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Journal articles on the topic 'Brachytherapy'
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Marosevic, Goran, Dzenita Ljuca, Hasan Osmic, Semir Fazlic, Oliver Arsovski, and Dusan Mileusnic. "Inter-application displacement of brachytherapy dose received by the bladder and rectum of the patients with inoperable cervical cancer." Radiology and Oncology 48, no. 2 (June 1, 2014): 203–9. http://dx.doi.org/10.2478/raon-2013-0082.
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AbstractBackground. The aim of the study was to examine on the CT basis the inter-application displacement of the positions D0.1cc, D1ccand D2ccof the brachytherapy dose applied to the bladder and rectum of the patients with inoperable cervical cancer.Patients and methods. This prospective study included 30 patients with cervical cancer who were treated by concomitant chemo-radiotherapy. HDR intracavitary brachytherapy was made by the applicators type Fletcher tandem and ovoids. For each brachytherapy application the position D0.1ccwas determined of the bladder and rectum that receive a brachytherapty dose. Then, based on the X, Y, and Z axis displacement, inter-application mean X, Y, and Z axis displacements were calculated as well as their displacement vectors (R). It has been analyzed whether there is statistically significant difference in inter-application displacement of the position of the brachytherapy dose D0.1cc, D1ccand D2ccof the bladder and rectum. The ANOVA test and post-hoc analysis by Tukey method were used for testing statistical importance of differences among the groups analyzed. The difference among the groups analyzed was considered significant if p < 0.05. Results. There are significant inter-application displacements of the position of the brachytherapy dose D0,1cc, D1ccand D2ccof the bladder and rectum. Conclusions. When we calculate the cumulative brachytherapy dose by summing up D0,1cc, D1ccand D2ccof the organs at risk for all the applications, we must bear in mind their inter-application displacement, and the fact that it is less likely that the worst scenario would indeed happen
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Tanimoto, Ryuta, Kensuke Bekku, Yasuyuki Kobayashi, Shin Ebara, Motoo Araki, Norihisa Katayama, Yasutomo Nasu, and Hiromi Kumon. "Predictive factors for acute and late urinary toxicities after permanent prostate brachytherapy." Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 90. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.90.
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90 Background: To describe the frequency of acute and late Radiation Therapy Oncology Group (RTOG) urinary toxicity associated with predictive factors and International Prostate Symptom Score (IPSS) in consecutive prostate brachytherapy patients. Methods: From January 2004 to April 2011, 466 patients underwent permanent 125I-seed brachytherapy (median follow-up, 48 months). The IPSS and RTOG toxicity data were prospectively collected. The prostate volume, IPSS before and after brachytherapy and postimplant analysis were examined for an association with urinary toxicity which was defined as urinary RTOG toxicity 1 or more. Logistic regression analysis was used to examine the factors associated with urinary toxicities. Results: The rate of RTOG urinary toxicity Grade 1 or more at 1, 6, 12, 24, 36, 48 months was 67%, 40%, 21%, 31%, 27%, 28%, respectively. Grade 2 or more urinary toxicities were less than 1% at an each point. IPSS was highest at 3 months and returned to normal level at 12 months after brachytherpapy. On univariate analysis, patients with larger prostate size, greater baseline IPSS, the higher post V100 (volume of the prostate covered by 100% of the dose), higher post V150 and higher post D90 (dose that 90% of the target volume received) had more acute urinary toxicities 1 month as well as 12 months after brachytherapy. On multivariate analysis, the significant predictors for urinary toxicities were a greater baseline IPSS and post V100 one month as well as 12 months after brachytherapy (shown below). Conclusions: Most urinary symptoms were tolerated and resolved within 12 months after prostate brachytherapy. Acute and late urinary toxicities after brachytherapy were strongly related with baseline IPSS and the post V100.
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Maj-Dziedzic, Monika, Anna Brzozowska, Marcelina Sikora, Marta Zarzycka, Ines Plewniok, Jeremiasz Dubiel, Adrian Maj, Greta Śmietana, Martyna Warno, and Wiktor Kozik. "Brachytherapy in Breast Cancer Treatment: Physical and Biological Aspects." Journal of Education, Health and Sport 62 (February 22, 2024): 164–71. http://dx.doi.org/10.12775/jehs.2024.62.011.
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This scientific paper focuses on the treatment of breast cancer, one of the most common cancers among women. Despite increased awareness and the popularity of screening tests, statistics indicate a significant rise in incidence. The paper presents breast-conserving treatment methods, including brachytherapy, as a modern technique with promising outcomes. It describes the physical properties of ionizing radiation used in brachytherapy, discussing the photoelectric effect, Compton effect, and the phenomenon of pair production.
The paper then delves into the biological effects of ionizing radiation, emphasizing the dependence on the cell cycle phase. It highlights lethal, sublethal, and potentially lethal cellular damage, categorizing the effects of radiation interaction into early and late responses.
The discussion transitions to the application of brachytherapy in breast cancer treatment, focusing on various techniques such as LDR, PDR, and HDR. The paper provides a detailed description of brachytherapy's use in breast-conserving treatment, considering contraindications, treatment planning, and Accelerated Partial Breast Irradiation (APBI) techniques.
The radioisotopes used in brachytherapy are also presented, with special attention to Iridium-192. The physical and practical aspects related to this isotope are discussed, along with other commonly used radioisotopes such as Cesium-137, Cobalt-60, and Strontium-90.
The paper concludes with a summary, emphasizing the significance of brachytherapy in breast cancer treatment and outlining its prospects for development. The authors highlight precision and shortened therapy duration.
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Leskinen, Sandra, Netanel Ben-Shalom, Jason Ellis, David Langer, John A. Boockvar, Randy S. D’Amico, and A. Gabriella Wernicke. "Brachytherapy in Brain Metastasis Treatment: A Scoping Review of Advances in Techniques and Clinical Outcomes." Cancers 16, no. 15 (July 31, 2024): 2723. http://dx.doi.org/10.3390/cancers16152723.
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Brain metastases pose a significant therapeutic challenge in the field of oncology, necessitating treatments that effectively control disease progression while preserving neurological and cognitive functions. Among various interventions, brachytherapy, which involves the direct placement of radioactive sources into or near tumors or into the resected cavity, can play an important role in treatment. Current literature describes brachytherapy’s capacity to deliver targeted, high-dose radiation while minimizing damage to adjacent healthy tissues—a crucial consideration in the choice of treatment modality. Furthermore, advancements in implantation techniques as well as in the development of different isotopes have expanded its efficacy and safety profile. This review delineates the contemporary applications of brachytherapy in managing brain metastases, examining its advantages, constraints, and associated clinical outcomes, and provides a comprehensive understanding of advances in the use of brachytherapy for brain metastasis treatment, with implications for improved patient outcomes and enhanced quality of life.
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Petera, Jiri, Renata Neumanová, Karel Odrazka, Martin Ondrak, and Egon Prochazka. "Perioperative Hyperfractionated High-Dose Rate Brachytherapy Combined with External Beam Radiotherapy in the Treatment of Soft Tissue Sarcomas." Tumori Journal 91, no. 4 (July 2005): 331–34. http://dx.doi.org/10.1177/030089160509100409.
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Aims and background Low-dose rate brachytherapy alone or in combination with external beam radiotherapy represents a well-established adjuvant treatment in soft tissue sarcomas following surgical resection. The experience with high-dose radiotherapy in this indication is limited. The purpose of our study was an evaluation of the viability of perioperative hyperfractionated high-dose rate brachytherapy in combination with external beam radiotherapy for primary and recurrent soft tissue sarcomas. Patients and methods From February 1998 through June 2002, 10 adult patients with soft tissue sarcomas were treated by interstitial perioperative high-dose rate brachytherapy and external beam radiotherapy. TNM classification was pT2bpN0pM0 in 9 patients and pT1bpN0pM0 in 1 patient. Grade of differentiation was G1 (2 patients), G2 (n = 1), G3 (n = 5), G4 (n = 2). Surgical margins were negative in 7 cases, close in 2 cases and positive in 1 case. The tumor was localized in an extremity in all cases. Hyperfractionation 3 Gy twice daily at 10 mm from the plane of sources was used for brachytherapy, with total doses 18–30 Gy. The patients received external beam radiotheapy with doses 40–50 Gy after brachytherhapy. Follow-up periods were between 24–71 months (median, 46). Results Local control of the disease was achieved in all 10 patients. Distant metastases occurred in 2 cases. One patient was disease free after salvage surgery and chemotherapy, and one patient died of lung disease progression 14 months after brachytherapy. In one case, subcutaneous fistula occurred after radiotherapy and was cured by an excision. Six patients experienced grade 1 or 2 fibrosis and 1 case a mild peripheral neuropathy was recorded. Conclusions Our study on a small number of patients suggests that perioperative hyperfractionated high-dose rate brachytherapy with doses 8 × 3 Gy in combination with external beam radiotherapy 40–50 Gy is a promising method to achieve high biological doses in the postoperative radiotherapy of soft tissue sarcomas without severe late morbidity and warrants further research.
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Pons-Llanas, Olga, Rosa Ballester-Sánchez, Francisco Javier Celada-Álvarez, Cristian Candela-Juan, Teresa García-Martínez, Margarita Llavador-Ros, Rafael Botella-Estrada, et al. "Clinical implementation of a new electronic brachytherapy system for skin brachytherapy." Journal of Contemporary Brachytherapy 4 (2014): 417–23. http://dx.doi.org/10.5114/jcb.2014.47996.
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Shao, Tianchi. "Clinical progress of brachytherapy for cervical cancer." BIO Web of Conferences 111 (2024): 02019. http://dx.doi.org/10.1051/bioconf/202411102019.
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Cervical cancer is a prevalent malignant tumour of the female reproductive system, posing a significant threat to women's health and lives in China. Brachytherapy is a crucial component of radiotherapy for patients with locally intermediate and advanced cervical cancer. This includes intracavitary brachytherapy, interstitial brachytherapy, intracavitary and interstitial combined brachytherapy, and radioactive seed implantation brachytherapy. The aim of this article is to provide an update on the use of intracavitary brachytherapy, interstitial brachytherapy, and radioactive particle implantation.
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Murofushi, Keiko, Yasuo Yoshioka, Minako Sumi, Hitoshi Ishikawa, Masahiko Oguchi, and Hideyuki Sakurai. "Outcomes analysis of pre-brachytherapy MRI in patients with locally advanced cervical cancer." International Journal of Gynecologic Cancer 30, no. 4 (March 11, 2020): 473–79. http://dx.doi.org/10.1136/ijgc-2019-000925.
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IntroductionVarious brachytherapy options are available for treating cervical cancer. This study investigated whether pre-brachytherapy magnetic resonance imaging (MRI) findings could help identify the appropriate brachytherapy technique for cervical cancer.MethodsWe retrospectively evaluated patients with cervical cancer who underwent pre-brachytherapy MRI within 7 days before their first high-dose rate brachytherapy treatment between December 2009 and September 2015. Patients who could not undergo MRI at pre-treatment and/or pre-brachytherapy and complete radical radiotherapy were excluded. Conventional intracavitary brachytherapy was the preferred treatment for ≤4 cm and symmetrical tumors. Non-conventional intracavitary brachytherapy, including interstitial brachytherapy, was the preferred treatment for bulky tumors, asymmetrical tumors, tumors with severe vaginal invasion, or bulky barrel-shaped tumors. The 3-year rates of overall survival, disease-free survival, and local control were compared using the Kaplan–Meier method and the log-rank test. Overall survival and local control rates were assessed using Cox regression analysis to identify risk factors for poor overall survival and local control outcomes.ResultsA total of 146 patients were included in the study. The median tumor sizes were 52 mm (range 17–85) at the pre-treatment MRI and 30 mm (range 0–78) at the pre-brachytherapy MRI. Six patients had International Federation of Gynecology and Obstetrics (FIGO) stage IB2, 67 patients had stage II, 64 patients had stage III, and nine patients had stage IVA disease. A total of 124 (85%) patients had squamous cell carcinoma and 22 (15%) patients had adenosquamous cell carcinoma or adenocarcinoma. The MRI findings showed severe vaginal invasion (pre-treatment: 19 patients, pre-brachytherapy: 10 patients), asymmetrical bulky tumors (pre-treatment: 28 patients, pre-brachytherapy: 16 patients), and severe corpus invasion (pre-treatment: 39 patients, pre-brachytherapy: 18 patients). Based on the pre-brachytherapy MRI findings, non-conventional intracavitary brachytherapy was administered to 34 (23.3%) patients. Brachytherapy seemed to be appropriate for 133 (91.1%) patients and inappropriate for 13 (8.9%) patients. The 3-year rates were 84.2% for overall survival and 90.1% for local control. Grade 3 late rectal complications occurred in two (1%) patients. Multivariate analysis showed that tumor characteristics (size, shape, and extent of invasion) were not risk factors, although inappropriate brachytherapy was significantly related to poor local control (p<0.001).ConclusionPre-brachytherapy MRI may help to select appropriate brachytherapy for cervical cancer and reduce the likelihood of inappropriate brachytherapy leading to poor local control.
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Kubicek, G. J., G. J. Kubicek, S. Brown, and S. Redfield. "Combined brachytherapy and external beam radiation for prostate cancer in a community setting." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e16147-e16147. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e16147.
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e16147 Background: Prostate cancer is the most common male malignancy, and there is no one standard treatment modality. One treatment option is the combination of external beam radiotherapy and permanent transperineal brachytherapy seed implant Methods: Retrospective review of prostate cancer and side effect outcomes at a single institution in the community setting. All patients were treated with a combination of low dose rate transperineal brachytherapy seed placement and external beam radiation. Results: A total of 897 patients were analyzed, 781 had a minimum follow-up of one year. Median pre-treatment PSA was 8.1 (range 0.3 to 106) and the median Gleason score was 6. With a median follow-up of 3.6 years, 33 (3.4 %) patients had biochemical failure based on the phoenix definition of Nadir + 2. Not including impotence, acute toxicity greater than or equal to Grade 2 was seen in 115 patients (102 GU and 13 GI) and 193 patients had late toxicity greater than or equal to Grade 2 (155 GU and 38 GI). 563 patients received hormone therapy prior to or concurrent with the radiation. Conclusions: This is the largest series reporting on the outcome of combination brachytherpay implant and external beam radiation in the treatment of prostate cancer. Combination treatment using brachytherapy and external beam radiation is well tolerated, with a low rate of biochemical failure and should be considered one of the treatment options for prostate cancer. No significant financial relationships to disclose.
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Bansal, Indu, Debashis Panda, Arun Rathi, Anil Anand, and Anil Bansal. "Rationale, indications, techniques and applications of interstitial brachytherapy for carcinoma cervix." Asian Journal of Oncology 02, no. 02 (July 2016): 069–78. http://dx.doi.org/10.4103/2454-6798.197374.
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AbstractWith evolution of different newer radiotherapy techniques, still the role of brachytherapy in different gynecological malignancies has not sublimed. Most commonly used form of brachytherapy in carcinoma cervix patients is intracavitary brachytherapy. However, all the patients do not qualify for the treatment with intracavitary brachytherapy due to certain clinicopathological conditions. This warrants use of interstitial brachytherapy technique for treatment. For getting good results from interstitial brachytherapy, a good expertise and a proper infrastructure are needed. For perineal interstitial brachytherapy, different templates have been designed, used, and published by authors in different literature over the period. Among all these different templates, Martinez Universal Perineal Interstitial Template (MUPIT) has been used in gynecological, urological, and anorectal malignancies. In this literature review, we have discussed mainly MUPIT.
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CENGIZ, M., A. K. SINGH, and P. W. GRIGSBY. "Postoperative vaginal brachytherapy alone is the treatment of choice for grade 1–2, stage IC endometrial cancer." International Journal of Gynecologic Cancer 15, no. 5 (September 8, 2005): 926–31. http://dx.doi.org/10.1136/ijgc-00009577-200509000-00034.
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The aim was to determine outcome and toxicity in grade 1–2, FIGO stage IC endometrial cancer patients treated with external beam radiotherapy plus vaginal cuff brachytherapy or vaginal cuff brachytherapy alone. Between 1986 and 1999, a total of 132 patients were diagnosed with FIGO stage IC endometrial carcinoma. The median age was 67.5 years (range, 36–88). Median follow-up was 54 months (range, 6–157). Grade 1 disease was present in 64 patients, grade 2 in 45 patients, and grade 3 in 23 patients. Patients with grade 3 disease usually received external radiotherapy and were excluded from this analysis. Of the patients with grade 1–2 disease, 31 received brachytherapy alone and 78 received both external radiotherapy and brachytherapy. Ten (8%) patients experienced failure. Isolated pelvic relapse occurred in five patients. Three patients experienced both distant and local relapse. Two patients had isolated distant relapse. Nine failures occurred in patients treated with both external radiotherapy and brachytherapy. Only one failure occurred in those treated with brachytherapy alone. Overall survival and disease-free survival at 5 years were 85% and 92%, respectively. For those treated with both external radiotherapy and brachytherapy, 5-year locoregional control was 95%. For those treated with brachytherapy alone, 5-year locoregional control was 96.4%. There was no significant survival or local control difference between the two groups. Nine patients (9%) treated with both external radiotherapy and brachytherapy developed Radiation Therapy Oncology Group grade 3–4 toxicity. No patient treated with vaginal cuff brachytherapy alone developed grade 3–4 toxicity (P< 0.001). In patients with well-differentiated (grade 1–2) stage IC endometrial cancer, external beam radiotherapy plus brachytherapy versus vaginal cuff brachytherapy alone achieved equivalent local control and survival. However, vaginal cuff brachytherapy alone produced significantly less toxicity.
