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Barkeer S, Pothuraju R, Malakar P, Pimentel TC, Siddiqui JA, Nair SA. Gum acacia dietary fiber: Significance in immunomodulation, inflammatory diseases, and cancer. Phytother Res 2024; 38:1509-1521. [PMID: 38272848 DOI: 10.1002/ptr.8125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/11/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024]
Abstract
Gum arabic/acacia (GA), derived from Acacia trees, is a versatile natural product offering a broad spectrum of applications. Its rich content of soluble dietary fibers, coupled with a low caloric profile, renders GA a valuable dietary component associated with numerous health benefits. Furthermore, its fermentation by gut microbiota yields short-chain fatty acids, renowned for their positive impact on health. Immunomodulation, a crucially regulated mechanism in the body, serves to fend off pathogenic infections by releasing pro-inflammatory cytokines. However, prolonged synthesis of these cytokines can lead to chronic inflammation, tissue damage, and potentially contribute to the development of autoimmune diseases and cancer. Hence, there is an urgent need to identify plant-based biomolecules that can effectively reduce inflammation and inhibit inflammation-induced complications or disorders. In this context, edible biomolecules like GA are gaining prominence for their noteworthy immunomodulatory properties. Therefore, in the present review we have explored the role of GA in immunomodulation, inflammation, and inflammation-associated metabolic diseases, and cancer.
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Affiliation(s)
- Srikanth Barkeer
- Department of Biochemistry, College of Agriculture, Gangavathi, University of Agricultural Sciences, Raichur, India
| | - Ramesh Pothuraju
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, India
| | - Pushkar Malakar
- Department of Biomedical Science and Technology, School of Biological Sciences, Ramakrishna Mission Vivekananda Educational and Research Institute, Narendrapur, India
| | | | - Jawed A Siddiqui
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, USA
| | - S Asha Nair
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, India
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Peptide Modification Diminishes HLA Class II-restricted CD4 + T Cell Recognition of Prostate Cancer Cells. Int J Mol Sci 2022; 23:ijms232315234. [PMID: 36499557 PMCID: PMC9738740 DOI: 10.3390/ijms232315234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/08/2022] Open
Abstract
Prostate cancer poses an ongoing problem in the western world accounting for significant morbidity and mortality in the male population. Current therapy options are effective in treating most prostate cancer patients, but a significant number of patients progress beyond a manageable disease. For these patients, immunotherapy has emerged as a real option in the treatment of the late-stage metastatic disease. Unfortunately, even the most successful immunotherapy strategies have only led to a four-month increase in survival. One issue responsible for the shortcomings in cancer immunotherapy is the inability to stimulate helper CD4+ T cells via the HLA class II pathway to generate a potent antitumor response. Obstacles to proper HLA class II stimulation in prostate cancer vaccine design include the lack of detectable class II proteins in prostate tumors and the absence of defined class II specific prostate tumor antigens. Here, for the first time, we show that the insertion of a lysosomal thiol reductase (GILT) into prostate cancer cells directly enhances HLA class II antigen processing and results in increased CD4+ T cell activation by prostate cancer cells. We also show that GILT insertion does not alter the expression of prostate-specific membrane antigen (PSMA), an important target in prostate cancer vaccine strategies. Our study suggests that GILT expression enhances the presentation of the immunodominant PSMA459 epitope via the HLA class II pathway. Biochemical analysis showed that the PSMA459 peptide was cysteinylated under a normal physiologic concentration of cystine, and this cysteinylated form of PSMA459 inhibited T cell activation. Taken together, these results suggest that GILT has the potential to increase HLA class II Ag presentation and CD4+ T cell recognition of prostate cancer cells, and GILT-expressing prostate cancer cells could be used in designing cell therapy and/or vaccines against prostate cancer.
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Doyle AJ, Cody D, Knight S, King DM, Sullivan FJ, Browne JE. Contrast-Specific Spherical Lesion Phantoms and Ancillary Analysis Software for the Objective Evaluation of Transrectal Ultrasound System Contrast Detectability. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1615-1627. [PMID: 35659496 DOI: 10.1016/j.ultrasmedbio.2022.04.007] [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: 01/20/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
Brachytherapy is an efficacious treatment option because of its benefits for patient recovery, dose localization and conformity, but these favorable outcomes can be ensured only if the transrectal ultrasound (TRUS) system is optimized for the specific application of ultrasound-guided prostate brachytherapy. The ability to delineate the prostate from surrounding tissue during TRUS-guided prostate brachytherapy is vital for treatment planning, and consequently, so is the contrast resolution. This study describes the development of task-specific contrast-detail phantoms with clinically relevant contrast and spherical target sizes for contrast-detail performance evaluation of TRUS systems used in the brachytherapy procedure. The procedure for objective assessment of the contrast detectability of the TRUS systems is also described; a program was developed in MATLAB (R2017a, The MathWorks, Natick, MA, USA) to quantitatively analyze image quality in terms of the lesion signal-to-noise ratio (LSNR) and validated with representative control test images. The LSNR of the Hitachi EUB-7500A (2013, Hitachi, Ltd, Tokyo, Japan) TRUS system was measured on sagittal and transverse TRUS images of the contrast-detail phantoms described in this work. Results revealed the efficacy of the device as an image quality evaluation tool and the impact of the size, depth and relative contrast of the targets to the surrounding tissue on the contrast detectability of a TRUS system for both transducer arrays. The MATLAB program objectively measured the contrast detectability of the TRUS system and has the potential to determine optimized imaging parameters that could be designed as part of standardization of the imaging protocol used in TRUS-guided prostate brachytherapy for prostate cancer.
