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Roy A, Brenneman RJ, Hogan J, Barnes JM, Huang Y, Morris R, Goddu S, Altman M, Garcia-Ramirez J, Li H, Zoberi JE, Bullock A, Kim E, Smith Z, Figenshau R, Andriole GL, Baumann BC, Michalski JM, Gay HA. Does the sequence of high-dose rate brachytherapy boost and IMRT for prostate cancer impact early toxicity outcomes? Results from a single institution analysis. Clin Transl Radiat Oncol 2021; 29:47-53. [PMID: 34136665 PMCID: PMC8182264 DOI: 10.1016/j.ctro.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/26/2022] Open
Abstract
The optimal sequence of HDR-BT boost and EBRT for prostate cancer is unclear. We compared early toxicity based on the timing of HDR-BT boost. The timing of HDR-BT was not based on any specific patient or clinical factors. We found no difference in early GI/GU toxicity between the two groups. Longer follow-up is needed to evaluate late toxicity and long-term disease control.
Background We present the first report comparing early toxicity outcomes with high-dose rate brachytherapy (HDR-BT) boost upfront versus intensity modulated RT (IMRT) upfront combined with androgen deprivation therapy (ADT) as definitive management for intermediate risk or higher prostate cancer. Methods and Materials We reviewed all non-metastatic prostate cancer patients who received HDR-BT boost from 2014 to 2019. HDR-BT boost was offered to patients with intermediate-risk disease or higher. ADT use and IMRT target volume was based on NCCN risk group. IMRT dose was typically 45 Gy in 25 fractions to the prostate and seminal vesicles ± pelvic lymph nodes. HDR-BT dose was 15 Gy in 1 fraction, delivered approximately 3 weeks before or after IMRT. The sequence was based on physician preference. Biochemical recurrence was defined per ASTRO definition. Gastrointestinal (GI) and Genitourinary (GU) toxicity was graded per CTCAE v5.0. Pearson Chi-squared test and Wilcoxon tests were used to compare toxicity rates. P-value < 0.05 was significant. Results Fifty-eight received HDR-BT upfront (majority 2014–2016) and 57 IMRT upfront (majority 2017–2018). Median follow-up was 26.0 months. The two cohorts were well-balanced for baseline patient/disease characteristics and treatment factors. There were differences in treatment sequence based on the year in which patients received treatment. Overall, rates of grade 3 or higher GI or GU toxicity were <1%. There was no significant difference in acute or late GI or GU toxicity between the two groups. Conclusion We found no significant difference in GI/GU toxicity in intermediate-risk or higher prostate cancer patients receiving HDR-BT boost upfront versus IMRT upfront combined with ADT. These findings suggest that either approach may be reasonable. Longer follow-up is needed to evaluate late toxicity and long-term disease control.
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Affiliation(s)
- Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Randall J. Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jacob Hogan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Yi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert Morris
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sreekrishna Goddu
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael Altman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Harold Li
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jacqueline E. Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Arnold Bullock
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric Kim
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Zachary Smith
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert Figenshau
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Gerald L. Andriole
- Department of Urology, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
- Corresponding author at: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, LL, Campus Box 8224, St. Louis, MO 63110, United States.
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Roy A, Brenneman RJ, Hogan J, Barnes J, Huang Y, Morris R, Goddu SM, Michael A, Garcia-Ramirez J, Li H, Zoberi JE, Bullock A, Kim E, Smith Z, Figenshau R, Andriole G, Baumann B, Michalski J, Gay H. PRSOR07 Presentation Time: 12:30 PM. Brachytherapy 2021. [DOI: 10.1016/j.brachy.2021.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maughan N, Kim H, Roach M, Garcia-Ramirez J, Amurao M, Hao Y, Zoberi J. PO-1770: Failure Modes and Effects Analysis with Lu-177 Dotatate PRRT in a Radiation Oncology-based Program. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rudra S, Roy A, Brenneman R, Gabani P, Roach MC, Ochoa L, Prather H, Appleton C, Margenthaler J, Peterson LL, Bagegni NA, Zoberi JE, Garcia-Ramirez J, Thomas MA, Zoberi I. Radiation-Induced Brachial Plexopathy in Patients With Breast Cancer Treated With Comprehensive Adjuvant Radiation Therapy. Adv Radiat Oncol 2020; 6:100602. [PMID: 33665488 PMCID: PMC7897772 DOI: 10.1016/j.adro.2020.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/15/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Our purpose was to describe the risk of radiation-induced brachial plexopathy (RIBP) in patients with breast cancer who received comprehensive adjuvant radiation therapy (RT). Methods and Materials Records for 498 patients who received comprehensive adjuvant RT (treatment of any residual breast tissue, the underlying chest wall, and regional nodes) between 2004 and 2012 were retrospectively reviewed. All patients were treated with conventional 3 to 5 field technique (CRT) until 2008, after which intensity modulated RT (IMRT) was introduced. RIBP events were determined by reviewing follow-up documentation from oncologic care providers. Patients with RIBP were matched (1:2) with a control group of patients who received CRT and a group of patients who received IMRT. Dosimetric analyses were performed in these patients to determine whether there were differences in ipsilateral brachial plexus dose distribution between RIBP and control groups. Results Median study follow-up was 88 months for the overall cohort and 92 months for the IMRT cohort. RIBP occurred in 4 CRT patients (1.6%) and 1 IMRT patient (0.4%) (P = .20). All patients with RIBP in the CRT cohort received a posterior axillary boost. Maximum dose to the brachial plexus in RIBP, CRT control, and IMRT control patients had median values of 56.0 Gy (range, 49.7-65.1), 54.8 Gy (47.4-60.5), and 54.8 Gy (54.2-57.3), respectively. Conclusions RIBP remains a rare complication of comprehensive adjuvant breast radiation and no clear dosimetric predictors for RIBP were identified in this study. The IMRT technique does not appear to adversely affect the development of this late toxicity.
