American Brachytherapy Society Research Articles

Assessment of Eligibility and Utilization of Accelerated Partial Breast Irradiation in Korean Breast Cancer Patients (KROG 22-15).

We investigated the proportions of patients eligible for accelerated partial breast irradiation (APBI) among those with pT1-2N0 breast cancer, based on the criteria set by the American Society for Radiation Oncology (ASTRO), the Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC-ESTRO), the American Brachytherapy Society (ABS), and the American Society of Breast Surgeons (ASBS). Additionally, we analyzed the rate of APBI utilization among eligible patients. Patients diagnosed with pT1-2N0 breast cancer in 2019 were accrued in four tertiary medical centers in Korea. All patients had undergone breast conserving surgery followed by radiotherapy, either whole breast irradiation or APBI. To determine which guideline best predicts the use of APBI in Korea, the F1 score and Matthews Correlation Coefficient (MCC) were determined for each guideline. A total of 1,251 patients were analyzed, of whom 196 (15.7%) underwent APBI. The percentages of eligible patients identified by the ASTRO, GEC-ESTRO, ABS, and ASBS criteria were 13.7%, 21.0%, 50.5%, and 63.5%, respectively. APBI was used to treat 54.4%, 37.2%, 27.1%, and 23.7% of patients eligible by the ASTRO, GEC-ESTRO, ABS, and ASBS criteria, respectively. The ASTRO guideline exhibited the highest F1 score (0.76) and MCC (0.67), thus showing the best prediction of APBI utilization in Korea. The proportion of Korean breast cancer patients who are candidates for APBI is substantial. The actual rate of APBI utilization among eligible patients may suggest there is a room for risk-stratified optimization in offering radiation therapy.

Feasibility and Workflow Efficiency in MRI-Based HDR Brachytherapy for Cervical Cancer at a Community-Based Practice

Image-guided brachytherapy (IGBT) has seen widespread use in high-volume centers around the country in the last ten years. GEC-ESTRO recommendations stipulate that the dose be prescribed to the high-risk clinical target volume, which includes the residual tumor present at the time of brachytherapy. This practice has resulted in lesser normal tissue toxicity and improved local control. We introduced MRI volumetric planning at our center three years ago to confer this advantage to our patients. Based on a practice pattern survey by the American brachytherapy society in 2014, IGBT with MRI-based planning was grossly underutilized due to challenges associated with the work stream and availability of MRI. The combined mean procedure time for MR imaging and planning reported at a high-volume brachytherapy center was 63.2 minutes. Our study aimed to identify the time required for MRI-based IGBT for the first HDR fraction for cervical cancer patients at our institution. We aim to understand how we differ from a typical high-volume center and how we may improve our efficiency and workflow. Between 2020 and 2023, 14 patients were treated with HDR brachytherapy for a diagnosis of cervical cancer. Of these individuals, 7 patients were treated with MRI-guided IGBT during the first HDR fraction. The following time intervals were recorded: 1. Time from applicator insertion to completion of MRI imaging 2. Time from completion of MRI imaging to start of CT simulation 3. Time from start of CT simulation to completion of treatment delivery Materials and methods: Between 2020 and 2023, 14 patients were treated with HDR brachytherapy for a diagnosis of cervical cancer. Of these individuals, 7 patients were treated with MRI-guided IGBT during the First HDR fraction. The following time intervals were recorded: 1. Time from applicator insertion to completion of MRI imaging 2. Time from completion of MRI imaging to start of CT simulation 3. Time from start of CT simulation to completion of treatment delivery. The mean total procedure time was 582 minutes (Range 494- 665). The mean time and ranges for each phase were as follows. The mean time from the implant insertion to MRI completion was 157.7 minutes (Range 70-307), and the time from MRI completion to the start of CT simulation was 114.7 minutes (Range 17-173), and the time from the start of CT simulation to the treatment delivery was 310 minutes (Range 251-476). Our study demonstrates that MRI-based HDR brachytherapy with a skilled multidisciplinary team in a small community-based practice with an MRI imaging facility is a feasible approach similar to a high-volume center but differs in the total treatment time. Considering high treatment time in the community-based practice, the department is taking a team approach to improve efficiency. This includes establishing a dedicated brachytherapy suite closer to the MRI imaging and incorporating artificial intelligence to assist planning.

