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Azarcon CP, Williams PJ, Grossniklaus HE, Bergstrom C, Wells JR. INFUSION PORT SITE TUMOR SEEDING AFTER PARS PLANA VITRECTOMY-ASSISTED BIOPSY OF CHOROIDAL MELANOMA. Retin Cases Brief Rep 2024; 18:328-331. [PMID: 36580667 DOI: 10.1097/icb.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To report a rare case of infusion port site tumor seeding of choroidal melanoma after pars plana vitrectomy-assisted biopsy and successful treatment with second plaque brachytherapy. METHODS Observational case report with clinical data and diagnostic images. RESULTS A 55-year-old White woman diagnosed with choroidal melanoma of the left eye was found to have a second intraocular tumor 30 months after plaque brachytherapy and pars plana vitrectomy-assisted tumor biopsy. The second melanoma developed at the 5 o'clock vitrectomy infusion port site. The tumor regressed after plaque brachytherapy, and the patient has not developed systemic metastasis 5 years after diagnosis of intraocular seeding. CONCLUSION Intraocular seeding into the infusion port site, although rare, may be encountered after pars plana vitrectomy-assisted biopsy of choroidal melanoma.
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Affiliation(s)
- Corrina P Azarcon
- Ocular Oncology and Pathology Section, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | - Parker J Williams
- Ascension Eye Institute, Ascension Macomb-Oakland Hospital, Warren, Michigan
- Kresge Eye Institute, Wayne State University, Detroit, Michigan; and
| | - Hans E Grossniklaus
- Ocular Oncology and Pathology Section, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | - Chris Bergstrom
- Retina Consultants of Carolina, P.A., Anderson, South Carolina
| | - Jill R Wells
- Ocular Oncology and Pathology Section, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
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Gimeno-Morales M, Martínez-Monge R, Martinez-Lage A, Jablonska PA, Blanco J, Martínez-Regueira F, Rodriguez-Spiteri N, Olartecoechea B, Ramos L, Insausti LP, Elizalde A, Abengozar M, Cambeiro M. Long-term results of intraoperative multicatheter breast implant (IOMBI) for accelerated partial breast irradiation (APBI) on early breast cancer patients. Radiother Oncol 2024; 194:110193. [PMID: 38432310 DOI: 10.1016/j.radonc.2024.110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND PURPOSE Multicatheter breast brachytherapy is a standard technique for accelerated partial breast irradiation (APBI) in early breast cancer patients. Intraoperative multicatheter breast implant (IOMBI) followed by perioperative high-dose-rate brachytherapy (PHDRBT) offers a novel and advantageous approach. We present long-term oncological, toxicity, and cosmesis outcomes for a well-experienced single institution. MATERIALS AND METHODS Eligible women aged ≥ 40 years with clinically and radiologically confirmed unifocal invasive or in situ ≤ 3 cm breast tumors underwent IOMBI during breast-conserving surgery. Patients meeting APBI criteria by definitive pathologic results received 3.4 Gy × 10fx with PHDRBT. Patients not suitable for APBI received PHDRBT-boost followed by WBRT. RESULTS A total of 171 patients underwent IOMBI during BCS, 120 patients (70.1 %) were suitable for APBI and 51 (29.8 %) for anticipated PHDRBT-boost. The median age was 61 years (range: 40-78), the median tumor size was 1.1 cm (range: 0.2-3.5), with a histological diagnosis of invasive ductal carcinoma in 78.9 % and ductal in situ in 21.1 %. A median of 9 catheters (range: 4-14) were used. For APBI, the median CTV and V100 were 40.8 cc (range: 8.6-99) and 35.4 cc (range: 7.2-94). The median of healthy breast tissue irradiated represents 7.2 % (range: 2.3-28 %) and the median local treatment duration was 10 days (range: 7-16). With a median follow-up of 8.8 years (range: 0.3-16.25), the 8-year local, locoregional, and distant control rates were 99 %, 98.1 %, and 100 %. G1-G2 late-toxicity rate was 53.4 %. Long-term cosmetic evaluation was excellent-good in 90.8 %. CONCLUSION IOMBI&PHDRBT program reports excellent long-term oncological outcomes, with a reduction from unnecessary irradiation exposure which translates into low long-term toxicity and good cosmesis outcomes, especially on well-selected APBI patients.
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Affiliation(s)
- Marta Gimeno-Morales
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain.
| | - Rafael Martínez-Monge
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Adriana Martinez-Lage
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Paola Anna Jablonska
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Javier Blanco
- Medical Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Fernando Martínez-Regueira
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Natalia Rodriguez-Spiteri
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Begoña Olartecoechea
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Luis Ramos
- Departament of Medical Physic, Hospital Arnau de Villanova, Lleida, Spain
| | - Luis Pina Insausti
- Radiology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Arlette Elizalde
- Radiology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Marta Abengozar
- Pathology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Mauricio Cambeiro
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
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Hui C, Ewongwo A, Mendoza MG, Kozak MM, Jackson S, Fu J, Kidd E. Less than whole uterus irradiation for patients with locally advanced cervical cancer. Radiother Oncol 2024; 194:110199. [PMID: 38438017 DOI: 10.1016/j.radonc.2024.110199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Current consensus guidelines for definitive cervical cancer intensity modulated radiation therapy (IMRT) recommend inclusion of the entire uterus within the clinical target volume, however this is debated. We aimed to evaluate outcomes of patients with cervical cancer who were treated with less than whole uterus irradiation. METHODS We identified 109 patients with FIGO Stage IB-IVA cervical cancer treated definitively with concurrent chemoradiation, including IMRT and brachytherapy, from 2010 to 2022 at a single institution where the practice was to include the gross cervix tumor with an internal target volume with differences in bladder filing accounted for, plus additional 5 mm planning target volume (PTV) margin. Local, regional, and distant recurrences were analyzed using competing risk methods, and a Wilcoxon rank sum test was performed to assess differences in dose to organs at risk based on the proportion of the uterus included in the PTV, with the median proportion of the uterus included (75 %) used as the cut-point. RESULTS The median follow-up time was 65 months (range 3-352 months). The 2-year cumulative incidence of LR for the entire cohort was 4.2 % (95 % confidence interval [CI] 1.3-9.7). Compared with patients who had ≥ 75 % of the uterus included in the PTV, patients who had < 75 % of the uterus included in the PTV had significantly lower bowel D200cc (p = 0.02). The cumulative incidence of local failure (LR) was not significantly different between the two groups. CONCLUSIONS Including less than the whole uterus for definitive cervix cancer IMRT does not seem to compromise local control. Less than whole uterus irradiation could be considered for carefully selected cervix cancer patients to decrease bowel dose and possible treatment-related toxicity.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, United States
| | - Agnes Ewongwo
- Department of Radiation Oncology, Stanford University, United States
| | - Maria G Mendoza
- Department of Radiation Oncology, Stanford University, United States
| | - Margaret M Kozak
- Department of Radiation Oncology, UT Southwestern Medical Center, United States
| | - Scott Jackson
- Department of Radiation Oncology, Stanford University, United States.
| | - Jie Fu
- Department of Radiation Oncology, Stanford University, United States
| | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University, United States.
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Sato K, Fuchikami H, Takeda N, Natsume N, Kato M. Preliminary report on ultrashort perioperative partial-breast irradiation with multicatheter interstitial brachytherapy for early-stage breast cancer. Breast Cancer 2024; 31:382-390. [PMID: 38363473 DOI: 10.1007/s12282-024-01546-w] [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: 09/21/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Perioperative partial-breast irradiation (PBI) with multicatheter interstitial brachytherapy (MIB) is less invasive and more convenient than postoperative one. This study aimed to compare ultrashort perioperative MIB-PBI (uPBI) and conventional perioperative MIB-PBI (cPBI) performed during the same period of time. METHODS Inclusion criteria of the study were patients aged ≥ 40 years and those with T0-2 (≤ 3 cm), N0-mi, and negative margins on mammography. The locoregional recurrence (LRR) and toxicity rates were compared between uPBI at a dose of 25.2 Gy in four fractions and cPBI at a dose of 32 Gy in eight fractions. RESULTS In total, 198 patients (151 with uPBI and 47 with cPBI) were evaluated. At a median follow-up of 20.1 months, one (0.66%) patient in the uPBI group had LRR. The 2-year ipsilateral breast tumor recurrence-free survival rates of the uPBI and cPBI groups were 98.7% and 100%, respectively. The highest toxicity grades were grade 1 in 23 (15.2%) and grade 2 in 2 (1.3%) patients in the uPBI group, and grade 1 in 8 (17.0%) and grade 2 in 1 (2.1%) patient in the cPBI group. None of the patients in the two groups presented with grade 3 and higher toxicities. The toxicity rates between the two groups did not significantly differ. Further, 22 (14.6%) patients in the uPBI group and 8 (17.0%) in the cPBI group, and 3 (2.0%) patients in the uPBI group and 1 (2.1%) in the cPBI had acute and late toxicities, respectively. The timing of toxicity development between the two groups did not significantly differ. CONCLUSIONS Although this preliminary report included a small sample size and had a short follow-up period, the local control and toxicity rates were similar between the uPBI and cPBI groups. Further research is warranted to investigate the ideal dose schedule of MIB-PBI.
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Affiliation(s)
- Kazuhiko Sato
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Tokyo, Japan.
| | - Hiromi Fuchikami
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Tokyo, Japan
| | - Naoko Takeda
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Tokyo, Japan
| | - Nana Natsume
- Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, Tokyo, Japan
| | - Masahiro Kato
- Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, Tokyo, Japan
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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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Lin C, Huang H, Song L, Zhao X, Zeng J, Li L, Ge Q, Li R, Wu Z. Treatment of malignant airway obstruction with Y-shape sigma stent loaded with I 125 seeds installed via rigid bronchoscopy. BMC Pulm Med 2024; 24:201. [PMID: 38658897 DOI: 10.1186/s12890-024-03012-x] [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: 11/27/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To summarize and analyze the safety and efficacy of a Y-shape Sigma stent loaded with I125 in patients with inoperable malignant main airway obstruction. METHODS This study was approved by the Institutional Ethics Committee, and a written informed consent was obtained from each participant. A Y-shape Sigma stent loaded with I125 was placed under vision from rigid bronchoscopy. The primary endpoint was alleviation of symptoms and improvement of Karnofsky Performance Status (KPS) score, and the secondary endpoint was complications and technical success. RESULTS From November 2018 through June 2023, total 33 patients with malignant airway obstruction were palliatively treated by installing Y-shape Sigma stents loaded with I125. The airway lumen was immediately restored and the average airway opening significantly increased to 70 ± 9.4% after the procedure from baseline 30.2 ± 10.5% (p < 0.05). Average KPS score was improved from baseline 30.0 ± 10.0 to 70.0 ± 10.0 (p < 0.05) as well as PaO2 from baseline 50.1 ± 15.4 mmHg to 89.3 ± 8.6 mmHg (p < 0.05). The technical success rate of placing the stent in this study was 73%, and adverse events or complications including bleeding, I125 loss, and airway infection occurred during or after the procedure. CONCLUSION Placement of Y-shape Sigma stents under vision from rigid bronchoscopy in the patients with malignant airway obstruction is feasible and it immediately alleviates dyspnea and significantly improves quality of life.
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Affiliation(s)
- Chunlong Lin
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China.
| | - Hesong Huang
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Lixia Song
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Xixi Zhao
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Jialing Zeng
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Lun Li
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Qilong Ge
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Rui Li
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Zhiyuan Wu
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
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Li Y, Chen Z, Tian S, Han X, Wang C, Wang Y, Liu B. Stereotactic ablative brachytherapy versus percutaneous microwave ablation as salvage treatments for lung oligometastasis from colorectal cancer. BMC Cancer 2024; 24:481. [PMID: 38627695 PMCID: PMC11020186 DOI: 10.1186/s12885-024-12163-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The treatment for lung oligometastasis from colorectal cancer (CRC) remains challenging. This retrospective study aimed to compare the local tumor control, survival and procedure-related complications in CRC patients undergoing low-dose rate stereotactic ablative brachytherapy (L-SABT) versus percutaneous microwave ablation (MWA) for lung oligometastasis. METHODS Patients between November 2017 and December 2020 were retrospectively analyzed. Local tumor progression-free survival (LTPFS) and overall survival (OS) were analyzed in the entire cohort as well as by stratified analysis based on the minimal ablation margin (MAM) around the tumor. RESULTS The final analysis included 122 patients: 74 and 48 in the brachytherapy and MWA groups, respectively, with a median follow-up of 30.5 and 35.3 months. The 1- and 3-year LTPFS rate was 54.1% and 40.5% in the brachytherapy group versus 58.3% and 41.7% in the MWA group (P = 0.524 and 0.889, respectively). The 1- and 3-year OS rate was 75.7% and 48.6% versus 75.0% and 50.0% (P = 0.775 and 0.918, respectively). Neither LTPFS nor OS differed significantly between the patients with MAM of 5-10 mm versus > 10 mm. Pulmonary complication rate did not differ in the overall analysis, but was significantly higher in the MWA group in the subgroup analysis that only included patients with lesion within 10 mm from the key structures (P = 0.005). The increased complications was primarily bronchopleural fistula. CONCLUSIONS Considering the caveats associated with radioisotope use in L-SABT, MWA is generally preferable. In patients with lesion within 10 mm from the key pulmonary structures, however, L-SABT could be considered as an alternative due to lower risk of bronchopleural fistula.
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Affiliation(s)
- Yuliang Li
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
| | - Zitong Chen
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
| | - Shuhui Tian
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
| | - Xujian Han
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
- Department of Radiology, Shandong Provincial Hospital, Jinan, PR of China
| | - Changjun Wang
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
- Department of Radiology, People's Hospital of Jiyang County, Jinan, PR of China
| | - Yongzheng Wang
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China
- Interventional Oncology Institute, Shandong University, Jinan, PR of China
| | - Bin Liu
- Department of Interventional Medicine and Minimally Invasive Oncology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, PR of China.
- Interventional Oncology Institute, Shandong University, Jinan, PR of China.