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Strom, Tobin Joel Crill, Alex Cruz, Nicholas Figura, Kushagra Shrinath, Kevin Nethers, Eric Albert Mellon, Daniel Celestino Fernandez, et al. "Health-related quality of life changes due to high-dose rate brachytherapy, low-dose rate brachytherapy, or intensity-modulated radiation therapy for prostate cancer." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 72. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.72.
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72 Background: To compare urinary, bowel, and sexual health-related quality of life (HRQOL) changes due to high-dose rate (HDR) brachytherapy, low-dose rate (LDR) brachytherapy, or intensity modulated radiation therapy (IMRT) monotherapy for prostate cancer. Methods: Between January 2002 and September 2013, 413 low-risk or favorable intermediate-risk prostate cancer patients were treated with HDR brachytherapy monotherapy to 2,700-2,800 cGy in two fractions (n=85), iodine-125 LDR brachytherapy monotherapy to 14,500 cGy in one fraction (n=249), or IMRT monotherapy to 7,400-8,100 cGy in 37-45 fractions (n=79) without pelvic lymph node irradiation. No androgen deprivation therapy was given. Patients used an International Prostate Symptoms Score questionnaire, an Expanded Prostate cancer Index Composite-26 bowel questionnaire, and a Sexual Health Inventory for Men questionnaire to assess their urinary, bowel, and sexual HRQOL, respectively, pre-treatment and at 1, 3, 6, 9, 12, and 18 months post-treatment. Results: Median follow-up was 32 months. HDR brachytherapy and IMRT patients had significantly less deterioration in their urinary HRQOL than LDR brachytherapy patients at 1 and 3 months post-irradiation. The only significant decrease in bowel HRQOL between the groups was seen 18 months following treatment, at which point IMRT patients had a slight, but significant, deterioration in their bowel HRQOL compared with HDR and LDR brachytherapy patients. HDR brachytherapy patients had worse sexual HRQOL than both LDR brachytherapy and IMRT patients following treatment. Conclusions: IMRT and HDR brachytherapy cause less severe acute worsening of urinary HRQOL than LDR brachytherapy. However, IMRT causes a slight, but significant, worsening of bowel HRQOL compared with HDR and LDR brachytherapy.
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Lacy, John M., William A. Wilson, Raevti Bole, Li Chen, Ali S. Meigooni, Randall G. Rowland, and William H. St Clair. "Salvage Brachytherapy for Biochemically Recurrent Prostate Cancer following Primary Brachytherapy." Prostate Cancer 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/9561494.
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Purpose. In this study, we evaluated our experience with salvage brachytherapy after discovery of biochemical recurrence after a prior brachytherapy procedure.Methods and Materials. From 2001 through 2012 twenty-one patients treated by brachytherapy within University of Kentucky or from outside centers developed biochemical failure and had no evidence of metastases. Computed tomography (CT) scans were evaluated; patients who had an underseeded portion of their prostate were considered for reimplantation.Results. The majority of the patients in this study (61.9%) were low risk and median presalvage PSA was 3.49 (range 17.41–1.68). Mean follow-up was 61 months. At last follow-up after reseeding, 11/21 (52.4%) were free of biochemical recurrence. There was a trend towards decreased freedom from biochemical recurrence in low risk patients (p=0.12). International Prostate Symptom Scores (IPSS) increased at 3-month follow-up visits but decreased and were equivalent to baseline scores at 18 months.Conclusions. Salvage brachytherapy after primary brachytherapy is possible; however, in our experience the side-effect profile after the second brachytherapy procedure was higher than after the first brachytherapy procedure. In this cohort of patients we demonstrate that approximately 50% oncologic control, low risk patients appear to have better outcomes than others.
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ITAMI, Jun. "Brachytherapy." RADIOISOTOPES 61, no. 3 (2012): 153–59. http://dx.doi.org/10.3769/radioisotopes.61.153.
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Hitchon, Patrick, Pamela Schneider, Jim Torner, Marge Rogers, and John VanGilder. "Brachytherapy." Neurosurgery 43, no. 3 (September 1998): 688. http://dx.doi.org/10.1097/00006123-199809000-00247.
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Goffinet, Don R., Richard S. Cox, Daniel H. Clarke, Karen K. Fu, Basil Hilaris, and Clifton C. Ling. "Brachytherapy." American Journal of Clinical Oncology 11, no. 3 (June 1988): 342–54. http://dx.doi.org/10.1097/00000421-198806000-00010.
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Morris, Nancy B. "Brachytherapy." Critical Care Nursing Clinics of North America 11, no. 3 (September 1999): 333–46. http://dx.doi.org/10.1016/s0899-5885(18)30150-3.
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Blasko, John C. "Brachytherapy." Urology 55, no. 3 (March 2000): 306–8. http://dx.doi.org/10.1016/s0090-4295(99)00472-0.
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Bossi, A., and G. Roussy. "Brachytherapy." European Urology Supplements 15, no. 2 (January 2016): 52–52. http://dx.doi.org/10.1016/s1569-9056(16)30026-4.
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Goffinet, Don R., Richard S. Cox, Daniel H. Clarke, Karen K. Fu, Basil Hilaris, and Clifton C. Ling. "Brachytherapy." Medical Dosimetry 14, no. 1 (1989): 59. http://dx.doi.org/10.1016/0958-3947(89)90157-x.
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Dalwadi, Shraddha M., Andrew M. Farach, and Michelle S. Ludwig. "Brachytherapy." JAMA Oncology 6, no. 4 (April 1, 2020): 596. http://dx.doi.org/10.1001/jamaoncol.2019.5882.
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Koot, R. W., M. Maarouf, M. C. C. M. Hulshof, J. Voges, H. Treuer, C. Koedooder, V. Sturm, and D. A. Bosch. "Brachytherapy." Cancer 88, no. 12 (June 15, 2000): 2796–802. http://dx.doi.org/10.1002/1097-0142(20000615)88:12<2796::aid-cncr19>3.0.co;2-1.
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Vordermark, Dirk. "Brachytherapy." Cancer 91, no. 6 (2001): 1185–86. http://dx.doi.org/10.1002/1097-0142(20010315)91:6<1185::aid-cncr1116>3.0.co;2-q.
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Parsons, Matthew W., Y. Jessica Huang, Lindsay Burt, Gita Suneja, and David Gaffney. "Vaginal cuff brachytherapy for endometrial cancer: a review of major clinical trials with a focus on fractionation." International Journal of Gynecologic Cancer 32, no. 3 (March 2022): 311–15. http://dx.doi.org/10.1136/ijgc-2021-002456.
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The use of vaginal cuff brachytherapy in the adjuvant management of endometrial cancer has increased over time. Recommendations from the American Brachytherapy Society, American Society of Radiation Oncology, and European Society for Medical Oncology help to guide the application of vaginal cuff brachytherapy. However, wide variation in practice remains regarding treatment techniques. This article reviews the use of vaginal cuff brachytherapy in the post-operative management of endometrial cancer. It covers risk stratification, treatment rationale, outcomes, and treatment planning recommendations with a specific focus on dose-fractionation regimens. The authors performed a thorough literature review of articles pertinent to the goals of this review. Also presented are early results of the Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared with Standard of Care (SAVE) trial of a two-fraction vaginal cuff brachytherapy regimen.Adjuvant vaginal cuff brachytherapy for early-stage endometrial cancer results in excellent disease control with minimal toxicity. The PORTEC-2 trial showed that vaginal cuff brachytherapy is non-inferior to external beam radiation for vaginal recurrence in patients at high-intermediate risk. Vaginal cuff brachytherapy may also be used as a boost following external beam radiation in combination with chemotherapy for high-risk histologies. Numerous techniques can be used for vaginal cuff brachytherapy, including various medical devices, dose-fractionation schedules, and treatment planning approaches. The early control results of the SAVE trial are promising and we are hopeful that this trial establishes two fraction regimens as a viable option for vaginal cuff brachytherapy.
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Keyes, Mira, Juanita Crook, W. James Morris, Gerard Morton, Tom Pickles, Nawaid Usmani, and Eric Vigneault. "Canadian Prostate Brachytherapy in 2012." Canadian Urological Association Journal 7, no. 1-2 (February 20, 2013): 51. http://dx.doi.org/10.5489/cuaj.218.
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Prostate brachytherapy can be used as a monotherapy for low- and intermediate-risk patients or in combination with external beam radiation therapy (EBRT) as a form of dose escalation for selected intermediate- and high-risk patients. Prostate brachytherapy with either permanent implants (low dose rate [LDR]) or temporary implants (high dose rate [HDR]) is emerging as the most effective radiation treatment for prostate cancer. Several large Canadian brachytherapy programs were established in the mid- to late-1990s. Prostate brachytherapy is offered in British Columbia, Alberta, Manitoba, Ontario, Quebec and New Brunswick. We anticipate the need for brachytherapy services in Canada will significantly increase in the near future. In this review, we summarize brachytherapy programs across Canada, contemporary eligibility criteria for the procedure, toxicity and prostate-specific antigen recurrence free survival (PRFS), as published from Canadian institutions for both LDR and HDR brachytherapy.
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Andruska, Neal, Benjamin W. Fischer-Valuck, Ruben Carmona, Temitope Agabalogun, Randall J. Brenneman, Hiram A. Gay, Jeff M. Michalski, and Brian C. Baumann. "Outcomes of Patients With Unfavorable Intermediate-Risk Prostate Cancer Treated With External-Beam Radiotherapy Versus Brachytherapy Alone." Journal of the National Comprehensive Cancer Network 20, no. 4 (April 2022): 343–50. http://dx.doi.org/10.6004/jnccn.2021.7061.
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Background: The NCCN Guidelines for Prostate Cancer currently recommend several definitive radiotherapy (RT) options for men with unfavorable intermediate-risk (UIR) prostate cancer: external-beam RT (EBRT) plus androgen deprivation therapy (ADT) or EBRT plus brachytherapy boost with or without ADT. However, brachytherapy alone with or without ADT is not well defined and is currently not recommended for UIR prostate cancer. We hypothesized that men treated with brachytherapy with or without ADT have comparable survival rates to men treated with EBRT with or without ADT. Methods: A total of 31,783 men diagnosed between 2004 and 2015 with UIR prostate cancer were retrospectively reviewed from the National Cancer Database. Men were stratified into 4 groups: EBRT (n=12,985), EBRT plus ADT (n=12,960), brachytherapy (n=4,535), or brachytherapy plus ADT (n=1,303). Inverse probability of treatment weighting (IPTW) was used to adjust for covariable imbalances, and weight-adjusted multivariable analysis (MVA) using Cox regression modeling was used to compare overall survival (OS) hazard ratios (HRs). Results: Relative to EBRT alone, the following treatments were associated with improved OS: EBRT plus ADT (HR, 0.92; 95% CI, 0.87–0.97; P=.002), brachytherapy alone (HR, 0.90; 95% CI, 0.83–0.98; P=.01), and brachytherapy plus ADT (HR, 0.78; 95% CI, 0.69–0.88; P=.00006). Brachytherapy correlated with improved OS relative to EBRT in men who were not treated with ADT (HR, 0.92; 95% CI, 0.84–0.99; P=.03) and in those receiving ADT (HR, 0.84; 95% CI, 0.75–0.95; P=.004). At 10-year follow-up, 56% and 63% of men receiving EBRT and brachytherapy, respectively, were alive (P<.0001). IPTW was used to determine the average treatment effect of definitive brachytherapy. Relative to EBRT, definitive brachytherapy correlated with improved OS (HR, 0.90; 95% CI, 0.84–0.97; P=.009) on weight-adjusted MVA. Conclusions: Definitive brachytherapy was associated with improved OS compared with EBRT. The addition of ADT to both EBRT and definitive brachytherapy was associated with improved OS. These results suggest that definitive brachytherapy should be considered as an option for men with UIR prostate cancer.
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Kawamoto, Terufumi, Naoki Nakamura, Tetsuo Saito, Ayako Tonari, Hitoshi Wada, Hideyuki Harada, Hikaru Kubota, et al. "Palliative brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer: a nationwide survey in Japan." Japanese Journal of Clinical Oncology 51, no. 6 (February 24, 2021): 950–55. http://dx.doi.org/10.1093/jjco/hyab015.
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Abstract Background International guidelines recommend brachytherapy for patients with dysphagia from esophageal cancer, whereas brachytherapy is infrequently used to palliate dysphagia in some countries. To clarify the availability of palliative treatment for dysphagia from esophageal cancer and explain why brachytherapy is not routinely performed are unknown, this study investigated the use of brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer. Methods Japanese Radiation Oncology Study Group members completed a survey and selected the treatment that they would recommend for hypothetical cases of dysphagia from esophageal cancer. Results Of the 136 invited facilities, 61 completed the survey (44.9%). Four (6.6%) facilities performed brachytherapy of the esophagus, whereas brachytherapy represented the first-line treatment at three (4.9%) facilities. Conversely, external beam radiotherapy alone and chemoradiotherapy were first-line treatments at 61 and 58 (95.1%) facilities, respectively. In facilities that performed brachytherapy, the main reason why brachytherapy of the esophagus was not performed was high invasiveness (30.2%). Definitive-dose chemoradiotherapy with (≥50 Gy) tended to be used in patients with expected long-term survival. Conclusions Few facilities routinely considered brachytherapy for the treatment of dysphagia from esophageal cancer in Japan. Conversely, most facilities routinely considered external beam radiotherapy. In the future, it will be necessary to optimize external beam radiotherapy.
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Mitra, Devarati, Yaguang Pei, Ivan Buzurovic, Phillip M. Devlin, Katherine Thornton, Chandrajit P. Raut, Elizabeth H. Baldini, and Miranda B. Lam. "Angiosarcoma of the Scalp and Face: A Dosimetric Comparison of HDR Surface Applicator Brachytherapy and VMAT." Sarcoma 2020 (August 25, 2020): 1–6. http://dx.doi.org/10.1155/2020/7615248.
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Purpose. Angiosarcoma of the face and scalp is a rare disease with high rates of recurrence. The optimal treatment approach is not well defined. This study presents a dosimetric comparison of high-dose-rate surface applicator (HDR-SA) brachytherapy to volumetric-modulated arc therapy (VMAT). Methods. Between 2011 and 2018, 12 patients with primary or recurrent angiosarcoma of the face or scalp were treated with HDR-SA brachytherapy using CT-based planning at our institution. For comparison, deliverable VMAT plans for each patient were generated, and dose distribution was compared to the delivered HDR-SA brachytherapy plans. Results. Both VMAT and HDR-SA brachytherapy plans delivered good coverage of the clinical target. However, the dose distribution of VMAT was significantly different from HDR-SA brachytherapy across a variety of parameters. Mean doses to the lacrimal gland, orbit, lens, and cochlea were significantly higher with HDR-SA brachytherapy vs. VMAT. Brain Dmax, V80%, and V50% were also significantly higher with HDR-SA brachytherapy. Conclusions. There may be dosimetric advantages to VMAT over HDR-SA brachytherapy for many patients. However, individual tumor location, patient anatomy, and treatment reproducibility may result in HDR-SA brachytherapy being the preferred technique in a subset of patients. Ultimately, a personalized approach is likely to be the optimal treatment plan.
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Taparra, Kekoa, Brandon I. Ing, Agnes Ewongwo, Jacqueline B. Vo, Jaimie Z. Shing, Megan Y. Gimmen, Kiana M. K. Keli‘i, Jason Uilelea, Erqi Pollom, and Elizabeth Kidd. "Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancer in the United States." Cancers 15, no. 9 (April 30, 2023): 2571. http://dx.doi.org/10.3390/cancers15092571.
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Brachytherapy improves clinical outcomes among women diagnosed with cervical and endometrial cancers. Recent evidence demonstrates that declining brachytherapy boosts for women with cervical cancer were associated with higher mortality. In this retrospective cohort study, women diagnosed with endometrial or cervical cancer in the United States between 2004 and 2017 were selected from the National Cancer Database for evaluation. Women ≥18 years of age were included for high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers and FIGO Stage IA-IVA—non-surgically treated cervical cancers. The aims were to (1) evaluate brachytherapy treatment practice patterns for cervical and endometrial cancers in the United States; (2) calculate rates of brachytherapy treatment by race; and (3) determine factors associated with not receiving brachytherapy. Treatment practice patterns were evaluated over time and by race. Multivariable logistic regression assessed predictors of brachytherapy. The data show increasing rates of brachytherapy for endometrial cancers. Compared to non-Hispanic White women; Native Hawaiian and other Pacific Islander (NHPI) women with endometrial cancer and Black women with cervical cancer were significantly less likely to receive brachytherapy. For both NHPI and Black women, treatment at community cancer centers was associated with a decreased likelihood of brachytherapy. The data suggest racial disparities among Black women with cervical cancer and NHPI women with endometrial cancer and emphasize an unmet need for brachytherapy access within community hospitals.
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Rai, Bhavana, Firuza D. Patel, Parsee Tomar, Oinam A. Singh, Vijai Simha, Bhaswanth Dhanireddy, and Suresh C. Sharma. "A study to assess the feasibility of using CT (±diagnostic MRI) instead of MRI at brachytherapy in image guided brachytherapy in cervical cancer." Journal of Radiotherapy in Practice 13, no. 4 (February 13, 2014): 438–46. http://dx.doi.org/10.1017/s1460396914000053.