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Affiliation(s)
- Soumon Rudra
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael C Roach
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Laura Ochoa
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Heidi Prather
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.,Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine Appleton
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lindsay L Peterson
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Nusayba A Bagegni
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
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Lin AJ, Samson P, Zoberi J, Garcia-Ramirez J, Williamson JF, Markovina S, Schwarz J, Grigsby PW. Concurrent chemoradiation for cervical cancer: Comparison of LDR and HDR brachytherapy. Brachytherapy 2019; 18:353-360. [PMID: 30971370 DOI: 10.1016/j.brachy.2018.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/21/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare clinical outcomes between low-dose-rate (LDR) brachytherapy and high-dose-rate (HDR) brachytherapy for cervical cancer patients. METHODS AND MATERIALS All consecutive newly diagnosed cervical cancer patients undergoing pretreatment 18-fluorodeoxyglucose positron emission tomography imaging and treated with curative-intent definitive chemoradiation from 1997 to 2016 at a U.S. academic center were included. Brachytherapy boost was LDR or HDR 2D treatment planning from 1997 to 2005 and HDR with MR-based 3D planning from 2005 to 2016. Local control (LC), cancer-specific survival (CSS), and late bowel/bladder complications were evaluated. RESULTS Tumor stages were International Federation of Gynecology and Obstetrics IB1-IIB (n = 457; 75%) and III-IVA (n = 152; 25%). Brachytherapy was LDR for 104 patients and HDR for 505 patients. Concurrent weekly cisplatin was administered to 536 patients (88%). With median followup of 9.4 years, there was no difference in LC (p = 0.24) or CSS (p = 0.50) between LDR and HDR brachytherapy. Cox multivariable regression showed that only International Federation of Gynecology and Obstetrics stage III-IVA (HR=2.4, p = 0.004) was associated with worse LC. A propensity-matched cohort (90 LDR vs. 90 HDR) was created, and the 5-year LC rates were 88% LDR and 82% HDR, p = 0.26; 5-year CSS rates were 66% LDR and 58% HDR, p = 0.19; 5-year grade ≥3 bowel/bladder toxicities were 23% LDR and 16% HDR, p = 0.44. For all patients, the 5-year late toxicity in stage III-IVA patients was higher with LDR 47% vs. HDR 15%, p = 0.03, with no difference in LC, 86% and 75%, respectively (p = 0.09). CONCLUSIONS There was no difference in LC with either LDR or HDR brachytherapy. The late complication rate was reduced with HDR and 3D-planned brachytherapy compared to LDR and 2D-planned brachytherapy.
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Affiliation(s)
- Alexander J Lin
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Pamela Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jacqueline Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey F Williamson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
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Lin AJ, Samson P, Zoberi J, Garcia-Ramirez J, Williamson J, Markovina S, Schwarz J, Grigsby P. Concurrent Chemoradiation for Cervical Cancer: Comparison of LDR and HDR Brachytherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/s0360-3016(19)30443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gach HM, Mackey SL, Hausman SE, Jackson DR, Benzinger TL, Henke L, Murphy LA, Fluchel JL, Cai B, Zoberi JE, Garcia-Ramirez J, Mutic S, Schwarz JK. MRI safety risks in the obese: The case of the disposable lighter stored in the pannus. Radiol Case Rep 2019; 14:634-638. [PMID: 30923590 PMCID: PMC6424094 DOI: 10.1016/j.radcr.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 11/15/2022] Open
Abstract
Obese patients are subject to higher MRI risks than lower weight patients. Obese patients typically require additional setup and acquisition times for MRI. Unanticipated safety threats may arise in obese patients despite vigilant screening. Threats to MRI safety may impact other clinical procedures.
