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Hannoun-Levi JM, Gimeno Morales M, Gal J, Anchuelo J, Guinot JL, Gaztañaga M, Meszaros N, Polgar C, Strnad V, Schiappa R, Gutierrez C. Very accelerated partial breast irradiation in 1 or 2 days: Late toxicity and early oncological outcome of the GEC-ESTRO VAPBI cohort. Radiother Oncol 2024; 194:110217. [PMID: 38460552 DOI: 10.1016/j.radonc.2024.110217] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To analyze late toxicity after very accelerated partial breast irradiation (VAPBI) for low-risk breast cancer. MATERIALS Methods: In this retrospective, observational, international multicenter study (HDH F20220713143949), patients with low-risk breast cancer underwent lumpectomy + vAPBI (high-dose rate multicatheter interstitial brachytherapy-MIBT). VAPBI was performed with 4(4x6.2 Gy/2d), 3(3x7.45 Gy/2d) or 1 fraction (1x16Gy or 1x18Gy/1d). Primary endpoint was late toxicity. Secondary endpoints were cumulative incidence of breast cancer local relapse (LR) and distant metastatic relapse (DMR) and specific (SS) and overall (OS) survivals. Prognostic factors for late toxicity were analyzed. RESULTS From 01/2012 to 06/2022, 516 pts with early breast cancer were enrolled. Median follow-up was 44 months [95 %CI 39-46]. Median age was 71 years [40-100]. Median tumor size was 12 mm [1-35]. VAPBI delivered 1, 3 and 4 fractions for 205pts (39.7 %), 167pts (32.4 %) and 144pts (28 %) respectively. 221 late toxicity events were observed in 168pts (32.6 %) (Fibrosis, dyschromia, pain and telangiectasia). Grade 2 and 3 late toxicities were observed in 7.2 and 0.6 % respectively (no G4) with no difference between 1 and ≥ 2 treatment days. CTV > 50 cc (p = 0.007) and V150 > 40 % (p = 0.027) were prognostic factors for G ≥ 2 late toxicity. Four-year cumulative incidence rates of LR and DMR were 2 % [95 %CI 0-3] and 1 % [95 %CI 0-2] respectively. CONCLUSIONS VAPBI based on 1 or ≥ 2 days of MIBT represents an attractive de-escalation of irradiation approach for low-risk breast cancer. Late toxicity profile appears acceptable while early oncological outcome shows encouraging local control. Longer follow-up is warranted in order to confirm these preliminary results.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University Côte d'Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France.
| | - Marta Gimeno Morales
- Department of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jocelyn Gal
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Javier Anchuelo
- Department of Radiation Oncology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jose-Luis Guinot
- Department of Radiation Oncology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Miren Gaztañaga
- Department of Radiation Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - Norbert Meszaros
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Polgar
- National Institute of Oncology and National Tumor Biology Laboratory, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