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Affiliation(s)
- Andrea Jane Doyle
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Dervil Cody
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland
| | - Silvin Knight
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | | | - Francis J Sullivan
- Prostate Cancer Institute, National University of Ireland Galway, Galway, Ireland; Department of Radiotherapy, Galway Clinic, Galway, Ireland
| | - Jacinta E Browne
- School of Physics and Clinical and Optometric Sciences, Medical Ultrasound Physics and Technology Group, Centre for Industrial and Engineering Optics, Focas, Technological University Dublin, Dublin, Ireland; Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Tsumura H, Tanaka N, Oguchi T, Owari T, Nakai Y, Asakawa I, Iijima K, Kato H, Hashida I, Tabata KI, Satoh T, Ishiyama H. Comparative effectiveness of low-dose-rate brachytherapy with or without external beam radiotherapy in favorable and unfavorable intermediate-risk prostate cancer. Sci Rep 2022; 12:11023. [PMID: 35773371 PMCID: PMC9246877 DOI: 10.1038/s41598-022-15028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
We compared clinical outcomes associated with seed brachytherapy (SEED-BT) alone and SEED-BT plus external-beam radiotherapy (EBRT) for intermediate-risk prostate cancer using propensity score-matched analysis. From 2006 to 2011, 993 patients diagnosed with intermediate-risk were treated with either SEED-BT alone (n = 775) or SEED-BT plus EBRT (n = 158) at 3 tertiary hospitals. In the propensity score-matched analysis (102 pairs), median follow-up was 95 months (range 18–153 months). The 8-year biochemical recurrence-free rate (bRFR) was significantly better with SEED-BT alone than with combined radiotherapy (93.3% vs. 88.4%; HR 0.396; 95% CI 0.158–0.991). Grade 2 or greater late genitourinary toxicities were significantly fewer with SEED-BT alone than with combined radiotherapy (21.0% vs. 33.2%; HR 0.521; 95% CI 0.308–0.881). Similarly, grade 2 or greater late gastrointestinal toxicities were significantly fewer with SEED-BT alone (0% vs. 12.2%; HR 0.125; 95% CI 0.040–0.390). For the unfavorable intermediate-risk subgroups, SEED-BT alone yielded a significantly better bRFR than the combined radiotherapy (HR 0.325; 95% CI 0.115–0.915). SEED-BT alone might be a better disease-management plan than SEED-BT plus EBRT for intermediate-risk prostate cancer regardless of favorable and unfavorable characteristics.
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Affiliation(s)
- Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Tomohiko Oguchi
- Department of Urology, Nagano Municipal Hospital, Nagano, Japan
| | - Takuya Owari
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Isao Asakawa
- Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
| | | | - Haruaki Kato
- Department of Urology, Nagano Municipal Hospital, Nagano, Japan
| | - Iwao Hashida
- Department of Radiation Therapy, Nagano Municipal Hospital, Nagano, Japan
| | - Ken-Ichi Tabata
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hiromichi Ishiyama
- Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
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Kocsis ZS, Major T, Pesznyák C, Mihály D, Stelczer G, Kun-Gazda M, Farkas G, Székely G, Ágoston P, Jorgo K, Gesztesi L, Polgár C, Jurányi Z. Relationship between biodosimetric parameters and treatment volumes in three types of prostate radiotherapy. Sci Rep 2021; 11:24406. [PMID: 34949762 PMCID: PMC8702546 DOI: 10.1038/s41598-021-03417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/26/2021] [Indexed: 11/09/2022] Open
Abstract
Brachytherapy (BT) and external beam radiotherapy (EBRT) apply different dose rates, overall treatment times, energies and fractionation. However, the overall impact of these variables on the biological dose of blood is neglected. As the size of the irradiated volume influences the biological effect as well, we studied chromosome aberrations (CAs) as biodosimetric parameters, and explored the relationship of isodose surface volumes (ISVs: V1%, V1Gy, V10%, V10Gy, V100%, V150%) and CAs of both irradiation modalities. We performed extended dicentrics assay of lymphocytes from 102 prostate radiotherapy patients three-monthly for a year. Aberration frequency was the highest after EBRT treatment. It increased after the therapy and did not decrease significantly during the first follow-up year. We showed that various types of CAs 9 months after LDR BT, 3 months after HDR BT and in a long time-range (even up to 1 year) after EBRT positively correlated with ISVs. Regression analysis confirmed these relationships in the case of HDR BT and EBRT. The observed differences in the time points and aberration types are discussed. The ISVs irradiated by EBRT showed stronger correlation and regression relationships with CAs than the ISVs of brachytherapy.
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Affiliation(s)
- Zsuzsa S Kocsis
- Department of Radiobiology and Diagnostic Onco-Cytogenetics, Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Tibor Major
- Department of Oncology, Semmelweis University, Budapest, Hungary. .,Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
| | - Csilla Pesznyák
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Dalma Mihály
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Gábor Stelczer
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Márta Kun-Gazda
- Department of Radiobiology and Diagnostic Onco-Cytogenetics, Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Gyöngyi Farkas
- Department of Radiobiology and Diagnostic Onco-Cytogenetics, Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Gábor Székely
- Department of Radiobiology and Diagnostic Onco-Cytogenetics, Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Péter Ágoston
- Department of Oncology, Semmelweis University, Budapest, Hungary.,Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Kliton Jorgo
- Department of Oncology, Semmelweis University, Budapest, Hungary.,Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - László Gesztesi
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Csaba Polgár
- Department of Oncology, Semmelweis University, Budapest, Hungary.,Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Zsolt Jurányi
- Department of Radiobiology and Diagnostic Onco-Cytogenetics, Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
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High-dose-rate brachytherapy as monotherapy for localized prostate cancer using three different doses - 14 years of single-centre experience. J Contemp Brachytherapy 2020; 12:533-539. [PMID: 33437300 PMCID: PMC7787203 DOI: 10.5114/jcb.2020.101685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/16/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose To evaluate clinical outcomes in patients with localized prostate cancer (LPC) treated with 3D conformal high-dose-rate (HDR) brachytherapy (BT) as monotherapy. Material and methods From March 2004 to November 2017, 277 men with LPC underwent 3D conformal HDR-BT as monotherapy, with a temporary implant. The dose prescription was: 38 Gy in 4 fractions (149 patients), 27 Gy in 2 fractions (41 patients), and 19-20 Gy in a single fraction (87 patients). Biochemical progression-free survival (bPFS), progression-free survival (PFS), and cancer-specific survival (CSS) were calculated. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicity assessment were performed using Common Terminology Criteria for Adverse Events v5.0. Results The mean age was 67 (range, 47-81) years. Overall, 145 patients were low-risk, 116 intermediate-risk, and 16 high-risk prostate cancer. After a median follow-up of six years (range, 6-160 months), bPFS, PFS, and CSS were 81%, 96%, and 97%, respectively. Dose prescription, initial prostate specific antigen (iPSA) ≥ 9,5 ng/ml, and high-risk disease resulted in prognostic factors regarding bPFS. Only G2-G3 acute or late GI and GU toxicities were observed. Conclusions HDR-BT as monotherapy is a valid and safe treatment modality for localized prostate cancer. After a long follow-up, patients receiving 19-20 Gy in a single fraction had a lower biochemical control rate compared to patients receiving 38 Gy in 4 fractions or 27 Gy in 2 fractions. Randomized prospective trials with a longer follow-up are necessary to confirm our results, and define total doses and dose per fraction for HDR-BT in patients with LPC.