The American Brachytherapy Society and Indian Brachytherapy Society consensus statement for the establishment of high-dose-rate brachytherapy programs for gynecological malignancies in low- and middle-income countries

PURPOSEThe global cervical cancer burden is disproportionately high in low- and middle-income countries (LMICs), and outcomes can be governed by the accessibility of appropriate screening and treatment. High-dose-rate (HDR) brachytherapy plays a central role in cervical cancer treatment, improving local control and overall survival. The American Brachytherapy Society (ABS) and Indian Brachytherapy Society (IBS) collaborated to provide this succinct consensus statement guiding the establishment of brachytherapy programs for gynecological malignancies in resource-limited settings. METHODS AND MATERIALSABS and IBS members with expertise in brachytherapy formulated this consensus statement based on their collective clinical experience in LMICs with varying levels of resources. RESULTSThe ABS and IBS strongly encourage the establishment of HDR brachytherapy programs for the treatment of gynecological malignancies. With the consideration of resource variability in LMICs, we present 15 minimum component requirements for the establishment of such programs. Guidance on these components, including discussion of what is considered to be essential and what is considered to be optimal, is provided. CONCLUSIONSThis ABS/IBS consensus statement can guide the successful and safe establishment of HDR brachytherapy programs for gynecological malignancies in LMICs with varying levels of resources.

Listing of the Abstracts of the 2023 American Brachytherapy Society Annual Meeting

Listing of the Abstracts of the 2023 American Brachytherapy Society Annual Meeting

Author Index of the Abstracts of the 2023 American Brachytherapy Society Annual Meeting

Author Index of the Abstracts of the 2023 American Brachytherapy Society Annual Meeting

Plaque brachytherapy - Radiating positivity.

Plaque brachytherapy is an evolving, yet effective globe and vision-sparing modality for the treatment of intraocular tumors by transscleral irradiation of the tumor base with a radioactive implant. The American Brachytherapy Society (ABS) along with the collaboration of the international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to reach a consensus regarding establishing practice guidelines and setting standards of care for intraocular tumors. The advent of plaque brachytherapy has revolutionized the outcomes of intraocular tumors, thus ensuring globe salvage, reducing morbidity and mortality, and avoiding cosmetic disfigurement. A well-planned dosimetry for plaque brachytherapy results in achieving local tumor control and excellent prognosis. This technique provides the advantage of focal radiation, thus eliminating the damage to the adjacent structures, minimal periorbital tissue damage, absence of cosmetic disfigurement owing to lack of retarded bone growth as seen in external beam radiotherapy. Thus, it reduces the risk of metastasis, and with the recent advances, it provides a shorter duration of treatment. : In this video, we shall display the concept of plaque brachytherapy, the various types of plaques available, different radiations sources, planning dosimetry and calculations, target disease spectrum, surgical placement, and post-radiation outcomes in terms of local tumor control and prognosis. This video highlights the history, basic principles and techniques of plaque brachytherapy and provides an understanding of its applications in the world of ocular oncology. https://youtu.be/7PX0mDQETRY.

Abstract P1-10-11: Optical stimulated luminescence dosimeters for skin dose measurements during accelerated partial breast brachytherapy: In vivo dosimetric validation and clinical outcomes