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Hannoun-Levi JM, Morales MG, Gal J, Anchuelo J, Guinot JL, Boronat MG, Meszaros N, Polgar C, Strnad V, Schiappa R, Gutierrez C. Very APBI in 1 or 2 Days: Late Toxicity and Early Oncological Outcomes of the GEC-ESTRO Cohort. Int J Radiat Oncol Biol Phys 2023; 117:S174-S175. [PMID: 37784433 DOI: 10.1016/j.ijrobp.2023.06.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To analyze late toxicity after very accelerated partial breast irradiation (VAPBI) for low-risk breast cancer. MATERIALS/METHODS In this retrospective observational international multicenter study (HDH F20220713143949) from 7 European centers, patients with low-risk breast cancer underwent lumpectomy + adjuvant VAPBI based on high-dose rate (HDR) multicatheter interstitial brachytherapy (MIB). VAPBI was performed with 4 (4 × 6.2 Gy/2 d), 3 (3 × 7.45 Gy/2 d) or 1 fraction (1 × 16 Gy or 1 × 18 Gy/1 d). Primary endpoint was late toxicity. Secondary endpoints were oncological outcome based on cumulative incidence of breast cancer local relapse (LR) and distant metastasis disease (DMD) and cause-specific (CSS) and overall (OS) survival. Prognostic factors for late toxicity were analyzed. RESULTS From 01/2012 to 06/2022, the GEC-ESTRO VAPBI cohort included 516 pts with an early breast cancer. Median follow-up was 42 months [95% CI = 39 - 44]. Median age was 71 years [40 - 100]. Median tumor size was 12 mm [1 - 46]. Tumor was mainly invasive ductal carcinoma (78%), pN0 (88.5%), with positive hormonal receptors (98.5%) and negative HER2 overexpression (96%). Patients underwent hormonal and chemo-therapy in 93.8% and 2.3% respectively. Catheter placement was performed peri or post-operatively in 50.2% and 49.8% respectively. Median time interval between surgery and VABPI was 10 days [6 - 65]. VAPBI delivered 1, 3 and 4 fractions for 205 pts (39.7%), 167 pts (32.4%) and 144 pts (28%) respectively. Median CTV was 40.7 cc [95% CI = 26.6 - 72], median V100%, V150%, D90% and Dose non-uniformity ratio (DNR) were 90.2% [95% CI = 84.1 - 97.2], 24.2% [95% CI = 18.9 - 31.6], 103.8% [95% CI = 100.1 - 107.4] and 0.28 [95% CI = 0.23 - 0.33] respectively, 211 late toxicity events were observed in 168 pts (32.6%). Fibrosis, dyschromia, pain and telangiectasia were observed in 26.7%, 7.9%, 7.2% and 0.4 respectively. Grade 2 and 3 late toxicities were observed in 7.2 and 0.6% respectively (no G4). Grade ≥2 late toxicity was observed in 8.1%, 16.7% and 3.7% after 1, 3 and 4 fractions, respectively (p = 0.004). CTV > 50 cc (p = 0.007) and V150 > 40% (p = 0.027) were prognostic factors for G≥2 late toxicity. Regarding oncological outcome, 4-year cumulative incidence of LR, RR and DMD were 2% [95% CI = 0 - 3], 1% [95% CI = 0 - 2] and 1% [95% CI = 0 - 2] respectively. CSS and OS were 98% [95% CI = 96 - 100] and 93% [95% CI = 90 - 96] respectively. No significant difference was observed in terms of oncological outcome between the 3-fractionation groups. CONCLUSION VAPBI based on 1 or 2 days of HDR MIB represents an attractive de-escalation irradiation approach for low-risk breast cancer. Late toxicity profile appears acceptable while early oncological outcome shows excellent local control. Brachytherapy technique remains a key component of clinical outcome. Longer follow-up is warranted in order to confirm these encouraging preliminary results.