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EGSnrc-based depth-dependent photon energy response and phantom scatter corrections for low-energy brachytherapy sources. Radiol Phys Technol 2020; 13:256-267. [PMID: 32816228 DOI: 10.1007/s12194-020-00578-z] [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: 01/20/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
In the present study, beam quality correction, [Formula: see text], and phantom scatter correction, kphan(r), for low-energy brachytherapy sources, 131Cs, 125I, and 103Pd, are calculated using the Monte Carlo-based EGSnrc code system as a function of the distance along the transverse axis of the source. The solid-state detectors investigated are diamond, LiF, Li2B4O7, Al2O3, and radiochromic films, such as HS, EBT, EBT2, EBT3, RTQA, XRT, and XRQA. The solid phantoms investigated are polystyrene, PMMA, virtual water, solid water, plastic water (LR), A150, RW1, RW3, and WE210. For a given detector and brachytherapy source, [Formula: see text] is independent of distance in the water phantom. Meanwhile, for a given detector, kphan(r) depends on the distance from the source for the investigated solid phantoms. Moreover, the kphan(r) values do not change with the detector type for sources 131Cs, 125I, and 103Pd at all distances. The LR and A150 phantoms are water equivalent for the investigated distances of 1-5 cm. The phantoms including solid water, virtual water, and WE210 are not water-equivalent for distances beyond 1 cm. Furthermore, PMMA, polystyrene, RW1, and RW3 are not water equivalent.
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Beaulieu L, Radford DA, Eduardo Villarreal-Barajas J. COMP report: CPQR technical quality control guidelines for low-dose-rate permanent seed brachytherapy. J Appl Clin Med Phys 2018. [PMID: 29542269 PMCID: PMC5978974 DOI: 10.1002/acm2.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology. This article contains detailed performance objectives and safety criteria for low‐dose‐rate (LDR) permanent seed brachytherapy.
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Affiliation(s)
- Luc Beaulieu
- Department of Physics, Université Laval Cancer Research Centre, Quebec, QC, Canada.,Department of Radiation Oncology, CRCHU de Québec, CHU de Québec - Université Laval, Ville de Québec, QC, Canada
| | - Dee-Ann Radford
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - J Eduardo Villarreal-Barajas
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
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Singh MKA, Parameshwarappa V, Hendriksen E, Steenbergen W, Manohar S. Photoacoustic-guided focused ultrasound for accurate visualization of brachytherapy seeds with the photoacoustic needle. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:120501. [PMID: 27924348 DOI: 10.1117/1.jbo.21.12.120501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/14/2016] [Indexed: 05/20/2023]
Abstract
An important problem in minimally invasive photoacoustic (PA) imaging of brachytherapy seeds is reflection artifacts caused by the high signal from the optical fiber/needle tip reflecting off the seed. The presence of these artifacts confounds interpretation of images. In this letter, we demonstrate a recently developed concept called photoacoustic-guided focused ultrasound (PAFUSion) for the first time in the context of interstitial illumination PA imaging to identify and remove reflection artifacts. In this method, ultrasound (US) from the transducer is focused on the region of the optical fiber/needle tip identified in a first step using PA imaging. The image developed from the US diverging from the focus zone at the tip region visualizes only the reflections from seeds and other acoustic inhomogeneities, allowing identification of the reflection artifacts of the first step. These artifacts can then be removed from the PA image. Using PAFUSion, we demonstrate reduction of reflection artifacts and thereby improved interstitial PA visualization of brachytherapy seeds in phantom and <italic<ex vivo</italic< measurements on porcine tissue.
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Affiliation(s)
- Mithun Kuniyil Ajith Singh
- University of Twente, P.O. Box 217, Biomedical Photonic Imaging Group, Enschede 7500 AE, The Netherlands
| | - Vinay Parameshwarappa
- University of Twente, P.O. Box 217, Biomedical Photonic Imaging Group, Enschede 7500 AE, The Netherlands
| | - Ellen Hendriksen
- Department of Radiation Oncology, Medisch Spectrum Twente, P.O. Box 50000, Enschede 7512 KZ, The Netherlands
| | - Wiendelt Steenbergen
- University of Twente, P.O. Box 217, Biomedical Photonic Imaging Group, Enschede 7500 AE, The Netherlands
| | - Srirang Manohar
- University of Twente, P.O. Box 217, Biomedical Photonic Imaging Group, Enschede 7500 AE, The Netherlands
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Valluru KS, Wilson KE, Willmann JK. Photoacoustic Imaging in Oncology: Translational Preclinical and Early Clinical Experience. Radiology 2016; 280:332-49. [PMID: 27429141 PMCID: PMC4976462 DOI: 10.1148/radiol.16151414] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Photoacoustic imaging has evolved into a clinically translatable platform with the potential to complement existing imaging techniques for the management of cancer, including detection, characterization, prognosis, and treatment monitoring. In photoacoustic imaging, tissue is optically excited to produce ultrasonographic images that represent a spatial map of optical absorption of endogenous constituents such as hemoglobin, fat, melanin, and water or exogenous contrast agents such as dyes and nanoparticles. It can therefore provide functional and molecular information that allows noninvasive soft-tissue characterization. Photoacoustic imaging has matured over the years and is currently being translated into the clinic with various clinical studies underway. In this review, the current state of photoacoustic imaging is presented, including techniques and instrumentation, followed by a discussion of potential clinical applications of this technique for the detection and management of cancer. (©) RSNA, 2016.