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Budrukkar A, Murthy V, Kashid S, Swain M, Rangarajan V, Laskar SG, Kannan S, Kale S, Upreti R, Pai P, Pantvaidya G, Gupta T, Agarwal JP. Intensity-Modulated Radiation Therapy Alone Versus Intensity-Modulated Radiation Therapy and Brachytherapy for Early-Stage Oropharyngeal Cancers: Results From a Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2024; 118:1541-1551. [PMID: 37660737 DOI: 10.1016/j.ijrobp.2023.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The objective of this study was to compare clinical outcomes of intensity-modulated radiation therapy (IMRT) alone versus IMRT + brachytherapy (BT) in patients with T1-T2N0M0 oropharyngeal squamous cell cancers (OPSCC). METHODS AND MATERIALS This open-label randomized controlled trial was conducted at Tata Memorial Hospital, Mumbai, India. Patients with stage I and II OPSCC were considered for IMRT to a dose of 50 Gy/25 fractions/5 weeks in phase I followed by randomization (1:1) to further treatment with IMRT (20 Gy/10 fractions/2 weeks) or BT (192Ir high dose rate, 21 Gy/7 fractions/2 fractions per day). The primary endpoint of the trial was the reduction in xerostomia at 6 months evaluated using 99mTc salivary scintigraphy. Severe salivary toxicity (xerostomia) was defined as posttreatment salivary excretion fraction ratio <45%. Secondary endpoints were local control, disease-free survival, and overall survival. RESULTS Between November 2010 and February 2020, 90 patients were randomized to IMRT (n = 46) alone or IMRT + BT (n = 44). Eleven patients (8 residual/recurrent disease, 2 lost to follow-up, 1 second primary) in the IMRT arm and 9 patients (8 residual/recurrence, 1 lost to follow-up) in the BT arm were not evaluable at 6 months for the primary endpoint. At 6 months, xerostomia rates using salivary scintigraphy were 14% (5/35: 95% CI, 5%-30%) in the BT arm while it was seen in 44% (14/32: 95% CI, 26%-62%) in the IMRT arm (P = .008). Physician-rated Radiation Therapy Oncology Group grade ≥2 xerostomia at any time point was observed in 30% of patients (9/30) in the IMRT arm and 6.7% (2/30) in the BT arm (P = .02). At a median follow-up of 42.5 months, the 3-year local control in the IMRT arm was 56.4% (95% CI, 43%-73%) while it was 66.2% (95% CI, 53%-82%) in the BT arm (P = .24). CONCLUSIONS The addition of BT to IMRT for T1-T2N0M0 OPSCC results in a significant reduction in xerostomia. This strongly supports the addition of BT to IMRT in suitable cases.
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Affiliation(s)
- Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Vedang Murthy
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sheetal Kashid
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sadhana Kannan
- Clinical Research Secretariat, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shrikant Kale
- Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rituraj Upreti
- Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prathamesh Pai
- Department of Head Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Konishi M, Shimabukuro K, Hirokawa J, Sadatoki T, Katsuta T, Imano N, Nishibuchi I, Murakami Y, Kakimoto N. Radiation doses of medical radiation workers performing low-dose-rate brachytherapy with 198Au grains and 192Ir pins for patients with oral cancers. Oral Radiol 2024; 40:234-241. [PMID: 38108954 DOI: 10.1007/s11282-023-00728-0] [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: 08/22/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Low-dose-rate brachytherapy (LDR-BT) with 198Au grains and 192Ir pins is an essential treatment option for oral cancer due to its high rate of local control and low invasiveness. However, the radiation exposure of medical radiation workers is concerning. Thus, we aimed to determine the radiation dose delivered to medical radiation workers during LDR-BT using 198Au grains and 192Ir pins for oral cancer. METHODS Thirty-two patients with oral cancer underwent 198Au grain interstitial LDR-BT between June 2016 and May 2023, and 23 patients with tongue cancer underwent 192Ir pin interstitial LDR-BT between March 2015 and November 2017 at our hospital. Dosimetry was performed by attaching a dosimeter to the chest pocket of the operator and assistant during 198Au grain or 192Ir pin LDR-BT. Since the operator also loads 198Au grains into the implantation device, the operator's radiation dose includes the dose received during this preparation. RESULTS Mean radiation doses of the operators with 198Au grain and 192Ir pin LDR-BT were 165.8 and 211.2 μSv, respectively. Statistically significant differences between the radioactive sources of 198Au grain and 192Ir pin LDR-BT were observed (p = 0.0459). The mean radiation doses of the assistants with 198Au grain and 192Ir pin LDR-BT were 92.0 and 162.0 μSv, respectively. Statistically significant differences were observed between the radioactive sources of 198Au grains and 192Ir pin LDR-BT (p = 0.0003). CONCLUSIONS Regarding radioactive source differences, 192Ir pin LDR-BT resulted in higher doses delivered to medical radiation workers than 198Au grain LDR-BT.
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Affiliation(s)
- Masaru Konishi
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan.
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8553, Japan
| | - Junichi Hirokawa
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Takashi Sadatoki
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Tsuyoshi Katsuta
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
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Muñoz Muñoz Ó, Gomis Sellés E, Delgado León BD, Mateos Perez JC, Baeza Trujillo M, Perucha Ortega M, López Guerra JL, Cabrera Roldán P. Reirradiation salvage radiotherapy for recurrent prostate cancer after primary low-dose brachytherapy. Clin Transl Oncol 2024; 26:872-879. [PMID: 37672205 DOI: 10.1007/s12094-023-03315-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/06/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Local recurrence of prostate cancer after low-dose rate brachytherapy is a clinical problem with limited salvage treatment options. This prospective study evaluated the tolerability and outcome of salvage external beam radiation therapy (S-EBRT) for locally recurrent prostate cancer after primary low-dose rate prostate brachytherapy (LDR-BT). MATERIALS AND METHODS Between October 2012 and 2022, 18 patients with biopsy-proven locally recurrent prostate cancer after primary LDR-BT and received S-EBRT. We evaluated biochemical failure (BF), overall survival (OS) and acute/late gastrointestinal and urinary toxicities (CTCAE v5.0 or CTCAE v4, only before 2017). RESULTS Median follow-up was 32 months (range, 5-124). The median age was at S-EBRT 68 years (range 59-79). 34% (6/18) were low risk, 44% (8/18) intermediate risk, 5% (1/18) high risk, and 17% (3/18) not specified. All patients were treated with IMRT/VMAT and received 60 Gy (2.5 Gy/fraction) to the prostate and 40% (7/18) 55.2 Gy (2,3 Gy/fx) to the seminal vesicles. 56% received ADT The 3-year OS and biochemical relapse-free survival after S-EBRT were 100% and 89%, respectively, with a median PSA nadir 0,035 ng/mL (0,01-0,34). Acute cystitis was present in 72% (13/18) of patients (27% of Grade > 2). Urethritis was present in 78% (14/18) patients (16% of cases Grade > 3), and acute rectitis occurred in 22% (4/18) of patients (no cases Grade > 3). CONCLUSIONS Our data suggest that the treatment of locally recurrent prostate cancer with S-EBRT could provide adequate disease control safely and be used as an additional treatment in the natural history of prostate cancer patients. However, the results are still early and the sample is small; larger studies with longer follow-up would be mandatory.
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Affiliation(s)
- Óscar Muñoz Muñoz
- Department of Radiation Oncology, University Hospital Virgen del Rocío, Manuel Siurot Avenue, S/N., 41013, Seville, Spain
| | - Elías Gomis Sellés
- Department of Radiation Oncology, University Hospital Virgen del Rocío, Manuel Siurot Avenue, S/N., 41013, Seville, Spain
| | - Blas David Delgado León
- Department of Radiation Oncology, University Hospital Virgen del Rocío, Manuel Siurot Avenue, S/N., 41013, Seville, Spain
| | - Juan Carlos Mateos Perez
- Department of Medical Physiology and Biophysics, Medical Radiation Physics, University of Seville, University Hospital Virgen del Rocío, Seville, Spain
| | | | - Maria Perucha Ortega
- Department of Medical Radiation Physics, University Hospital Virgen del Rocío, Seville, Spain
| | - José Luis López Guerra
- Department of Radiation Oncology, University Hospital Virgen del Rocío, Manuel Siurot Avenue, S/N., 41013, Seville, Spain.
| | - Patricia Cabrera Roldán
- Department of Radiation Oncology, University Hospital Virgen del Rocío, Manuel Siurot Avenue, S/N., 41013, Seville, Spain
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Hasegawa N, Teh BS, Tran K, Ivey F, Olek D, Pino R, Chuang AZ, Bretana ME, Butler EB, Schefler AC. Retrospective Analysis of Radiation-Induced Complications of Uveal Melanoma Patients Treated With Brachytherapy in the Era of Anti-VEGF. Am J Ophthalmol 2024; 260:49-59. [PMID: 38081570 DOI: 10.1016/j.ajo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/19/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To associate clinical factors and radiation doses delivered by iodine-125 plaque brachytherapy to visual outcomes and development of radiation-induced ocular complications in patients with uveal melanoma in the era of anti-vascular endothelial growth factor (anti-VEGF) injections. DESIGN Retrospective cohort study. METHODS A retrospective chart review was performed for 225 patients treated with iodine-125 brachytherapy for uveal melanoma. The effects of radiation doses (focal doses, average dose to the entire eye, and integral dose) on visual outcomes and development of radiation complications (radiation retinopathy, radiation optic neuropathy, vitreous hemorrhage, and neovascular glaucoma) were analyzed using multivariate Cox regression snalysis. RESULTS Median follow-up was 33.6 months (range, 12-105.6 months). Radiation retinopathy was associated with younger age, tumor distance to optic nerve <6 mm, and maximum radiation dose to fovea. Radiation optic neuropathy was associated with White race, tumor distance to optic nerve <6 mm, and integral radiation dose. Vitreous hemorrhage was associated with White race and integral radiation dose. Incidence of neovascular glaucoma was low in our study, with 2 patients (0.9%) developing the complication. Of the 123 patients who developed radiation retinopathy, 82 patients (66.7% of radiation retinopathy patients, 37.3% of total patients) received anti-VEGF injections. CONCLUSIONS Our study found multiple associations between radiation doses and complications as well as visual outcomes on multivariate analysis. Given that the majority of our patients who developed radiation retinopathy received anti-VEGF injections, our study helps to illustrate the course and progression of radiation-induced complications in the new era of anti-VEGF.
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Affiliation(s)
- Naomi Hasegawa
- From the Department of Ophthalmology (N.H., A.Z.C.), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Bin S Teh
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Kevin Tran
- Department of Radiation Oncology (K.T.), University of Texas Medical Branch, Galveston, Texas, USA
| | - Forrest Ivey
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Devin Olek
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Ramiro Pino
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Alice Z Chuang
- From the Department of Ophthalmology (N.H., A.Z.C.), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Maria E Bretana
- Retina Consultants of Texas (M.E.B., A.C.S.), Houston, Texas, USA
| | - Edward Brian Butler
- Department of Radiation Oncology (B.S.T., F.I., D.O., R.P., E.B.B.), Houston Methodist Hospital, Houston, Texas, USA
| | - Amy C Schefler
- Retina Consultants of Texas (M.E.B., A.C.S.), Houston, Texas, USA; Blanton Eye Institute, Houston Methodist Hospital (A.C.S.), Houston, Texas, USA.
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12
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Konishi M, Shimabukuro K, Kakimoto N. Retrospective analysis of tooth extraction and osteoradionecrosis after low-dose rate brachytherapy for patients with tongue cancer. Oral Radiol 2024; 40:158-164. [PMID: 37831428 DOI: 10.1007/s11282-023-00716-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES This study aimed to investigate the incidence of osteonecrosis of the jawbones (ORN) after tooth extraction in patients undergoing low-dose rate brachytherapy (LDR-BT) and assess its safety. METHODS This study retrospectively analyzed 145 patients with tongue cancer treated at Hiroshima University Hospital from 2007 to 2021 with LDR-BT using 192Ir or 198Au alone, LDR-BT and external beam radiotherapy (EBRT) with or without chemotherapy, and LDR-BT with chemotherapy. Patients' mandible and maxilla were protected with spacers. Forty-seven patients underwent tooth extraction, and the incidence, site, and relationship of ORN with tooth extraction were recorded. A subgroup of 26 patients received additional EBRT to the neck after dissection for late cervical lymph node metastases. RESULTS Of 145 patients, six (4.1%) developed ORN on the same side of the mandible as LDR-BT, and EBRT was performed before and/or after LDR-BT on the sites where ORNs developed. Five of 47 (10.6%) patients who underwent tooth extraction after LDR-BT developed ORN. ORN incidence was 1.8% (2/109) in the LDR-BT and/or chemotherapy group and 11.1% (4/36) in the combination LDR-BT and EBRT and/or chemotherapy group for primary tongue cancer. Different irradiation methods (LDR-BT and/or chemotherapy and combination LDR-BT and EBRT and/or chemotherapy) and the presence or absence of tooth extraction showed significant differences (p = 0.0335 and p = 0.0139, respectively) with or without ORN. CONCLUSIONS Mandibular tooth extraction should be avoided on the side of LDR-BT in combined EBRT cases. However, tooth extraction is feasible using a spacer in LDR-BT and/or chemotherapy.
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Affiliation(s)
- Masaru Konishi
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Kiichi Shimabukuro
- Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Naoya Kakimoto
- Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan
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Cuenin M, Salleron J, Peiffert D, Meknaci É, Gallet P, Abushama Y, Py JF, Renard S. Interstitial brachytherapy for lip carcinomas: Comparison between Ir-192 low-dose-rate and high-dose-rate treatment. Cancer Radiother 2024; 28:145-151. [PMID: 38072744 DOI: 10.1016/j.canrad.2023.06.031] [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: 03/03/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 04/22/2024]
Abstract
PURPOSE Low-dose-rate (LDR) and high-dose-rate (HDR) interstitial brachytherapy are known to be effective in the treatment of lip carcinomas. The aim of this study was to retrospectively compare oncologic and toxicity outcomes between the two techniques. PATIENTS AND METHODS From 2007 to 2018, patients at the Institut de cancérologie de Lorraine (France) who received exclusive or adjuvant interstitial brachytherapy for lip squamous carcinomas were studied. Two groups were defined: the LDR/PDR group, including patients treated with iridium-192 wires, or pulsed-dose rate technique, and the high-dose-rate group, with patients treated by high-dose-rate technique. The dose ranged between 50Gy and 65Gy (depending on previous surgery) for low-dose-/pulsed-dose rate treatments, and 39Gy for high-dose-rate (twice a day). Early, late toxicity events and oncologic control were reported. RESULTS Among the 61 patients whose data were analyzed retrospectively, 36 received the low-dose-/pulsed-dose rate treatment (59%) and 25 the high-dose-rate brachytherapy (41%). The median follow-up time was 44 months. At 36 months, the local control rates were 96.3% for LDR/PDR group and 100% for HDR (P=0.180). The regional control rates were 85.9% and 92% without any difference according to the two groups (P=0.179). The specific overall survival rate was 95.5% with no difference between groups. There were more grade 2 or higher mucositis in the HDR group than in LDR/PDR group (40% versus 16.7%, P=0.042). One case of grade 3 mucositis was recorded in each group. No grade 3 late complications were recorded. High-dose-rate brachytherapy reduced the length of hospitalization by 2 days (P<0.001). CONCLUSION High-dose- or low-dose-/pulsed-dose rate brachytherapy seemed to be as effective and well tolerated in our experience of 61 patients.