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Affiliation(s)
- J M Hannoun-Levi
- Antoine Lacassagne Cancer Center, Nice, France; University Côte d'Azur, Nice, France
| | - M Gimeno Morales
- epartment of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - J Gal
- Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - J Anchuelo
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - J L Guinot
- Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - N Meszaros
- Semmelweis University, Budapest, Hungary
| | - C Polgar
- Semmelweis University, Budapest, Hungary; National Institute of Oncology, Budapest, Hungary
| | - V Strnad
- Radiation Oncology, University Clinic Erlangen, Erlangen, Germany; Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - R Schiappa
- Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - C Gutierrez
- University of Barcelona, L'Hospitalet-Barcelona, Spain; Department of Radiation Oncology, Instituto Catalan Oncologia (ICO), Barcelona, Spain
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Jimeno Fraile J, Anchuelo J, Sánchez M, Lopez S, Albendea J, Alonso A, Hermana S, Sánchez S, Ruiz-Rueda C, Nombela S, Hernanz F. Quality of life and lymphedema incidence after axillary surgery in pN1 breast cancer patients: lymphadenectomy vs. Sentinel lymph node biopsy. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01420-4] [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: 11/19/2022]
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Anchuelo J, Rivero A, Galdós P, Alonso L, Astudillo R, Navarrete P, Arrojo E, Jimeno J, Albendea J, Pinto F, Fabregat R, De Juan A, Hinojo C, Hernanz F, Merino P, Díaz de Tuesta M, Borniquel F, Mazaira J, Muñoz P, Prada P. Accelerated partial breast irradiation (APBI) in a single 18 Gy fraction with high-dose-rate brachytherapy (HDR). Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01483-6] [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: 11/19/2022]
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Prada PJ, Ferri M, Cardenal J, Blanco AG, Arrojo E, Anchuelo J, de Cerio ID, Lastra P, Fernández A, Vázquez A, Arrebola SR. Intraoperative Neurovascular Bundle Preservation with Hyaluronic Acid during Radical Brachytherapy for Localized Prostate Cancer: Technique and MicroMosfet In Vivo Dosimetry. Biomedicines 2022; 10:biomedicines10050959. [PMID: 35625695 PMCID: PMC9138225 DOI: 10.3390/biomedicines10050959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/11/2022] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To evaluate the reduction in the absorbed dose delivered to the neurovascular bundle (NB) in patients with localized prostate cancer treated with only HDR brachytherapy and NB protection with hyaluronic acid (HA) on the side of the prostate to increase the distance from NB to the radioactive sources. Methods: This is the first published report in the medical literature that studies a new approach to decrease neurovascular bundle toxicity and improve quality of life for patients with prostate cancer treated with radical brachytherapy as monotherapy. Transperineal HA injection on the side of the prostate into the lateral aspect of the prostate fat was used to consistently displace several autonomic fibers and vessels on the lateral wall of the prostate away from radiation sources. Results: When a protection in the form of an HA layer is placed, the reduction effect at the maximum dose is between 46% and 54% (calculated values), which means that the method for protection is highly recommended. The values of the absorbed dose calculated in this project have been compared with the ones given by the treatment planning system. Conclusions: This newly created space decreases absorbed dose in the NB, calculated with the TPS and measured by microMOSFET due to the thickness of HA.
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Affiliation(s)
- Pedro J. Prada
- Radiation Oncology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (P.J.P.); (J.C.); (A.G.B.); (E.A.); (J.A.); (I.D.d.C.)
| | - María Ferri
- Radiation Oncology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (P.J.P.); (J.C.); (A.G.B.); (E.A.); (J.A.); (I.D.d.C.)
- Correspondence: ; Tel.: +34-942202520
| | - Juan Cardenal
- Radiation Oncology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (P.J.P.); (J.C.); (A.G.B.); (E.A.); (J.A.); (I.D.d.C.)
| | - Ana García Blanco
- Radiation Oncology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (P.J.P.); (J.C.); (A.G.B.); (E.A.); (J.A.); (I.D.d.C.)
| | - Elisabeth Arrojo
- Radiation Oncology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (P.J.P.); (J.C.); (A.G.B.); (E.A.); (J.A.); (I.D.d.C.)
| | - Javier Anchuelo
- Radiation Oncology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (P.J.P.); (J.C.); (A.G.B.); (E.A.); (J.A.); (I.D.d.C.)
| | - Ivan Diaz de Cerio
- Radiation Oncology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (P.J.P.); (J.C.); (A.G.B.); (E.A.); (J.A.); (I.D.d.C.)
| | - Pedro Lastra
- Radiology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain;
| | - Alejandro Fernández
- Radiology Department, Hospital Sierrallana, Torrelavega, Cantabria, 39008 Santander, Spain;
| | - Andrés Vázquez
- Radiation Physics Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (A.V.); (S.R.A.)
| | - Samuel Ruiz Arrebola
- Radiation Physics Department, Hospital Universitario Marqués de Valdecilla, Cantabria, 39008 Santander, Spain; (A.V.); (S.R.A.)
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Conde-Moreno A, Lopez F, Hervas A, Morillo V, Mendez A, Puertas M, Albarrán J, De Iturriaga A, Rico M, Vázquez de la Torre M, Ots P, Romasanta L, Peidro J, Ibañez C, Ferrer F, Zapatero A, Anchuelo J, Rodriguez A, Albiach C. Phase II Trial of SBRT and Androgen Deprivation for Oligometastases in Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Cañón V, Anchuelo J, Diaz de Cerio I, Cardenal J, Ferri M, Garcia Blanco A, Corro U, Navarrete P, Galdós P, Rivero A, Albendea J, Astudillo R, Gutierrez M, Alonso J, Alonso L, Vidal H, Velasco S, Fabregat R, Ruiz S, Garnacho M, Aviles A, Pacheco M, Prada P. PO-1489 Radiotherapy in benign pathology: treatment of lymphorrheas. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07940-8] [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: 10/20/2022]
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Salmón-González Z, Anchuelo J, Borregán JC, Del Real A, Riancho JA, Valero C. Influence of hyperbaric oxygen therapy on bone metabolism in patients with neoplasm. ACTA ACUST UNITED AC 2021; 26:163-169. [PMID: 34211765 DOI: 10.5603/rpor.a2021.0022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/30/2021] [Indexed: 11/25/2022]
Abstract
Background Hyperbaric oxygen therapy (HBOT) is useful in the treatment of complications due to radiotherapy in patients with neoplasm. Its effects on bone metabolism are unclear. In our study, we analyzed the effects of HBOT on bone remodeling in oncological patients with radiotherapy. Materials and methods Prospective clinical study in 23 patients with neoplasms undergoing treatment with HBOT due to complications of radiotherapy (hemorrhagic cystitis, proctitis or radionecrosis) and 25 patients with chronic anal fissure. The average number of HBOT sessions was 20 ± 5 (100% oxygen, 2.3 atmospheres and 90 min per day). Serum levels of aminoterminal propeptide of type I collagen (P1NP), C terminal telopeptide of type I collagen (CTX), alkaline phosphatase (AP), 25hydroxyvitamin D (25-OHD), parathyroid hormone (PTH), were measured at 3 time points: T0 (before beginning HBOT), T1 (at the end of HBOT) and T2 (6 months after HBOT). Results At baseline, the patients with neoplasm have higher bone turnover than those with anal fissure. These differences were 41% in CTX (0.238 ± 0.202 ng/mL in neoplasm and 0.141 ± 0.116 ng/mL in fissure; p = 0.04), 30% for PTH (46 ± 36 pg/mL in neoplasm and 32 ± 17 pg/mL in fissure; p = 0.04) and 15% for alkaline phosphatase (80 ± 24 U/L in neoplasm and 68 ± 16 U/L in fissure; p = 0.04). In the group with neoplasm, the values of P1NP decreased 6% after HBOT (T0: 49 ± 31 ng/mL, T2: 46 ± 12 ng/mL; p = 0.03). Also, there were non-significant decreases in PTH (-34%) and CTX (-30%). Conclusions Patients with neoplasm and complications with radiotherapy have an increase in bone remodeling that may be diminished after HBOT.
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Affiliation(s)
- Zaida Salmón-González
- Department of Internal Medicine, Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Javier Anchuelo
- Service of Radiation Oncology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Juan C Borregán
- Service of Intensive Care, Hospital Marqués de Valdecilla Santander, Spain
| | - Alvaro Del Real
- Department of Internal Medicine, Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - José A Riancho
- Department of Internal Medicine, Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Carmen Valero
- Department of Internal Medicine, Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
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Anchuelo J, Rivero A, Galdós P, Hernanz F, Jaime J, Muñoz P, Estévez J, Paz L, Prada P. Patients reported outcomes (PRO) in breast conserving treatment. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30837-6] [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: 11/16/2022]
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Salmón-González Z, Anchuelo J, Borregán JC, Real AD, Sañudo C, García Ibarbia C, Pérez Nuñez MI, Riancho JA, Valero C. Influencia del oxígeno a alta concentración en cámara hiperbárica sobre el metabolismo óseo. Rev Osteoporos Metab Miner 2020. [DOI: 10.4321/s1889-836x2020000100005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ruiz-Arrebola S, Fabregat-Borrás R, Rodríguez E, Fernández-Montes M, Pérez-Macho M, Ferri M, García A, Cardenal J, Pacheco MT, Anchuelo J, Tornero-López AM, Prada PJ, Guirado D. Characterization of microMOSFET detectors for in vivo dosimetry in high-dose-rate brachytherapy with 192 Ir. Med Phys 2020; 47:2242-2253. [PMID: 32031263 DOI: 10.1002/mp.14080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/01/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The objective of this study was to characterize the Best Medical Canada microMOSFET detectors for their application in in vivo dosimetry for high-dose-rate brachytherapy (HDRBT) with 192 Ir. We also developed a mathematical model to correct dependencies under the measurement conditions of these detectors. METHODS We analyzed the linearity, reproducibility, and interdetector variability and studied the microMOSFET response dependence on temperature, source-detector distance, and angular orientation of the receptor with respect to the source. The correction model was applied to 19 measurements corresponding to five simulated treatments in a custom phantom specifically designed for this purpose. RESULTS The detectors (high bias applied in all measurements) showed excellent linearity up to 160 Gy. The response dependence on source-detector distance varied by (8.65 ± 0.06)% (k = 1) for distances between 1 and 7 cm, and the variation with temperature was (2.24 ± 0.05)% (k = 1) between 294 and 310 K. The response difference due to angular dependence can reach (10.3 ± 1.3)% (k = 1). For the set of measurements analyzed, regarding angular dependences, the mean difference between administered and measured doses was -4.17% (standard deviation of 3.4%); after application of the proposed correction model, the mean difference was -0.1% (standard deviation of 2.2%). For the treatments analyzed, the average difference between calculations and measures was 4.7% when only the calibration coefficient was used, but it is reduced to 0.9% when the correction model is applied. CONCLUSION Important response dependencies of microMOSFET detectors used for in vivo dosimetry in HDRBT treatments, especially the angular dependence, can be adequately characterized by a correction model that increases the accuracy of this system in clinical applications.
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Affiliation(s)
- Samuel Ruiz-Arrebola
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Rosa Fabregat-Borrás
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Eduardo Rodríguez
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Manuel Fernández-Montes
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Mercedes Pérez-Macho
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - María Ferri
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Ana García
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Juan Cardenal
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - María T Pacheco
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Javier Anchuelo
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Ana M Tornero-López
- Servicio de Radiofísica y Protección Radiológica, Hospital Universitario Dr. Negrín, Gran Canaria, Spain
| | - Pedro J Prada
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Damián Guirado
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospital Clínico Universitario San Cecilio, Unidad de Radiofísica, Granada, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
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Prada PJ, Cardenal J, García Blanco A, Andreescu J, Ferri M, Anchuelo J, Diaz de Cerio I, Sierrasesumaga N, Vázquez A, Pacheco M, Ruiz Arrebola S. Focal high-dose-rate brachytherapy for localized prostate cancer: toxicity and preliminary biochemical results. Strahlenther Onkol 2020; 196:222-228. [PMID: 31942652 DOI: 10.1007/s00066-019-01561-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/09/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to evaluate the outcomes and the toxicity of focal high-dose-rate (HDR) brachytherapy in selected localized prostate cancer patients. METHODS Fifty patients were treated with focal high-dose-rate brachytherapy between March 2013 and November 2017, representing 5% of the cases treated by our group during this period. Only patients with very limited and localized tumors, according to strict criteria, were selected for the procedure. The prescribed dose for the focal volume was 24 Gy. RESULTS The treated volume corresponded to a mean value of 32% of the total prostatic volume. The mean focal D90 in our series was 23 Gy (range 16-26 Gy). The mean initial IPSS was 8.2 (range 0-26), at 6 months 7.5 (range 0-23), and at 24 months 6.7 (range 0-18). No acute or late urinary retention was seen. When the ICIQ-SF score was 0 at the end of treatment, it remained nil thereafter at 1 and 2 years for all patients. No intraoperative or perioperative complications occurred. No rectal toxicity was reported after treatment. Of the total patients identified as potent, only three patients had a very slight decrease of the mean IIEF5. The mean initial PSA was 6.9 ng/mL (range 1.9-13.4). At the last follow-up visit, the mean PSA was 3 ng/ml (range 0.48-8.11). CONCLUSION HDR focal brachytherapy in selected patients with low intermediate-risk prostate cancer could achieve the same satisfactory results in terms of relapse-free survival as conventional whole prostate brachytherapy with less toxicity.
