Development, implementation, and associated challenges of a new HDR brachytherapy program
We present a simple and generic outline that lays out the process for developing and implementing a new HDR brachytherapy program in any setting, but with particular emphasis on challenges associated with starting the program in a limited resource setting.
Abstract A new high dose rate (HDR) brachytherapy program was initiated in a community hospital setting, with the goal of using magnetic resonance (MR) images with the implant in place during the planning process. Physics acceptance testing and commissioning was completed for key program components, including multiple applicators. To image new applicators for MRI-based planning prior to use with patients, agar gel doped with copper sulfate was created using simple, MR-safe household materials as a practical and inexpensive alternative to custom-machined precision phantoms. Applicators in-phantom were scanned in a ...
CONCLUSION: Hypofractionated stereotactic photon radiotherapy showed a high rate of local tumor control for choroidal melanoma and an acceptable rate of radiogenic side effects. PMID: 32969745 [PubMed - as supplied by publisher]
The esophagus lies in close proximity to many organs at risk (OARs), including the heart, spinal cord, and lungs. Currently at our institution, esophageal cancer patients undergoing high-dose-rate intraluminal brachytherapy (HDR-IBT) receive a single planning computed tomography (CT) scan during one of three treatment appointments. Dose to surrounding OARs are calculated using the CT scan, with the assumption that treatment lengths will remain the same for all three fractions. In reality, inter-fractional treatment lengths may vary, as they are assessed using combined esophageal endoscopy visualization and fluoroscopy before each fraction.
Conclusion: Apatinib alone may be a good second-line therapy for advanced lung cancer patients who are refractory to platinum-based doublet chemotherapy. However, its potential benefits, especially as combination therapy, need further investigation by future prospective clinical studies. Elderly patients with advanced lung cancer may benefit from concurrent apatinib with iodine-125 radioactive seeds brachytherapy when chemotherapy is not tolerated or effective. Further studies are needed to investigate the clinical outcomes and toxicities associated with concurrent apatinib and radiation therapy in patients with advanced lung cancer.
A 28-year-old female with locally advanced adenocarcinoma of the cervix was undergoing treatment with external beam radiation therapy (EBRT), concurrent chemotherapy and high dose rate brachytherapy (BT). On-board imaging obtained prior to one of her external beam treatments revealed four radiopaque foreign bodies in her abdomen. The patient's treatment was delayed for further work-up of this new finding. Upon further investigation, it was discovered that the patient had recently started taking bismuth subsalicylate tablets (brand name: Pepto-Bismol, Procter&Gamble Co., Cincinnati, OH).
Publication date: Available online 26 July 2020Source: Actas Urológicas Españolas (English Edition)Author(s): E. López Rodríguez, J.L. Tirado Hospital, R.M Álvarez Pérez, L. Gómez Izquierdo, J.M. Jiménez-Hoyuela
Conclusions: The use of asynchronous MRI for target delineation, with co-registration to CT for each fraction of brachytherapy was associated with higher D90 to the HR-CTV. We observed slightly higher D2cc rectal doses with MRI, but cumulative rectal doses were within accepted thresholds. High-risk target volumes were not consistently increased or decreased, but MRI fusion was associated with target volume changes greater than 20% in over half of the treated patients. PMID: 32695201 [PubMed]
Eliminating patient computed tomography (CT) scans for tandem and ring (T&R) brachytherapy can reduce overall procedure time and eliminates imaging dose. However, reconstructing titanium applicators in magnetic resonance imaging (MRI) is challenging. We evaluated the uncertainty of different applicator reconstruction workflows in MR-guided brachytherapy, and assessed the clinical impact of reconstruction uncertainties.
CONCLUSION: 18F-choline PET/CT could be a useful technique in the group of patients with biochemical recurrence after brachytherapy, providing locoregional and distant involvement findings which had not been detected with conventional imaging tests, thus determining a more adequate therapeutic management. PMID: 32576406 [PubMed - as supplied by publisher]
We evaluate the role of stereotactic body radiotherapy using volumetric modulated arc therapy (VMAT) technique as an alternative to high-dose rate brachytherapy (HDR-BT) in the treatment of vaginal cuff in postoperative endometrial cancer. CT scans of 8 patients were used in this study. The clinical target volume (CTV) was defined as the 0.5 cm tissue around the applicator (then subtracting the applicator). Total dose was 30Gy delivered in 5 fractions. In HDR-BT, dose was prescribed at a distance of 0.5 cm from the surface applicator.