Addiction, the opioid crisis, and family pain
In 2015, the opioid crisis was escalating to emergency-level proportions, claiming as many lives as car accidents. As the daughter of a longtime drug addict, the current burgeoning opioid epidemic managed to be both familiar and strange to me at the same time. My mother developed her addictions during the height of drug epidemics that occurred in New York City in the mid-1980s. The timeframe also marked the infancy of the AIDS crisis and the height of Reagan-era “Just Say No” programs. Back then, addiction was treated and viewed more as a crime than a disease, supposedly committed by scoundrels and misfits. The theory held that respectable people did not associate with addicts, much less share their homes and their blood with them. The intense societal shaming and criminalization of her addictions led to more resistance by my mother to seek the treatment she needed, until she eventually stopped trying to quit altogether. The stigmatization of her disease impacted me profoundly as a child — almost as much as the regular abuses I endured from her due to her addictive behavior. Whether it was being the regular target of smacking, lying, spitting, stealing, or vicious name-calling, it stung all the more because society made me feel complicit by relation. I had no healthy outlet to vent my escalating outrage at my own victimization, at an age when I was too young to properly process or even fully understand what was happening. I learned to stay silent, to repress...
We present a new technique of three dimensional (3D) computed tomography (CT) guided interstitial (IS) brachytherapy (BT) and evaluate the dosimetric advantage of the current technique compared with the conventional intracavitary brachytherapy for locally advanced cervical cancer, offering a more advantageous clinical treatment approach.
Image-guided high-dose-rate multichannel vaginal cylinder (MCVC) brachytherapy (BT) permits conformal dose delivery to a vaginal tumor while sparing surrounding organs-at-risk. Due to the proximity of the peripheral channels to the tumor and cylinder surface, the adjacent vaginal mucosa is a dose-limiting structure when using MCVC, however, specific dose-volume limitations are not well characterized. We explored vaginal dose-volume parameters in a series of consecutive patients treated with MCVC for gynecologic cancers involving the vagina.
Doppler ultrasound (US) gives real-time information regarding anatomy and blood vessel location to guide needle placement for gynecologic interstitial brachytherapy (BT). We retrospectively assessed Doppler US images for vessel quantity, size, and distribution in cervical cancer patients undergoing high dose rate (HDR) BT at our institution.
To report survival outcomes in women with stage II uterine endometrioid carcinoma who received adjuvant radiation therapy (RT) without chemotherapy (CT) using the National Cancer Database (NCDB).
Image-guided brachytherapy in locally advanced cervical cancer, with MRI regarded as the gold standard, is increasingly recognized as the new paradigm. GEC-ESTRO has recognized the importance of MRI for cervical cancer, and has issued a series of recommendations. MRI has superior soft tissue depiction quality. OARs (bladder, rectum and sigmoid) and the relevant patho-anatomical structures (uterine cervix and corpus, vagina, parametrium) can be appropriately visualized on T2-weighted MR images without contrast media injection.
For 3D-image guided adaptive brachytherapy in cervical cancer, the current standard of ICRU 89 recommends recording numerous dose parameters. Conventionally, dosimetric parameters from a plan are reviewed and then manually entered into a spreadsheet for cumulative dose analysis. This process is error-prone and poses a significant challenging in a routine clinical practice given the large amount of data recommended by ICRU 89. To address these problems, we have developed an Autobrachy system to automatically document ICRU 89 dosimetric parameters.
To report workflow and the required time for each step of the treatment procedure with MR image guided HDR brachytherapy (MR IGBT) for cervical cancer in a high brachytherapy volume center.
MRI-based, image guided adaptive brachytherapy is now the standard of care for cervical cancer. There is increasing interest in the use of hybrid intracavitary/interstitial applicators for dose escalation in bulky tumors (HR-CTV>30 cc) as currently recommended in the EMBRACE II trial. The value of hybrid intracavitary/interstitial applicators for tumors with smaller HR-CTV is less certain. The purpose of this study is to evaluate the organ at risk sparing of hybrid applicators (Hybrid TR) compared to conventional tandem and ring(TR) applicators.
This is a feasibility study to demonstrate the use of 3D printing technology to create patient specific models for precise pre-planning of applicator using pre-brachytherapy MRI, without the need of applicator in-situ for image guided cervix cancer brachytherapy.
To compare plan quality achieved with the Yb169, Ir192, and Co60 HDR sources used in combination with conventional tandem and ring (Con.T&R) applicators for cervical cancer brachytherapy.