatic radioactive seed placement for the treatment of tumours in the skull base. METHODS A fully automatic radioactive seed placement robot was established, and 4 phantoms of skull base tumours were built for experimental validation. All the phantoms were subjected to computed tomography (CT) scans. Then, the CT data were imported into the Remebot software to design the preoperative seed placement plan. After the phantoms were fixed in place, navigation registration of the Remebot was carried out, and the automatic seed placement device was controlled to complete the needle insertion and particle placement operations. After all of the seeds were implanted in the 4 phantoms, postoperative image scanning was performed, and the results were verified via image fusion. RESULTS A total of 120 seeds were implanted in 4 phantoms. The average error of seed placement was (2.51 ± 1.44) mm. CONCLUSION This study presents an innovative, fully automated radioactive particle implantation system utilizing the Remebot device, which can successfully complete automated localization, needle insertion, and radioactive particle implantation procedures for skull base tumours. The phantom experiments showed the robotic system to be reliable, stable, efficient and safe. However, further research on the needle-soft tissue interaction and deformation mechanism of needle puncture is still needed.
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Affiliation(s)
- Meng Fanhao
- Department of Oral and Maxillofacial Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xie Dongsheng
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Jin Nenghao
- Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Song Yu
- Department of Prosthodontics, Beijing Citident Stomatology Hospital, Beijing, China
| | - Tian Huanyu
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China
| | - Qiao Bo
- Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Liang Bofu
- Clinical Engineering Department, Beijing Baihui Weikang Technology Co., Ltd, Beijing, China
| | - Zhang Ning
- Department of Oral and Maxillofacial Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chang Shimin
- Department of Oral and Maxillofacial Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gao Runtao
- Department of Oral and Maxillofacial Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Duan Xingguang
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing, China.
| | - Zhang Haizhong
- Department of Stomatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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Govil N, Tripathi M, Parag K, Agrawal SP, Kumar M, Varshney S. Role of protocol-guided perioperative care to enhance recovery after head and neck neoplasm surgery: An institutional experience. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:491-500. [PMID: 37678465 DOI: 10.1016/j.redare.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/30/2022] [Indexed: 09/09/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. METHODS We performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. RESULTS Baseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) vs 11 (8-16); p-value = 0.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group [8 (7-11) vs 12 (9-17); p-value = 0.002]. Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88 ± 12.50) compared to non-ERAS group (85.44 ± 12.68) [p value < 0.001]. CONCLUSION Implementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery.
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Affiliation(s)
- N Govil
- Department of Anaesthesiology, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India.
| | - M Tripathi
- Institute of Medical Sciences Mangalagiri, Mangalagiri, India
| | - K Parag
- Department of Anaesthesiology, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India
| | - S P Agrawal
- Department of Otorhinolaryngology-Head & Neck Surgery, AIIMS Rishikesh, Rishikesh, India
| | - M Kumar
- Department of Anaesthesiology, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India
| | - S Varshney
- Department of Anaesthesiology, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, India
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Soror T, Paul J, Melchert C, Idel C, Rades D, Bruchhage KL, Kovács G, Leichtle A. Salvage High-Dose-Rate Interventional Radiotherapy (Brachytherapy) Combined with Surgery for Regionally Relapsed Head and Neck Cancers. Cancers (Basel) 2023; 15:4549. [PMID: 37760518 PMCID: PMC10526533 DOI: 10.3390/cancers15184549] [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: 08/09/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: to report on the use of high-dose-rate (HDR) interventional radiotherapy (brachytherapy, IRT) as a salvage treatment for patients with regionally relapsed head and neck cancers. (2) Methods: A retrospective study of 60 patients treated with HDR-IRT for loco-regionally relapsed head and neck cancers at our institution (2016-2020). Treatment procedure, results, and related toxicities were collected. Local and overall survival outcomes were analyzed. (3) Results: The median follow-up was 22.4 months. Twenty-nine (48.3%) patients had locoregional recurrences with a median time of 28.9 months. The local-recurrence free-survival was 88.1% and 37.3% at 3 years and 5 years. At the last follow-up, 21 patients were alive and the median time to death was 24 months. The overall survival was 39.2% and 16.6% at 3 years and 5 years. Collectively, there were 28 events of grade ≥ 3 late toxicities recorded in 21 patients (35%). (4) Conclusions: Salvage HDR-IRT combined with surgery offers a second-line curative treatment option for regionally relapsed head and neck cancers with acceptable outcomes and toxicities.