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Affiliation(s)
- Pedro J Prada
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain.
| | - Juan Cardenal
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Ana García Blanco
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Jon Andreescu
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - María Ferri
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Javier Anchuelo
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Ivan Diaz de Cerio
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Nicolas Sierrasesumaga
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Andrés Vázquez
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Maite Pacheco
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Samuel Ruiz Arrebola
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Prada PJ, Ferri M, Cardenal J, Blanco AG, Anchuelo J, Díaz de Cerio I, Vázquez A, Pacheco M, Raba I, Ruiz S. High-dose-rate interstitial brachytherapy as monotherapy in one fraction of 20.5 Gy for the treatment of localized prostate cancer: Toxicity and 6-year biochemical results. Brachytherapy 2018; 17:845-851. [DOI: 10.1016/j.brachy.2018.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/18/2018] [Accepted: 06/08/2018] [Indexed: 12/01/2022]
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Prada PJ, Cardenal J, García Blanco A, Anchuelo J, Ferri M, Diaz de Cerio I, Vázquez A, Pacheco M, Ruiz Arrebola S. Long-term outcomes in patients younger than 60 years of age treated with brachytherapy for prostate cancer. Strahlenther Onkol 2017; 194:311-317. [DOI: 10.1007/s00066-017-1238-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/03/2017] [Indexed: 11/28/2022]
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Prada PJ, Anchuelo J, Blanco AG, Paya G, Cardenal J, Acuna E, Ferri M, Vazquez A, Pacheco M, Sanchez J. Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Longterm results. Int Braz J Urol 2016; 42:47-52. [PMID: 27136466 PMCID: PMC4811225 DOI: 10.1590/s1677-5538.ibju.2014.0531] [Citation(s) in RCA: 5] [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: 08/25/2014] [Accepted: 03/19/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy. Methods and Materials From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the “Phoenix consensus”. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition. Results The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function. Conclusions The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer.
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Affiliation(s)
- Pedro J Prada
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Javier Anchuelo
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Ana Garcia Blanco
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Gema Paya
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Juan Cardenal
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Enrique Acuna
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Maria Ferri
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Andres Vazquez
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Maite Pacheco
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Jesica Sanchez
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Rovirosa Á, Anchuelo J, Crispin V, Gutiérrez C, Herreros A, Herruzo I, Menéndez JC, Pino P, Polo A, Rodríguez S. Recommendations of the Spanish Brachytherapy Group of SEOR for HDR endoluminal treatments. Part 1: Oesophagus. Clin Transl Oncol 2015; 17:581-9. [DOI: 10.1007/s12094-015-1284-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022]
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Garcia A, Ferri M, Anchuelo J, Sanchez J, Cardenal J, Payá G, Prada P. PO-1046: Quantification of dosimetric uncertainty in patients treated with brachytherapy in localized prostate cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41038-2] [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: 11/16/2022]
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