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Affiliation(s)
- M Cuenin
- Radiation Oncology Department, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France.
| | - J Salleron
- Biostatistics Department, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - D Peiffert
- Radiation Oncology Department, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - É Meknaci
- Radiation Oncology Department, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - P Gallet
- Head and Neck Surgery Department, CHU de Nancy, Nancy, France
| | - Y Abushama
- Head and Neck Surgery Department, CHU de Nancy, Nancy, France
| | - J-F Py
- Radiation Oncology Department, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - S Renard
- Radiation Oncology Department, Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
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14
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Wickberg Å, Prag C, Valachis A, Karlsson L, Johansson B. Intraoperative Radiation Therapy Delivered by Brachytherapy in Breast Cancer: An Interim Analysis of a Phase 2 Trial. Clin Breast Cancer 2024; 24:243-252. [PMID: 38185607 DOI: 10.1016/j.clbc.2023.12.006] [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: 08/27/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Intraoperative breast cancer radiotherapy (IORT) offers an alternative to external beam radiotherapy (EBRT) after breast-conserving surgery (BCS). The Intraoperative brachytherapy (IOBT) trial applies high dose rate (HDR) brachytherapy with a new applicator prototype as IORT after BCS. In this interim analysis of the IOBT trial, we present the oncological safety and toxicity of the method METHODS: Eligible patients were women, ≥ 50 years old with an unifocal nonlobular, estrogen-receptor-positive, HER2-negative breast cancer, cN0, ≤ 3 cm, treated with BCS and sentinel node biopsy (SNB). Toxicity was registered according to the LENT-SOMA scale. Cumulative incidence of local (LR) and regional recurrence (RR) were calculated through cumulative incidence function whereas overall survival (OS) was illustrated through Kaplan-Meier curve. RESULTS Until February 2023, 155 women (median age 68 years) were included in the trial. Twenty-nine women (18.7%) received supplemental EBRT, mostly due to positive SNB. Three-year cumulative incidence of LR and RR were 1.0% (CI 95 % 0.1%-2.3%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five- year cumulative incidence of LR and RR were 3.9% (CI 95% 1.8%-6.4%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five-year OS was 96.3% (CI 95% 93.6%-98.4%). Side effects were limited, low grade, and transient. CONCLUSION Acknowledging the short median follow-up time at interim analysis, our initial results indicate that delivering IORT through HDR brachytherapy in carefully selected breast cancer patients is feasible and oncological safe so far. A long-term follow-up is essential to confirm the initial results.
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Affiliation(s)
- Åsa Wickberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden.
| | - Clara Prag
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden
| | - Leif Karlsson
- Department of medical Physics, Örebro University Hospital, Örebro, Sweden
| | - Bengt Johansson
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden
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15
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Hardy-Abeloos C, Xiao J, Oh C, Barbee D, Shah B, Maisonet O, Perez C, Adams S, Schnabel F, Axelrod D, Guth A, Karp N, Cahlon O, Gerber N. Effectiveness and toxicity of five-fraction prone accelerated partial breast irradiation. Breast Cancer Res Treat 2024; 204:485-495. [PMID: 38183516 DOI: 10.1007/s10549-023-07190-w] [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: 08/25/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Our institution was an early adopter of 5-fraction accelerated partial breast irradiation (ABPI) to treat women with early-stage breast cancer. This study reports long-term oncologic and cosmetic outcomes. METHODS We included patients receiving APBI 600 cGy × 5 fx delivered every other day or every day between 2010 and 2022. Logistic regression models were used to identify factors associated with development of late toxicities, clinician, and patient-rated cosmesis. Kaplan-Meier methodology was used to calculate overall survival (OS), disease-free survival (DFS), and locoregional recurrence-free survival (LR-RFS). RESULTS 442 patients received APBI either daily (56%) or every other day (44%) in the prone position (92%). At a median follow-up of 48 months (range: 5.96-155 months), 12 (2.7%) patients developed a local recurrence (LR). Out of 258 patients with > 3-month toxicity data available, the most common late grade ≥ 2 adverse event was breast fibrosis (6.2%). On multivariate analysis, daily APBI treatment (vs every other day) did not correlate with an increased risk of any late grade ≥ 2 toxicity though it did correlate with a lower risk of any late grade ≥ 2 fibrosis. Overall, at a median follow-up of 80 months, the rates of good-excellent physician and patient-rated cosmesis were 95% and 85%, respectively, with no difference between patients treated on consecutive vs. every other day. On multivariate analysis, patients who did not receive any adjuvant therapy were at increased risk of developing a LR. Five-year OS, LRFS, and DFS were 97.2%, 97.7%, and 89.5%, respectively. CONCLUSIONS Five-fraction APBI delivered primarily in the prone position either daily or every other day was effective with low rates of local recurrence, minimal toxicity, and excellent cosmesis at long-term follow-up.
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Affiliation(s)
- Camille Hardy-Abeloos
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Julie Xiao
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Cheongeun Oh
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - David Barbee
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Bhartesh Shah
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Olivier Maisonet
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Carmen Perez
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sylvia Adams
- Department of Medical Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Freya Schnabel
- Department of Surgical Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Deborah Axelrod
- Department of Surgical Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Amber Guth
- Department of Surgical Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Nolan Karp
- Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Oren Cahlon
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA
| | - Naamit Gerber
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, NY, USA.
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16
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Miyajima K, Sato S, Uchida N, Suzuki H, Iwatani K, Imai Y, Aikawa K, Yanagisawa T, Kimura S, Tashiro K, Tsuzuki S, Honda M, Koike Y, Miki J, Miki K, Shimomura T, Yuen S, Yamada Y, Aoki M, Takahashi H, Urabe F, Kimura T. Clinical Significance of Intraductal Carcinoma of the Prostate After High-Dose Brachytherapy With External Beam Radiation Therapy: A Single Institution Series and an Updated Meta-Analysis. Clin Genitourin Cancer 2024; 22:149-156.e1. [PMID: 38007354 DOI: 10.1016/j.clgc.2023.10.005] [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: 08/17/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND We compared oncological outcomes between prostate cancer (PCa) patients with and without intraductal carcinoma of the prostate (IDC-P) after high-dose-rate brachytherapy (HDR-BT) with external beam radiation therapy (EBRT). METHODS We performed a retrospective analysis of 138 patients with clinically high-risk, very high-risk, or locally advanced PCa who received HDR-BT with EBRT. Of these, 70 (50.7 %) patients were diagnosed with IDC-P; 68 (49.3 %) patients with acinar adenocarcinoma of prostate. The oncological outcomes, including biochemical recurrence-free survival (BCRFS) and clinical progression-free survival (CPFS), were assessed using Kaplan-Meier curves. Additionally, Cox proportional hazards models were used to identify significant prognostic indicators or biochemical recurrence (BCR). Meta-analysis of existing literatures was performed to evaluate the risk of BCR in patients with IDC-P after radiation therapy, compared to those without IDC-P. RESULTS Kaplan-Meier curves demonstrated significantly inferior BCRFS and CPFS in patients with IDC-P. Multivariate analysis revealed that IDC-P and Grade Group 5 status were associated with increased BCR risk. in our meta-analysis, IDC-P was associated with BCR (HR = 2.13, P = .003). CONCLUSION Amongst the patients who received HDR-BT, patients with IDC-P displayed significantly more rapid disease progression, compared with patients who did not have IDC-P.
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Affiliation(s)
- Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Uchida
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirotaka Suzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei University Kashiwa Hospital, Kashiwa, Chiba
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei University Kashiwa Hospital, Kashiwa, Chiba
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mariko Honda
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, Jikei University Kashiwa Hospital, Kashiwa, Chiba
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuya Shimomura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Steffi Yuen
- Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Yuta Yamada
- Department of Urology, University of Tokyo, Tokyo, Japan
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Zhang K, Wang T, Liu Z, He J, Sun X, Zhong W, Zhao F, Li X, Li S, Zhu H, Ma Z, Hu K, Zhang F, Hou X, Wei L, Zou L. Clinical characteristics and radiation therapy modality of younger patients with early-stage endometrial cancer, a multicenter study in China's real world. BMC Cancer 2024; 24:360. [PMID: 38509492 PMCID: PMC10956334 DOI: 10.1186/s12885-024-12090-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Endometrial cancer is a prevalent gynecologic malignancy found in postmenopausal women. However, in the last two decades, the incidence of early-stage has doubled in women under 40 years old. This study aimed to investigate the clinical and pathological characteristics and adjuvant therapeutic modalities of both young and not -young patients with early-stage endometrial cancer in China's real world. METHODS This retrospective study analyzed patients with early-stage endometrial cancer at 13 medical institutions in China from 1999 to 2015. The patients were divided into two groups: young (≤ 45 years old) and non-young (> 45 years old). Statistical comparisons were conducted between the two groups for clinical characteristics, pathological features, and survival. The study also identified factors that affect local recurrence-free survival (LRFS) using Cox proportional risk regression analysis. Propensity score matching (1:1) was used to compare the effects of local control between vaginal brachytherapy (VBT) alone and pelvic external beam radiotherapy (EBRT) ± VBT. RESULTS The study involved 1,280 patients, 150 of whom were 45 years old or younger. The young group exhibited a significantly higher proportion of stage II, low-risk, lower uterine segment infiltration (LUSI), and cervical invasion compared to the non-young group. Additionally, the young patients had significantly larger maximum tumor diameters. The young group also had a significantly higher five-year overall survival (OS) and a five-year LRFS. Age is an independent risk factor for LRFS. There was no significant difference in LRFS between young patients with intermediate- to high-risk early-stage endometrial cancer who received EBRT ± VBT and those who received VBT alone. CONCLUSIONS In the present study, young patients had better characteristics than the non-young group, while they exhibited higher levels of aggressiveness in certain aspects. The LRFS and OS outcomes were better in young patients. Age is an independent risk factor for LRFS. Additionally, VBT alone may be a suitable option for patients under 45 years of age with intermediate- to high-risk early-stage endometrial cancer, as it reduces the risk of toxic reactions and future second cancers while maintaining similar local control as EBRT.
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Affiliation(s)
- Kun Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Tiejun Wang
- Department of Radiation Oncology, The second hospital Affiliated by Jilin University, Changchun, People's Republic of China
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jianli He
- Department of Radiation Oncology, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Xiaoge Sun
- Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People's Republic of China
| | - Wei Zhong
- Gynaecological Oncology Radiotherapy, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Fengjv Zhao
- Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Xiaomei Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, People's Republic of China
| | - Sha Li
- Department of Radiation Oncology, The 940th Hospital of Joint Logistics Support force of Chinese People's Liberation Army, Lanzhou, Gansu, People's Republic of China
| | - Hong Zhu
- Department of Radiation Oncology, Xiangya Hospital Central South University, Changsha, Hunan, People's Republic of China
| | - Zhanshu Ma
- Department of Radiation Oncology, Affiliated Hospital of Chi feng University, Chifeng, Inner Mongolia, People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital Chin ese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, People's Republic of China.
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University of PLA (the Fourth Military Medical University, Xi'an, People's Republic of China.
| | - Lijuan Zou
- Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China.
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Wu C, Cao B, He G, Li Y, Wang W. Stereotactic ablative brachytherapy versus percutaneous microwave ablation for early-stage non-small cell lung cancer: a multicenter retrospective study. BMC Cancer 2024; 24:304. [PMID: 38448897 PMCID: PMC10916219 DOI: 10.1186/s12885-024-12055-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND To analyze the efficacy of stereotactic ablative brachytherapy (SABT) and percutaneous microwave ablation (MWA) for the treatment of early-stage non-small cell lung cancer (NSCLC). METHODS Patients with early-stage (T1-T2aN0M0) NSCLC who underwent CT-guided SABT or MWA between October 2014 and March 2017 at four medical centers were retrospectively analyzed. Survival, treatment response, and procedure-related complications were assessed. RESULTS A total of 83 patients were included in this study. The median follow-up time was 55.2 months (range 7.2-76.8 months). The 1-, 3-, and 5-year overall survival (OS) rates were 96.4%, 82.3%, and 68.4% for the SABT group (n = 28), and 96.4%, 79.7%, and 63.2% for MWA group (n = 55), respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 92.9%, 74.6%, and 54.1% for SABT, and 92.7%, 70.5%, and 50.5% for MWA, respectively. There were no significant differences between SABT and MWA in terms of OS (p = 0.631) or DFS (p = 0.836). The recurrence rate was also similar between the two groups (p = 0.809). No procedure-related deaths occurred. Pneumothorax was the most common adverse event in the two groups, with no significant difference. No radiation pneumonia was found in the SABT group. CONCLUSIONS SABT provided similar efficacy to MWA for the treatment of stage I NSCLC. SABT may be a treatment option for unresectable early-stage NSCLC. However, future prospective randomized studies are required to verify these results.
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Affiliation(s)
- Chuanwang Wu
- Department of Interventional Medicine,The Second Hospital of Shandong University, Institute of Tumor Intervention,Cheeloo college of medicine, Shandong University, Jinan City, Shandong Province, China
- Department of Fifth Internal Medicine, People's Hospital of Shizhong District, No.156 Jiefang Road, Zaozhuang City, Shandong Province, China
| | - Binglong Cao
- Department of Oncology, Qufu Hospital of Traditional Chinese Medicine, No.129 Canggeng Road, Qufu City, Shandong Province, China
| | - Guanghui He
- Department of Interventional Medicine, Weifang Second People's Hospital, Weifang city, Shandong Province, China
| | - Yuliang Li
- Department of Interventional Medicine,The Second Hospital of Shandong University, Institute of Tumor Intervention,Cheeloo college of medicine, Shandong University, Jinan City, Shandong Province, China
| | - Wujie Wang
- Department of Interventional Medicine,The Second Hospital of Shandong University, Institute of Tumor Intervention,Cheeloo college of medicine, Shandong University, Jinan City, Shandong Province, China.
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Mitsunari K, Kurata H, Ito I, Harada J, Nakamura Y, Matsuo T, Ohba K, Mochizuki Y, Imamura R. Efficacy and Safety of Brachytherapy for Localized Prostate Cancer in Renal Transplant Recipients. Transplant Proc 2024; 56:285-289. [PMID: 38320870 DOI: 10.1016/j.transproceed.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/01/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Prostate cancer is common among male renal transplant recipients and can present challenges for medical management and patient survival. It is imperative to have a comprehensive understanding of available treatment options in this population to determine the most effective and safe therapies. Brachytherapy, a safe and effective treatment for localized prostate cancer, has not been sufficiently studied in this patient population. Therefore, this study aimed to evaluate the safety and effectiveness of brachytherapy in treating prostate cancer in renal transplant recipients. METHODS We retrospectively reviewed our brachytherapy database to identify patients with a previous history of renal transplantation who underwent seed implantation for localized prostate cancer. Long-term prostate-specific antigen control and treatment-related toxicity, including graft dysfunction and urinary and rectal complications, were assessed and compared with published outcomes. Results were analyzed to evaluate the efficacy and safety of seed implantation in this patient population. RESULTS We identified 2 patients with previous renal transplantation who underwent permanent seed implantation for localized prostate cancer. Follow-ups ranged from 53 to 57 months, and both patients remained free of prostate-specific antigen progression with normal graft function. No acute and late complications occurred. CONCLUSION Brachytherapy is a safe and effective treatment option for post-renal transplant prostate cancer. Given the paucity of reports on brachytherapy in this population, the findings of this study, despite a small sample size, contribute to the increasing body of evidence supporting the use of brachytherapy in this patient population.
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Affiliation(s)
- Kensuke Mitsunari
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Hiroki Kurata
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Itsuho Ito
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junki Harada
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuichiro Nakamura
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiro Matsuo
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasushi Mochizuki
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryoichi Imamura
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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20
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Song M, Zhou X, Hou R, Sigdel M, Liu Y, Zhang C, Xu K, Han X, Jiao D. CT-guided radioactive 125I seeds brachytherapy for lung oligometastases from colorectal cancer: initial results. BMC Cancer 2024; 24:265. [PMID: 38403626 PMCID: PMC10895717 DOI: 10.1186/s12885-024-12013-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/16/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVES To evaluate the safety and effectiveness of computed tomography (CT)-guided radioactive 125I seeds brachytherapy (RISB) for lung oligometastases (LO) from colorectal cancer (CRC). METHODS Data for 144 LOs from 70 CRC patients who underwent CT-guided RISB were retrospectively analyzed. The primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were technical success, local control rate (LCR), and complications. Kaplan-Meier method was used for survival analysis. Cox model was used to identify the independent predictors of poor prognosis. RESULTS The RISB procedures were successfully performed in all patients, and the success rate was 100%. The median follow-up was 27.8 months. The median PFS was 10.0 months (95% CI: 8.9-11.1) and the 1- and 2-year PFS rates were 32.9% and 5.9%, respectively. On multivariate analysis, serum carcinoembryonic antigen (CEA) ≤ 15 ng/ml (P = 0.048), middle-high differentiated pathological classification (P = 0.015), primary TNM stages I-III (P = 0.001), LO number ≤ 2 (P < 0.001) and cumulative gross tumor volume (GTV) ≤ 40 cm3 (P < 0.001) showed superior PFS. The median OS was 30.8 months (95% CI: 27.1-34.4) and the 1-, 2-, and 3-year OS rates were 95.7%, 67.4%, and 42.5%, respectively. On multivariate analysis, serum CEA ≤ 15 ng/ml (P = 0.004), middle-high differentiated pathological classification (P < 0.001), primary TNM stages I-III (P < 0.001), LO number ≤ 2 (P < 0.001), cumulative GTV ≤ 40 cm3 (P < 0.001) and system treatments combined with chemotherapy and target therapy (P < 0.001) showed superior OS. The LCR for 3, 6, and 12 months was 97.9%, 91.0%, and 83.6%, respectively. There were 4 cases of pneumothorax at 5.7% that required drainage. CONCLUSIONS RISB for LO from CRC is safe and effective, and serum CEA, TNM stage, LO number, cumulative GTV, and system treatments should be emphasized for long OS.
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Affiliation(s)
- Mengyao Song
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Rongna Hou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Milan Sigdel
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yiming Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chengzhi Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Kaihao Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China.
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21
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Kovács G, Cellini F, Trani C, Tagliaferri L. Editorial: How intravascular brachytherapy can turn to a renaissance due to high quality assurance in radiotherapy? Cardiovasc Revasc Med 2024; 59:35-36. [PMID: 37848353 DOI: 10.1016/j.carrev.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Affiliation(s)
- György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS Educational Director, Italy.
| | - Francesco Cellini
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Carlo Trani
- Università Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy; Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy) - Interventional Oncology Center (IOC), Italy
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22
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Wang H, Mendez L, Morton G, Loblaw A, Chung HT, Cheung P, Mesci A, Escueta V, Petchiny TN, Huang X, White SD, Downes M, Vesprini D, Liu SK. Brachytherapy for high grade prostate cancer induces distinct changes in circulating CD4 and CD8 T cells - Implications for systemic control. Radiother Oncol 2024; 191:110077. [PMID: 38176656 DOI: 10.1016/j.radonc.2023.110077] [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: 08/17/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024]
Abstract
This exploratory study is a follow up to our previous investigation of immune response in the circulation of high-grade Gleason 9 prostate cancer patients treated with EBRT + BT compared to EBRT alone. Notably, EBRT + BT demonstrates the potential to elicit an effect on CD4/CD8 ratio which may have attributed to improved clinical response to therapy. Our findings show promise for leveraging circulating immune cells as predictive biomarkers for radiotherapy response.
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Affiliation(s)
- H Wang
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada
| | - L Mendez
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - G Morton
- Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - A Loblaw
- Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - H T Chung
- Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - P Cheung
- Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - A Mesci
- Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - V Escueta
- Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - T N Petchiny
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - X Huang
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - S D White
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada
| | - M Downes
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - D Vesprini
- Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - S K Liu
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
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23
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Wallner K, Kearney KE, Tiwana J, Pristera N, Kim EY, Sandison G, Lombardi WL, Phillips ML, Don C, Azzalini L, Kim M. Extreme coronary radiation doses from intravascular brachytherapy. Cardiovasc Revasc Med 2024; 59:29-34. [PMID: 37684192 DOI: 10.1016/j.carrev.2023.08.014] [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: 04/28/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE To evaluate coronary artery integrity after very high radiation doses from intravascular brachytherapy (IVBT) in the setting of source asymmetry. METHODS Ten patients treated for right coronary artery (RCA) in-stent restenosis (ISR) between 2017 and 2021 and for whom follow-up angiograms were available were identified from departmental records. Procedural angiograms, taken to document source position, were used to estimate vascular wall doses. The 2.5 mm proximal source marker was used to estimate the distance from source center to the media and adventitia. Distances were converted to dose (Gy) using the manufacturers' dose fall-off table, measured in water. Follow-up films were scrutinized for any sign of late vascular damage. RESULTS The average minimal distance from catheter center to the adjacent media and the adventitia was 0.9 mm (±0.2) mm and 1.4 mm (±0.2), respectively. The average maximum media and adventitial doses adjacent to the source were 75 Gy (±26) and 39 Gy (±14), respectively. Follow-up angiograms were available from 0.6 years to 3.9 years following IVBT (median: 1.6 years). No IVBT-treated vascular segment showed signs of degeneration, dissection or aneurysm. CONCLUSION IVBT vascular wall doses are frequently far higher than prescribed. The lack of complications in this unselected group of patients gives a modicum of reassurance that raising the prescription dose is unlikely to lead to a sudden appearance of complications.
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Affiliation(s)
- Kent Wallner
- Department of Radiation Oncology, University of Washington, Seattle, WA, United States of America.
| | - Kathleen E Kearney
- Department of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Jasleen Tiwana
- Department of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Nicole Pristera
- Department of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Edward Y Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA, United States of America
| | - George Sandison
- Department of Radiation Oncology, University of Washington, Seattle, WA, United States of America
| | - William L Lombardi
- Department of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Mark L Phillips
- Department of Radiation Oncology, University of Washington, Seattle, WA, United States of America
| | - Creighton Don
- Department of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Lorenzo Azzalini
- Department of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Minsun Kim
- Department of Radiation Oncology, University of Washington, Seattle, WA, United States of America
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24
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King MT, Orio PF, D'Amico AV. Can Extreme Dose Escalation With External Beam Radiation Therapy and Low-Dose-Rate Brachytherapy Boost Obviate the Need for Long-Term Androgen Deprivation Therapy in Patients With High-Risk Localized Prostate Cancer? Int J Radiat Oncol Biol Phys 2024; 118:402-403. [PMID: 38220257 DOI: 10.1016/j.ijrobp.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Martin T King
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Peter F Orio
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
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Chitapanarux N, Tharavichitkul E, Kittidachanan K, Muangwong P, Chakrabandhu S, Klunklin P, Onchan W, Jia-Mahasap B, Torapichattrakul P, Chitapanarux I. Retrospective Analysis of All Types of Adjuvant Radiotherapy in Endometrial Cancer: Single-Center Experiences in a Middle-Income Country. Asian Pac J Cancer Prev 2024; 25:485-494. [PMID: 38415534 DOI: 10.31557/apjcp.2024.25.2.485] [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: 08/03/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE We retrospectively analyzed the efficacy, focusing on overall survival (OS) and the patterns of failure, along with the toxicities of adjuvant radiotherapy (RT) in endometrial cancer patients. METHODS Two-hundred and nineteen patients with endometrial cancer patients who received adjuvant radiotherapy ± adjuvant chemotherapy (ACT) from January 2014 to December 2018 were investigated for overall survival (OS), local recurrence-free survival rate (LRFS), regional recurrence-free survival rate (RRFS), and distant metastasis-free survival rate (DMFS). RESULT Two-hundred and fourteen patients were evaluated. The numbers of VBT alone, EBRT plus VBT, and adjuvant chemotherapy (ACT) plus EBRT plus VBT were 65 (30.4%), 80 (37.4%), and 69 (32.2%) patients, respectively. Stage I (107 patients) was the most common followed by stage III (87 patients). With a median follow-up time of 67 months (IQR 56-78), the 5-year overall survival rates for VBT alone, EBRT plus VBT, and EBRT plus VBT plus ACT were 84.4%, 65%, and 57.4%, respectively. The most common severe (grade 3-4) acute toxicity was neutropenia (4.6%), followed by diarrhea (3.7%). Grade 3-4 late proctitis was found in only 1.9%. On multivariate analysis, advanced age (HR 6.15, p: 0.015), lymph node involvement (HR 6.66, p: 0.039), cervical involvement (HR 10.60, p: 0.029), and substantial LVSI (HR 21.46, p: 0.005) were associated with a higher risk of death. CONCLUSION Advanced age (>65), substantial LVSI, lymph node involvement, and cervical stromal involvement were associated with poor overall survival. These findings here will help identifying high-risk patients and would make it possible to avoid unnecessary adjuvant treatment among patients with a good prognosis.
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Affiliation(s)
| | | | | | - Pooriwat Muangwong
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | | | - Wimrak Onchan
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Bongkot Jia-Mahasap
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
| | | | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Thailand
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Rydzinski M, Bijok M, Michalski W, Kowalczyk A, Gruszczynska E, Zolciak-Siwinska A. Image-guided high-dose-rate brachytherapy as the method of choice in medically inoperable early-stage endometrial cancer patients. Gynecol Oncol 2024; 180:6-13. [PMID: 38035868 DOI: 10.1016/j.ygyno.2023.11.020] [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: 06/29/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE About 3-9% of patients with endometrial cancer are unable to undergo surgery due to medical comorbidities, including morbid obesity, or age-related frailty syndrome. An alternative curative option is irradiation. The aim of this prospective study was to evaluate clinical outcomes of high-dose-rate intracavitary brachytherapy (HDR-ICBT) treatment in such patients. MATERIALS AND METHODS Seventy-eight patients with FIGO stage I-II endometrial cancer disqualified from surgery were treated with HDR-ICBT with 45-52,5 Gy prescribed to high-risk clinical target volume (HR-CTV) in 5-9 fractions given once a week. All fractions were planned using computed tomography (CT) scans. RESULTS The median follow-up time was 67 months. Median age was 79 years (range: 42-93 years). Median body mass index (BMI) was 39,1 kg/m2 (range: 24,2-68 kg/m2). We observed no statistically significant impact of BMI ≥ 40 on overall survival (OS) or prgression free survival (PFS). The 3- and 5-year OS for the whole population were 69% and 55%, respectively. The impact of high risk features (FIGO II, grade 3 or type 2 cancer) on OS was significant (p = 0,049). The 5-year cumulative incidence of local failure, distant metastases and non-cancer death were 12,9% [95% CI: 5,4%-20,5%], 6,4% [95% CI: 0,9%-11,9%], 33,1% [95% CI: 22,3%-43,9%], respectively. The 5-year risk of cancer and non-cancer death were 9% (95% CI: 3%-16%) and 36% (95% CI: 25%-47%), respectively. We observed G1 vaginal apex stenosis only. CONCLUSIONS CT-guided HDR-ICBT is a feasible and safe management of FIGO stage I endometrial cancer in obese and elderly patients. The survival outcome of the treated group is influenced more by associated comorbidities than by the progression of endometrial cancer.