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Affiliation(s)
- Tamer Soror
- Radiation Oncology Department, University of Lübeck/UKSH-CL, 23562 Lübeck, Germany; (C.M.); (D.R.)
- National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Giza 12613, Egypt
| | - Justina Paul
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
| | - Corinna Melchert
- Radiation Oncology Department, University of Lübeck/UKSH-CL, 23562 Lübeck, Germany; (C.M.); (D.R.)
| | - Christian Idel
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
| | - Dirk Rades
- Radiation Oncology Department, University of Lübeck/UKSH-CL, 23562 Lübeck, Germany; (C.M.); (D.R.)
| | - Karl-Ludwig Bruchhage
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, 00168 Rome, Italy;
| | - Anke Leichtle
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, 23562 Lübeck, Germany; (J.P.); (C.I.); (K.-L.B.); (A.L.)
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8
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Defourny N, Mackenzie P, Spencer K. Health Services Research in Brachytherapy: Current Understanding and Future Challenges. Clin Oncol (R Coll Radiol) 2023; 35:548-555. [PMID: 36941146 DOI: 10.1016/j.clon.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
Brachytherapy is an integral component of cancer care. Widespread concerns have been expressed though about the need for greater brachytherapy availability across many jurisdictions. Yet, health services research in brachytherapy has lagged behind that in external beam radiotherapy. Optimal brachytherapy utilisation, to help inform expected demand, have not been defined beyond the New South Wales region in Australia, with few studies having reported observed brachytherapy utilisation. There is also a relative lack of robust cost and cost-effectiveness studies, making investment decisions in brachytherapy even more uncertain and challenging to justify, despite its key role in cancer control. As the range of indications for brachytherapy expands, providing organ/function preservation for a wider range of diagnoses, there is an urgent need to redress this balance. By outlining the work undertaken in this area to date, we highlight its importance and explore where further study is required.
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Affiliation(s)
- N Defourny
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester, UK.
| | - P Mackenzie
- Royal Australian and New Zealand College of Radiologists (RANZCR), The University of New South Wales, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, Sydney, Australia; St Andrew's Hospital, Toowoomba, Queensland, Australia
| | - K Spencer
- University of Leeds Faculty of Medicine and Health, Academic Unit of Health Economics, Leeds Institute of Health Sciences, Leeds, UK
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Alterio D, Zaffaroni M, Bossi P, Dionisi F, Elicin O, Falzone A, Ferrari A, Jereczek-Fossa BA, Sanguineti G, Szturz P, Volpe S, Scricciolo M. Reirradiation of head and neck squamous cell carcinomas: a pragmatic approach, part II: radiation technique and fractionations. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01671-0. [PMID: 37415056 DOI: 10.1007/s11547-023-01671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Reirradiation (reRT) of local recurrent/second primary tumors of the head and neck represents a potential curative treatment for patients not candidate to a salvage surgery. Aim of the present study is to summarize literature data on modern radiation techniques and fractionations used in this setting of patients. MATERIALS AND METHODS A narrative review of the literature was conducted on three topics: (1) target volume delineation (2) reRT dose and techniques and (3) ongoing studies. Patients treated with postoperative reRT and palliative intent were not considered for the current analysis. RESULTS Recommendations on the target volume contouring have been reported. 3D-Conformal Radiotherapy, Intensity Modulated Radiotherapy, Stereotactic body Radiotherapy Intraoperative Radiotherapy, Brachytherapy and Charged Particles have been analyzed in terms of indication and fractionation in the field of reRT. Ongoing studies on the topic have been reported for IMRT and Charged Particles. Moreover, according to literature data a stepwise approach has been proposed aiming to provide a useful tool to select patients candidate to a curative reRT in daily clinical practice. Two clinical cases were also provided for its application. CONCLUSION Different radiation techniques and fractionations can be used for a second course of radiotherapy in patients with recurrent/second primary tumor of head and neck region. Tumor characteristics as well as radiobiological considerations should be take into account to define the best reRT approach.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Francesco Dionisi