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AbstractPurposeTo compare the contours and dose volume histograms (DVH) parameters of the high-risk clinical target volume (HRCTV) contoured on computed tomography (CT) using clinical findings at brachytherapy, clinical findings at brachytherapy with magnetic resonance imaging (MRI) at diagnosis and HRCTV defined on MRI at brachytherapy in cervical cancer patients.Materials and methodsFifteen patients undergoing MRI-guided image-based brachytherapy underwent both CT and MRI after applicator insertion. Two sets of contours were defined on CT. In the first set, the HRCTV was defined with the help of clinical findings at brachytherapy (CT-HRCTV). In the second set, HRCTV was defined with MRI at diagnosis and clinical findings at brachytherapy (CT-HRCTVdmri). This was compared with the HRCTV defined on MRI at brachytherapy (MR-HRCTV). The doses to the organs at risk (OARs) were compared for CT and MRI.ResultsA significant overestimation of the maximum width and width at point A was observed for CT-HRCTV (p −0·00; 0·00) and CT-HRCTVdmri (p −0·03; 0·01), respectively. The height was underestimated with CT-HRCTV in patients with intrauterine disease extension. For a single fraction, the mean difference in the D90 for the CT contours was <1 Gy. The doses to the OARs were comparable.ConclusionsCT may be an alternative when facilities for MRI image-based brachytherapy are lacking, provided at least one MRI is available before brachytherapy.
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.., Kala, and Tanya Elizabeth. "Anesthesia for Brachytherapy: A Review." Indian Journal of Anesthesia and Analgesia 7, no. 6 (December 15, 2020): 1439–14444. http://dx.doi.org/10.21088/ijaa.2349.8471.7620.83.
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Radiotherapy is a commonly employed and an important modality of treatment for cancer with about 50 % of the patients receiving radiotherapy during their course of treatment.1 Two major categories for the application of radiation are external beam radiation and brachytherapy.1 Brachytherapy is derived from the greek word brachys meaning “short distance”.2 Brachytherapy is administered by inserting a radiation source inside a specific cancer site which needs anesthesia, analgesia and muscle relaxation. The theory behind brachytherapy is to deliver low intensity radiation over an extended period to a relatively small volume of tissue covering the tumour area and sparing the surrounding normal tissue. The demand for anesthesia in brachytherapy is increasing nowadays. Anesthetic management is crucial because it poses a number of challenges for the anesthesiologist. Patients for brachytherapy are often elderly and are high risk patients with multiple co morbidities, brachytherapy for head and neck malignancy may pose the problem of difficult airway, to achieve a stable position of the applicators and implants immobilization is essential.3 Brachytherapy often has an unpredictable procedural duration. Transportation of the anesthetized patients to different radiological suite is a typical challenge.3 Various modalities of anesthesia employed include general, spinal, combined spinal epidural anesthesia and local anesthesia with sedation. Anesthesiologist play a major and an important role in the ongoing challenge to provide an optimal treatment conditions for brachytherapy.
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Wegener, Eric, Justin Samuels, Mark Sidhom, Yuvnik Trada, Swetha Sridharan, Samuel Dickson, Nicholas McLeod, and Jarad M. Martin. "Virtual HDR Boost for Prostate Cancer: Rebooting a Classic Treatment Using Modern Tech." Cancers 15, no. 7 (March 28, 2023): 2018. http://dx.doi.org/10.3390/cancers15072018.
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Prostate cancer (PC) is the most common malignancy in men. Internal radiotherapy (brachytherapy) has been used to treat PC successfully for over a century. In particular, there is level-one evidence of the benefits of using brachytherapy to escalate the dose of radiotherapy compared with standard external beam radiotherapy approaches. However, the use of PC brachytherapy is declining, despite strong evidence for its improved cancer outcomes. A method using external beam radiotherapy known as virtual high-dose-rate brachytherapy boost (vHDRB) aims to noninvasively mimic a brachytherapy boost radiation dose plan. In this review, we consider the evidence supporting brachytherapy boosts for PC and the continuing evolution of vHDRB approaches, culminating in the current generation of clinical trials, which will help define the role of this emerging modality.
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Banerjee, Susovan, Shikha Goyal, Saumyaranjan Mishra, Deepak Gupta, Shyam Singh Bisht, Venketesan K, Kushal Narang, and Tejinder Kataria. "Artificial intelligence in brachytherapy: a summary of recent developments." British Journal of Radiology 94, no. 1122 (June 1, 2021): 20200842. http://dx.doi.org/10.1259/bjr.20200842.
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Artificial intelligence (AI) applications, in the form of machine learning and deep learning, are being incorporated into practice in various aspects of medicine, including radiation oncology. Ample evidence from recent publications explores its utility and future use in external beam radiotherapy. However, the discussion on its role in brachytherapy is sparse. This article summarizes available current literature and discusses potential uses of AI in brachytherapy, including future directions. AI has been applied for brachytherapy procedures during almost all steps, starting from decision-making till treatment completion. AI use has led to improvement in efficiency and accuracy by reducing the human errors and saving time in certain aspects. Apart from direct use in brachytherapy, AI also contributes to contemporary advancements in radiology and associated sciences that can affect brachytherapy decisions and treatment. There is a renewal of interest in brachytherapy as a technique in recent years, contributed largely by the understanding that contemporary advances such as intensity modulated radiotherapy and stereotactic external beam radiotherapy cannot match the geometric gains and conformality of brachytherapy, and the integrated efforts of international brachytherapy societies to promote brachytherapy training and awareness. Use of AI technologies may consolidate it further by reducing human effort and time. Prospective validation over larger studies and incorporation of AI technologies for a larger patient population would help improve the efficiency and acceptance of brachytherapy. The enthusiasm favoring AI needs to be balanced against the short duration and quantum of experience with AI in limited patient subsets, need for constant learning and re-learning to train the AI algorithms, and the inevitability of humans having to take responsibility for the correctness and safety of treatments.
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Presley, Carolyn J., Pamela R. Soulos, Jeph Herrin, Kenneth B. Roberts, James B. Yu, Brigid Killelea, Beth-Ann Lesnikoski, Jessica B. Long, and Cary P. Gross. "Patterns of Use and Short-Term Complications of Breast Brachytherapy in the National Medicare Population From 2008–2009." Journal of Clinical Oncology 30, no. 35 (December 10, 2012): 4302–7. http://dx.doi.org/10.1200/jco.2012.43.5297.
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Purpose Brachytherapy has disseminated into clinical practice as an alternative to whole-breast irradiation (WBI) for early-stage breast cancer; however, current national treatment patterns and associated complications remain unknown. Patients and Methods We constructed a national sample of Medicare beneficiaries ages 66 to 94 years who underwent breast-conserving surgery from 2008 to 2009 and were treated with brachytherapy or WBI. We used hospital referral regions (HRRs) to assess national treatment variation and an instrumental variable analysis to compare complication rates between treatment groups, adjusting for patient and clinical characteristics. We compared overall, wound and skin, and deep-tissue and bone complications between brachytherapy and WBI at 1 year of follow-up. Results Of 29,648 women in our sample, 4,671 (15.8%) received brachytherapy. The percent of patients receiving brachytherapy varied substantially across HRRs, ranging from 0% to over 70% (interquartile range, 7.5% to 23.3%). Of women treated with brachytherapy, 34.3% had a complication compared with 27.3% of women undergoing WBI (P < .001). After adjusting for patient and clinical characteristics, 35.2% of women treated with brachytherapy (95% CI, 28.6 to 41.9) had a complication compared with 18.4% treated with WBI (95% CI, 15.5 to 21.3; P value for difference, <.001). Brachytherapy was associated with a 16.9% higher rate of wound and skin complications compared with WBI (95% CI, 10.0 to 23.9; P < .001), but there was no difference in deep-tissue and bone complications. Conclusion Brachytherapy is commonly used among Medicare beneficiaries and varies substantially across regions. After 1 year, wound and skin complications were significantly higher among women receiving brachytherapy compared with those receiving WBI.
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Chen, A. B., A. V. D’Amico, B. A. Neville, and C. C. Earle. "Predictors of complications following prostate brachytherapy." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 6021. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.6021.