Abstract BACKGROUND: The role of multi-lumen catheter devices in the delivery of high dose rate (HDR) brachytherapy for adjuvant accelerated partial breast irradiation (APBI) for women with DCIS or early-stage breast cancer has been well established. In vivo dosimetry (IVD) using optically stimulating luminescence dosimeters (OSLD) is a feasible way to detect applicator instability that may cause translational and rotational inaccuracies during HDR brachytherapy delivery. Herein, we evaluate the accuracy and effectiveness of IVD to improve patient outcomes following APBI brachytherapy using the Strut Adjusted Volume Irradiation (SAVI) device. METHODS: Single-institution cohort study piloting the use of OSLD on the patient’s skin during HDR brachytherapy APBI to assess the estimated maximum skin dose (skin Dmax) and the achievable accuracy of OSLD for skin Dmax measurements. Women treated with SAVI-based APBI between November 1, 2018 and October 1, 2021 were eligible to enroll in our study. All patients met the American Society for Radiation Oncology “suitable” or “cautionary” criteria and were treated according to the American Brachytherapy Society consensus treatment planning guidelines. A SAVI preplan was created to estimate the probable point of skin Dmax. During CT simulation, a radiopaque marker was placed on the skin for visualization during treatment planning. Correction factors were applied to account for the OSLD tissue-air interface that is not present in the TG-43 expected dose calculations. Measured and calculated IVD doses were analyzed to assess agreement and cause for discrepancies found. Breast phantom IVD measurements repeated seven times with two independent dose points were analyzed to assess the best accuracy achievable under ideal conditions. RESULTS: We enrolled 41 patients with an average age of 68 years. Table 1 details the brachytherapy treatment delivery and dosimetry data. Higher skin Dmax as a percentage of the radiation prescription was associated with the occurrence of breast volume loss noted on subsequent clinical breast exams (OR 1.84 per each 5% increase in skin Dmax; 95% CI 1.21 – 3.32; p=0.016). The graphically estimated skin Dmax threshold was 80% with all cases of noted breast volume loss occurring above this threshold. The overall level of achievable IVD accuracy was ±3.32% based on breast phantom measurements. Under ideal conditions, all measurements were in the ±7% range. Three of 14 phantom measurement exceeded the 6% discrepancy range. Clinical IVD measurements detected 5 true positive cases (12.2% of cohort) that required intervention due to rotations in the SAVI applicator. For a ±7% tolerance criteria, 90.2% of the patients tested passed IVD. Of the eight patients that failed at the 7% level, IVD detected 3 OSLD placement errors, 2 rotational discrepancy cases, and 1 large air-gap at the point of measurement. CONCLUSIONS: Accuracy and reproducibility are imperative tenets of HDR brachytherapy APBI. IVD utilizing OSLD is an effective method for detecting treatment set-up and delivery errors for patients receiving SAVI-based APBI with dose accuracy within ±3.32%. Errors requiring intervention due to SAVI device rotation were detected in 12.2% of our cohort, and these errors would have likely gone undetected without IVD. Using OSLD as IVD to measure skin Dmax doses that may increase the risk of breast cosmetic defects should be investigated further. Table 1. Brachytherapy treatment delivery and dosimetry data. *PTV-Eval is a uniform 10 mm expansion on the CTV with exclusion of PTV within 5 mm of skin or chest wall. +Percent dose discrepancy refers to difference in dose between APBI plan calculations and IVD measurements. Citation Format: Tyler Gutschenritter, Afua Yorke, Nayak Polissar, Nirnaya Miljacic, Janice Kim, Lori Young. Optical stimulated luminescence dosimeters for skin dose measurements during accelerated partial breast brachytherapy: In vivo dosimetric validation and clinical outcomes [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-11.

Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician perceived benefits of a graphic narrative discussion guide

Many current radiotherapy patient education materials are not patient-centered. An interprofessional team developed Communicating the Gynecologic Brachytherapy Experience (CoGBE), a graphic narrative discussion guide for cylinder, intracavitary, and interstitial high-dose-rate (HDR) gynecologic brachytherapy. This study assesses perceived clinical benefits, usability, and anxiety-reduction of CoGBE. An electronic survey was sent to members of the American Brachytherapy Society. Participants were assigned to assess one of the three modality-specific CoGBE versions using a modified Systems Usability Scale (SUS), modified state-trait anxiety index (mSTAI), and Likert-type questions. Free response data was analyzed using modified grounded theory. Median modified SUS score was 76.3 (interquartile range [IQR], 71.3-82.5) and there were no significant differences between guide types. Median mSTAI was 40 (IQR, 40-43.3) for all guides collectively. The cylinder guide had a significantly higher median mSTAI than the intracavitary and interstitial guides (41.6 vs. 40.0 and 40.0; p = 0.04) suggesting the cylinder guide may have less impact on reducing anxiety. Most respondents reported that CoGBE was helpful (72%), would improve patient understanding (77%) and consultation memorability (82%), and was at least moderately likely to be incorporated into their practice (80%). Qualitative analysis themes included personalization and relatability (positive); generalizability (negative); illustrations (both). Clinicians rate CoGBE as usable with potential to reduce patient anxiety, especially with more invasive treatment modalities including intracavitary or interstitial high-dose-rate. CoGBE has the potential to improve patient-clinician communication for a wider range of patients due to its accessible, adaptable, and patient-centered design.

Interfraction variations in doses at OARs during three-dimensional high dose rate brachytherapy planning of cervix cancer.

