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Laskar S, Manjali JJ, Chargari C, Chard J. Brachytherapy for Organ and Function Preservation in Soft-Tissue Sarcomas in Adult and Paediatric Patients. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00218-2. [PMID: 37344243 DOI: 10.1016/j.clon.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
Adjuvant radiotherapy is an integral component in the management of soft-tissue sarcomas. Brachytherapy is a very convenient and conformal way of delivering adjuvant radiotherapy in such tumours, which spares the surrounding normal tissue. Randomised studies have established the efficacy of brachytherapy in the adjuvant setting, with a 5-year local control of 80-85%. High dose rate, low dose rate and pulsed dose rate have shown equivalent local control, but high dose rate has gained popularity owing to patient convenience, radiation safety and flexibility in dose optimisation. Freehand insertion perioperative brachytherapy (intraoperative placement and postoperative treatment) is the most commonly used technique in soft-tissue sarcomas, with intraoperative radiotherapy and radioactive seed placement being the less commonly used techniques. Brachytherapy can be used as monotherapy or in combination with external beam radiotherapy, such as in cases of close/positive margins for safe dose escalation. Although the quantum of side-effects with external beam radiotherapy has considerably reduced with the evolution of technology and the introduction of intensity modulation (intensity-modulated radiotherapy), brachytherapy still scores better in terms of dose conformality, especially in recurrent tumours (previously irradiated) and when used to treat paediatric and geriatric patients.
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Affiliation(s)
- S Laskar
- Department of Radiation Oncology, Tata Memorial Centre (TMC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India.
| | - J J Manjali
- Department of Radiation Oncology, Tata Memorial Centre (TMC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - C Chargari
- Department of Radiation Oncology, Institute Gustave Roussy, France
| | - J Chard
- Department of Radiation Oncology, Westmead Hospital, Sydney, Australia
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Ling H, Huang W, Zhong W, Tan P, Zhang H, Liu Y, Chen J. Tolerance limit of external beam radiotherapy combined with low-dose rate brachytherapy in normal rabbit tissue. JOURNAL OF RADIATION RESEARCH 2023:7174994. [PMID: 37210630 DOI: 10.1093/jrr/rrad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/21/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Dosage-optimized multimodal radiotherapies that are safe for head and neck cancer patients are desirable. In this study, we investigated tissue tolerance to varying doses of external beam radiotherapy (EBRT) combined with low-dose rate brachytherapy in the neck of a rabbit model. METHODS Twenty rabbits were used in the four test groups (five each) with iodine-125 seeds implanted in the neck treated with EBRT in four doses at 50, 40, 30 and 20 Gy each. Twelve rabbits for three control groups (four each). Three months after implantation, all rabbits were euthanized, and target tissues were collected. Analyses included seed implantation assessment, histopathological evaluation, immunohistochemistry staining, terminal deoxynucleotidyl transferase dUTP nick end labeling assay, electron microscopy and statistics with the SPSS software. RESULTS Five rabbits died in the four test groups, and three rabbits died in the three control groups (one per group), which showed no significant difference by survival analysis. The calculated minimum peripheral dose was 17.6 Gy, the maximum dose near the seed was 1812.5 Gy, the D90 was 34.5 Gy and the mean dose was 124.5 Gy. In all groups that received radiation, apoptosis occurred primarily in the esophageal mucosa and corresponded to the dose of radiation; a higher dose caused a greater apoptosis, with significant difference between groups (P < 0.05). Electron microscopy of carotid arteries revealed that endothelial cells were swollen and some were shed from basement membrane, but no other noticeable tissue damages. CONCLUSIONS Limited EBRT at maximal dose (50 Gy) combined with the brachytherapy interstitially applied to the neck was tolerated well in the rabbit model.
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Affiliation(s)
- Hang Ling
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, Hunan, 410008, China
| | - Wenxiao Huang
- Department of Head and Neck Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Tongzipo Road, Yuelu District, Changsha, Hunan, 410000, China
| | - Waisheng Zhong
- Department of Head and Neck Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Tongzipo Road, Yuelu District, Changsha, Hunan, 410000, China
| | - Pingqing Tan
- Department of Head and Neck Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Tongzipo Road, Yuelu District, Changsha, Hunan, 410000, China
| | - Hailin Zhang
- Department of Head and Neck Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Tongzipo Road, Yuelu District, Changsha, Hunan, 410000, China
| | - Yong Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Xiangya Road, Kaifu District, Changsha, Hunan, 410008, China
| | - Jie Chen
- Department of Head and Neck Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Tongzipo Road, Yuelu District, Changsha, Hunan, 410000, China
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Brachytherapy in the Treatment of Soft-Tissue Sarcomas of the Extremities-A Current Concept and Systematic Review of the Literature. Cancers (Basel) 2023; 15:cancers15041133. [PMID: 36831476 PMCID: PMC9954233 DOI: 10.3390/cancers15041133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Evidence on the use of brachytherapy in soft-tissue sarcoma (STS) is sparse. Therapy regimens are determined more by local interdisciplinary tumor conferences than by standardized protocols. Patient-specific factors complicate the standardized application of therapy protocols. The individuality of the treatment makes it difficult to compare results. MATERIALS AND METHODS A comprehensive literature search was conducted, whereby the literature from a period of almost 44 years (1977-2021) was graded and included in this systematic review. For this purpose, PubMed was used as the primary database. Search string included "soft-tissue sarcoma", "brachytherapy", and "extremity." Four independent researchers reviewed the literature. Only full-text articles written in English or German were included. RESULTS Of the 175 identified studies, 70 were eligible for analysis based on the inclusion and exclusion criteria. The key points to compare were local complications, recurrence rate and correlation with margins of resection, and the use of brachytherapy regarding tumor grading. CONCLUSION Brachytherapy represents an important subset of radiotherapy techniques used in STSs, whose indications and applications are constantly evolving, and for which a local control rate of 50% to 96% has been reported as monotherapy, depending on risk factors. However, the best benefit is seen in the combination of further resection and brachytherapy, and most authors at many other centers agree with this treatment strategy.