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Affiliation(s)
- Keerthi S. Valluru
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, 300 Pasteur Dr, Room H1307, Stanford, CA 94305-5621
| | - Katheryne E. Wilson
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, 300 Pasteur Dr, Room H1307, Stanford, CA 94305-5621
| | - Jürgen K. Willmann
- From the Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, 300 Pasteur Dr, Room H1307, Stanford, CA 94305-5621
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Ashida S, Yamasaki I, Tamura K, Shimamoto T, Inoue K, Kariya S, Kobayashi K, Yamagami T, Shuin T. Feasibility and early outcome of high-dose-rate Ir-192 brachytherapy as monotherapy in two fractions within 1 day for high-/very high-risk prostate cancer. Mol Clin Oncol 2016; 4:789-793. [PMID: 27123280 DOI: 10.3892/mco.2016.786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/09/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to evaluate the feasibility and preliminary outcomes of high-dose-rate (HDR)-brachytherapy as a monotherapy in two fractions within 1 day for localized prostate cancer, including high-/very high-risk cases. Among the 68 patients treated with HDR monotherapy between July 2011 and December 2014, 65 had a minimal follow-up of 12 months without adjuvant androgen deprivation therapy and were enrolled in the present study [42/65 (64.6%) exhibited high-/very high-risk diseases]. HDR monotherapy was performed in two fractions with a minimal interval of 6 h and the prescribed dose was 13.5 Gy (×2). Adverse events (AEs) were assessed using Common Terminology Criteria for Adverse Events (version 4; http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_40), and biochemical failure was assessed by the Phoenix definition. The median follow-up time was 30.1 months. The majority of patients had Grade 0-1 acute AEs. Four patients (6.2%) exhibited urinary retention, requiring a Foley catheter. Grade 3 acute AEs occurred at a frequency of 3.1% and hematuria at 1.5%. The majority of patients also exhibited Grade 0-1 chronic AEs. Grade 3 chronic AEs occurred at a frequency of 1.5% and urethral stricture at 1.5%, for which endoscopic treatment was indicated. Acute and chronic gastrointestinal AEs were uncommon, and no Grade 3 or above AEs developed. Biochemical failure occurred in 4 patients who all exhibited high-/very high-risk diseases. Kaplan-Meier estimated that 3 year biochemical failure-free survival was 91.6% overall and 88.0% in high-/very high-risk cases. The present two-fraction 1 day HDR monotherapy is feasible with minimal AEs and achieved acceptable biochemical control of localized prostate cancer, including high-/very high-risk cases, although long-term follow-up is required.
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Affiliation(s)
- Shingo Ashida
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Ichiro Yamasaki
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Kenji Tamura
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Tsutomu Shimamoto
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Shinji Kariya
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Kana Kobayashi
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic Radiology and Radiation Oncology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Taro Shuin
- Department of Urology, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
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Veccia A, Caffo O, Fellin G, Mussari S, Ziglio F, Maines F, Tomio L, Galligioni E. Impact of post-implant dosimetric parameters on the quality of life of patients treated with low-dose rate brachytherapy for localised prostate cancer: results of a single-institution study. Radiat Oncol 2015; 10:130. [PMID: 26054532 PMCID: PMC4464626 DOI: 10.1186/s13014-015-0434-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/01/2015] [Indexed: 11/12/2022] Open
Abstract
Background To assess the relationship between dosimetric parameters and the quality of life (QL) outcomes of patients with low-intermediate-risk localised prostate cancer (LPC) treated with low-dose-rate brachytherapy (LDR-BT). Materials and methods We evaluated the participants in two consecutive prospective studies of the QL of patients treated with LDR-BT for LPC. QL was evaluated by means of a patient-completed questionnaire assessing non functional [physical (PHY) and psychological (PSY) well-being, physical autonomy (POW), social relationships (REL)] and functional scales [urinary (URI), rectal (REC), and sexual (SEX) function]; a scale for erectile function (ERE) was included in the second study. Urethra (D10 ≤ 210 Gy) and rectal wall constraints (V100 ≤ 0.5 cc) were used for pre-planning dosimetry and were assessed with post planning computerized tomography one month later for each patient. Results QL was assessed in 251 LPC patients. Dosimetry did not influence the non-functional scales. As expected, a progressive impairment in sexual and erectile function was reported one month after LDR-BT, and became statistically significant after the third year. Rectal function significantly worsened after LDR-BT, but the differences progressively decreased after the 1-year assessment. Overall urinary function significantly worsened immediately after LDR-BT and then gradually improved over the next three years. Better outcomes were reported for V100 rectal wall volumes of ≤ 0.5 cc and D10 urethra values of ≤ 210 Gy. Conclusions The findings of this study show that dosimetric parameters influence only functional QL outcomes while non-functional outcomes are only marginally influenced.
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Affiliation(s)
- Antonello Veccia
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Orazio Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Giovanni Fellin
- Radiotherapy Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Salvatore Mussari
- Radiotherapy Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Francesco Ziglio
- Health Physics Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Francesca Maines
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Luigi Tomio
- Radiotherapy Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
| | - Enzo Galligioni
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie d'Oro 1, 38100, Trento, Italy.
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McGeachy P, Madamesila J, Beauchamp A, Khan R. An open-source genetic algorithm for determining optimal seed distributions for low-dose-rate prostate brachytherapy. Brachytherapy 2015; 14:692-702. [PMID: 26023047 DOI: 10.1016/j.brachy.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE An open source optimizer that generates seed distributions for low-dose-rate prostate brachytherapy was designed, tested, and validated. METHODS The optimizer was a simple genetic algorithm (SGA) that, given a set of prostate and urethra contours, determines the optimal seed distribution in terms of coverage of the prostate with the prescribed dose while avoiding hotspots within the urethra. The algorithm was validated in a retrospective study on 45 previously contoured low-dose-rate prostate brachytherapy patients. Dosimetric indices were evaluated to ensure solutions adhered to clinical standards. The SGA performance was further benchmarked by comparing solutions obtained from a commercial optimizer (inverse planning simulated annealing [IPSA]) with the same cohort of 45 patients. RESULTS Clinically acceptable target coverage by the prescribed dose (V100) was obtained for both SGA and IPSA, with a mean ± standard deviation of 98 ± 2% and 99.5 ± 0.5%, respectively. For the prostate D90, SGA and IPSA yielded 177 ± 8 Gy and 186 ± 7 Gy, respectively, which were both clinically acceptable. Both algorithms yielded reasonable dose to the rectum, with V100 < 0.3 cc. A reduction in dose to the urethra was seen using SGA. SGA solutions showed a slight prostate volume dependence, with smaller prostates (<25 cc) yielding less desirable, although still clinically viable, dosimetric outcomes. SGA plans used, on average, fewer needles than IPSA (21 vs. 24, respectively), which may lead to a reduction in urinary toxicity and edema that alters post-implant dosimetry. CONCLUSIONS An open source SGA was validated that provides a research tool for the brachytherapy community.