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Affiliation(s)
- Martin Rydzinski
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
| | - Michal Bijok
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Wojciech Michalski
- Department of Clinical Trials and Biostatistics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Adam Kowalczyk
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ewelina Gruszczynska
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Agnieszka Zolciak-Siwinska
- Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Sammouri J, Venkatesan AM, Lin LL, Jhingran A, Klopp AH, Joyner MM, Eifel PJ, Colbert LE. Management and long-term clinical outcomes of patients with stage IVA cervical cancer with bladder involvement. Gynecol Oncol 2024; 180:24-34. [PMID: 38041900 DOI: 10.1016/j.ygyno.2023.11.011] [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: 06/28/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE To describe the long-term outcomes of patients with stage IVA cervical cancer, a rare and deadly disease for which long-term toxicity data are scarce, to guide clinician counseling and survivorship support. METHODS In a retrospective review of a prospectively maintained database, we identified 76 patients with stage IVA cervical cancer with biopsy- or MRI-proven bladder mucosal involvement who received definitive radiotherapy (external beam radiotherapy [EBRT] alone or EBRT plus brachytherapy) with or without chemotherapy at our institution between 2000 and 2020. We used Kaplan-Meier modeling to estimate recurrence-free survival (RFS) and overall survival (OS) and used proportional hazard modeling to identify clinical variables associated with recurrence or survival. We performed actuarial competing risk modeling for severe late toxicity (grades 3 to 5, occurring >6 months of follow-up) and vesicovaginal fistulae (VVF), censoring for pelvic recurrence and death, and made comparisons between potential predictors using Gray's test and binary logistic regression. RESULTS The median follow-up time was 76 months (interquartile range 58-91). The median OS duration was 35 months (range, 18-not reached), and the 2- and 5-year OS rates were 53.6% and 40.9%, respectively. OS and RFS did not differ significantly between patients who received EBRT alone (N = 18) or EBRT plus brachytherapy (N = 49). Current smoking was a strong predictor of severe late toxicity, whose incidence was 14% at 2 years and 17% at 10 years. The VVF incidence was 24% at 2 years and 32% at 10 years. CONCLUSION Patients with stage IVA cervical cancer, even those who receive EBRT alone, can have long-term survival. These patients should be followed closely for late radiation-related toxicity.
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Affiliation(s)
- Julie Sammouri
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aradhana M Venkatesan
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa M Joyner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren E Colbert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Habra K, Pearson JRD, Le Vu P, Puig‐Saenz C, Cripps MJ, Khan MA, Turner MD, Sale C, McArdle SEB. Anticancer actions of carnosine in cellular models of prostate cancer. J Cell Mol Med 2024; 28:e18061. [PMID: 38018900 PMCID: PMC10826443 DOI: 10.1111/jcmm.18061] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023] Open
Abstract
Treatments for organ-confined prostate cancer include external beam radiation therapy, radical prostatectomy, radiotherapy/brachytherapy, cryoablation and high-intensity focused ultrasound. None of these are cancer-specific and are commonly accompanied by side effects, including urinary incontinence and erectile dysfunction. Moreover, subsequent surgical treatments following biochemical recurrence after these interventions are either limited or affected by the scarring present in the surrounding tissue. Carnosine (β-alanyl-L-histidine) is a histidine-containing naturally occurring dipeptide which has been shown to have an anti-tumorigenic role without any detrimental effect on healthy cells; however, its effect on prostate cancer cells has never been investigated. In this study, we investigated the effect of carnosine on cell proliferation and metabolism in both a primary cultured androgen-resistant human prostate cancer cell line, PC346Flu1 and murine TRAMP-C1 cells. Our results show that carnosine has a significant dose-dependent inhibitory effect in vitro on the proliferation of both human (PC346Flu1) and murine (TRAMP-C1) prostate cancer cells, which was confirmed in 3D-models of the same cells. Carnosine was also shown to decrease adenosine triphosphate content and reactive species which might have been caused in part by the increase in SIRT3 also shown after carnosine treatment. These encouraging results support the need for further human in vivo work to determine the potential use of carnosine, either alone or, most likely, as an adjunct therapy to surgical or other conventional treatments.
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Affiliation(s)
- K. Habra
- John van Geest Cancer Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
- Chemistry Department, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
| | - J. R. D. Pearson
- John van Geest Cancer Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
- Centre for Systems Health and integrated Metabolic Research (SHiMR), School of Science and TechnologyNottingham Trent UniversityNottinghamUK
| | - P. Le Vu
- John van Geest Cancer Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
| | - C. Puig‐Saenz
- John van Geest Cancer Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
- Centre for Systems Health and integrated Metabolic Research (SHiMR), School of Science and TechnologyNottingham Trent UniversityNottinghamUK
| | - M. J. Cripps
- Centre for Diabetes, Chronic Diseases, and Ageing, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
| | - M. A. Khan
- Department of UrologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - M. D. Turner
- Centre for Systems Health and integrated Metabolic Research (SHiMR), School of Science and TechnologyNottingham Trent UniversityNottinghamUK
- Centre for Diabetes, Chronic Diseases, and Ageing, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
| | - C. Sale
- Institute of Sport, Manchester Metropolitan UniversityManchesterUK
| | - S. E. B. McArdle
- John van Geest Cancer Research Centre, School of Science and TechnologyNottingham Trent UniversityNottinghamUK
- Centre for Systems Health and integrated Metabolic Research (SHiMR), School of Science and TechnologyNottingham Trent UniversityNottinghamUK
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Yoshida M, Yoshimura RI, Notake R, Shinjo H, Miyaura K, Kuwayama T, Kawanaka T, Shien T, Yoshio K, Shiga T, Kaneyasu Y, Nakagawa T, Kubota K, Nakamura S, Itami J. Feasibility of accelerated partial breast irradiation with strut-adjusted volume implant brachytherapy in Japan focusing on dosimetry and acute toxicity: a Japanese multi-institutional prospective study. Breast Cancer 2024; 31:75-83. [PMID: 37865624 DOI: 10.1007/s12282-023-01513-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/07/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND A Japanese multi-institutional prospective study was initiated to investigate the effectiveness and safety of accelerated partial breast irradiation (APBI) using strut-adjusted volume implant (SAVI) brachytherapy, with subjects registered between 2016 and 2021. Herein, we report the preliminary results on the feasibility of this treatment modality in Japan, focusing on the registration process, dosimetry, and acute toxicities. PATIENTS AND METHODS Primary registration was conducted before breast-conserving surgery (BCS) and the eligibility criteria included the following: age ≥ 40 years, tumor unifocal and unicentric, ≤ 3 cm in diameter, cN0M0, proven ductal, mucinous, tubular, medullary, or lobular carcinoma by needle biopsy. Secondary registration was conducted after BCS had been performed leaving a cavity for device implantation and pathological evaluations, and the eligibility criteria were as follows: negative surgical margin, tumor ≤ 3 cm in diameter on gross pathological examination, histologically confirmed ductal, mucinous, tubular medullary, colloid, or lobular carcinoma, pN0, L0V0, no extensive ductal component, no initiation of chemotherapy within 2 weeks of the brachytherapy APBI planning with SAVI was performed for the patients successfully entered in the study by the secondary registration process, and the treatment was administered at the dose of 34 Gy in 10 fractions administered twice daily. RESULTS Between 2016 and 2021, 64 women were enrolled in the study through primary registration, of which 19 were excluded from the secondary registration process, and in one, it was deemed impossible to comply with the dose constraints established during treatment planning. After the exclusion of these latter 20 patients, we treated the remaining 44 patients by APBI with SAVI. The dose constraints could be adhered to in all the patients, but re-planning was necessitated in 3 patients because of applicator movement during the treatment period. Grade 2 acute toxicities were observed in 18% of all patients, but more severe acute toxicities than Grade 2 were not observed in any of the patients. CONCLUSION APBI with SAVI brachytherapy is feasible in Japan from the aspects of compliance with dose constraints and frequency of acute toxicities.
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Affiliation(s)
- Masahiro Yoshida
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
- Department of Radiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, Japan
| | - Ryo-Ichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Ryoichi Notake
- Radiology Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Hidenori Shinjo
- Division of Radiation Oncology, Department of Radiology, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Kazunori Miyaura
- Division of Radiation Oncology, Department of Radiology, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Takashi Kuwayama
- Division of Breast Surgical Oncology, Department of Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Takashi Kawanaka
- Department of Radiology and Radiation Oncology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, Japan
| | - Kotaro Yoshio
- Department of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, Japan
| | - Toshiko Shiga
- Department of Radiology, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, Japan
| | - Yuko Kaneyasu
- Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima, Japan
| | - Tsuyoshi Nakagawa
- Department of Breast Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Minamikoshigaya 2-1-50, Koshigaya, Saitama, Japan
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University, 1-5-8 Hatanodai Shinagawa-ku, Tokyo, Japan
| | - Jun Itami
- ShinMatsudo Accuracy Radiation Therapy Center, ShinMatsudo Central General Hospital, Matsudo 1-380, Matsudo City, Chiba, Japan
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Zhong Y, Lyu X, Huang M, Zheng L, Liu S, Shi Y, Wu W, Zhang J, Zhang J. Sole brachytherapy for inoperable, recurrent, and irradiated salivary gland cancer. Radiother Oncol 2024; 190:110022. [PMID: 38043903 DOI: 10.1016/j.radonc.2023.110022] [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: 10/10/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND AND PURPOSE Salivary gland cancers (SGCs) are hard to treat when inoperable, and sole brachytherapy appears to be a promising therapeutic strategy. This study aimed to evaluate the effectiveness, safety, and capability of pain palliation using sole brachytherapy for inoperable, recurrent, and irradiated SGCs. MATERIALS AND METHODS Patients with inoperable SGCs treated using sole brachytherapy at Peking University School and Hospital of Stomatology were retrospectively included. Patients were divided into primary and recurrent groups and irradiated and non-irradiated groups. Local control (LC), overall survival (OS), radiation-relevant toxicities, and Visual Analogue Scale (VAS) score for pain, were recorded and evaluated. RESULTS A total of 176 patients from 2006 to 2020 were included. The 5-year LC rate was 48.6 %; for the primary, recurrent, non-irradiated and irradiated groups, the rates were 72.6 %, 39.5 %, 56.8 %, and 34.5 %, respectively. The 5-year OS rates was 52.6 %; for the primary, recurrent, non-irradiated, and irradiated groups, the rates were 62.9 %, 48.6 %, 58.9 %, and 42.3 %, respectively. The mean ± standard deviation of posttreatment VAS score of pain was 2.154 ± 2.989, which was significantly decreased from the score of 6.923 ± 2.280 prior to brachytherapy. Skin hyperpigmentation, mucositis, and dysphagia were the most frequently reported adverse events. CONCLUSIONS Brachytherapy as a sole modality, was retrospectively proven effective and safe in the management of inoperable SGCs and was beneficial in multiple irradiation and pain control.
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Affiliation(s)
- Yiwei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Xiaoming Lyu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Mingwei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Shuming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Yan Shi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Wenjie Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China
| | - Jianguo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, PR China; National Center for Stomatology & National Clinical Research Center for Oral Diseases, Beijing & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, 100081, PR China.
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Schwarzlmueller P, Corradini S, Seidensticker M, Zimmermann P, Schreiner J, Maier T, Triebig A, Knösel T, Pazos M, Pfluger T, Weigand I, Belka C, Ricke J, Reincke M, Schmidmaier R, Kroiss M. High-Dose Rate Brachytherapy Combined with PD-1 Blockade as a Treatment for Metastatic Adrenocortical Carcinoma - A Single Center Case Series. Horm Metab Res 2024; 56:30-37. [PMID: 37748508 DOI: 10.1055/a-2150-3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The response rate of advanced adrenocortical carcinoma (ACC) to standard chemotherapy with mitotane and etoposide/doxorubicin/cisplatin (EDP-M) is unsatisfactory, and benefit is frequently short lived. Immune checkpoint inhibitors (CPI) have been examined in patient's refractory to EDP-M, but objective response rates are only approximately 15%. High-dose rate brachytherapy (HDR-BT) is a catheter-based internal radiotherapy and expected to favorably combine with immunotherapies. Here we describe three cases of patients with advanced ACC who were treated with HDR-BT and the CPI pembrolizumab. None of the tumors were positive for established response markers to CPI. All patients were female, had progressed on EDP-M and received external beam radiation therapy for metastatic ACC. Pembrolizumab was initiated 7 or 23 months after brachytherapy in two cases and prior to brachytherapy in one case. Best response of lesions treated with brachytherapy was complete (n=2) or partial response (n=1) that was ongoing at last follow up after 23, 45 and 4 months, respectively. Considering all sites of tumor, response was complete and partial remission in the two patients with brachytherapy prior to pembrolizumab. The third patient developed progressive disease with severe Cushing's syndrome and died due to COVID-19. Immune-related adverse events of colitis (grade 3), gastroduodenitis (grade 3), pneumonitis (grade 2) and thyroiditis (grade 1) occurred in the two patients with systemic response. HDR-BT controlled metastases locally. Sequential combination with CPI therapy may enhance an abscopal antitumoral effect in non-irradiated metastases in ACC. Systematic studies are required to confirm this preliminary experience and to understand underlying mechanisms.
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Affiliation(s)
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Petra Zimmermann
- Department of General, Visceral and Transplant Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Jochen Schreiner
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Tanja Maier
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Alexandra Triebig
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Pfluger
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Isabel Weigand
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Reincke
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Ralf Schmidmaier
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Kroiss
- Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
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Xiang X, Ji Z, Jin J. Brachytherapy is an effective and safe salvage option for re-irradiation in recurrent glioblastoma (rGBM): A systematic review. Radiother Oncol 2024; 190:110012. [PMID: 37972737 DOI: 10.1016/j.radonc.2023.110012] [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: 09/03/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To evaluate the clinical efficacy and toxicity of brachytherapy as a salvage therapy for patients with recurrent glioblastoma (rGBM). METHODS AND MATERIALS We searched the PubMed, Embase, and Cochrane libraries from its inception to June 2023, for eligible studies in which patients underwent brachytherapy for rGBM. Outcomes of interest were mOS, mPFS, OS, PFS, and adverse events (AEs). For individual clinical survival outcomes and common AEs, weighted-mean descriptive statistics were calculated as a summary measure using study sample size as the weight. The calculation formula is as follows: weighted-mean = Σwx/Σw (w is the sample size and x is the outcome). RESULTS This review included 29 studies with a total of 1202 rGBM patients, including 22 retrospective and 7 prospective studies. The results showed that from the time of brachytherapy, the mOS and mPFS were 6.8 to 24.4 months and 3.7 to 11.7 months. The OS of 6 months, 1 year, 18 months, 2 years, and 3 years after brachytherapy were 58.3 % to 85.2 % (weighted-mean 76.2 %), 26 % to 66 % (weighted-mean 41.9 %), 20 % to 37 % (weighted-mean 27.6 %), 11 % to 23 % (weighted-mean 14.8 %), and 8 % to 15 % (weighted-mean 12.1 %), respectively. The PFS of 6 months and 1 year after brachytherapy were 26.7 % to 86 % (weighted-mean 53.4 %) and 14 % to 81 % (weighted-mean 24.1 %). Most patients with rGBM will experience treatment failure again during the follow-up period, mainly local (10.7 % to 79.4 %) or marginal(3.6 % to 22.2 %) recurrence, followed by distant failure (6.7 % to 57.7 %). Although therapeutic AEs had not been uniformly reported, the overall toxicity rate was considered to be low. The common AEs reported included progressive neurologic deterioration, seizures, CSF leak, brain necrosis, hemorrhage, and infection/meningitis, with a weighted-mean incidence of 1.9 %, 2.4 %, 4.1 %, 5.4 %, 2.1 %, and 3.8 %, respectively. CONCLUSIONS The evidence summarized above, albeit mostly level III, suggests that brachytherapy has acceptable safety and good post-treatment clinical efficacy for selected patients with rGBM. Well-designed, high-quality, large-sample randomized controlled and prospective studies are needed to further validate these findings.