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6021 Background: Prior studies on complications from prostate brachytherapy have reported on single institution experiences. We assessed the prevalence and predictors of complications following brachytherapy for prostate cancer on a population basis. Methods: We analyzed the claims of Medicare-enrolled men over age 65 living in SEER surveillance areas diagnosed with locoregional prostate cancer from 1991–1999 who underwent brachytherapy as initial treatment. Two-year complications were identified using Medicare diagnosis and procedure codes from the time of brachytherapy through 2001. Results: We identified 6,879 men who had brachytherapy as initial treatment for locoregional prostate cancer, 5,682 of whom had at least two years follow-up. Of these patients, 54.63% had at least one diagnosis or procedure associated with rectal, urinary, or erectile dysfunction, and 14.33% underwent at least one invasive surgical procedure for treating bowel, urinary, or erectile morbidity within two years of brachytherapy. 10.30% of men had procedures for urinary obstruction, 0.18% had procedures for urinary incontinence, 0.77% had rectal procedures, and 4.08% had invasive procedures for erectile dysfunction. Predictors of two-year complication procedures on multivariable analysis are shown in the Table . Conclusions: A significant proportion of men have diagnoses associated with rectal, urinary, or erectile morbidity following prostate brachytherapy. Though procedures for urinary obstruction are common following brachytherapy, invasive interventions for rectal complications, urinary incontinence, and erectile dysfunction are rare. Procedures for complications following brachytherapy appear to have declined over the 1990s. [Table: see text] No significant financial relationships to disclose.
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Cherr, Gregory S., Hall M. D. Craig, Benoit C. Pineau, and Gregory S. Waters. "Rectourethral Fistula and Massive Rectal Bleeding from Iodine-125 Prostate Brachytherapy: A Case Report." American Surgeon 67, no. 2 (February 2001): 131–34. http://dx.doi.org/10.1177/000313480106700207.
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Iodine-125 brachytherapy is an effective well-tolerated treatment for localized prostate cancer. Gastrointestinal complications of brachytherapy (minor rectal bleeding or tenesmus) are uncommon. Rectal ulceration or rectourethral fistulas after prostate brachytherapy are rare. We present a case of massive refractory rectal bleeding and rectourethral fistula, a complication of prostate brachytherapy never before reported. As a result of the patient's life-threatening symptoms aggressive surgical therapy was necessary.
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Brandão, Sâmia de Freitas, and Tarcísio Passos Ribeiro de Campos. "Comparative dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for brain tumors." Radiologia Brasileira 46, no. 4 (August 2013): 221–26. http://dx.doi.org/10.1590/s0100-39842013000400008.
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Objective Comparative analysis of dosimetry in intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT for treatment of brain tumors. Materials and Methods Simulations of intracavitary balloon catheter brachytherapy with I-125 and in Cf-252 brachytherapy combined with BNCT were performed with the MCNP5 code, modeling the treatment of a brain tumor on a voxel computational phantom representing a human head. Absorbed dose rates were converted into biologically weighted dose rates. Results Intracavitary balloon catheter brachytherapy with I-125 produced biologically weighted mean dose rates of 3.2E-11, 1.3E-10, 1.9E-11 and 6.9E-13 RBE.Gy.h-1.p-1.s, respectively, on the healthy tissue, on the balloon periphery and on the I 1 and I 2 tumor infiltration zones. On the other hand, Cf-252 brachytherapy combined with BNCT produced a biologically weighted mean dose rate of 5.2E-09, 2.3E-07, 8.7E-09 and 2.4E-09 RBE.Gy.h-1.p-1.s, respectively on the healthy tissue, on the target tumor and on the I 1 and I 2 infiltration zones. Conclusion Cf-252 brachytherapy combined with BNCT delivered a selective irradiation to the target tumor and to infiltration zones, while intracavitary balloon catheter brachytherapy with I-125 delivered negligible doses on the tumor infiltration zones.
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Kato, Manabu, Shinichiro Higashi, Yusuke Sugino, Shinya Kajiwara, Shiori Tanaka, Goshi Kitano, Yasuhumi Yamashita, et al. "Clinical Efficacy and Openness to New Challenges of Low Dose Rate Brachytherapy for Prostate Cancer." Current Oncology 30, no. 11 (November 8, 2023): 9824–35. http://dx.doi.org/10.3390/curroncol30110713.
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Over a century ago, low-dose-rate (LDR) brachytherapy was introduced to treat prostate cancer (PCa). Since then, it has been widely applied worldwide, including in East Asia. LDR brachytherapy has been performed in 88 institutes in Japan. Beneficial clinical outcomes of LDR brachytherapy for intermediate-to-high-risk PCa have been demonstrated in large clinical trials. These clinical outcomes were achieved through advances in methods, such as urological precise needle puncture and seed placement, and the quantitative decision making regarding radiological parameters by radiation oncologists. The combined use of LDR brachytherapy with other therapeutic modalities, such as external beam radiation and androgen deprivation therapy, for the clinical risk classification of PCa has led to better anticancer treatment efficacy. In this study, we summarized basic LDR brachytherapy findings that should remain unchanged and be passed down in urology departments. We also discussed the applications of LDR brachytherapy for PCa in various clinical settings, including focal and salvage therapies. In addition, we highlighted technologies associated with brachytherapy that are under development.
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Lee, Misuk, and Hyo Chun Lee. "Geographic disparities in brachytherapy accessibility for cervical cancer." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): 1577. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.1577.
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1577 Background: While brachytherapy stands as a crucial component of the treatment for locally advanced cervical cancer, the issue of geographic disparities in brachytherapy accessibility has become a noteworthy public health concern in South Korea. Moreover, the specific factors contributing to these disparities have not been clearly elucidated. In light of this, we conducted a nationwide ecologic study to comprehensively investigate the socioeconomic factors associated with brachytherapy accessibility. Methods: A total of 2,998 patients newly diagnosed with cervical cancer in 2020 were identified through the Korea Central Cancer Registry (KCCR). Across 17 administrative districts in South Korea, 32 brachytherapy facilities were available. To capture unique socioeconomic factors for each region, including the number of Korean Medicaid (K-Medicaid), Medicare (K-Medicare) beneficiaries, marriage immigrants, registered foreigners, and total residents, data were obtained from the Korean Statistical Information Service (KOSIS). Notably, K-Medicaid and K-Medicare represent governmental medical insurance assistance for patients in poverty and those aged over 65, respectively. The brachytherapy accessibility rate (BAR) was defined as the number of brachytherapy procedures divided by new cervical cancer cases. Additionally, each district's socioeconomic factor was normalized by the number of residents. Univariate and multivariate logistic regression analyses were conducted to explore the relationships between BAR and socioeconomic factors. Results: The capital city and its adjoining metropolitan area accounted for 46.9% of the total brachytherapy facilities, with Seoul having 25% (8 out of 32) and Gyeonggi having 21.9% (7 out of 32). Conversely, three non-metropolitan regions had no brachytherapy facilities. In the multivariate logistic regression analysis, the brachytherapy accessibility rate (BAR) demonstrated an inverse association with both the number of K-Medicare beneficiaries and the total immigrant population (Odds ratios of 0.66 and -2.85, respectively). Conclusions: To the best of our knowledge, this is the inaugural study highlighting the robust associations between older age and foreign residency status with reduced accessibility to brachytherapy. The observed inaccessibility to brachytherapy has the potential to impede the delivery of standard care, consequently leading to a poorer prognosis for vulnerable populations. Future research endeavors and targeted social interventions will be imperative to rectify geographic disparities in brachytherapy accessibility and ensure equitable healthcare outcomes.
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Presley, Carolyn J., Pamela R. Soulos, Jeph Herrin, Kenneth B. Roberts, James B. Yu, Brigid K. Killelea, Beth-Ann Lesnikoski, Jessica B. Long, and Cary P. Gross. "Short-term complications and use of breast brachytherapy in the national Medicare population in 2008-2009." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 1030. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.1030.
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1030 Background: Brachytherapy as an alternative to whole-breast irradiation (WBI) for early-stage breast cancer has disseminated into clinical practice; however, current national treatment patterns and associated complications remain unknown. Methods: We constructed a national sample of Medicare beneficiares aged 66 to 94 who underwent breast conserving surgery in 2008-2009 and who were treated with brachytherapy or WBI. We used hospital referral regions to assess national treatment variation and an instrumental variable analysis to compare complication rates between treatment groups, adjusting for patient and clinical characteristics such as age, number of comorbidities, receipt of chemotherapy or screening mammogram, and type of radiation facility. We compared one-year overall, wound and skin, and deep tissue and bone complications between brachytherapy and WBI using specific procedure and diagnosis codes identified in Medicare claims. Results: Of the 29,648 women in our sample, 4,671 (15.8%) received brachytherapy. The median percent of patients receiving brachytherapy varied substantially across hospital referral regions (interquartile range: 7.5%-23.3%). In the bivariate analysis, 34.3% of women treated with brachytherapy had a complication compared to 27.3% of those who received WBI (P<0.001). After adjusting for patient and clinical characteristics, 35.3% (95% CI: 34.7, 35.8) of women treated with brachytherapy had a complication compared to 18.7% (95% CI: 18.2,19.2) treated with WBI (average predicted difference: 16.5%, 95% CI: 15.8, 17.3, P<0.001). While brachytherapy was associated with a 16.9% (95% CI: 10.0, 23.8, P<0.001) higher absolute percentage of wound and skin complications compared to WBI, there was no difference in deep tissue and bone complications. Conclusions: Brachytherapy is commonly used among Medicare beneficiaries; in some regions nearly one in four women who underwent adjuvant radiation received brachytherapy. After one year, wound and skin complications were significantly more common among women who received brachytherapy compared to those receiving WBI, but there was no difference in deep tissue and bone complications.