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Affiliation(s)
- P McGeachy
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB, Canada.
| | - J Madamesila
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB, Canada
| | - A Beauchamp
- Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB, Canada
| | - R Khan
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB, Canada; Department of Oncology, University of Calgary, AB, Canada
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A Decision Aid to Support Informed Choices for Patients Recently Diagnosed With Prostate Cancer. Cancer Nurs 2015; 38:E42-50. [DOI: 10.1097/ncc.0000000000000170] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Focal radiotherapy treatment procedures play an increasingly important role in function-preservation and organ-preservation treatment techniques. As an alternative to traditional whole-gland radiotherapy regimes, focal prostate radiotherapy may be of benefit for both primary tumor as well as locally recurrent disease. This is a review of the current literature on the topic, including patient selection, preliminary toxicity, and outcome data as well as a technical overview on treatment delivery techniques. RECENT FINDINGS Partial organ treatment in early prostate cancer (PCa) is now technically feasible with both newer external-beam and brachytherapy technology. To date, only small and generally monoinstitutional series have been published in the literature. Early feasibility and toxicity data are encouraging, and demonstrate potential advantages for the role of focal brachytherapy in early PCa. Although some advanced external-beam techniques can also be used to deliver focal therapy within the prostate, there is no relevant publication in the literature. SUMMARY Radiotherapy, especially interventional radiotherapy (brachytherapy), is a technically feasible treatment technique to deliver focal radiotherapy for PCa. To date, only preliminary results are available for all forms of interventional radiotherapy (high dose rate, low dose rate, and pulsed dose rate) for focal PCa treatment and no large cohort comparative results are published. As interventional radiotherapy (brachytherapy) as yet lacks any such long-term studies, comparative outcome data are not available to suggest differences in efficacy for one form of brachytherapy or another.
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Lediju Bell MA, Kuo NP, Song DY, Kang JU, Boctor EM. In vivo visualization of prostate brachytherapy seeds with photoacoustic imaging. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:126011. [PMID: 25531797 PMCID: PMC4272925 DOI: 10.1117/1.jbo.19.12.126011] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/02/2014] [Accepted: 10/13/2014] [Indexed: 05/18/2023]
Abstract
We conducted a canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. A fiber coupled to a 1064-nm Nd:YAG laser was inserted into high-dose-rate brachytherapy needles, which diffused light spherically. These needles were inserted through the perineum into the prostate for interstitial light delivery and the resulting acoustic waves were detected with a transrectal ultrasound probe. Postoperative computed tomography images and ex vivo photoacoustic images confirmed seed locations. Limitations with insufficient light delivery were mitigated with short-lag spatial coherence (SLSC) beamforming, providing a 10-20 dB contrast improvement over delay-and-sum (DAS) beamforming for pulse energies ranging from 6.8 to 10.5 mJ with a fiber-seed distance as large as 9.5 mm. For the same distance and the same range of energy densities, signal-to-noise ratios (SNRs) were similar while the contrast-to-noise ratio (CNR) was higher in SLSC compared to DAS images. Challenges included visualization of signals associated with the interstitial fiber tip and acoustic reverberations between seeds separated by ≤ 2 mm. Results provide insights into the potential for clinical translation to humans.
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Affiliation(s)
- Muyinatu A. Lediju Bell
- Johns Hopkins University, CISST Engineering Research Center, Baltimore, Maryland 21218, United States
- Address all correspondence to: Muyinatu A. Lediju Bell, E-mail: ; Emad M. Boctor, E-mail:
| | - Nathanael P. Kuo
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland 21218, United States
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland 21218, United States
| | - Danny Y. Song
- Johns Hopkins University School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, Maryland 21205, United States
| | - Jin U. Kang
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland 21218, United States
| | - Emad M. Boctor
- Johns Hopkins University, CISST Engineering Research Center, Baltimore, Maryland 21218, United States
- Johns Hopkins University, Department of Electrical and Computer Engineering, Baltimore, Maryland 21218, United States
- Johns Hopkins University, School of Medicine, Department of Radiology, Baltimore, Maryland 21205, United States
- Address all correspondence to: Muyinatu A. Lediju Bell, E-mail: ; Emad M. Boctor, E-mail:
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Axiak-Bechtel SM, Upendran A, Lattimer JC, Kelsey J, Cutler CS, Selting KA, Bryan JN, Henry CJ, Boote E, Tate DJ, Bryan ME, Katti KV, Kannan R. Gum arabic-coated radioactive gold nanoparticles cause no short-term local or systemic toxicity in the clinically relevant canine model of prostate cancer. Int J Nanomedicine 2014; 9:5001-11. [PMID: 25378926 PMCID: PMC4218919 DOI: 10.2147/ijn.s67333] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Gum arabic-coated radioactive gold nanoparticles (GA-198AuNPs) offer several advantages over traditional brachytherapy in the treatment of prostate cancer, including homogenous dose distribution and higher dose-rate irradiation. Our objective was to determine the short-term safety profile of GA-198AuNPs injected intralesionally. We proposed that a single treatment of GA-198AuNPs would be safe with minimal-to-no evidence of systemic or local toxicity. Methods Nine dogs with spontaneously occurring prostatic cancer were treated. Injections were performed with ultrasound or computerized tomography guidance. Complete blood counts, chemistry panels, and urinalyses were performed at weekly intervals for 1 month and imaging was repeated 4 weeks postinjection. Planar scintigraphic images were obtained within 30 minutes of injection. Results No statistically significant difference was found in any hematologic or biochemical parameter studied, nor was any evidence of tumor swelling or abscessation found in eight dogs with repeat imaging; one dog died secondary to urethral obstruction 12 days following injection. At 30 minutes postinjection, an average of 53% of injected dose in seven dogs was retained in the prostate, with loss of remaining activity in the bladder and urethra; no systemic uptake was detected. Conclusion GA-198AuNP therapy had no short-term toxicity in the treatment of prostatic cancer. While therapeutic agent was found in the prostate immediately following injection, some loss of agent was detected in the bladder and urethra. Localization of radioactivity within the prostate was lower than anticipated and likely due to normal vestigial prostatic ducts. Therefore, further study of retention, dosimetry, long-term toxicity, and efficacy of this treatment is warranted prior to Phase I trials in men.