Obese patients constitute 40% of the adult population. MRIs of obese patients are typically challenging because of the effects of a large field of view on image quality and the increased risk of thermal burns from contact with the bore. In this case report, the impacts of obesity on MRI procedures and safety are introduced. Then a case is presented of a 30-year old female cervical cancer patient who received an MRI simulation to verify the placement of a titanium tandem and colpostats for brachytherapy. A large magnetic susceptibility artifact was detected near the right pelvis during the MRI scout indicating the presence of ferrous material. The source of the artifact turned out to be a disposable lighter that was stored inside the patient's pannus. The finding highlights an unanticipated risk to MRI safety and image quality associated with large body habitus.
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Affiliation(s)
- H Michael Gach
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, US.,Department of Radiology, Washington University School of Medicine in St. Louis, 4921 Parkview Place, St. Louis, MO 63110, US.,Department of Biomedical Engineering, Washington University in St. Louis School of Engineering & Applied Science, 6201 Forsyth Blvd, St. Louis, MO 63105, US
| | - Stacie L Mackey
- Department of Radiation Oncology, Barnes Jewish Hospital, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Sarah E Hausman
- Department of Radiation Oncology, Barnes Jewish Hospital, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Danielle R Jackson
- Department of Radiation Oncology, Barnes Jewish Hospital, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Tammie L Benzinger
- Department of Radiology, Washington University School of Medicine in St. Louis, 4921 Parkview Place, St. Louis, MO 63110, US.,Department of Neurological Surgery, Washington University School of Medicine in St. Louis, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Lindsay A Murphy
- Department of Radiation Oncology, Barnes Jewish Hospital, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Jamie L Fluchel
- Department of Radiation Oncology, Barnes Jewish Hospital, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Bin Cai
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, US
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, St. Louis, MO 63110, US
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Maughan NM, Garcia-Ramirez J, Arpidone M, Swallen A, Laforest R, Goddu SM, Parikh PJ, Zoberi JE. Validation of post-treatment PET-based dosimetry software for hepatic radioembolization of Yttrium-90 microspheres. Med Phys 2019; 46:2394-2402. [PMID: 30742714 DOI: 10.1002/mp.13444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Yttrium-90 (90 Y) microsphere radioembolization enables selective internal radiotherapy for hepatic malignancies. Currently, there is no standard postdelivery imaging and dosimetry of the microsphere distribution to verify treatment. Recent studies have reported utilizing the small positron yield of 90 Y (32 ppm) with positron emission tomography (PET) to perform treatment verification and dosimetry analysis. In this study, we validated a commercial dosimetry software, MIM SurePlan™ LiverY90 (MIM Software Inc., Cleveland, OH), for clinical use. METHODS A MATLAB-based algorithm for 90 Y PET-based dosimetry was developed in-house and validated for the purpose of commissioning the commercial software. The algorithm is based on voxel S values and dosimetry formalism reported in MIRD Pamphlet 17. We validated the in-house algorithm to establish it as the ground truth by comparing results from a digital point phantom and a digital uniform cylinder to manual calculations. Once we validated our in-house MATLAB-based algorithm, we used it to perform acceptance testing and commissioning of the commercial dosimetry software, MIM SurePlan, which uses the same dosimetry formalism. A 0.4 cm/5% gamma test was performed on PET-derived dose maps from each algorithm of uniform digital and nonuniform physical phantoms filled with 90 Y chloride solution. Average dose (Davg ) and minimum dose to 70% (D70 ) of a given volume of interest (VOI) were compared for the digital phantom, the physical phantom, and five patient cases (27 tumor VOIs), representing different clinical scenarios. RESULTS The gamma-pass rates were 97.26% and 97.66% for the digital and physical phantoms, respectively. The differences between Davg and D70 were 0.076% and 0.10% for the digital phantom, respectively, and <5.2% for various VOIs in the physical phantom. In the clinical cases, 96.3% of the VOIs had a difference <5% for Davg , and 88.9% of the VOIs had a difference <5% for D70 . CONCLUSIONS Dose calculation results from MIM SurePlan were found to be in good agreement with our in-house algorithm. This indicates that MIM SurePlan performs as it should and, hence, can be deemed accepted and commissioned for clinical use for post-implant PET-based dosimetry of 90 Y radioembolization.