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Leskinen, Sandra, Netanel Ben-Shalom, Jason Ellis, David Langer, John A. Boockvar, Randy S. D’Amico, and A. Gabriella Wernicke. "RADT-01 A COMPREHENSIVE REVIEW OF THE UTILITY OF BRACHYTHERAPY IN THE MANAGEMENT OF BRAIN METASTASIS." Neuro-Oncology Advances 6, Supplement_1 (August 2024): i29. http://dx.doi.org/10.1093/noajnl/vdae090.097.
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Abstract PURPOSE This literature review investigates the current applications of brachytherapy in treating brain metastases (BMs), focusing on its advantages, limitations, and clinical outcomes. METHODS A comprehensive literature search was conducted using PubMed, Embase, and ClinicalTrials.gov, focusing on studies related to brachytherapy in BM treatment and adhering to PRISMA guidelines. We included studies if they reported brachytherapy techniques, isotopes, and patient outcomes. RESULTS Our initial search yielded 1,813 articles, of which 42 studies met inclusion criteria reporting on brachytherapy techniques, the isotopes utilized, and patient outcomes. Specifically, we identified 19 total studies assessing the use of Iodine-125 (I-125) brachytherapy, including two prospective studies, 16 retrospective studies, and one case report. There were 23 total studies assessing the use of Cesium-131 (Cs-131) brachytherapy, including five clinical trials, four prospective studies, 11 retrospective studies, and three case reports. Two retrospective studies used both Cs-131 and I-125 seeds. We identified three registered national clinical trials examining the use of Cs-131 brachytherapy for BM treatment. Although I-125 brachytherapy was found to be effective in BM treatment with local control rates and median overall survival paralleling stereotactic radiosurgery and whole brain radiotherapy, the rates of radiation necrosis were as high as 23% in one study. Conversely, Cs-131 studies described high rates of locoregional tumor control with minimal rates of radiation necrosis. One clinical trial found a statistically significant improvement in cognitive functioning and quality of life at four- and six-months following Cs-131 seed implantation. CONCLUSION Brachytherapy, with a particular focus on I-125 and Cs-131 isotopes, has shown promise in treating brain metastases, offering targeted radiation with minimal effects on surrounding healthy tissue. Future research, including randomized controlled trials and long-term follow-up studies, is necessary to optimize the role of brachytherapy in the treatment of brain metastases.
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Fields, Emma C., Jenna M. Kahn, and Lisa Singer. "Education in gynecological brachytherapy." International Journal of Gynecologic Cancer 32, no. 3 (March 2022): 407–13. http://dx.doi.org/10.1136/ijgc-2021-002516.
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Brachytherapy is an essential component in the curative treatment of many gynecological malignancies. In the past decade, advances in magnetic resonance imaging and the ability to adapt and customize treatment with hybrid interstitial applicators have led to improved clinical outcomes with decreased toxicity. Unfortunately, there has been a shift in clinical practice away from the use of brachytherapy in the United States. The decline in brachytherapy is multifactorial, but includes both a lack of exposure to clinical cases and an absence of standardized brachytherapy training for residents. In other medical specialties, a clear relationship has been established between clinical case volumes and patient outcomes, especially for procedural-based medicine. In surgical residencies, simulation-based medical education (SBME) is a required component of the program to allow for some autonomy before operating on a patient. Within radiation oncology, there is limited but growing experience with SBME for training residents and faculty in gynecological brachytherapy. This review includes single institutional, multi-institutional and national initiatives using creative strategies to teach the components of gynecological brachytherapy. These efforts have measured success in various forms; the majority serve to improve the confidence of the learners, and many have also demonstrated improved competence from the training as well. The American Brachytherapy Society launched the 300 in 10 initiative in 2020 with a plan of training 30 competent brachytherapists per year over a 10 year period and has made great strides with a formal mentorship program as well as externships available to senior residents interested in starting brachytherapy programs. Moving forward, these curricula could be expanded to provide standardized brachytherapy training for all residents. SBME could also play a role in initial certification and maintenance of certification. Given the burden of disease, it would be valuable to develop similar training for providers in low and middle income countries.
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Setiawan, Alfredo Abrian Erlangga, Aidyl Fitrisyah, Rizal Zainal, Budi Santoso, and Arwan Bin Laeto. "Pain and Complications Assessment in Gynecological Cancer Brachytherapy Patients Under Spinal Anesthesia." Journal of Anaesthesia and Pain 4, no. 3 (September 30, 2023): 53–56. http://dx.doi.org/10.21776/ub.jap.2023.004.03.03.
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Background: Brachytherapy is a radiation therapy that can deliver radiation to cancer by minimizing radiation exposure to adjacent organs or tissues. In its implementation, brachytherapy can cause pain so that adequate anesthesia is needed in order to get optimal results. This study was aimed to determine the adequacy of anesthesia and complications that occur in gynecological cancer patients undergoing brachytherapy with spinal anesthesia. Methods: A descriptive observational study using primary data that taken by interviewing the patients who underwent gynecological brachytherapy under spinal anesthesia at dr. Mohammad Hoesin Palembang. The number of samples in this study that met the inclusion criteria was 18 subjects. Pain was assessed using an 11-point numeric rating scale. Data were collected in 5 different times, before procedure, during applicator insertion, during radiation process, during applicator removal, and 4 hours after brachytherapy. in addition, all complications that occurred during the procedure were recorded. Data were analyzed to describe the mean, median, minimum, and maximum of pain scores. Result: The average pain score before brachytherapy was 0.78, at the time of applicator insertion was 0, 0.28 at irradiation, 0,11 at removal of the applicator and 1.33 after the brachytherapy procedure. The most common complications were back pain (27.8%) and urinary retention (27.8%). Conclusion: For most patients, high dose rate (HDR) brachytherapy under spinal anesthesia was well tolerated, in fact most patients experienced no pain and no significant life-threatening complications. The post-brachytherapy pain score had the highest average score. Then, back pain and urinary retention were the most common complications.
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Eustace, Nicholas, Jason Liu, Colton Ladbury, Andrew Tam, Scott Glaser, An Liu, and Yi-Jen Chen. "Current Status and Future Directions of Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer." Cancers 16, no. 5 (March 2, 2024): 1031. http://dx.doi.org/10.3390/cancers16051031.
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Purpose: The standard of care for patients with locally advanced cervical cancer is definitive chemoradiation followed by a brachytherapy boost. This review describes the current status and future directions of image-guided adaptive brachytherapy for locally advanced cervical cancer. Methods: A systematic search of the PubMed and Clinicaltrials.gov databases was performed, focusing on studies published within the last 10 years. The search queried “cervical cancer [AND] image-guided brachytherapy [OR] magnetic resonance imaging (MRI) [OR] adaptive brachytherapy”. Discussion: The retroEMBRACE and EMBRACE-I trials have established the use of MRI as the standard imaging modality for brachytherapy application and planning. Quantitative imaging and radiomics have the potential to improve outcomes, with three ongoing prospective studies examining the use of radiomics to further risk-stratify patients and personalize brachytherapy. Another active area of investigation includes utilizing the superior soft tissue contrast provided by MRI to increase the dose per fraction and decrease the number of fractions needed for brachytherapy, with several retrospective studies demonstrating the safety and feasibility of three-fraction courses. For developing countries with limited access to MRI, trans-rectal ultrasound (TRUS) appears to be an effective alternative, with several retrospective studies demonstrating improved target delineation with the use of TRUS in conjunction with CT guidance. Conclusions: Further investigation is needed to continue improving outcomes for patients with locally advanced cervical cancer treated with image-guided brachytherapy.
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Shchukina, E. O., V. A. Biryukov, O. B. Karyakin, and S. A. Ivanov. "High-dose-rate brachytherapy as monotherapy in patients with localized prostate cancer." Experimental and Сlinical Urology 16, no. 3 (September 25, 2023): 136–45. http://dx.doi.org/10.29188/2222-8543-2023-16-3-136-145.