The American Brachytherapy (BT) Society recommends that BT must be included as a component of the definitive radiation therapy for cervical carcinoma because recurrences and complications are decreased when BT is used in addition to external beam radiotherapy. The aim of this study is to quantify the interfraction dose variations (VARacts) during high dose rate (HDR) BT, the effect of variation in dose in terms of excess "unrecognized" dose to OAR and to conclude the reason of the variation in reference of applicator position/geometry versus deformation of the organ at risk (OAR) concerned. Total 30 patients of carcinoma cervix, biopsy proven, between June 2018 and May 2019, were taken for the study. All patients were treated with external beam radiation therapy to a dose of 50 Gy in 25 fractions over 5 weeks, followed by three fractions of HDR intracavitary brachytherapy (ICBT) (7.5 Gy to point A in each fraction) by two-dimensional (2D) X-ray-based planning. Before treatment in the first and last fraction of BT, computed tomography (CT) scan was done for every patient. Then, a 3D-based planning was performed with CT images on our HDR Plus software with image sequence option. VARact was calculated. Rigid image registration of consecutive fraction images was used for quantification of the hypothetical variation in dose (VARhypo) arising exclusively due to changes in applicator placement and geometry. The mean contoured rectal volumes for the first and third fractions were 41.49 cc and 44.72 cc, respectively, while the respective volumes for bladder were 9.33 cc and 9.35 cc cm. These differences were statistically insignificant (P value: 0.263 and 0.919 for rectum and bladder, respectively). The mean equivalent dose in 2 Gy fraction (EQD2) bladder D2cc was 5.68 Gy and 5.79 Gy in the first and third fraction ICBT, respectively. The mean EQD2 for the rectal D2cc was 11.63 Gy and 12.85 Gy in the first and third fraction ICBT, respectively. None of the patients had an actual cumulative EQD2 more than 90 Gy for bladder, but 36.66% of the patients had a rectal dose exceeding the tolerance (75 Gy). Regression plots showed that VARhypo alone could predict about 42.2% of the VARact in the rectum and 19.2% of the VARact in the bladder. Thus, the remaining variation was due to the organ deformation-related dose variations between the two fractions. There were no statistically significant variations in the volumes or doses of OAR between the two fractions. However, a significant proportion of patients may have a higher dose to the OAR in the third fraction in the absence of individualized planning. This increase is likely to be more detrimental where higher doses per fraction are used. Variations in OAR doses may be caused by organ deformation and/or changes in applicator placement/geometry.

HDR-brachytherapy for accelerated partial breast irradiation: Long-term experience from a Japanese institution.

We investigated the long-term oncological outcome of high-dose-rate (HDR) multicatheter interstitial brachytherapy (MIB) for adjuvant accelerated partial breast irradiation (APBI) after breast conserving surgery in Japanese patients. Between June 2002 and October 2011, 86 breast cancer patients were treated at National Hospital Organization Osaka National Hospital (trial number of the local institutional review board, 0329). Median age was 48 years (range, 26-73 years). Eighty patients had invasive and 6 patients non-invasive ductal carcinoma. Tumor stage distribution was pT0 in 2, pTis in 6, pT1 in 55, pT2 in 22, and pT3 in one patient, respectively. Twenty-seven patients had close/positive resection margins. Total physical HDR dose was 36-42 Gy in 6-7 fractions. At a median follow-up of 119 months (range, 13-189 months), the 10-year local control (LC) and overall survival rate was 93% and 88%, respectively. Concerning the 2009 Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology risk stratification scheme, the 10-year LC rate was 100%, 100%, and 91% for patients considered as low-risk, intermediate-risk, and high-risk, respectively. According to the 2018 American Brachytherapy Society risk stratification scheme, the 10-year LC rate was 100% and 90% for patients 'acceptable' and 'unacceptable' for APBI, respectively. Wound complications were observed in 7 patients (8%). Risk factors for wound complications were the omission of prophylactic antibiotics during MIB, open cavity implantation, and V100 ≥ 190 cc. No grade ≥ 3 late complications (CTCVE version 4.0) were observed. Adjuvant APBI using MIB is associated with favorable long-term oncological outcomes in Japanese patients for low-risk, intermediate-risk, and acceptable groups of patients.