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Affiliation(s)
- Nichole M Maughan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | | | | | - Richard Laforest
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - S Murty Goddu
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Parag J Parikh
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Cai B, Altman MB, Reynoso F, Garcia-Ramirez J, He A, Edward SS, Zoberi I, Thomas MA, Gay H, Mutic S, Zoberi JE. Standardization and automation of quality assurance for high-dose-rate brachytherapy planning with application programming interface. Brachytherapy 2018; 18:108-114.e1. [PMID: 30385115 DOI: 10.1016/j.brachy.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/01/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To standardize and automate the high-dose-rate (HDR) brachytherapy planning quality assurance (QA) process utilizing scripting with application programming interface (API) in a commercially available treatment planning system (TPS). METHODS AND MATERIALS Site- and applicator-dependent plan quality (PQ) evaluation criteria and plan integrity (PI) checklists were established based on published guidelines, clinical protocols, and institutional experience. User designed C# programs ("scripts") were created and executed through the API to access planning information in TPS. A set of standardized quality control reports, focusing on PQ evaluations and PI checks, were automatically generated. Information derived from the TPS was compared against predetermined QA metrics with color-coded pass/fail indicators to aid and enhance the efficiency of plan evaluation. Five independent, blinded observers reviewed mock plans with simulated errors to validate the scripts and to quantify the improvement of plan review efficiency. RESULTS Scripts were developed for HDR prostate and breast. Forty-one parameters were reported/checked in the PI report; the PQ report returned dose-volume indices and an independent check of dwell time. All simulated errors were detected by the PI scripts with appropriate warning messages displayed, and any values failing to meet the planning constraints were red-flagged successfully in the PQ report. An average time reduction of 16 min for plan review was observed when using the scripts. CONCLUSIONS API scripting-based automated planning QA for HDR brachytherapy including PI checks and PQ evaluations was designed and implemented. The simulated error study showed promising results in terms of error catching and efficiency improvement.
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Affiliation(s)
- Bin Cai
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO.
| | - Michael B Altman
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Francisco Reynoso
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Angell He
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Sharbacha S Edward
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
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10
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Zoberi JE, Garcia-Ramirez J, Hedrick S, Rodriguez V, Bertelsman CG, Mackey S, Hu Y, Gach HM, Rao PK, Grigsby PW. MRI-based treatment planning and dose delivery verification for intraocular melanoma brachytherapy. Brachytherapy 2017; 17:31-39. [PMID: 28818442 DOI: 10.1016/j.brachy.2017.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/30/2017] [Accepted: 07/14/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Episcleral plaque brachytherapy (EPB) planning is conventionally based on approximations of the implant geometry with no volumetric imaging following plaque implantation. We have developed an MRI-based technique for EPB treatment planning and dose delivery verification based on the actual patient-specific geometry. METHODS AND MATERIALS MR images of 6 patients, prescribed 85 Gy over 96 hours from Collaborative Ocular Melanoma Study-based EPB, were acquired before and after implantation. Preimplant and postimplant scans were used to generate "preplans" and "postplans", respectively. In the preplans, a digital plaque model was positioned relative to the tumor, sclera, and nerve. In the postplans, the same plaque model was positioned based on the imaged plaque. Plaque position, point doses, percentage of tumor volume receiving 85 Gy (V100), and dose to 100% of tumor volume (Dmin) were compared between preplans and postplans. All isodose plans were computed using TG-43 formalism with no heterogeneity corrections. RESULTS Shifts and tilts of the plaque ranged from 1.4 to 8.6 mm and 1.0 to 3.8 mm, respectively. V100 was ≥97% for 4 patients. Dmin for preplans and postplans ranged from 83 to 118 Gy and 45 to 110 Gy, respectively. Point doses for tumor apex and base were all found to decrease from the preimplant to the postimplant plan, with mean differences of 16.7 ± 8.6% and 30.5 ± 11.3%, respectively. CONCLUSIONS By implementing MRI for EPB, we eliminate reliance on approximations of the eye and tumor shape and the assumption of idealized plaque placement. With MRI, one can perform preimplant as well as postimplant imaging, facilitating EPB treatment planning based on the actual patient-specific geometry and dose-delivery verification based on the imaged plaque position.