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Affiliation(s)
- Xiaoyong Xiang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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Azarcon CP, Qiu RLJ, Sobol EK, Hubbard GB, Craven CM, Bergstrom CS, Wells JR. IODINE-125 PLAQUE BRACHYTHERAPY FOR DIFFUSE CHOROIDAL HEMANGIOMA. Retin Cases Brief Rep 2024; 18:51-58. [PMID: 36007192 DOI: 10.1097/icb.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To report 6 cases of diffuse choroidal hemangioma in children treated with iodine-125 plaque brachytherapy at a single tertiary care center. METHODS Retrospective case series. RESULTS Six pediatric patients diagnosed with diffuse choroidal hemangioma were included in the study. Preplaque visual acuity ranged from 20/150 to no light perception. All patients had extensive serous retinal detachment at presentation. An iodine-125 radioactive plaque was placed on the affected eye to administer a dose of 34.2-42.1 Gy to the tumor apex over a median of 4 days. Tumor regression and subretinal fluid resolution were observed in all eyes within 17 months of treatment. Visual acuity improved in two patients. Radiation-induced cataract and subretinal fibrosis were documented in one case, and one patient developed radiation retinopathy. No patients developed neovascular glaucoma within the follow-up time of 12-65 months. CONCLUSION Iodine-125 plaque radiotherapy is an effective option for diffuse choroidal hemangioma, although there is a risk for radiation-induced complications.
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Affiliation(s)
- Corrina P Azarcon
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Richard L J Qiu
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia; and
| | - Ethan K Sobol
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - G Baker Hubbard
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Caroline M Craven
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jill R Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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Sarwar A, Syed L, Patel K, Reid I, Abonyi E, Banas N, Lowe G, Bryant L, Hoskin P. Image-guided Interstitial Brachytherapy in the Treatment of Primary and Recurrent Vulvovaginal Gynaecological Malignancies. Clin Oncol (R Coll Radiol) 2024; 36:6-11. [PMID: 37923687 DOI: 10.1016/j.clon.2023.10.051] [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: 09/22/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
AIMS To evaluate the use, outcomes and toxicities of high dose rate brachytherapy (HDRB) to the vulvovaginal region in previously irradiated and radiotherapy-naïve patients for primary or recurrent gynaecological malignancies. MATERIALS AND METHODS From January 2010 to December 2020, 94 women with a median age of 64 years (range 31-88 years) were treated with interstitial HDRB for vulvovaginal disease. Treatment details, including cumulative radiotherapy doses, were recorded together with reported toxicity, using Common Terminology Criteria for Adverse Events (CTCAE) grading. Dosimetric parameters, including D90, V100 and V150 together with treatment response at 3 months, overall survival, relapse-free survival and long-term toxicity data, were collated from referring centres. RESULTS The median follow-up was 78 months (range 2-301). Primary sites of disease included vagina (37), endometrium (29), vulva (16), ovary (7) and cervix (5). Eighty-six (91.5%) patients were treated with curative intent, eight (8.5%) were palliative treatments. Fifty patients received HDRB for recurrent disease, 39 patients for primary disease and five as part of adjuvant treatment. The anatomical site of disease treated with HDRB ranged from vagina (76), vulva (14) and peri-urethral sites (four). The 2- and 5-year local relapse-free survival rates were 76% and 72%, respectively; 15 patients experienced local failure only, whereas six patients had local and nodal/distant failure. The median time to local recurrence was 8 months (range 2-88 months). The 2- and 5-year overall survival rates for all patients were 67% and 47%, respectively; the median overall survival was 59 months. Seventy-nine (84%) patients had a complete response measured with imaging at 3 months. Grade 3 toxicity was reported in 14 patients (14.8%). CONCLUSION This retrospective series suggests the use of interstitial brachytherapy for vulvovaginal gynaecological malignancy to be an effective and safe treatment option. Good local control was achieved with a tolerable toxicity profile; it is a valuable treatment modality.
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Affiliation(s)
- A Sarwar
- Mount Vernon Cancer Centre, Northwood, UK.
| | - L Syed
- Mount Vernon Cancer Centre, Northwood, UK
| | - K Patel
- Mount Vernon Cancer Centre, Northwood, UK
| | - I Reid
- Mount Vernon Cancer Centre, Northwood, UK
| | - E Abonyi
- Mount Vernon Cancer Centre, Northwood, UK
| | - N Banas
- Mount Vernon Cancer Centre, Northwood, UK
| | - G Lowe
- Mount Vernon Cancer Centre, Northwood, UK
| | - L Bryant
- Mount Vernon Cancer Centre, Northwood, UK
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
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Narang S, Pandey AK, Kaur G, Giran M, Saxena SK, Moudgil S, Walia DK, Handa U, Meena VK, Kaur R, Astrahan M. Iodine-125 brachytherapy for choroidal melanoma by using Ocuprosta seeds with indigenous non-collimated plaques: Our initial experience. Indian J Ophthalmol 2024; 72:S90-S95. [PMID: 38131548 PMCID: PMC10833169 DOI: 10.4103/ijo.ijo_1694_23] [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: 06/28/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Brachytherapy is the gold-standard treatment for choroidal melanoma. This study evaluated iodine-125 brachytherapy by using Ocuprosta seeds with indigenous non-collimated plaques in Asian patients. METHODS Retrospective single-center study in a tertiary care hospital of 12 eyes with choroidal melanoma in 12 Asian patients who underwent brachytherapy with Ocuprosta seeds fixed on non-collimated plaques and had a follow-up of at least 32 months (mean: 42.4 ± 9.5 months; median: 40 months). Radiotherapy was planned after developing the digital 3D model of the tumor within the eye by using radiological images and clinical pictures. Ocuprosta iodine-125 seeds were used on indigenous non-collimated gold plaques to deliver the radiation for precalculated time. "Successful outcome" was taken as a decrease in the volume of the tumor, and "unsuccessful outcome" was defined as no change in the tumor volume or increase in the tumor volume at 24 months after brachytherapy. RESULTS The mean decrease in tumor volume was 21% (914.5 ± 912.2 mm3 to 495.7 ± 633.6 mm3) after brachytherapy, which correlated with the baseline volume of the tumor. Ten eyes (83.3%) showed a reduction in tumor volume, whereas two eyes showed an increase in the volume of the tumor after brachytherapy. One of the cases with a reduction in tumor size developed neovascular glaucoma. Enucleation was done in three eyes. A globe salvage rate of 75% and tumor regression rate of 83% were seen in the present study using Ocuprosta seeds. CONCLUSIONS Iodine-125 brachytherapy with uncollimated indigenous gold plaques is an effective treatment modality for choroidal melanomas in Asian patients.
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Affiliation(s)
- Subina Narang
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Awadesh K Pandey
- Department of Radiotherapy, Government Medical College and Hospital, Chandigarh, India
| | - Gurbir Kaur
- Department of Radiotherapy, Government Medical College and Hospital, Chandigarh, India
| | - Mannat Giran
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Sanjay K Saxena
- Radiopharmaceuticals Division, Radiochemistry and Isotope Group, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Sandeep Moudgil
- Department of Radiology, Government Medical College and Hospital, Chandigarh, India
| | - Dinesh K Walia
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Vijay K Meena
- CSIR-Central Scientific Instruments Organisation (CSIO), Chandigarh, India
| | - Ravinder Kaur
- Department of Radiology, Government Medical College and Hospital, Chandigarh, India
| | - Melvin Astrahan
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
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Turkheimer LM, Petroni GR, Berger AC, Schroen AT, Brenin DR, Lazar M, Libby B, Janowski EM, Showalter TN, Showalter SL. Novel Form of Breast Intraoperative Radiation Therapy with CT-Guided High-Dose-Rate Brachytherapy: Interim Results of a Prospective Phase-II Clinical Trial. J Am Coll Surg 2024; 238:10-20. [PMID: 37870228 DOI: 10.1097/xcs.0000000000000869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Precision breast intraoperative radiation therapy (PB-IORT) is a novel method of IORT that uses customized CT-based treatment plans and high-dose-rate (HDR) brachytherapy. We conducted a phase-II multi-institution trial to evaluate the efficacy of PB-IORT. STUDY DESIGN Between 2015 and 2022, 3 centers enrolled women aged 45 years and older with invasive or in situ carcinoma measuring 3 cm or smaller and N0 status (n = 358). Breast-conserving surgery was performed, and a multilumen balloon catheter was placed in the lumpectomy bed. CT images were used to create customized HDR brachytherapy plans that delivered 12.5 Gy to the tumor bed. The primary outcome assessed was the 5-year rate of index quadrant tumor recurrence. An interim analysis was conducted after one-third of eligible participants completed 5 years of follow-up. This trial is registered with clinicaltrials.gov (NCT02400658). RESULTS The cohort comprised 153 participants with a median age of 64 years and median follow-up time of 5.9 years. The estimated 5-year index quadrant tumor recurrence rate and overall survival were 5.08% (95% CI 2.23 to 9.68) and 95.1%, respectively. Locoregional (ipsilateral breast and axilla) and distant recurrence rates were each 1.96%. Seven deaths occurred during the first 5 years of follow-up, with only 1 attributable to breast cancer. Overall, 68.6% of patients experienced any adverse effects, and 4 cases of breast-related severe toxicities were observed. CONCLUSIONS This study presents the results of a planned interim analysis of a phase-II trial investigating PB-IORT and demonstrates the efficacy and safety of single-fraction, CT-based, HDR brachytherapy after breast-conserving surgery. These findings provide valuable insights into the use of PB-IORT as a treatment modality.
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Affiliation(s)
- Lena M Turkheimer
- From the Departments of Surgery (Turkheimer, Schroen, Brenin, SL Showalter), University of Virginia School of Medicine, Charlottesville, VA
| | - Gina R Petroni
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA (Petroni)
| | - Adam C Berger
- Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (Berger)
| | - Anneke T Schroen
- From the Departments of Surgery (Turkheimer, Schroen, Brenin, SL Showalter), University of Virginia School of Medicine, Charlottesville, VA
| | - David R Brenin
- From the Departments of Surgery (Turkheimer, Schroen, Brenin, SL Showalter), University of Virginia School of Medicine, Charlottesville, VA
| | - Melissa Lazar
- Department of Surgery, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA (Lazar)
| | - Bruce Libby
- Radiation Oncology, Moffitt Cancer Center, Tampa, FL (Libby)
| | - Einsley M Janowski
- Radiation Oncology (Janowski, TN Showalter), University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy N Showalter
- Radiation Oncology (Janowski, TN Showalter), University of Virginia School of Medicine, Charlottesville, VA
| | - Shayna L Showalter
- From the Departments of Surgery (Turkheimer, Schroen, Brenin, SL Showalter), University of Virginia School of Medicine, Charlottesville, VA
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Hsieh K, Bloom JR, Dickstein DR, Hsieh C, Marshall D, Ghiassi-Nejad Z, Raince J, Lymberis S, Chadha M, Gupta V. Dose and fractionation regimen for brachytherapy boost in cervical cancer in the US. Gynecol Oncol 2024; 180:55-62. [PMID: 38052109 DOI: 10.1016/j.ygyno.2023.11.014] [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: 08/28/2023] [Revised: 11/06/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Curative-intent radiotherapy for locally advanced and select early stage cervical cancer in the US includes external beam radiotherapy (EBRT) with brachytherapy. Although there are guidelines for brachytherapy dose and fractionation regimens, there are limited data on practice patterns. This study aims to evaluate the contemporary utilization of cervical cancer brachytherapy in the US and its association with patient demographics and facility characteristics. METHODS We retrospectively analyzed clinical covariates of cervical cancer patients diagnosed and treated in 2018-2020 with curative-intent radiotherapy from the 2020 National Cancer Database. Associations between patient and institutional factors with the number of brachytherapy fractions were identified with logistic regression. Factors with association (p < 0.10) were then included in a multivariable logistic regression model. All tests were two-sided with significance <0.05 unless specified otherwise. RESULTS Among the eligible 2517 patients, 97.3% received HDR or LDR and is further analyzed. More patients received HDR than LDR brachytherapy (98.9% vs 1.1%) and intracavitary than interstitial brachytherapy (86.4% vs 13.6%). The most common number of HDR fractions prescribed were 5 (51.0%), 4 (32.9%), and 3 (8.6%). After adjusting for the other variables in the model, ethnicity, private insurance status, overall insurance status, and facility type were the only factors that were significantly associated with the number of brachytherapy factions (p < 0.0001, p = 0.028, p = 0.001, and p < 0.0001, respectively, n = 2184). CONCLUSIONS In the US, various HDR brachytherapy regimens are utilized depending on patient and institutional factors. Future research may optimize cervical cancer brachytherapy by correlating specific dose and fractionation regimens with patient outcomes.