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Affiliation(s)
- Sandra M Axiak-Bechtel
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Anandhi Upendran
- Department of Physics, University of Missouri, Columbia, MO, USA ; Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA
| | - Jimmy C Lattimer
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - James Kelsey
- Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA ; Missouri University Research Reactor, Columbia, MO, USA
| | | | - Kim A Selting
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Jeffrey N Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Carolyn J Henry
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA ; Department of Internal Medicine, University of Missouri, Columbia, MO, USA
| | | | - Deborah J Tate
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Margaret E Bryan
- Department of Statistics, University of Missouri, Columbia, MO, USA
| | - Kattesh V Katti
- Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA ; Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Raghuraman Kannan
- Nanoparticle Biochem, Inc., and Shasun-NBI LLC, Columbia, MO, USA ; Department of Radiology, University of Missouri, Columbia, MO, USA
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Mashouf S, Lechtman E, Lai P, Keller BM, Karotki A, Beachey DJ, Pignol JP. Dose heterogeneity correction for low-energy brachytherapy sources using dual-energy CT images. Phys Med Biol 2014; 59:5305-16. [PMID: 25146446 DOI: 10.1088/0031-9155/59/18/5305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Permanent seed implant brachytherapy is currently used for adjuvant radiotherapy of early stage prostate and breast cancer patients. The current standard for calculation of dose around brachytherapy sources is based on the AAPM TG-43 formalism, which generates the dose in a homogeneous water medium. Recently, AAPM TG-186 emphasized the importance of accounting for tissue heterogeneities. We have previously reported on a methodology where the absorbed dose in tissue can be obtained by multiplying the dose, calculated by the TG-43 formalism, by an inhomogeneity correction factor (ICF). In this work we make use of dual energy CT (DECT) images to extract ICF parameters. The advantage of DECT over conventional CT is that it eliminates the need for tissue segmentation as well as assignment of population based atomic compositions. DECT images of a heterogeneous phantom were acquired and the dose was calculated using both TG-43 and TG-43 [Formula: see text] formalisms. The results were compared to experimental measurements using Gafchromic films in the mid-plane of the phantom. For a seed implant configuration of 8 seeds spaced 1.5 cm apart in a cubic structure, the gamma passing score for 2%/2 mm criteria improved from 40.8% to 90.5% when ICF was applied to TG-43 dose distributions.
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Affiliation(s)
- S Mashouf
- Medical Biophysics Department, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N3M5, Canada
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Wu W, Xue J, Liang P, Cheng Z, Zhang M, Mu M, Qi C. The assistant function of three-dimensional information for I125 particle implantation. IEEE J Biomed Health Inform 2014; 18:77-82. [PMID: 24108481 DOI: 10.1109/jbhi.2013.2259180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to explore the assistant function of 3-D information for I125 particle implantation of multineedle intervention under the guidance of ultrasound. The assistant function of 3-D information was verified by a simulation experiment system which consists of an ultrasound probe, an abdominal phantom, the preoperative computed tomography image of a patient, the electromagnetic tracking device, and the self-developed 3-D image navigation software with a practical and friendly graphical user interface. The simulation particle implantation experiments were divided into the two groups. The first group of experiments was performed with the aid of 3-D information. Seven days later, the second group of experiments was carried out with the aid of 2-D information. We made the statistical analysis of the experimental results obtained by nine medical students, nine interventional radiologists, and nine attending physicians. With the assistance of 3-D information, the percentage of tumor coverage increased (p < 0.01), the operation time shortened (p < 0.01), and the number of insertions reduced (p < 0.01). The assistant function of 3-D information for particle implantation of multineedle intervention under the guidance of ultrasound was technically feasible and effective.
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Camara-Lopes G, Marta GN, Leite ETT, Siqueira GSMD, Hanna SA, Silva JLFD, Camara-Lopes LH, Leite KRM. Change in the risk stratification of prostate cancer after Slide Review by a uropathologist: the experience of a reference center for the treatment of prostate cancer. Int Braz J Urol 2014; 40:454-9; discussion 460-2. [DOI: 10.1590/s1677-5538.ibju.2014.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/26/2014] [Indexed: 11/22/2022] Open
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High-dose-rate brachytherapy with two or three fractions as monotherapy in the treatment of locally advanced prostate cancer. Radiother Oncol 2014; 112:63-7. [DOI: 10.1016/j.radonc.2014.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 05/02/2014] [Accepted: 06/14/2014] [Indexed: 11/15/2022]
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Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy. J Contemp Brachytherapy 2014; 6:154-60. [PMID: 25097555 PMCID: PMC4105645 DOI: 10.5114/jcb.2014.43299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/06/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of intraoperative MRI/TRUS fusion procedure in cT3a prostate cancer patients treated with high-dose-rate (HDR) real-time brachytherapy. Material and methods Prostate gland, dominant intraprostatic lesions (DILs), and extracapsular extension (ECE) were delineated in the pre-brachytherapy magnetic resonance images (MRI) of 9 consecutive patients. The pre-implant P-CTVUS (prostate clinical target volume) was defined as the prostate seen in the transrectal ultrasound (TRUS) images. The CTVMR includedthe prostate with the ECE image (ECE-CTV) as defined on the MRI. Two virtual treatment plans were performed based on the MRI/TRUS fusion images, the first one prescribing 100% of the dose to the P-PTVUS, and the second prescribing to the PTVMR. The implant parameters and dose-volume histogram (DVH) related parameters of the prostate, OARs, and ECE were compared between both plans. Results Mean radial distance of ECE was 3.6 mm (SD: 1.1). No significant differences were found between prostate V100, V150, V200, and OARs DVH-related parameters between the plans. Mean values of ECE V100, V150, and V200 were 85.9% (SD: 15.1), 18.2% (SD: 17.3), and 5.85% (SD: 7) when the doses were prescribed to the PTVUS, whereas ECE V100, V150, and V200 were 99.3% (SD: 1.2), 45.8% (SD: 22.4), and 19.6% (SD: 12.6) when doses were prescribed to PTVMR (p = 0.028, p = 0.002 and p = 0.004, respectively). Conclusions TRUS/MRI fusion provides important information for prostate brachytherapy, allowing for better coverage and higher doses to extracapsular disease in patients with clinical stage T3a.