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American Brachytherapy Society (ABS) consensus statement for soft-tissue sarcoma brachytherapy. Brachytherapy 2021; 20:1200-1218. [PMID: 34303600 DOI: 10.1016/j.brachy.2021.05.011] [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: 04/17/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Growing data supports the role of radiation therapy in the treatment of soft tissue sarcoma (STS). Brachytherapy has been used for decades in the management of STS and can be utilized as monotherapy or as a boost to external beam radiation. We present updated guidelines from the American Brachytherapy Society regarding the utilization of brachytherapy in the management of STS. METHODS AND MATERIALS Members of the American Brachytherapy Society with expertise in STS and STS brachytherapy created an updated clinical practice guideline including step-by-step details for performing STS brachytherapy based on a literature review and clinical experience. RESULTS Brachytherapy monotherapy should be considered for lower-recurrence risk patients or after a local recurrence following previous external beam radiation; a brachytherapy boost can be considered in higher-risk patents meeting implant criteria. Multiple dose/fractionation regimens are available, with determination based on tumor location and treatment intent. Techniques to limit wound complications are based on the type of wound closure; wound complication can be mitigated with a delay in the start of brachytherapy with immediate wound closure or by utilizing a staged reconstruction technique, which allows an earlier treatment start with a delayed wound closure. CONCLUSIONS These updated guidelines provide clinicians with data on indications for STS brachytherapy as well as guidelines on how to perform and deliver high quality STS brachytherapy safely with minimal toxicity.
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Zhao N, Yang R, Ren L, Fan Y, Li J, Zhang J. Dosimetric characterization of GMS BT-125-1 125 I radioactive seed with Monte Carlo simulations and experimental measurement. J Appl Clin Med Phys 2017; 18:49-57. [PMID: 28905514 PMCID: PMC5689916 DOI: 10.1002/acm2.12173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 07/10/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the dosimetric characteristics of the new GMS BT‐125‐1 125I radioactive seed, including dose rate constant, radial dose functions, and anisotropy functions. Methods Dosimetric parameters of GMS BT‐125‐1 125I seed including dose rate constant, radial dose functions, and anisotropy functions were calculated using the Monte Carlo code of MCNP5, and measured with thermoluminescent dosimeters (TLDs). The results were compared with those of PharmaSeed BT‐125‐1, PharmaSeed BT‐125‐2 125I, and model 6711 125I seeds. Results The dose rate constant of GMS BT‐125‐1 125I seed was 0.959 cGy·h−1·U−1, with the difference of 0.94%, 0.83%, and 0.73% compared with the PharmaSeed BT‐125‐1 125I seed, PharmaSeed BT‐125‐2 125I seed, and Model 6711 125I seed, respectively. For radial dose function, the differences between the Monte Carlo and the experimental g(r) results were mostly within 10%. Monte Carlo results of g(r) for GMS BT‐125‐1 125I seed were found in agreement (within 3.3%) with corresponding results for the PharmaSeed BT‐125‐2 125I seed. The largest differences were 8.1% and 6.2% compared with PharmaSeed BT‐125‐1 125I seed and model 6711 125I seed, respectively. For anisotropy function, the difference between GMS BT‐125‐1 125I seed and PharmaSeed BT‐125‐2 125I seed was typically <10%. Conclusions The measured dose rate constant, radial dose functions, and two‐dimensional anisotropy functions for the GMS BT‐125‐1 125I seed showed good agreement with the Monte Carlo results. The dose rate constant of the GMS BT‐125‐1 125I seed is similar to that of the PharmaSeed BT‐125‐1 125I seed, the PharmaSeed BT‐125‐2 125I seed, and the model 6711 125I seed. For radial dose functions and two‐dimensional anisotropy functions, the GMS BT‐125‐1 125I seed is similar to the PharmaSeed BT‐125‐2 125I seed but different from the PharmaSeed BT‐125‐1 125I seed and the model 6711 125I seed.
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Affiliation(s)
- Nan Zhao
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Li Ren
- Key Laboratory of High Energy Radiation Imaging Fundamental Science, Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Yi Fan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Junli Li
- Key Laboratory of High Energy Radiation Imaging Fundamental Science, Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Department of Engineering Physics, Tsinghua University, Beijing, China
| | - Jianguo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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