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Falzone
- Unità Operativa Multizonale di Radiologia Ospedale di Rovereto e Arco, Azienda Sanitaria per i Servizi Provinciali di Trento, Trento, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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10
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Ghazbani A, Abdolahi M, Mansourzadeh MJ, BasirianJahromi R, Behzadipour S, Mohseni Azad A, Talebzadeh B, Khosravi A, Hamidi A. Knowledge domain and emerging trends in brachytherapy: A scientometric analysis. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Arash Ghazbani
- Student Research Committee Bushehr University of Medical Sciences Bushehr Iran
| | - Mohammad Abdolahi
- Department of Radiology Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | | | - Reza BasirianJahromi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | - Sina Behzadipour
- Student Research Committee Bushehr University of Medical Sciences Bushehr Iran
| | - Anali Mohseni Azad
- Department of Surgery Faculty of Medicine Bushehr University of Medical Sciences Bushehr Iran
| | | | - Abdolrasoul Khosravi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | - Ali Hamidi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
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11
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Yamazaki H, Masui K, Suzuki G, Yoshida K, Nakamura S, Isohashi F, Kotsuma T, Takaoka Y, Tanaka E, Akiyama H, Ishibashi N. Reirradiation for recurrent head and neck carcinoma using high-dose-rate brachytherapy: A multi-institutional study. Brachytherapy 2022; 21:341-346. [DOI: 10.1016/j.brachy.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
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12
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Luginbuhl A, Calder A, Kutler D, Zender C, Wise-Draper T, Patel J, Cheng M, Karivedu V, Zhan T, Parashar B, Gulati S, Yao M, Lavertu P, Takiar V, Tang A, Johnson J, Keane W, Curry J, Cognetti D, Bar-Ad V. Multi-Institutional Study Validates Safety of Intraoperative Cesium-131 Brachytherapy for Treatment of Recurrent Head and Neck Cancer. Front Oncol 2021; 11:786216. [PMID: 34900741 PMCID: PMC8660666 DOI: 10.3389/fonc.2021.786216] [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: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Surgery is the primary treatment for resectable, non-metastatic recurrent head and neck squamous cell carcinoma (HNSCC). We explore the safety and oncologic benefit of intraoperative Cesium-131 (Cs-131) brachytherapy combined with salvage local and/or regional surgical resection. Methods and Materials Findings were reported from a single arm multi-institutional prospective phase 1/2 trial involving surgery plus Cs-131 (surgery + Cs-131) treatment. The results of two retrospective cohorts—surgery alone and surgery plus intensity modulated radiation therapy (surgery + ReIMRT)—were also described. Included patients had recurrent HNSCC and radiation history. Safety, tumor re-occurrence, and survival were evaluated. Results Forty-nine patients were enrolled in the surgery + Cs-131 prospective study. Grade 1 to 3 adverse events (AEs) occurred in 18 patients (37%), and grade 4 AEs occurred in 2 patients. Postoperative percutaneous endoscopic gastrostomy (PEG) tubes were needed in 10 surgery + Cs-131 patients (20%), and wound and vascular complications were observed in 12 patients (24%). No cases of osteoradionecrosis were reported in the surgery + Cs-131 cohort. We found a 49% 2-year disease-free survival at the site of treatment with a substantial number of patients (31%) developing metastatic disease, which led to a 31% overall survival at 5 years. Conclusions Among patients with local/regional recurrent HNSCC status-post radiation, surgery + Cs-131 demonstrated acceptable safety with compelling oncologic outcomes, as compared to historic control cohorts. Clinical Trial Registration ClinicalTrials.gov, identifiers NCT02794675 and NCT02467738.
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Affiliation(s)
- Adam Luginbuhl
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Alyssa Calder
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | - David Kutler
- Department of Otolaryngology, Weill Cornell Medical Center, New York, NY, United States
| | - Chad Zender
- Department of Otolaryngology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Trisha Wise-Draper
- Department of Medical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Jena Patel
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Michael Cheng
- Department of Otolaryngology, Weill Cornell Medical Center, New York, NY, United States
| | - Vidhya Karivedu
- Department of Medical Oncology, Ohio State University, Columbus, OH, United States
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, United States
| | - Bhupesh Parashar
- Department of Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States
| | - Shuchi Gulati
- Department of Medical Oncology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland, OH, United States
| | - Pierre Lavertu
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland, OH, United States
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Alice Tang
- Department of Otolaryngology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Jennifer Johnson
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - William Keane
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Joseph Curry
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | - David Cognetti
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Voichita Bar-Ad
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States
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Salvage brachytherapy with or without external beam radiotherapy for oral or oropharyngeal squamous cell carcinomas in previously irradiated areas: carcinologic and toxicity outcomes of 25 patients. J Contemp Brachytherapy 2021; 13:402-409. [PMID: 34484354 PMCID: PMC8407255 DOI: 10.5114/jcb.2021.108594] [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: 11/15/2020] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to assess outcomes of salvage brachytherapy for oral and oropharyngeal squamous cell carcinoma in previously irradiated areas. Material and methods This was a retrospective study with 25 patients, treated between 1997 and 2016 for primary (21 cases) or recurrent (4 cases) oral or oropharyngeal squamous cell carcinomas in previously irradiated areas. Fifteen patients were treated with salvage brachytherapy (BT) alone, while 10 patients additionally received external beam radiotherapy (EBRT). Median BT dose was 45 Gy (range, 15-64 Gy), and a median total cumulative dose was 57 Gy (range, 40-70 Gy). Patient age, tumor stage, radiotherapy dose, and time between first treatment and recurrence were analyzed as prognostic factors. Results Median overall survival (OS) was 16 months. Patients with less advanced (T1) tumors survived significantly longer (27 vs. 14.5 months, p = 0.046). Five patients experienced a local recurrence, and only one of them was treated with a total dose greater than 60 Gy. In multivariate analysis, patients with T1 lesions had a significant higher OS rate compared to patients with larger lesions (HR = 6.25, 95% CI: 1.18-33.1%, p = 0.031). Patients who received more than 60 Gy had a non-significant, 80% increased OS than those treated with a lower dose (p = 0.072). There was four grade 3 acute toxicities, and no grade 3 or more late toxicities. Conclusions Multimodal treatment, including salvage BT, may offer a curative option for selected patients with an acceptable risk of severe toxicity for the treatment of primary or recurrent tumors in previously irradiated areas.
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14
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Blažek T, Zděblová Čermáková Z, Knybel L, Hurník P, Štembírek J, Resová K, Paračková T, Formánek M, Cvek J, Soumarová R. Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost. Radiat Oncol 2021; 16:122. [PMID: 34187494 PMCID: PMC8243893 DOI: 10.1186/s13014-021-01842-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We evaluated the efficiency and toxicity of stereotactic hypofractionated boost in combination with conventionally fractionated radiotherapy in the treatment of advanced floor of the mouth cancer. METHODS Thirty-seven patients with advanced stage of the floor of the mouth cancer, histologically confirmed squamous cell carcinoma (p16 negative) ineligible for surgical treatment, were indicated for radiochemotherapy or hyperfractionated accelerated radiotherapy (HART). The radiotherapy protocol combined external beam radiotherapy (EBRT) and a stereotactic hypofractionated boost to the primary tumor. The dose delivered from EBRT was 70-72.5 Gy in 35/50 fractions. The hypofractionated boost followed with 10 Gy in two fractions. For the variables-tumor volume, stage and grade a multivariate analysis was performed to find the relationship between overall survival, local progression and metastasis. Toxicity was evaluated according to CTCAE scale version 4. RESULTS After a median follow-up of 16 months, 23 patients (62%) achieved complete remission. The median time to local progression and metastasis was 7 months. Local control (LC) at 2 and 5-years was 70% and 62%, respectively. Progression-free survival (PFS) and overall survival (OS) were 57% and 49% at 2 years and 41% and 27% at 5 years, respectively. Statistical analysis revealed that larger tumors had worse overall survival and a greater chance of metastasis. Log-Rank GTV > 44 ccm (HR = 1.96; [95% CI (0.87; 4.38)]; p = 0.11). No boost-related severe acute toxicity was observed. Late osteonecrosis was observed in 3 patients (8%). CONCLUSION The combination of EBRT and stereotactic hypofractionated boost is safe and seems to be an effective option for dose escalation in patients with advanced floor of the mouth tumors who are ineligible for surgical treatment and require a non-invasive approach.