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Chabrera C, Font A, Caro M, Areal J, Zabalegui A. Developing a decision aid to support informed choices for newly diagnosed patients with localized prostate cancer. Cancer Nurs 2014; 38:E55-60. [PMID: 24831045 DOI: 10.1097/ncc.0000000000000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decision aids (DAs) have been developed in several health disciplines to support decision making informed by evidence, such as the benefits and risks of different treatment options. Decision aids can improve the decision-making process by reducing decisional conflict and helping patients to participate in decision making. OBJECTIVE The aim of this study was to design and develop a DA for treatment decision making in localized prostate cancer in Spain with regard to surgery, radiotherapy, or watchful waiting. INTERVENTIONS/METHODS We developed a DA based on the principles of the International Patient Decision Aid Standards Collaboration and according to the Ottawa Decision Support Framework. The structural development process involved DA developers, expert feedback, use of the Delphi method, and patient feedback. We conducted a pilot test on 34 men with localized prostate cancer. RESULTS The DA is a structured booklet. According to the International Patient Decision Aid Standards checklist, the DA scored 22 of 27 points (81.48%). The development process section scored 22 of 24 points (91.6%), and the effectiveness of the decision-making process section scored 6 of 6 (100%). The clinical pilot test yielded positive feedback regarding the design, images, understandability, usability, explanations, and amount of information in the DA. CONCLUSIONS We developed a Spanish DA with a strong quality score to help patients make an informed choice regarding their prostate cancer treatment. Future research will assess the impact of the DA and its association with improved decision making. IMPLICATIONS FOR PRACTICE This tool provides information about the risks and benefits of different treatment options and helps patients to understand the importance of their own values for informing treatment choices.
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Affiliation(s)
- Carolina Chabrera
- Author Affiliations: School of Health Science-TecnoCampus, Department of Nursing, University Pompeu Fabra, Mataró (Ms Chabrera); Department of Oncology, Catalan Institute of Oncology, Badalona (Ms Chabrera and Dr Font); Department of Radiation Oncology, Oncology Catalan Institute, Badalona (Dr Caro); Department of Urology, Germans Trias i Pujol University Hospital, Badalona (Dr Areal); and Hospital Clinic, Barcelona, Spain (Dr Zabalegui)
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Salvage Low-Dose-Rate Brachytherapy for Prostate Cancer Local Recurrence after Radical Prostatectomy: Our First three Patients. Urologia 2013; 81:46-50. [DOI: 10.5301/urologia.5000034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/20/2022]
Abstract
Purpose of the Study To present our initial experience with brachytherapy (BT) as a primary salvage procedure for the treatment of prostate cancer (PCa) local recurrence following radical retropubic prostatectomy (RRP). Methods From December 2009 to May 2010, three patients underwent salvage BT due to local recurrences of high risk PCa after extrafascial RRP without additional adjuvant therapies. Local recurrence was confirmed by prostate biopsy and the relapse was well defined by endorectal ultrasonography and magnetic resonance imaging. Metastatic screening was negative. The patients were followed-up according to the American Brachytherapy Society guidelines. Results The median dose delivered to 90% of the local relapse (D90) was 115 Gy. The three patients reached a prostate specific antigen (PSA) nadir value within the first year that remained stable at a mean follow-up of 32 months. As regards morbidity, moderate de novo urgency was reported by only one patient. Conclusions We think that our data confirms the feasibility and safety of salvage BT as a possible alternative option to external beam radiotherapy (EBRT) for the treatment of locally recurrent PCa in selected patients when performed by experienced centers. However, larger series of patients with longer follow-ups are needed to define the oncologic role of this procedure.
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Cosset JM, Mornex F, Eschwège F. Hypofractionnement en radiothérapie : l’éternel retour. Cancer Radiother 2013; 17:355-62. [DOI: 10.1016/j.canrad.2013.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
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Hannoun-Lévi JM, Peiffert D. [How to prepare the brachytherapy of the future]. Cancer Radiother 2013; 17:395-9. [PMID: 23993062 DOI: 10.1016/j.canrad.2013.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 05/27/2013] [Accepted: 06/07/2013] [Indexed: 11/26/2022]
Abstract
For more than a century, brachytherapy has been a treatment of choice for delivering a high dose in a small volume. However, over the past 15 years, this irradiation technique has stalled. Even so, brachytherapy allows the delivery of the right dose at the right place by dispensing with target volume motion and repositioning. The evolution of brachytherapy can be based on a road-map including at least the following three points: the acquisition of clinical evidence, teaching and valuation of the procedures. The evolution of brachytherapy will be also impacted by technological considerations (end of the production of low dose rate 192 iridium wires). Regarding the evolution toward a personalized treatment, brachytherapy of the future should take its place as a partner of other modern external beam radiation techniques, be performed by experimented actors (physicians, physicists, technicians, etc.) who received adequate training, and be valued in proportion to the delivered medical service.
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Affiliation(s)
- J-M Hannoun-Lévi
- Pôle de radiothérapie oncologique, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06000 Nice, France; Université Nice-Sophia Antipolis, 06000 Nice, France.