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Affiliation(s)
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | | | - Vivian Rodriguez
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Carol G Bertelsman
- Department of Radiation Oncology, Barnes Jewish Hospital, Saint Louis, MO
| | - Stacie Mackey
- Department of Radiation Oncology, Barnes Jewish Hospital, Saint Louis, MO
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ
| | - H Michael Gach
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO; Department of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - P Kumar Rao
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
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11
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Maughan NM, Garcia-Ramirez J, Arpidone M, Swallen A, Laforest R, Goddu SM, Parikh PJ, Zoberi JE. Commissioning of Post-Treatment PET-Based Dosimetry Software for Hepatic Radioembolization with Yttrium-90 Microspheres. Brachytherapy 2017. [DOI: 10.1016/j.brachy.2017.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rao YJ, Zoberi JE, Kadbi M, Grigsby PW, Cammin J, Mackey SL, Garcia-Ramirez J, Goddu SM, Schwarz JK, Gach HM. Metal artifact reduction in MRI-based cervical cancer intracavitary brachytherapy. Phys Med Biol 2017; 62:3011-3024. [DOI: 10.1088/1361-6560/62/8/3011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Cai B, Altman MB, Garcia-Ramirez J, LaBrash J, Goddu SM, Mutic S, Parikh PJ, Olsen JR, Saad N, Zoberi JE. Process improvement for the safe delivery of multidisciplinary-executed treatments-A case in Y-90 microspheres therapy. Brachytherapy 2016; 16:236-244. [PMID: 27618420 DOI: 10.1016/j.brachy.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To develop a safe and robust workflow for yttrium-90 (Y-90) radioembolization procedures in a multidisciplinary team environment. METHODS AND MATERIALS A generalized Define-Measure-Analyze-Improve-Control (DMAIC)-based approach to process improvement was applied to a Y-90 radioembolization workflow. In the first DMAIC cycle, events with the Y-90 workflow were defined and analyzed. To improve the workflow, a web-based interactive electronic white board (EWB) system was adopted as the central communication platform and information processing hub. The EWB-based Y-90 workflow then underwent a second DMAIC cycle. Out of 245 treatments, three misses that went undetected until treatment initiation were recorded over a period of 21 months, and root-cause-analysis was performed to determine causes of each incident and opportunities for improvement. The EWB-based Y-90 process was further improved via new rules to define reliable sources of information as inputs into the planning process, as well as new check points to ensure this information was communicated correctly throughout the process flow. RESULTS After implementation of the revised EWB-based Y-90 workflow, after two DMAIC-like cycles, there were zero misses out of 153 patient treatments in 1 year. CONCLUSIONS The DMAIC-based approach adopted here allowed the iterative development of a robust workflow to achieve an adaptable, event-minimizing planning process despite a complex setting which requires the participation of multiple teams for Y-90 microspheres therapy. Implementation of such a workflow using the EWB or similar platform with a DMAIC-based process improvement approach could be expanded to other treatment procedures, especially those requiring multidisciplinary management.
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Affiliation(s)
- Bin Cai
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Michael B Altman
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jason LaBrash
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - S Murty Goddu
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Parag J Parikh
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jeffrey R Olsen
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Nael Saad
- Department of Radiology, Vascular and Interventional Radiology Section, Washington University School of Medicine, Saint Louis, MO
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO.
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Mooney KE, Altman MB, Edward S, Garcia-Ramirez J, Thomas MA, Zoberi I, DeWees T, Mullen D, Zoberi JE. Accelerated partial breast irradiation dosimetric criteria for the strut-adjusted volume implant. Brachytherapy 2016; 15:616-24. [DOI: 10.1016/j.brachy.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/27/2022]
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Mooney KE, Altman MB, Edward S, Garcia-Ramirez J, Thomas MA, Zoberi I, DeWees T, Mullen DF, Zoberi JE. Robustness of Plan Evaluation Criteria for Accelerated Partial Breast Irradiation with the Strut Adjusted Volume Implant (SAVI). Brachytherapy 2016. [DOI: 10.1016/j.brachy.2016.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cai B, He G, Altman MB, Li HH, Garcia-Ramirez J, Goddu SM, Edward SS, Zoberi I, Thomas MA, Gay H, Mutic S, Zoberi JE. Standardization and Automation of Quality Assurance for High Dose Rate Brachytherapy Planning Utilizing the API within Brachyvision. Brachytherapy 2016. [DOI: 10.1016/j.brachy.2016.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Zoberi JE, Garcia-Ramirez J, Hu Y, Sun B, Bertelsman CG, Dyk P, Schwarz JK, Grigsby PW. Clinical implementation of multisequence MRI-based adaptive intracavitary brachytherapy for cervix cancer. J Appl Clin Med Phys 2016; 17:121-131. [PMID: 26894342 PMCID: PMC5690214 DOI: 10.1120/jacmp.v17i1.5736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/17/2015] [Accepted: 08/27/2015] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study was to describe the clinical implementation of a magnetic resonance image (MRI)-based approach for adaptive intracavitary brachytherapy (ICBT) of cervix cancer patients. Patients were implanted with titanium tandem and colpostats. MR imaging was performed on a 1.5-T Philips scanner using T2-weighted (T2W), proton-density weighted (PDW), and diffusion-weighted (DW) imaging sequences. Apparent diffusion coefficient (ADC) maps were generated from the DW images. All images were fused. T2W images were used for the definition of organs at risk (OARs) and dose points. ADC maps in conjunction with T2W images were used for target delineation. PDW images were used for applicator definition. Forward treatment planning was performed using standard source distribution rules normalized to Point A. Point doses and dose-volume parameters for the tumor and OARs were exported to an automated dose-tracking application. Brachytherapy doses were adapted for tumor shrinkage and OAR variations during the course of therapy. The MRI-based ICBT approach described here has been clinically implemented and is carried out for each brachytherapy fraction. Total procedure time from patient preparation to delivery of treatment is typically 2 hrs. Implementation of our tech-nique for structure delineation, applicator definition, dose tracking, and adaptation is demonstrated using treated patient examples. Based on published recommendations and our clinical experience in the radiation treatment of cervix cancer patients, we have refined our standard approach to ICBT by 1) incorporating a multisequence MRI technique for improved visualization of the target, OARs, and applicator, and by 2) implementing dose adaptation by use of automated dose tracking tools.
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Mooney K, Altman M, Garcia-Ramirez J, Thomas M, Zoberi I, Mullen D, DeWees T, Esthappan J. SU-F-BRA-14: Optimization of Dosimetric Guidelines for Accelerated Partial Breast Irradiation (APBI) Using the Strut-Adjusted Volume Implant (SAVI). Med Phys 2015. [DOI: 10.1118/1.4925225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sun B, Yang D, Esthappan J, Garcia-Ramirez J, Price S, Mutic S, Schwarz JK, Grigsby PW, Tanderup K. Three-dimensional dose accumulation in pseudo-split-field IMRT and brachytherapy for locally advanced cervical cancer. Brachytherapy 2015; 14:481-9. [PMID: 25958039 DOI: 10.1016/j.brachy.2015.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Dose accumulation of split-field external beam radiotherapy (EBRT) and brachytherapy (BT) is challenging because of significant EBRT and BT dose gradients in the central pelvic region. We developed a method to determine biologically effective dose parameters for combined split-field intensity-modulated radiation therapy (IMRT) and image-guided BT in locally advanced cervical cancer. METHODS AND MATERIALS Thirty-three patients treated with split-field-IMRT to 45.0-51.2 Gy in 1.6-1.8 Gy per fraction to the elective pelvic lymph nodes and to 20 Gy to the central pelvis region were included in this study. Patients received six weekly fractions of high-dose rate BT to 6.5-7.3 Gy per fraction. A dose tracker software was developed to compute the equivalent dose in 2-Gy fractions (EQD2) to gross tumor volume (GTV), organs-at-risk and point A. Total dose-volume histogram parameters were computed on the 3D combined EQD2 dose based on rigid image registration. The dose accumulation uncertainty introduced by organ deformations between IMRT and BT was evaluated. RESULTS According to International Commission on Radiation Unit and Measurement and GEC European Society for Therapeutic Radiology and Oncology recommendations, D98, D90, D50, and D2cm3 EQD2 dose-volume histogram parameters were computed. GTV D98 was 84.0 ± 26.5 Gy and D2cc was 99.6 ± 13.9 Gy, 67.4 ± 12.2 Gy, 75.0 ± 10.1 Gy, for bladder, rectum, and sigmoid, respectively. The uncertainties induced by organ deformation were estimated to be -1 ± 4 Gy, -3 ± 5 Gy, 2 ± 3 Gy, and -3 ± 5 Gy for bladder, rectum, sigmoid, and GTV, respectively. CONCLUSIONS It is feasible to perform 3D EQD2 dose accumulation to assess high and intermediate dose regions for combined split-field IMRT and BT.
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Affiliation(s)
- Baozhou Sun
- Department of Radiation Oncology, Washington University Saint Louis, MO.