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Introduction. Prostate cancer is the second most common cancer among men. In Russia the number of patients with stage I-II prostate cancer increased from 47,7% in 2010 to 60,7% in 2021. One of the main methods of treatment of localized prostate cancer is high-dose-rate brachytherapy, which today provides high accuracy of prostate dose coverage and minimizes the impact on nearby risk organs. Within ever-increasing publications, high-dose-rate brachytherapy is considered as a method of safe and effective radical treatment of prostate cancer. Materials and methods. Relevant publications were searched for in the PubMed and е-Library databases with the use of the keywords «brachytherapy», «highdose-rate brachytherapy», «brachytherapy as monotherapy». As a result of the search, 52 sources were selected and included in the given literature review. Results and discussion. The first report on the use of brachytherapy as monotherapy appeared in 2000 where published the results of treatment and demonstrated the safety and effectiveness of the method. Despite the large number of studies conducted all over the world with various options of dose delivery per fraction, the optimal dose and fractionation mode for high-dose-rate brachytherapy as monotherapy have not been determined yet. Conclusions. Currently high-dose-rate brachytherapy of localized prostate cancer as monotherapy has become widespread. However, the available modern data on fractionation modes require further study and research.
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Kanaev, Sergey, Ye Bykova, I. Akulova, Nadezhda Popova, Pavel Krzhivitskiy, Petr Krivorotko, Olga Ponomareva, Zhanna Bryantseva, Sergey Novikov, and Yu Melnik. "RADIATION BOOST AFTER WHOLE-BREAST IRRADIATION: DOSIMETRIC COMPARISON OF HIGH DOSE RATE INTERSTITIAL BRACHYTHERAPY AND IRRADIATION WITH ELECTRONS." Problems in oncology 64, no. 3 (March 1, 2018): 303–9. http://dx.doi.org/10.37469/0507-3758-2018-64-3-303-309.
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Purpose: dosimetric comparison of high dose rate interstitial brachytherapy (HDR) and irradiation with electrons for radiation boost after whole-breast irradiation. Material and methods: in 62 patients with рТ1N0М0-рТ2№М0 breast cancer we used HDR brachytherapy for delivering boost to tumor bed. In all cases insertion of plastic needles was performed under CT control with subsequent 3D planning. Pre-insertion CT were used for 3D planning of boost delivery with electrons. Results: Boost delivery with HDR brachytherapy had several important advantages when compared with boost with electrons. HDR brachytherapy demonstrated more accurate irradiation of tumor bed: D90 HDR - 93,1 % (69,1 % - 118 %), D90 electrons - 86,2 % (47,6 % - 104,1 %). Boost delivery with HDR brachytherapy help to minimize radiation burden to left main coronary artery - Dmax electrons - 14.8 % (0.2 %-71.8%), Dmax HDR - 5.2 % (0.7 %-14.2 %). Radiation burden to left anterior descending artery is also decreasing: Dmax electrons - 21.9 % (0.8 %-94.1 %), Dmax HDR - 10.5 % (1.9 %-31.5 %). Radiation dose absorbed in ip-silateral lung also significantly lower with HDR brachytherapy: Dmed electrons - 6,5 % (0,5 % - 19,3 %), Dmed HDR - 2,3 % (0,8 % - 10,8 %). Conclusions: the present dosimetric analysis indicated that boost delivery with HDR brachytherapy is more accurate than irradiation with electrons.
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Relimpio-López, Isabel, Antonio Manuel Garrido-Hermosilla, Francisco Espejo, María Gessa-Sorroche, Lourdes Coca, Belen Domínguez, María Jesús Díaz-Granda, et al. "Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas." Journal of Clinical Medicine 11, no. 6 (March 15, 2022): 1616. http://dx.doi.org/10.3390/jcm11061616.
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Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery.
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Shahabaz, Amir, and Muhammad Afzal. "Implementation of High Dose Rate Brachytherapy in Cancer Treatment." Science Progress and Research 1, no. 3 (June 11, 2021): 77–106. http://dx.doi.org/10.52152/spr/2021.121.
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A technique of radiation therapy delivery in which the radioactive sources are placed very close or even inside the target volume is called Brachytherapy (BT). Brachytherapy is a type of radiation therapy. It destroys cancer cells by making it hard for them to multiply. In this technique, a radiation source is placed directly into or near a tumour. High dose-rate brachytherapy is also known as HDR brachytherapy, or temporary brachytherapy. It is a type of internal radiotherapy. HDR was developed to reduce the risk of cancer recurrence while shortening the amount of time it takes to get radiation treatment. HDR also limits the dose of radiation (associated side effects) to surrounding normal tissue. The important benefits of HDR brachytherapy include extremely precise radiation therapy delivered internally, used alone or after surgery to help prevent cancer recurrence, convenient treatments that are usually pain-free, and a reduction in the risk of common short- and long-term side effects. Currently, tumour dose, as well as doses of the surrounding normal structures, can be evaluated accurately, and high-dose-rate brachytherapy enables three-dimensional image guidance. The biological disadvantages of high-dose-rate were overcome by fractional irradiation. In the definitive radiation therapy of cervical cancer, high-dose-rate brachytherapy is most necessary. Most patients feel little discomfort during brachytherapy. There is no residual radioactivity when the treatment is completed. A patient may be able to go home shortly after the procedure, resuming his normal activities with few restrictions. An advantage of brachytherapy is to deliver a high dose to the tumour during treatment and save the surrounding normal tissues. High-dose-rate (HDR) brachytherapy has great promise with respect to proper case selection and delivery technique because it eliminates radiation exposure, can be performed on an outpatient basis and allows short treatment times. Additionally, by varying the dwell time at each dwell position, the use of a single-stepping source allows optimization of dose distribution. As the short treatment times do not allow any time for correction of errors, and mistakes can result in harm to patients, so the treatments must be executed carefully by using HDR brachytherapy. Refinements will occur primarily in the integration of imaging (computed tomography, magnetic resonance imaging, intraoperative ultrasonography) and optimization of dose distribution and it is expected that the use of HDR brachytherapy will greatly expand over the next decade. Various factors in the development of well-controlled randomized trials addressing issues of efficacy, quality of life, toxicity and costs-versus-benefits will ultimately define the role of HDR brachytherapy in the therapeutic armamentarium. Surrounding healthy tissues are not affected by the radiation due to the ability to target radiation therapy at high dose rates directly to the tumour. Treatment to be delivered as an outpatient in as few as one to five sessions is also allowed by this targeted high dose approach. HDR brachytherapy is the most precision radiation therapy, even better than carbon ion therapy. At the time of invasive placement of the radiation source into the tumour area, brachytherapy requires the skills and techniques of radiation oncologists.
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Jangjoo, Amir Ghasemi, Hosein Ghiasi, and Asghar Mesbahi. "A Monte Carlo study on the radio-sensitization effect of gold nanoparticles in brachytherapy of prostate by 103Pd seeds." Polish Journal of Medical Physics and Engineering 25, no. 2 (June 1, 2019): 87–92. http://dx.doi.org/10.2478/pjmpe-2019-0012.
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Abstract 103Pd seed is being used for prostate brachytherapy. Additionally, the dose enhancement effect of gold nanoparticles (GNP) has been reported in previous studies. The aim of this study was to characterize the dosimetric effect of gold nanoparticles in brachytherapy with a 103Pd source. Two brachytherapy seeds including 103 Pd source was simulated using MCNPX Monte Carlo code. The seeds’ models were validated by comparing the MC with reported results. Then, GNPs (10 nm in diameter) with a concentration of 7mg Au/g were simulated uniformly inside the prostate of a humanoid computational phantom. Additionally, the dose enhancement factor (DEF) of nanoparticles was calculated for both modeled brachytherapy seeds. A good agreement was found between the MC calculated and the reported dosimetric parameters. For both seeds, an average DEF of 23% was obtained in tumor volume for prostate brachytherapy. The application of GNPs in conjunction with 103Pd seed in brachytherapy can enhance the delivered dose to the tumor and consequently leads to better treatment outcome.
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Itami, Jun. "Modern development of high-dose-rate brachytherapy." Japanese Journal of Clinical Oncology 50, no. 5 (March 5, 2020): 490–501. http://dx.doi.org/10.1093/jjco/hyaa029.
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Abstract Brachytherapy is an invasive therapy with placement of radiation source into or near the tumor. The difference between planning target volume and clinical target volume is minimal, and the dose out of the tumor reduces rapidly due to the inverse-square law. High-dose-rate brachytherapy enables three-dimensional image guidance, and currently, tumor dose as well as doses of the surrounding normal structures can be evaluated accurately. High-dose-rate brachytherapy is the utmost precision radiation therapy even surpassing carbon ion therapy. Biological disadvantages of high-dose rate have been overcome by the fractional irradiation. High-dose-rate brachytherapy is indispensable in the definitive radiation therapy of cervical cancer. Also in prostate cancer and breast cancer, high-dose-rate brachytherapy plays a significant role. Brachytherapy requires techniques and skills of radiation oncologists at the time of invasive placement of the radiation source into the tumor area. Education of young radiation oncologists is most urgent and important.