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van Nieuwenhuysen J, Waterhouse D, Bydder S, Joseph D, Ebert M, Caswell N. Survey of high-dose-rate prostate brachytherapy practice in Australia and New Zealand, 2010-2011. J Med Imaging Radiat Oncol 2013; 58:101-8. [PMID: 24529063 DOI: 10.1111/1754-9485.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 06/19/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A survey was designed to establish a baseline data set for the current routine practice of high-dose-rate prostate brachytherapy (HDR-PB) in Australia and New Zealand. Existing treatment protocols and clinical implementations are not generally known. METHODS The survey, for the 2010 and 2011 calendar years, collected data including number of patients treated; equipment used; imaging modalities; applicator verification and correction methods; dose prescriptions and normal tissue dose constraints. The number of HDR-PB patients treated was compared with the most recently published prostate cancer incidence data in Australia and in New Zealand. Total biologically equivalent doses in 2.0 Gy fractions (EQD2) were calculated for each prescription regime reported. RESULTS There were reductions, of 25-60%, in patients treated with HDR-PB from 2010 to 2011 in four departments. Prostate cancer patients are two to six times more likely to be prescribed HDR-PB in Western Australia than elsewhere in the region. There were 12 different treatment prescriptions, with EQD2 doses ranging from 73.5 to 97.6 Gy, among the 18 reported by survey respondents. Normal tissue definition methodology and dose constraints varied, and 13 of 15 departments reported that no particular published external guidelines were followed in full. CONCLUSION The high survey response rate, 15 of 17 departments, has provided a representative baseline data set of contemporary HDR-PB practice in Australia and New Zealand that may assist government and professional bodies, such as the Australasian Brachytherapy Group, in formulating recommendations, setting standards and future planning.
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Affiliation(s)
- Jane van Nieuwenhuysen
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Cosset JM, Hannoun-Lévi JM, Peiffert D, Delannes M, Pommier P, Pierrat N, Nickers P, Thomas L, Chauveinc L. Curiethérapie du cancer prostatique par implants permanents : le point en 2013. Cancer Radiother 2013; 17:111-7. [DOI: 10.1016/j.canrad.2013.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Nickers P, Blanchard P, Hannoun-Lévi JM, Bossi A, Chapet O, Guérif S. Curiethérapie prostatique de haut débit de dose. Cancer Radiother 2013; 17:118-24. [DOI: 10.1016/j.canrad.2013.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
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Online correction of catheter movement using CT in high-dose-rate prostate brachytherapy. Brachytherapy 2013; 12:260-6. [PMID: 23453680 DOI: 10.1016/j.brachy.2012.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE To present a clinical procedure that readjusts catheters to its planned positions based on pretreatment computed tomography (CT) for patients undergoing high-dose-rate (HDR) prostate brachytherapy, and evaluate the magnitude and dosimetric impact of the adjustments. METHODS AND MATERIALS Patients received a pretreatment verification CT (vCT) before each fraction. The vCT dataset was imported to the treatment-planning system and fused to the planning CT (pCT) by rigid-body registration based on the implanted fiducials within the prostate. Catheter positions in the vCT were then compared with catheter positions in the pCT in a reconstructed plane through each catheter. Any catheter with difference in penetration larger than 3 mm was manually adjusted by a radiation oncologist before treatment. To evaluate treatment quality, the patient's plan was applied to the vCT off-line and dose delivered to prostate and normal structures were compared with their planned value. RESULTS Forty-four fractions of 13 consecutive patients were treated using this method. Thirty-nine fractions had at least one catheter adjusted before treatment. A total of 651 catheters were assessed, and 194 catheters (30%) were adjusted by an average amount of 5.8 ± 1.9 mm. In eight fractions the prostate D90 would have decreased by more than 10% from the planned value (with a maximum of 32%) if the catheter displacements were not rectified. After the adjustment, the maximum deviation of D90 was 10.6%. The improvement in D90 is 24% per 1 cm of time-averaged adjustment. CONCLUSIONS Interfraction catheter motion occurs without any particular pattern. Using pretreatment CTs and restoring each catheter to its planned position ensures that the delivered treatment closely matches the treatment plan and therefore enhances the overall quality of the HDR treatment. The procedure can be readily implemented in any clinical setting.
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Maturen KE, Feng MU, Wasnik AP, Azar SF, Appelman HD, Francis IR, Platt JF. Imaging Effects of Radiation Therapy in the Abdomen and Pelvis: Evaluating “Innocent Bystander” Tissues. Radiographics 2013; 33:599-619. [DOI: 10.1148/rg.332125119] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rebond de la concentration du PSA sérique après curiethérapie de prostate : retour sur un phénomène fréquent et perturbant. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kishimoto R, Saika T, Bekku K, Nose H, Abarzua F, Kobayashi Y, Araki M, Yanai H, Nasu Y, Kumon H. The clinical impact of pathological review on selection the treatment modality for localized prostate cancer in candidates for brachytherapy monotherapy. World J Urol 2011; 30:375-8. [PMID: 21847658 DOI: 10.1007/s00345-011-0738-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022] Open
Abstract
AIM To evaluate the impact of pathological review by pathologist with genitourinary expertise (PGU) on treatment modality of localized prostate cancer, we analyzed Gleason grade (GG) migration and the final treatment decision in a cohort of patients designated for permanent prostate brachytherapy (PPB). METHODS From February 2005 to July 2010, a total of 247 patients with localized prostate cancer diagnosed by local community hospitals were referred to our hospital for PPB monotheray. All pathologic slides of prostate biopsies were reviewed by a single PGU. Patients ultimately selected their treatment modality from our recommendations based on the review. Indication for PPB monotherapy was the NCCN classification of patients as good or intermediate risk. In addition, patient with Primary GG 4 was regarded as unadapted case. RESULTS Six cases were reinterpreted as no cancer (2.4%). GG change occurred in 94 cases (38.1%) of which 77 (81.9%) were upgraded and 17 (18.1%) downgraded. Of the total 247 patients, 86 (34.8%) changed therapies and 30 (12.1%) did so based on the pathologic slide review. CONCLUSIONS Pathological review of biopsy specimens is mandatory for the determination of treatment modality especially in candidates for monotherapy of permanent prostate brachytherapy.
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Affiliation(s)
- Ryo Kishimoto
- Department of Urology, Okayama University Graduate School of Medicine, Okayama, Japan
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