Saturday, June 18, 20229:30 AM - 10:30 AM GPP06  Presentation Time: 9:30 AM: Image-Guided Cervical Cancer Brachytherapy: Summary of Consensus Recommendations from the Society for Abdominal Radiology and American Brachytherapy Society

<h3>Purpose</h3> To summarize recommendations regarding imaging guidance for cervical cancer brachytherapy implant placement from the Society of Abdominal Radiology (SAR) and American Brachytherapy Society (ABS). <h3>Materials and Methods</h3> A comprehensive literature search was conducted on PubMed for image-guided cervical cancer brachytherapy (BT) using radiography, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Original research studies were included for evaluation if they included sensitivity and specificity of tumor detection, complication rates, or additional quantitative imaging results directly related to brachytherapy, such as geometric distortion measurements. The literature review was evaluated by an expert panel of members from the Society for Abdominal Radiology (SAR) and American Brachytherapy Society (ABS). These data were analyzed to determine an overall level of evidence for each recommendation and the subsequent strength of each claim. <h3>Results</h3> Three-dimensional (3D) imaging is recommended for treatment planning whenever feasible due to the rate of toxicities ≥ Grade 3 decreasing from between 0-13.5% with 2D planning to 0-5.8% with 3D planning. US guidance is highly recommended for tandem selection and insertion to reduce uterine perforation rates from 2.3-34%/insertion without US-guidance to 0-1.4%/insertion with US. US-guided interstitial needle placement is feasible when post-implant 3D imaging is available for treatment planning. Post-implant CT is recommended over orthogonal radiography to reduce genitourinary and gastrointestinal complications and evaluate proper applicator positioning. Tumor visualization is optimal on T2-weighted (T2w) MRI, which also provides improved specificity for assessment of parametrial invasion. CT-based treatment planning should refer to prior MRI for high risk-clinical target volume (HR-CTV) contouring, when available. Treatment planning on MRI is highly recommended for HR-CTV delineation, and post-applicator imaging should include at minimum both a 2D sagittal T2w and 3D axial T2w fast spin echo-based sequence. <h3>Conclusions</h3> Imaging-guidance for cervical brachytherapy implant placement is now standard-of-care. 3D imaging with MRI is highly recommended for treatment planning purposes, although CT-based planning also results in fewer complications as compared to 2D planning techniques. Ultrasound is useful for applicator placement, but application to treatment planning is limited.

GSOR4  Presentation Time: 9:15 AM: Predicting the Benefit of Hybrid Intracavitary + Interstitial Needle Applicators in Patients with Locally Advanced Cervical Cancer

<h3>Purpose</h3> The purpose of this study is to determine whether pre-treatment and brachytherapy (BRT) characteristics are associated with benefit from hybrid intracavitary + interstitial needle (IC/IS) applicator, as opposed to IC applicator, use in patients with locally advanced cervical cancer (LACC). <h3>Methods</h3> 53 LACC patients treated with IC/IS BRT from August 2014 to March 2020 using HDR were included. Patient variables included pre-treatment characteristics (age, histology, grade, T Stage, N Stage, max lateral, A-P, S-I, and overall tumor dimensions, tumor symmetry, max distance from endometrial canal, tumor volume, tumor max SUV on PET) and BRT characteristics (max lateral, A-P, S-I, and overall tumor dimensions, tumor symmetry, max distance from tandem, GTV and high-risk CTV (CTV HR) volumes). For each patient, an IC plan prescribed to match the IC/IS plan (CTV HR) coverage and optimized based on volumes was created. In addition, a standard loading IC plan prescribed to point A was also created. These plans were compared to the IC/IS plan. Benefit for IC/IS was defined by organ at risk (OAR) D2cc's transitioning from unacceptable to acceptable based on American Brachytherapy Society (ABS) guidelines. Patients were then placed into 3 categories: those having 0, 1, or 2 or more organs that benefited from IC/IS. Wilcoxon rank sum and Fisher's exact tests, proportional odds models, and linear regression models were used to determine which characteristics were associated with benefit from IC/IS. <h3>Results</h3> Analysis showed that 33 (62%) patients showed benefit from IC/IS compared to optimized IC plans. IC/IS resulted in an average decrease in EQD2 to normal structures of 11.4 Gy (bladder), 6.2 Gy (rectum), 5.7 Gy (sigmoid), and 4.4 Gy (small bowel). No pre-treatment characteristics were associated with an increase in the number of organs benefiting from IC/IS. Increasing BRT max S-I and overall dimension as well as GTV and CTV HR volumes were associated with increased organ sparing with IC/IS. The bladder had the greatest reduction in dose from IC/IS with greater than 10 Gy benefit with S-I extension or max tumor dimension greater than 5 cm, GTV greater than 27 cc, and CTV HR greater than 35 cc. Standard IC plans prescribed to point A had inferior coverage of the CTV HR compared to IC/IS plans above 2.9 cm max distance from tandem, 5.3 cm max lateral dimension, 4.1 cm max A-P dimension, 5.4 cm max S-I dimension, and 5.6 cm overall dimension. Standard IC plans prescribed to point A also began to treat the CTV HR inferiorly to IC/IS plans above a GTV and CTV HR of 37.4 and 43.1 cc, respectively. <h3>Conclusions</h3> Various BRT characteristics are significantly associated with benefit from IC/IS, and our data suggests patients having tumors with max overall dimensions > 5 cm, CTV HR > 35 cc and GTVs > 27 cc at the time of BRT would benefit from IC/IS. However, further analysis using independent data is needed to confirm these thresholds.