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Affiliation(s)
- Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Julie R Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Celina Hsieh
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Deborah Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Zahra Ghiassi-Nejad
- Department of Radiation Oncology, Columbia University Medical Center, New York, NY, United States of America
| | - Jagdeep Raince
- Department of Radiation Oncology, New York University Langone Health, New York, NY, United States of America
| | - Stella Lymberis
- Department of Radiation Oncology, New York University Langone Health, New York, NY, United States of America
| | - Manjeet Chadha
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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Laville A, Ka K, El-Ayachi R, Achkar S, Bockel S, Gouy S, Espenel S, Morice P, Sun R, Pautier P, Chargari C. Locoregional Treatment in Patients With Metastatic Cervical Cancer: Benefit of Dose Escalation Strategies. Int J Radiat Oncol Biol Phys 2024; 118:192-202. [PMID: 37586615 DOI: 10.1016/j.ijrobp.2023.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The objective of this work was to examine the benefit of an intensive locoregional treatment including an image guided adaptive brachytherapy (IGABT) among patients with cervical cancer and extrapelvic extension. METHODS AND MATERIALS Medical records of consecutive patients with a metastatic cervical cancer and receiving external beam radiation therapy and IGABT boost in Gustave Roussy Institute as part of their first line of treatment were examined. Depending on tumor sites, patients received pelvic ± para-aortic external beam radiation therapy. For those with visceral or supradiaphragmatic lymph node metastases, chemoradiation was delivered after usually 3 cycles of chemotherapy. All patients received a brachytherapy boost, guided by magnetic resonance imaging and aimed at increasing the dose to the high-risk clinical target volume (CTVHR). Local control (LC), patient overall survival (OS), progression-free survival, and radiation therapy-related side effects were examined, and prognostic factors were searched. RESULTS One hundred sixty-four patients were included; 76.2% had para-aortic lymph node extension without distant metastasis (N2) and 23.8% had distant metastatic sites (M1). There was not a statistically significant difference in survival between both groups. With a median follow-up of 36 months, OS, progression-free survival, and LC at 3 years were 55.5% (95% CI, 48%-64%), 40.6% (95% CI, 38%-54%), and 90% (95% CI, 85%-96%), respectively. In multivariate analysis, a D90CTVHR dose ≥80 Gy was significant for better OS (hazard ratio, 0.96; 95% CI, 0.94-0.98; P < .001). Most toxicities were mild to moderate, with 2% grade 3 late urinary toxicity, 7% late grade 2 vaginal sequelae, and 1 grade 3 proctitis. During follow-up, rectovaginal fistula occurred in 2 patients without local relapse. CONCLUSIONS IGABT permits dose escalation and high LC rates for patients with cervical cancer and extrapelvic extension. Dose/effect relationships for survival were shown. Because of high frequency of distant events, systemic intensification should be tested more specifically among these patients.
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Affiliation(s)
| | - Kanta Ka
- Department of Radiation Oncology
| | | | | | | | | | | | | | | | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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Adeyemi OF, Bentefour E. Side Effects of Permanent Radioactive Iodine-125 Implants Brachytherapy for Prostate Cancer in Nigeria. West Afr J Med 2023; 40:1369-1377. [PMID: 38266199] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Radioactive seeds implant is a novel option in the developed world for the treatment of organ-confined prostate cancer; however, it is a rare procedure in developing countries, especially in sub-Saharan African countries like Nigeria. The first prostate brachytherapy in Nigeria was performed in 2019 at La'Newton Oncology Clinic using low-dose radioactive iodine-125. The side effects on patients that were treated in three years of its existence in Nigeria are documented in this study. OBJECTIVES This study aimed to narrate the side effects and complications of the procedure in its three years of existence in Nigeria. METHODS This was a retrospective study of the 32 eligible patients treated at the only private clinic that offers permanent radioactive iodine-125 prostate seeds implant in Nigeria. The patients were followed-up for 24 months. The biodata, urinary symptoms and erectile function were analyzed using the medical records, a detailed expanded prostate cancer index composite questionnaire, and a modified Radiation Therapy Oncology Group Grading System. RESULT It was noticed that the burning sensation at the perineum, which was self-limiting within 72 hours, was a major complaint among all the subjects. All the patients experienced haematuria; 74% of the subjects noted that the haematuria resolved within 12 hours post-implant, while it resolved within 24 hours for the remaining 26%. Acute urinary retention occurred in one subject. The EPIC scoring system showed that only one subject lost the ability to have a firm erection adequate for sexual intercourse. There was no gastrointestinal toxicity recorded among the participants. CONCLUSION The side effects observed among the subjects were negligible compared to conventional surgery, so this procedure should be considered in all cases of organ-confined prostate cancer, especially as it is also cost-effective.
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Affiliation(s)
- O F Adeyemi
- La'Newton Oncology Clinic, Benin City. Nigeria.
- Department of Radiotherapy and Clinical Oncology, University of Benin Teaching Hospital, Benin City, Nigeria
- Department of Radiology, School of Medicine, University of Benin, Benin City, Nigeria
| | - E Bentefour
- American Radiology Oncology Solutions, Philadelphia, United States of America
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Miszczyk M, Suleja A, Sobel S, Stec M, Chyrek AJ, Kolbusz M, Spałek M, Nasiek A, Stankiewicz M, Lelek P, Moll M, Kluska A, Kazalski D, Saniewski P, Kaminiów K, Burchardt WM, Wojcieszek P, Chicheł A, Cichoń P, Krzysztofiak T. Salvage re-irradiation in non-melanoma skin cancers: A multicenter analysis. Radiother Oncol 2023; 189:109945. [PMID: 37806558 DOI: 10.1016/j.radonc.2023.109945] [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: 07/17/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND PURPOSE We conducted a multicentre real-world study to assess the outcomes of radical salvage re-irradiation for non-melanoma skin cancer (nMSC) recurrences following definitive or postoperative radiotherapy. MATERIALS AND METHODS Data on patients treated between 2006 and 2022 with re-irradiation for nMSCs were retrospectively collected from five high-volume brachytherapy centers. The primary endpoint was local control (LC). Secondary endpoints included overall survival, progression-free survival, and adverse events (AEs). The Kaplan-Meier estimator and Cox Proportional-Hazards Model were utilised in the analysis. RESULTS A total of 58 patients with a median age of 78.4 years with recurrences of previously irradiated nMSC in the head and neck region were included in the analysis. The majority had cutaneous basal cell carcinoma (BCC; 91.4%), and were irradiated with high-dose-rate brachytherapy (HDR-BT; 91.4%). The most common locations included the nasal region (36.2%) and external ear (18.9%). The 1-year LC was 73.1% and decreased to 41.7% at three years. The size of the re-irradiated lesion was the single independent prognostic factor in Cox analysis (per mm; HR 1.07; 95% CI 1.04-1.11; p < 0.001). Grade 3 or worse AEs were reported in 7 cases (12.1%). CONCLUSION Re-irradiation for nMSCs, predominantly administered with brachytherapy for radiorecurrent BCC, is associated with high recurrence rates, and the risk of failure significantly increases with the size of the treated lesion. Re-irradiation could be an option for selected elderly patients with small, localised, inoperable recurrences after RT to achieve local control or defer systemic treatment; however, prospective trials are necessary to confirm its safety and efficacy.
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Affiliation(s)
- Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Agata Suleja
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; II Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology Warsaw Branch, Wawelska 15/B, 00-001 Warszawa, Poland
| | - Szymon Sobel
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Maria Stec
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Artur Jan Chyrek
- Brachytherapy Department, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznań, Poland; Electroradiology Department, Poznań University of Medical Sciences, Garbary 15, 61-866 Poznań, Poland
| | - Mirosław Kolbusz
- Brachytherapy Department, Subcarpathian Cancer Center, ks Bielawskiego 18, 36-200 Brzozów, Poland
| | - Mateusz Spałek
- II Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology Warsaw Branch, Wawelska 15/B, 00-001 Warszawa, Poland
| | - Aleksandra Nasiek
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Magdalena Stankiewicz
- Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Piotr Lelek
- Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Matthias Moll
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Adam Kluska
- Brachytherapy Department, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznań, Poland
| | - Damian Kazalski
- Brachytherapy Department, Subcarpathian Cancer Center, ks Bielawskiego 18, 36-200 Brzozów, Poland
| | - Piotr Saniewski
- II Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology Warsaw Branch, Wawelska 15/B, 00-001 Warszawa, Poland
| | - Konrad Kaminiów
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; Clinical Department of Internal Diseases, Dermatology and Allergology in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Wojciech Maria Burchardt
- Brachytherapy Department, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznań, Poland; Electroradiology Department, Poznań University of Medical Sciences, Garbary 15, 61-866 Poznań, Poland
| | - Piotr Wojcieszek
- Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
| | - Adam Chicheł
- Brachytherapy Department, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznań, Poland
| | - Piotr Cichoń
- Brachytherapy Department, Subcarpathian Cancer Center, ks Bielawskiego 18, 36-200 Brzozów, Poland
| | - Tomasz Krzysztofiak
- Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland
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Prevost A, Molla-De-Testa P, Poulet V, Delanoe F. Frontal lesion after brachytherapy: What is your diagnosis? J Stomatol Oral Maxillofac Surg 2023; 124:101569. [PMID: 37490997 DOI: 10.1016/j.jormas.2023.101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Alice Prevost
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, Toulouse 31059, France
| | - Pierre Molla-De-Testa
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, Toulouse 31059, France
| | - Vinciane Poulet
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, Toulouse 31059, France
| | - Franck Delanoe
- Service de Chirurgie Maxillo-Faciale et Plastique de la Face, CHU de Toulouse, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac - TSA 40031, Toulouse 31059, France.
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Barbera F, Frassine F, Volpi G, Ghedi B, Pasinetti N. Locally advanced cervical cancer: how the improvement in techniques in external beam radiotherapy and brachytherapy impacts on survival outcomes and long-term toxicities. Radiol Med 2023; 128:1542-1552. [PMID: 37640897 DOI: 10.1007/s11547-023-01705-7] [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] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Platinum-based chemoradiotherapy and brachytherapy are the standard treatment for locally advanced cervical cancer. Reported long-term outcomes for treated with both IMRT and 3D-Image-guided-adaptive brachytherapy are lacking. METHODS This retrospective study included 165 patients with FIGO Stage IB-IVB cervical cancer, treated with chemoradiotherapy in combination with brachytherapy. External beam radiotherapy was delivered as IMRT/VMAT/TOMO helical or 3DCRT. The intracavitary brachytherapy treatment (ICBT) was performed using two different planning system (with or without optimization). RESULTS Among the patient subgroups, comprising those who received IMRT/VMAT/Tomo helical and 3DCRT, as well as those who underwent ICBT planning optimization and those who did not, homogeneity was observed in terms of age, performance status, T stage, N status, TNM stage, and histology. With a median follow-up time of 60.5 months, the 5-year overall survival (OS) in the 3DCRT and IMRT groups was 74.9% and 92.8%, respectively (p = 0.033). The 5-year OS in the ICBT planning optimization group was 93.7%, compared to 75% in the non-optimization group (p = 0.014). Regarding late radiation toxicities, patients in the IMRT group had a lower incidence of chronic rectal toxicity compared to those in the 3DCRT group (6.5% vs. 34.1%, p = 0.001). The group with ICBT planning optimization had a lower incidence of late urinary toxicities (10.4%) compared to the non-optimized ICBT planning group (18.2%, p = 0.012). Similarly, the ICBT planning optimization group had a lower incidence of late rectal toxicity (6.5% with 80% grade 1 and 20% grade 2) compared to the non-optimized ICBT planning group (34.1%, p = 0.001). CONCLUSION In this series, the group of patients receiving optimized ICBT had an advantage in terms of OS and CSS suggesting that the use of new Treatment Planning Systems associated with 3D imaging, improves the long-term survival. Additionally, a significant reduction in late rectal and urinary toxicity has been observed.
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Affiliation(s)
- Fernando Barbera
- Radiation Oncology Department, University of Brescia, Spedali Civili of Brescia. P.le Spedali Civili, 1, 24123, Brescia, Italy
| | - Francesco Frassine
- Radiation Oncology Department, University of Brescia, Spedali Civili of Brescia. P.le Spedali Civili, 1, 24123, Brescia, Italy
| | - Giulia Volpi
- Radiation Oncology Department, University of Brescia, Spedali Civili of Brescia. P.le Spedali Civili, 1, 24123, Brescia, Italy.
| | - Barbara Ghedi
- Department of Health Physics, Spedali Civili Hospital, Brescia, Lombardia, Italy
| | - Nadia Pasinetti
- Radiation Oncology Department, ASST Valcamonica Esine and University of Brescia, Brescia, Italy
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Di Stasi M, Cione F. Re: Binkley et al.: Postoperative echography for optimization of radiation dosimetry in patients with uveal melanoma treated with plaque brachytherapy (Ophthalmol Retina. 2023;7:620-627). Ophthalmol Retina 2023; 7:e21. [PMID: 37747391 DOI: 10.1016/j.oret.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Margherita Di Stasi
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
| | - Ferdinando Cione
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.
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Noorian F, Abellana R, Zhang Y, Herreros A, Baltrons C, Lancellota V, Tagliaferri L, Sabater S, Torne A, Rovirosa A. Are 7.5 Gy×2 fractions more efficient than 6 Gy×3 in exclusive postoperative endometrial cancer brachytherapy? A clinical and dosimetrical analysis. Radiother Oncol 2023; 189:109909. [PMID: 37699447 DOI: 10.1016/j.radonc.2023.109909] [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: 05/20/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE To compare two vaginal brachytherapy (VBT) schedules in postoperative endometrial carcinoma (PEC) patients considering vaginal-cuff relapses (VCR), late toxicities, dosimetry analysis and vaginal dilator use. MATERIAL AND METHODS 110 PEC patients were treated with exclusive high-dose-rate VBT using two schedules. Group-1:44-patients received 6 Gy×3fractions (September-2011-April-2014); Group-2:66-patients were treated with 7.5 Gy×2fractions with a dose limit of equivalent total doses in 2-Gy fr (EQD2(α/β=3)) of 68 Gy in the most exposed 2 cm3 of clinical target volume (CTV) (July-2015-November-2021). The dose was prescribed at 5 mm from the applicator surface. Were evaluated the overall radiation dose delivered to 90% of the CTV (D90), the CTV receiving 100% of the prescription dose (V100) and the EQD2(α/β=3) received in the most exposed 2 cm3 to dose in CTV. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum and objective LENT-SOMA criteria for late vaginal toxicity (LVT). STATISTICS Descriptive analysis, Chi-square, Student's t-tests and Kaplan and Meier method. RESULTS The median follow-up was 60 months (15.9-60). There were no VCR or late toxicities in bladder or rectum. LVT ≥ G1 appeared in 26/44 (59.1%) in Group-1 and 25/66 (37.9%) in Group-2. The mean EQD2(α/β=3) received by the most exposed 2 cm3 of CTV was 63.7 Gy ± 10.0 in Group-1 and 60.5 Gy ± 3.8 in Group-2 (p = 0.063). There were no differences in adherence to vaginal dilator use ≥9 months, overall D90 and V100. CONCLUSION Considering the lack of vaginal relapses and similar LVT over time, 7.5 Gy×2fractions seem more efficient in terms of patient comfort, workload, and cost. This is the first study using dosimetry parameters to compare effectivity of schedules. Larger series are needed to confirm the present results.