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Affiliation(s)
- Tomáš Blažek
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,3Rd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Zuzana Zděblová Čermáková
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - Lukáš Knybel
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Hurník
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jan Štembírek
- Department of Oral and Maxillofacial Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Brno, Czech Republic
| | - Kamila Resová
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, Palacký University Olomouc, Olomouc, Czech Republic
| | - Tereza Paračková
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, Palacký University Olomouc, Olomouc, Czech Republic
| | - Martin Formánek
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Otorhinolaryngology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jakub Cvek
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Renata Soumarová
- 3Rd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Oncology, University Hospital Královské Vinohrady Prague, Prague, Czech Republic
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15
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Salimi F, Saavedra F, Andrews B, FitzGerald J, Winter SC. Trans-cutaneous electrical nerve stimulation to treat dry mouth (xerostomia) following radiotherapy for head and neck cancer. A systematic review. Ann Med Surg (Lond) 2021; 63:102146. [PMID: 33664943 PMCID: PMC7903056 DOI: 10.1016/j.amsu.2021.01.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A dry mouth or xerostomia is one of the most common long-term complications following radiotherapy for head and neck cancer and has a negative impact on quality of life in cancer survivors. Transcutaneous electrical nerve stimulation (TENS) is a novel approach to improving saliva flow in these patients. OBJECTIVE To perform a systematic review of studies evaluating TENS in the treatment of radiotherapy induced xerostomia in head and neck cancer patients. DATA COLLECTION AND ANALYSIS A comprehensive electronic search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted in January 2020. Two review authors assessed all studies identified by the search strategy and carried out data extraction. RESULTS Five studies were included in the systematic review which analysed a total of 280 patients with head and neck cancer. Methodological quality and outcomes were evaluated in every study included. The outcome measure was either subjectively assessed or objectively measured. Three studies used conventional TENS therapy to stimulate parotid glands which produced a significant increase in saliva production following therapy. Two studies used acupunctured TENS type to electrically stimulate acupuncture points scattered in the body and they reported improvement in saliva production at the same level as medical treatment. No reported adverse effect of TENS was identified. CONCLUSIONS This systematic review confirms the safety and feasibility of TENS in the treatment of xerostomia. It is established that commencing daily TENS therapy simultaneously with radiotherapy has the most efficacy. Given the nonspecific parameters used in the included studies, further evidence is needed in order to establish optimal settings and parameters of TENS for treatment of xerostomia.
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Affiliation(s)
- Fatemeh Salimi
- Surgical Science Department, University of Oxford, United Kingdom
| | - Francisco Saavedra
- Electrical Engineering Department, Faculty of Engineering, University of Concepcion, Chile
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
| | - Brain Andrews
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
| | - James FitzGerald
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
| | - Stuart C. Winter
- Nuffield Department of Surgical Science, University of Oxford, United Kingdom
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16
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Venkat P, Han J, Demanes DJ. Brachytherapy of the head and neck: An University of California Los Angeles guide to morbidity reduction. Brachytherapy 2021; 20:1014-1040. [PMID: 33487561 DOI: 10.1016/j.brachy.2020.12.002] [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: 07/15/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/16/2022]
Abstract
The head and neck (H&N) region is among the most intricate and functional part of our anatomy. Major functional nerves and blood vessels with importance that affect the entire body emanate from the base of skull. Brachytherapy plays an important role as a single modality therapy in early cancer of the lip and oral cavity and a supplemental role in the pharynx or in advanced or recurrent disease. Morbidity in the H&N is intensely personal and disabling. Its avoidance is critical in determining the success or failure of a treatment program, and it is essential to preservation of quality of life. This article summarizes the current literature regarding morbidity related to H&N brachytherapy to aid patients and physicians to achieve optimal outcomes.
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Affiliation(s)
- Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
| | - James Han
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - D Jeffrey Demanes
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
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17
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Fanhao M, Xiaodong X, Bo Q, Lejun X, Yu S, Liang Z, Tingting J, Rui Z, Depeng Z, Ran A, Yu T, Suixin H, Zheng Z, Wenjun Y, Haizhong Z. A new multimodal, image-guided, robot-assisted, interstitial brachytherapy for the treatment of head and neck tumors-A preliminary study. Int J Med Robot 2020; 16:1-5. [PMID: 32500663 DOI: 10.1002/rcs.2133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Interstitial brachytherapy (BT) is becoming an accepted treatment option for head and neck cancer patients for whom surgery poses high risks. Multimodal, image-guided, robotic surgery has the potential to allow precise seed implantation into tumors. Our aim was to introduce a new multimodal, image-guided surgical robot during the performance of interstitial BT for the treatment of tumors in the head and neck regions. METHODS Clinical data for three patients were analyzed, retrospectively; patients had received 125 I seed implantations from July 2019 to October 2019. Multimodal, image-guided, robotic surgery was performed in all patients. Postoperative computed tomography data were imported to software to evaluate the accuracy of the seed position and the operation times. RESULTS The mean placement error of the 125 I seed was 1.9 ± 0.74 mm. The mean operation time is 47 minutes. CONCLUSION The experimental results showed that the Remebot has promise for use during BT for the head and neck.
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Affiliation(s)
- Meng Fanhao
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Xue Xiaodong
- Radiology Department, PLA Army General Hospital, Beijing, China
| | - Qiao Bo
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Xing Lejun
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Song Yu
- Department of Prosthodontics, Beijing Citident Stomatology Hospital, Beijing, China
| | - Zhu Liang
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Jia Tingting
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Zhao Rui
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Zhao Depeng
- Robotics Institute, Kagawa University, Takamatsu, Japan
| | - An Ran
- Clinical Engineering Department, Beijing Baihui Weikang Technology Co., Ltd, Beijing, China
| | - Tian Yu
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Hu Suixin
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Zhou Zheng
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Yu Wenjun
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
| | - Zhang Haizhong
- Oral Maxillofacial Surgery, PLA Army General Hospital, Beijing, China
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18
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Image-guided interstitial brachytherapy boost for nasopharyngeal carcinoma: technical aspects. J Contemp Brachytherapy 2020; 12:294-302. [PMID: 32695204 PMCID: PMC7366018 DOI: 10.5114/jcb.2020.96874] [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: 02/18/2020] [Accepted: 05/10/2020] [Indexed: 12/28/2022] Open
Abstract
Nasopharyngeal cancer generally responds well to concurrent chemoradiotherapy (CCRT). However, there is a small group of patients who respond poorly to CCRT, and experience local residual tumor or local relapse. Although several attempts have been performed to such a group of patients including re-irradiation with external beam radiation therapy (EBRT) or salvage surgery, clinical results remain unsatisfactory. Intracavitary brachytherapy (ICBT) boost after CCRT with EBRT has been explored, however, its efficacy is limited to those with superficial residual tumors. For those residual tumors thickness with more than 5 mm, interstitial brachytherapy (ISBT) boost would be an appropriate modality of choice. Here, we describe technical aspects of the high-dose-rate interstitial brachytherapy (HDR-ISBT) boost for nasopharyngeal cancer (NPC) patients who responded poorly to the CCRT with EBRT.
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Single institution implementation of permanent 131Cs interstitial brachytherapy for previously irradiated patients with resectable recurrent head and neck carcinoma. J Contemp Brachytherapy 2019; 11:227-234. [PMID: 31435429 PMCID: PMC6701381 DOI: 10.5114/jcb.2019.85778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/13/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose Permanent interstitial brachytherapy is an appealing treatment modality for patients with locoregional recurrent, resectable head and neck carcinoma (HNC), having previously received radiation. Cesium-131 (131Cs) is a permanent implant brachytherapy isotope, with a low average photon energy of 30 keV and a short half-life of 9.7 days. Exposure to medical staff and family members is low; patient isolation and patient room shielding are not required. This work presents a single institution’s implementation process of utilizing an intraoperative, permanent 131Cs implant for patients with completely resected recurrent HNC. Material and methods Fifteen patients receiving 131Cs permanent seed brachytherapy were included in this analysis. The process of pre-planning, selecting the dose prescription, seed ordering, intraoperative procedures, post-implant planning, and radiation safety protocols are described. Results Tumor volumes were contoured on the available preoperative PET/CT scans and a pre-implant treatment plan was created using uniform source strength and uniform 1 cm seed spacing. Implants were performed intraoperatively, following tumor resection. In five of the fifteen cases, intraoperative findings necessitated a change from the planned number of seeds and recalculation of the pre-implant plan. The average prescription dose was 56.1 ±6.6 Gy (range, 40-60 Gy). The average seed strength used was 2.2 ±0.2 U (3.5 ±0.3 mCi). Patients returned to a recovery room on a standard surgical floor and remained inpatients, without radiation safety restrictions, based on standard surgical recovery protocols. A post-implant treatment plan was generated based on immediate post-operative CT imaging to verify the seed distribution and confirm delivery of the prescription dose. Patients were provided educational information regarding radiation safety recommendations. Conclusions Cesium-131 interstitial brachytherapy is feasible and does not pose major radiation safety concerns; it should be considered as a treatment option for previously irradiated patients with recurrent, resectable HNC.
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20
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Dosimetry verification of 3D-printed individual template based on CT-MRI fusion for radioactive 125I seed implantation in recurrent high-grade gliomas. J Contemp Brachytherapy 2019; 11:235-242. [PMID: 31435430 PMCID: PMC6701383 DOI: 10.5114/jcb.2019.85729] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/29/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose To verify the accuracy and efficacy of three-dimensional printing individual template (3D-PIT) with computed tomography-magnetic resonance imaging (CT-MRI) fusion for radioactive iodine-125 (125I) seed implantation in high-grade brain gliomas. Material and methods Between June 2017 and June 2018, 16 patients with recurrent high-grade gliomas (rHGG) underwent radioactive seed implantation with 3D-PIT. The prescribed dose was 120-140 Gy. We compared the dose distribution of the postoperative plan with the preoperative plan. Dose parameters included D90, V100, V200, conformity index (CI), and external index of the target volume (EI). Local control and early complications were also analyzed. Results Sixteen treatment areas were reported in our study. Median gross tumor volume (preoperative) of patients was 64.2 cm3, median needle number was 8, and median number of implanted 125I seeds was 60. For postoperative plans, the median D90, V100, and V200 was 152.1 Gy, 96.8%, and 49.1%, respectively, and 151.7 Gy, 97.0%, and 48.9%, respectively, in preoperative plans. Comparing with the preplanned cases, the dose of the target volume was slightly higher; the high-dose area of the target volume was larger in postoperative cases, but the difference was not statistically significant (p > 0.05). Actual dose conformity of the target volume was greater than preplanned, and the difference was not statistically significant (p > 0.05). Local control was 81.25% and 75% at 3 and 6 months after implantation, respectively. No serious early toxicities were observed. Conclusions 3D-PIT based on the CT-MRI fusion images can result in good accuracy for positioning and dose distribution in radioactive seed implantation for treatment of rHGG.
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21
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Walsh A, Hubley E, Doyle L, Cognetti D, Curry J, Bar-Ad V, Luginbuhl A. Carotid dosimetry after re-irradiation with 131Cs permanent implant brachytherapy in recurrent, resected head and neck cancer. J Contemp Brachytherapy 2019; 11:221-226. [PMID: 31447900 PMCID: PMC6701389 DOI: 10.5114/jcb.2019.86298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/11/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Permanent seed implant cesium-131 (131Cs) brachytherapy provides highly localized radiation for patients with recurrent head and neck cancer (HNC), who may be ineligible for external beam radiation therapy due to a high-risk of toxicity. As carotid blowout is a concern in the setting of re-irradiation, a dose to the carotid artery was examined for 131Cs brachytherapy implants. MATERIAL AND METHODS Eleven patients were implanted with 131Cs adjacent to carotid at the time of resection for recurrent HNC. Vascularized tissue flaps were used in some patients. The carotid artery was contoured on the post-implant brachytherapy treatment plan, and the maximum carotid point dose and minimum carotid-seed distances are reported. The incidence of carotid blowout in the follow-up period was also measured. RESULTS The maximum carotid dose was 77 ±52 Gy (range, 3-158 Gy). The closest seed to the carotid artery was 0.8 ±0.8 cm (range, 0.2-2.6 cm). One patient without a flap experienced carotid blowout, which was attributed to a non-healing wound rather than to high radiation doses. CONCLUSIONS Carotid artery doses from 131Cs are reported. Vascularized tissue flaps should be considered when planning 131Cs brachytherapy.
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Affiliation(s)
- Amanda Walsh
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Emily Hubley
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura Doyle
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Cognetti
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph Curry
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Voichita Bar-Ad
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam Luginbuhl
- Department of Otolaryngology Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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