Listing of the Abstracts of the 2022 American Brachytherapy Society Annual Meeting

Listing of the Abstracts of the 2022 American Brachytherapy Society Annual Meeting

Author Index of the Abstracts of the 2022 American Brachytherapy Society Annual Meeting

Author Index of the Abstracts of the 2022 American Brachytherapy Society Annual Meeting

GEC-ESTRO (ACROP)–ABS–CBG Consensus Brachytherapy Target Definition Guidelines for Recurrent Endometrial and Cervical Tumors in the Vagina

Representatives from the Gynecologic Groupe European de Curietherapie-European Society for Radiation Therapy and Oncology (GYN GEC-ESTRO), the American Brachytherapy Society (ABS), and the Canadian Brachytherapy Group (CBG) met to develop international consensus recommendations for target definitions for image-guided adaptive brachytherapy for vaginal recurrences of endometrial or cervical cancer. Seventeen radiation oncologists and 2 medical physicists participated. Before an in-person meeting each participant anonymously contoured 3 recurrent endometrial/cervical cancer cases. Participants contoured the residual gross primary tumor volume (GTV-Tres), a high-risk clinical target volume (CTV-THR), and an intermediate-risk clinical target volume (CTV-TIR), on T2-weighted magnetic resonance images (MRIs). All contours were drawn using Falcon EduCase. Contours were reviewed at an in-person meeting during which a consensus document was created defining agreed-upon target definitions (Trial 1). After establishing these definitions, the group was sent one of the cases again (recurrent cervical cancer vaginal recurrence) and asked to contour the targets again (Trial 2). The Computerized Environment for Radiation Research (CERR) software (The Mathworks, Natwick, MA) was used to analyze the contours. Kappa statistics were generated to assess level of agreement between contours. A conformity index (CI), defined as the ratio between the intersection and union volume of a given pair of contours, was calculated. A simultaneous truth and performance level estimation (STAPLE) contour was created for the CTV-THR and CTV-TIR for the postmeeting case. Consensus definitions for GTV-Tres, CTV-THR, and CTV-TIR were established. Kappa statistics (Trial 1/Trial 2) for GTV-Tres, CTV-THR, and CTV-TIR were 0.536/0.583, 0.575/0.743 and 0.522/0.707. Kappa statistics for Trial 2 for the CTV-THR and CTV-TIR showed "substantial" agreement while the GTV-Tres remained at moderate agreement. This consensus provides recommendations to facilitate future collaborations for MRI-guided adaptive brachytherapy target definitions in endometrial/cervical vaginal recurrences.