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Affiliation(s)
- Faegheh Noorian
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain; Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
| | - Rosa Abellana
- Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
| | - Yaowen Zhang
- Cancer Center, Henan Provincial People's Hospital, No.7 Weiwu Road, Zhengzhou 450003, China.
| | - Antonio Herreros
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain; Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
| | - Clara Baltrons
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
| | - Vallentina Lancellota
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy.
| | - Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy.
| | | | - Aureli Torne
- Gynecological Cancer Unit, Hospital Clinic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain.
| | - Angeles Rovirosa
- Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain; Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
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Nakazono M, Urabe F, Iwatani K, Imai Y, Tashiro K, Honda M, Koike Y, Shimomura T, Sato S, Takahashi H, Miki K, Aoki M, Kimura T. Patients with PSA below 0.2 ng/mL at 8 years post high-dose-rate brachytherapy have an extremely low risk of subsequent recurrence. Int J Urol 2023; 30:1147-1154. [PMID: 37650359 DOI: 10.1111/iju.15289] [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: 04/13/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES We have analyzed the long-term follow-up data of patients with prostate cancer (PCa) who underwent high-dose-rate brachytherapy (HDR-BT) and external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT). The objective was to determine the optimal time for cessation of PSA monitoring after HDR-BT. METHODS We included 309 patients with clinical stage T1c-T4 N0-1 M0 PCa who received HDR-BT and EBRT combined with long-term ADT between 2005 and 2018. We stratified the patients based on their prostate-specific antigen (PSA) levels and identified the factors associated with biochemical recurrence (BCR) and clinical progression (CP). RESULTS The median follow-up duration was 98 months (range: 31-207 months). Among the 306 patients, 76 developed BCR and 47 developed CP subsequently. We found that the PSA levels at 3, 5, and 8 years significantly correlated with the oncological outcomes of brachytherapy. No patient with a PSA level ≤ 0.2 ng/mL at 8 years later developed BCR or CP. CONCLUSION Our long-term data suggest that in the presence of a PSA level ≤ 0.2 ng/mL at 8 years later, PSA monitoring may be safely discontinued due to the extremely low risk of subsequent oncological events. The data presented in this study will assist clinicians in determining the optimal management strategy for patients with PCa following HDR-BT and EBRT combined with long-term ADT.
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Affiliation(s)
- Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mariko Honda
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuya Shimomura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Tiruye T, David R, O'Callaghan M, FitzGerald LM, Higgs B, Kahokehr AA, Roder D, Beckmann K. Risk of secondary malignancy following radiation therapy for prostate cancer. Sci Rep 2023; 13:20083. [PMID: 37973983 PMCID: PMC10654670 DOI: 10.1038/s41598-023-45856-z] [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: 08/11/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
We investigated whether prostate cancer patients treated with external beam radiation therapy (EBRT) have a higher cumulative incidence of secondary cancer compared with patients treated with radical prostatectomy (RP). We used state-wide linked data from South Australia to follow men with prostate cancer diagnosed from 2002 to 2019. The cumulative incidence of overall and site-specific secondary cancers between 5 and 15 years after treatment was estimated. Fine-Gray competing risk analyses were performed with additional sensitivity analyses to test different scenarios. A total of 7625 patients were included (54% underwent RP and 46% EBRT). Characteristics of the two groups differed significantly, with the EBRT group being older (71 vs. 64 years), having higher comorbidity burden and being more likely to die during follow-up than the RP group. Fifteen-year cumulative incidence for all secondary cancers was 27.4% and 22.3% in EBRT and RP groups, respectively. In the adjusted models, patients in the EBRT group had a significantly higher risk of genitourinary (adjusted subhazard ratio (aSHR), 2.29; 95%CI 1.16-4.51) and lung (aSHR, 1.93; 95%CI 1.05-3.56) cancers compared with patients in the RP group. However, there was no statistically significant difference between the two groups for risk of any secondary cancer, gastro-intestinal, skin or haematologic cancers. No statistically significant differences in overall risk of secondary cancer were observed in any of the sensitivity analyses and patterns for risk at specific cancer sites were relatively consistent across different age restriction and latency/time-lag scenarios. In conclusion, the increased risk of genitourinary and lung cancers among men undergoing EBRT may relate partly to treatment effects and partly to unmeasured residual confounding.
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Affiliation(s)
- Tenaw Tiruye
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, North Terrace, SAHMRI Building, Adelaide, 5001, Australia.
- Public Health Department, Debre Markos University, Debre Markos, Ethiopia.
| | - Rowan David
- Urology Unit, Flinders Medical Centre, Bedford Park, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Michael O'Callaghan
- Urology Unit, Flinders Medical Centre, Bedford Park, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Liesel M FitzGerald
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Braden Higgs
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, North Terrace, SAHMRI Building, Adelaide, 5001, Australia
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Arman A Kahokehr
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- Urology Unit, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - David Roder
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, North Terrace, SAHMRI Building, Adelaide, 5001, Australia
| | - Kerri Beckmann
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, North Terrace, SAHMRI Building, Adelaide, 5001, Australia
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Garin O, Kowalski C, Zamora V, Roth R, Ferrer M, Breidenbach C, Pont A, Belin TR, Elashoff D, Wilhalme H, Nguyen AV, Kwan L, Pearman EK, Bolagani A, Sampurno F, Papa N, Moore C, Millar J, Connor SE, Villanti P, Litwin MS. Patient-reported outcomes before treatment for localized prostate cancer: are there differences among countries? Data from the True North Global Registry. BMC Urol 2023; 23:178. [PMID: 37919726 PMCID: PMC10623840 DOI: 10.1186/s12894-023-01344-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Similar Patient-Reported Outcomes (PROs) at diagnosis for localized prostate cancer among countries may indicate that different treatments are recommended to the same profile of patients, regardless the context characteristics (health systems, medical schools, culture, preferences…). The aim of this study was to assess such comparison. METHODS We analyzed the EPIC-26 results before the primary treatment of men diagnosed of localized prostate cancer from January 2017 onwards (revised data available up to September 2019), from a multicenter prospective international cohort including seven regions: Australia/New Zealand, Canada, Central Europe (Austria / Czech Republic / Germany), United Kingdom, Italy, Spain, and the United States. The EPIC-26 domain scores and pattern of three selected items were compared across regions (with Central Europe as reference). All comparisons were made stratifying by treatment: radical prostatectomy, external radiotherapy, brachytherapy, and active surveillance. RESULTS The sample included a total of 13,483 men with clinically localized or locally advanced prostate cancer. PROs showed different domain patterns before treatment across countries. The sexual domain was the most impaired, and the one with the highest dispersion within countries and with the greatest medians' differences across countries. The urinary incontinence domain, together with the bowel and hormonal domains, presented the highest scores (better outcomes) for all treatment groups, and homogeneity across regions. CONCLUSIONS Patients with localized or locally advanced prostate cancer undergoing radical prostatectomy, EBRT, brachytherapy, or active surveillance presented mainly negligible or small differences in the EPIC-26 domains before treatment across countries. The results on urinary incontinence or bowel domains, in which almost all patients presented the best possible score, may downplay the baseline data role for evaluating treatments' effects. However, the heterogeneity within countries and the magnitude of the differences found across countries in other domains, especially sexual, support the need of implementing the PRO measurement from diagnosis.
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Affiliation(s)
- O Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - V Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - R Roth
- Institute of Medical Statistics and Computational Biology (IMSB), Medical Faculty, University of Cologne, Cologne, Germany
| | - M Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | | | - A Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - T R Belin
- University of California, Los Angeles, USA
| | - D Elashoff
- University of California, Los Angeles, USA
| | - H Wilhalme
- University of California, Los Angeles, USA
| | - A V Nguyen
- University of California, Los Angeles, USA
| | - L Kwan
- University of California, Los Angeles, USA
| | | | - A Bolagani
- University of California, Los Angeles, USA
| | - F Sampurno
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - N Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - C Moore
- University College London, London, UK
| | - J Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S E Connor
- University of California, Los Angeles, USA
| | - P Villanti
- Movember Foundation, Melbourne, Australia
| | - M S Litwin
- University of California, Los Angeles, USA
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Cheng T, Peng R, Qu A, Wang H. High-dose rate endorectal brachytherapy for rectal cancer: A state-of-the-art review. Cancer Sci 2023; 114:4145-4156. [PMID: 37702196 PMCID: PMC10637059 DOI: 10.1111/cas.15959] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
Rectal cancer is a common malignancy that requires multidisciplinary treatment. By utilizing the dose-response relationship in rectal cancer radiotherapy, increasing the radiotherapy dose can improve clinical complete remission rates. High-dose rate endorectal brachytherapy (HDREBT) is a novel technique that delivers high doses of radiotherapy directly to the tumor via an endorectal applicator, sparing the adjacent normal tissues from excessive radiation exposure. HDREBT includes contact X-ray brachytherapy and high-dose-rate intracavitary brachytherapy. We introduce the latest developments in applicators and imaging techniques for HDREBT in rectal cancer and summarize the current evidence on the efficacy, safety, and feasibility of HDREBT as a neoadjuvant, definitive, or palliative treatment option for all stages of rectal cancer patients. We also discuss the potential advantages and challenges of HDREBT in achieving organ preservation and improving the quality of life of rectal cancer patients. HDREBT has shown promising results in achieving high complete response rates, enabling nonoperative management, improving organ preservation rates, and providing effective palliation in rectal cancer patients. More studies are needed to optimize its dose and fractionation schemes in different clinical scenarios.
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Affiliation(s)
- Tian Cheng
- Cancer CenterPeking University 3rd HospitalBeijingChina
- Peking University Health Science CenterPeking UniversityBeijingChina
| | - Ran Peng
- Department of Radiation OncologyPeking University 3rd HospitalBeijingChina
| | - Ang Qu
- Department of Radiation OncologyPeking University 3rd HospitalBeijingChina
| | - Hao Wang
- Cancer CenterPeking University 3rd HospitalBeijingChina
- Department of Radiation OncologyPeking University 3rd HospitalBeijingChina
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Wallner K, Kearney KE, Tiwana J, Pristera N, Kim EY, Azzalini L, Sandison G, Lombardi WL, Don C, Kim M. Increased prescription dose for large vessel intravascular brachytherapy. Catheter Cardiovasc Interv 2023; 102:1034-1039. [PMID: 37855145 DOI: 10.1002/ccd.30852] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/01/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Most randomized studies testing the effectiveness of IVBT were limited to vessels less than 4 mm diameter. In fact, it is now common to treat vessels larger than 4 mm. Accordingly, the authors instituted a prescription dose increase to 34 Gy at 2 mm from source center for vessels greater than 4.0 mm. The increase in prescription dose to 34 Gy at 2 mm from center is substantial, being 50% higher than the conventional maximum of 23 Gy. AIM To take a close look at group of patients treated to 34 Gy, and for whom follow-up angiograms are available. METHODS Ten patients treated for ISR with a prescription dose of 34 Gy and for whom follow-up angiograms were available were studied. Beta-radiation brachytherapy was performed with a Novoste Beta-Cath System using a strontium-90 (beta) source (Best Vascular, Springfield, VA). Source lengths of 40 or 60 mm were used. A dose of 34 Gy was prescribed at 2 mm from the source center. RESULTS Patients were re-catheterized from 2 to 21 months (median: 16 months) following IVBT, all for symptoms suggested of restenosis. All patients had some degree of ISR of the target vessel, but no IVBT-treated vascular segment showed angiographic signs of degeneration, dissection or aneurysm. CONCLUSION The authors' clinical impression, along with detailed review of the 10 cases, suggest that using a 34 Gy prescription dose at 2 mm from source center does not result in increased toxicity.
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Affiliation(s)
- Kent Wallner
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jasleen Tiwana
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Nicole Pristera
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Edward Y Kim
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Lorenzo Azzalini
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - George Sandison
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Creighton Don
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Minsun Kim
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
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50
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Aytac I, Guven Aytac B, Postaci A. Inadvertent hypothermia in patients undergoing brachytherapy under monitored anesthesia care: A prospective observational cohort study. Medicine (Baltimore) 2023; 102:e35735. [PMID: 37904466 PMCID: PMC10615515 DOI: 10.1097/md.0000000000035735] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
Brachytherapy, which is often performed under anesthesia, is one of the main treatment options for cervical cancer. It is unclear whether hypothermia and its associated negative outcomes are encountered during this procedure. This prospective observational cohort study aimed to investigate the prevalence and adverse effects of hypothermia during serial brachytherapies under deep sedation for cervical cancer. Female patients over the aged > of 18 years who underwent were taken to serial brachytherapy sessions under deep sedation on alternate dates at most twice a week for the treatment of cervical cancer were included. A total of 23 female were screened for initial and post-procedural hypothermia using infrared thermometers without contact to the skin at forehead between July and October 2022 at tertiary education and research hospital. Hypothermia was detected in 2 2 (8.7%) of the 23 patients and 5 5 (5.4%) of the 92 sessions. A negative correlation was found between the anesthesia time and post-procedural body temperature values (r = -0.385, P < .001). It was observed that there was a decrease in body temperature of at most -1.3 degrees and at least -0.1 degrees during the sessions. A decrease of ≥ 0.4°C was detected in any session in 16 (69.9%) of the 23 patients. A decrease of ≥ 0.4°C was detected in 34 (37%) of the 92 sessions. Involuntary hypothermia may occur during brachytherapy sessions performed under sedation. Institutions should encourage routine temperature monitoring and active warming to prevent hypothermia and adverse outcomes.
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Affiliation(s)
- Ismail Aytac
- Department of Anesthesia Chief Assistant, Health Science University, Ankara City Hospital, Department of Anesthesia, Ankara, Turkey
| | - Betül Guven Aytac
- Health Science University, Ankara City Hospital, Department of Anesthesia, Ankara, Turkey
| | - Aysun Postaci
- Health Science University, Ankara City Hospital, Department of Anesthesia, Ankara, Turkey
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