| | - Deshan Yang
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Jackie Esthappan
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | | | - Samantha Price
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Julie K Schwarz
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University Saint Louis, MO
| | - Kari Tanderup
- Department of Radiation Oncology, Washington University Saint Louis, MO
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Price S, Garcia-Ramirez J, Bertelsman C, Hu Y, Rivard M, Tanderup K, Rao P, Grigsby P, Esthappan J. MRI-Based Verification of Plaque Positioning and Treatment Planning for Episcleral Brachytherapy. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Sun B, Deshan Y, Esthappan J, Garcia-Ramirez J, Price S, Mutic S, Schwarz J, Grigsby P, Tanderup K. 3D Dose Accumulation in Pseudo-Split-Field IMRT and BT for Locally Advanced Cervical Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Knutson N, Cai B, Garcia-Ramirez J, Thomas M, Zoberi I, Esthappan J. Evaluation of Treatment Plan Robustness to Changes in Treatment Geometry for Strut Adjusted Volume Implant Breast Brachytherapy. Brachytherapy 2014. [DOI: 10.1016/j.brachy.2014.02.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Speirs C, Benegal A, Fowler K, Olsen J, Saad N, Sharma A, Garcia-Ramirez J, Laforest R, Parikh P. 90Y Microsphere Hepatic Distribution Can Be Evaluated Following Radioembolization With PET/MRI. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rodriguez V, Bertelsman C, DeWees T, Hu Y, Rao PK, Garcia-Ramirez J, Grigsby P, Esthappan J. WE-G-WAB-06: Three-Dimensional Visualization Using Magnetic Resonance Imaging for Episcleral Brachytherapy. Med Phys 2013. [DOI: 10.1118/1.4815648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hu Y, Esthappan J, Du D, Feng Y, Garcia-Ramirez J, Mutic S, Grigsby P. WE-G-WAB-09: Development of MRI Fiduciary Markers for Interstitial Brachytherapy. Med Phys 2013. [DOI: 10.1118/1.4815651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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26
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Badiyan SN, Rao RC, Apicelli AJ, Acharya S, Verma V, Garsa AA, DeWees T, Speirs CK, Garcia-Ramirez J, Grigsby PW, Harbour JW. Incidence and Treatment of Toxicity following 125I Episcleral Plaque Brachytherapy for Uveal Melanoma. Brachytherapy 2013. [DOI: 10.1016/j.brachy.2013.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Dyk PT, Richardson S, Garcia-Ramirez J, Schwarz JK, Grigsby PW. Outpatient High-Dose-Rate Interstitial Brachytherapy in the Treatment of Gynecologic Malignancies. Brachytherapy 2013. [DOI: 10.1016/j.brachy.2013.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sinovic L, Sun B, DeWees T, Dyk P, Garcia-Ramirez J, Grigsby P, Esthappan J. Evaluation of Tandem Localization Errors on MRI-Based Cervix Cancer Brachytherapy. Brachytherapy 2013. [DOI: 10.1016/j.brachy.2013.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Richardson S, Garcia-Ramirez J, Lu W, Myerson RJ, Parikh P. Design and dosimetric characteristics of a new endocavitary contact radiotherapy system using an electronic brachytherapy source. Med Phys 2013; 39:6838-46. [PMID: 23127076 DOI: 10.1118/1.4757915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To present design aspects and acceptance tests performed for clinical implementation of electronic brachytherapy treatment of early stage rectal adenocarcinoma. A dosimetric comparison is made between the historically used Philips RT-50 unit and the newly developed Axxent(®) Model S700 electronic brachytherapy source manufactured by Xoft (iCad, Inc.). METHODS Two proctoscope cones were manufactured by ElectroSurgical Instruments (ESI). Two custom surface applicators were manufactured by Xoft and were designed to fit and interlock with the proctoscope cones from ESI. Dose rates, half value layers (HVL), and percentage depth dose (PDD) measurements were made with the Xoft system and compared to historical RT-50 data. A description of the patient treatment approach and exposure rates during the procedure is also provided. RESULTS The electronic brachytherapy system has a lower surface dose rate than the RT-50. The dose rate to water on the surface from the Xoft system is approximately 2.1 Gy∕min while the RT-50 is 10-12 Gy∕min. However, treatment times with Xoft are still reasonable. The HVLs and PDDs between the two systems were comparable resulting in similar doses to the target and to regions beyond the target. The exposure rate levels around a patient treatment were acceptable. The standard uncertainty in the dose rate to water on the surface is approximately ±5.2%. CONCLUSIONS The Philips RT-50 unit is an out-of-date radiotherapy machine that is no longer manufactured with limited replacement parts. The use of a custom-designed proctoscope and Xoft surface applicators allows delivery of a well-established treatment with the ease of a modern radiotherapy device. While the dose rate is lower with the use of Xoft, the treatment times are still reasonable. Additionally, personnel may stand farther away from the Xoft radiation source, thus potentially reducing radiation exposure to the operator and other personnel.
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Affiliation(s)
- Susan Richardson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Dyk P, Apicelli A, Sun B, Bertelsman C, Kavanaugh J, DeWees T, Garcia-Ramirez J, Richardson S, Schwarz J, Grigsby P. Toxicity Following Adaptive MRI Image Guided HDR Brachytherapy and IMRT in the Treatment of Cervical Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Apicelli A, Dyk P, Sun B, Bertelsman C, Kavanaugh J, DeWees T, Garcia-Ramirez J, Richardson S, Schwarz J, Grigsby P. Adaptive MRI Image Guided HDR Brachytherapy Treatment Planning for Cervical Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sun B, Kavanaugh J, Yang D, Garcia-Ramirez J, Mutic S, Grigsby P, Richardson S. SU-E-T-305: Limitations of Using DICOM Data for BrachyVision Treatment Plan Evaluation. Med Phys 2012; 39:3773. [DOI: 10.1118/1.4735391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Li H, Noel C, Garcia-Ramirez J, Low D, Bradley J, Robinson C, Mutic S, Parikh P. Clinical evaluations of an amplitude-based binning algorithm for 4DCT reconstruction in radiation therapy. Med Phys 2012; 39:922-32. [DOI: 10.1118/1.3679015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Goddu SM, Mutic S, Pechenaya OL, Chaudhari SR, Garcia-Ramirez J, Rangaraj D, Klein EE, Yang D, Grigsby J, Low DA. Enhanced efficiency in helical tomotherapy quality assurance using a custom-designed water-equivalent phantom. Phys Med Biol 2009; 54:5663-74. [DOI: 10.1088/0031-9155/54/19/001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Stuart JE, Tan B, Myerson RJ, Garcia-Ramirez J, Goddu SM, Pilgram TK, Brown DB. Salvage radioembolization of liver-dominant metastases with a resin-based microsphere: initial outcomes. J Vasc Interv Radiol 2008; 19:1427-33. [PMID: 18755600 DOI: 10.1016/j.jvir.2008.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 07/03/2008] [Accepted: 07/14/2008] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The use of radioembolization of hepatic metastases with yttrium-90 ((90)Y) microspheres is increasing. The present report describes the outcomes in a cohort of patients with metastatic liver tumors treated with a resin-based microsphere agent. MATERIALS AND METHODS Thirty patients with colon (n = 13), breast (n = 7), and other primary cancers (n = 10) were treated after the failure of first- and second-line therapy. Overall survival (OS), time to progression (TTP), and time to treatment failure (TTTF) were calculated from the first treatment. Response was measured according to Response Evaluation Criteria In Solid Tumors at interval follow-up imaging. RESULTS Thirty patients underwent 56 infusions of (90)Y, and 18 remained alive at the end of the study. Fourteen patients (47%) had a partial response or stable disease. OS (604 vs 251 days), TTP (223 vs 87 days), and TTTF (363 vs 87 days) were all significantly longer for patients who had a partial response or stable disease (P < .05). Median OS, TTP, and TTTF for patients with colorectal carcinoma were 357, 112, and 107 days, respectively, versus 638, 118, and 363 days in patients with other metastatic sources. Median survival was not reached for patients with breast carcinoma, and the TTP and TTTF were each 282 days. One patient (3%) experienced grade 3 toxicity (gastrointestinal ulceration). CONCLUSIONS (90)Y microsphere therapy produced promising survival rates compared with systemic salvage options, with minimal toxicity.
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Affiliation(s)
- Jourdan E Stuart
- Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
The efficacy of local injection of botulinum toxin A in selected skeletal muscles to relieve muscle hypertonia and muscle contracture, and increase range of motion in children with cerebral palsy was studied in an open ABA (baseline-treatment-posttreatment phase) type of study. The first 6 months were the baseline phase, the day of injection the treatment phase, and the next 6 months the posttreatment phase. The patients acted as their own controls. Fifteen children with cerebral palsy (mean age: 6 years, 8 months) were included in the study. All had limb deformities associated with non-fixed joint contractures that had not responded to physical therapy. Clinical assessment of passive and active muscle tone was performed using a modified Ashworth scale. The range of motion to passive movement was measured with a manual goniometer. Botulinum toxin was injected directly into the muscle at several sites. The postinjection scores of muscle hypertonia were significantly lower (P < .01) and the range-of-motion values demonstrated a significant increase (P < .001). Functional improvement was measured by decreased scissoring on standing in all 6 children with adductor muscles injected; all 6 children with knee flexor muscles injected were able to straighten the knees. The 3 children with injected gastrocnemius muscles were able to achieve heel-strike while bare-footed. The study provides evidence that the intramuscular injection of botulinum toxin A in selected skeletal muscles decreases muscle tone and contractures, and increases range of motion and motor function.
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Affiliation(s)
- R Calderon-Gonzalez
- Department of Pediatric Neurology, Children and Adolescents Neurological Center, Monterrey, Mexico
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