Partial breast irradiation: An updated consensus statement from the American brachytherapy society

PurposeIn recent years, results with mature follow-up have been reported for several Phase III trials randomizing women to receive whole breast irradiation (WBI) versus varying modalities of partial breast irradiation (PBI). It is important to recognize that these methods vary in terms of volume of breast tissue treated, dose per fraction, and duration of therapy. As such, clinical and technical guidelines may vary among the various PBI techniques. MethodsMembers of the American Brachytherapy Society with expertise in PBI performed an extensive literature review focusing on the highest quality data available for the numerous PBI options offered in the modern era. Data were evaluated for strength of evidence and published outcomes were assessed. ResultsThe majority of women enrolled on randomized trials of WBI versus PBI have been age >45 years with tumor size <3 cm, negative margins, and negative lymph nodes. The panel also concluded that PBI can be offered to selected women with estrogen receptor negative and/or Her2 amplified breast cancer, as well as ductal carcinoma in situ, and should generally be avoided in women with extensive lymphovascular space invasion. ConclusionsThis updated guideline summarizes published clinical trials of PBI methods. The panel also highlights the role of PBI for women facing special circumstances, such as history of cosmetic breast augmentation or prior breast irradiation, and discusses promising novel modalities that are currently under study, such as ultrashort and preoperative PBI. Updated consensus guidelines are also provided to inform patient selection for PBI and to characterize the strength of evidence to support varying PBI modalities.

AAPM task group report 303 endorsed by the ABS: MRI implementation in HDR brachytherapy-Considerations from simulation to treatment.

The task group (TG) on magnetic resonance imaging (MRI) implementation in high-dose-rate (HDR) brachytherapy (BT)-Considerations from simulation to treatment, TG 303, was constituted by the American Association of Physicists in Medicine's (AAPM's) Science Council under the direction of the Therapy Physics Committee, the Brachytherapy Subcommittee, and the Working Group on Brachytherapy Clinical Applications. The TG was charged with developing recommendations for commissioning, clinical implementation, and on-going quality assurance (QA). Additionally, the TG was charged with describing HDR BT workflows and evaluating practical consideration that arise when implementing MR imaging. For brevity, the report is focused on the treatment of gynecologic and prostate cancer. The TG report provides an introduction and rationale for MRI implementation in BT, a review of previous publications on topics including available applicators, clinical trials, previously published BT-related TG reports, and new image-guided recommendations beyond CT-based practices. The report describes MRI protocols and methodologies, including recommendations for the clinical implementation and logical considerations for MR imaging for HDR BT. Given the evolution from prescriptive to risk-based QA, an example of a risk-based analysis using MRI-based, prostate HDR BT is presented. In summary, the TG report is intended to provide clear and comprehensive guidelines and recommendations for commissioning, clinical implementation, and QA for MRI-based HDR BT that may be utilized by the medical physics community to streamline this process. This report is endorsed by the American Brachytherapy Society.

Contemporary image-guided cervical cancer brachytherapy: Consensus imaging recommendations from the Society of Abdominal Radiology and the American Brachytherapy Society

To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.

Insights and Strategies to Revive Brachytherapy Using Social Media: A Google Trends Analysis.

Introduction: The utilization and public awareness of brachytherapy are both declining. Social media has an increasing presence in health promotions. As regards cancer care, social media has been successfully used as a platform for information dissemination, psychosocial support, and patient engagement and empowerment.Methods and materials: Using Google Trends (Google LLC, Mountain View, CA, USA), we analyzed the impacts on the public interest of three brachytherapy-related social media campaigns/publicity events and compared and contrasted them with three other campaigns/publicity events. We used descriptive statistics (mean ± standard deviation (SD)) to describe the search results, independent t-tests to compare means before and after campaigns/announcements for short-term effects, and one-way ANOVA (or Kruskal-Wallis test when appropriate) to compare mean values across distinct time periods for long-term effects.Results: We identified three major types of social media campaigns/events: those that have a short-term impact but little long-term impact, those that have both short-term and long-term impacts, and those with little short-term or long-term impact. We examined campaigns with significant and lasting impacts and noticed that they tend to be celebrity-related/celebrity-endorsed, focused on sharing personal experiences, and occur with regular frequency.Conclusions: To increase public awareness of brachytherapy, the American Brachytherapy Society (ABS) can consider tie-ins with events and people with high search traffic (such as Breast Cancer Awareness Month), having celebrities/influencers who were treated with brachytherapy to provide testimonials, encouraging patient engagement and sharing of their experiences with brachytherapy on social media, and setting up recurring brachytherapy publicity events.

The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors

PURPOSETo develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 (90Y) microspheres transarterial radioembolization (90Y TARE) for primary and metastatic cancers in the liver. METHODS AND MATERIALSMembers of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience. RESULTSThe ABS strongly recommends the use of 90Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of 90Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting 90Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90Y TARE should be carefully considered. CONCLUSIONSABS consensus for implementing a safe 90Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies.