Low Dose Rate Interstitial Brachytherapy Research Articles

Cesium-131 Low-Dose Rate Interstitial Brachytherapy as a Salvage Re-Irradiation Technique in Treating Cervical and Uterine Cancer Pelvic Recurrence with Prior History of Pelvic Radiation

Pelvic recurrence among cervical and uterine cancer patients with prior history of pelvic radiation is a poor prognostic factor and remains challenging. The standard of care is pelvic exenteration, which is a highly morbid surgical procedure. The purpose of this study is to report local control rate and toxicity profile of Cesium-131 low-dose rate interstitial brachytherapy (LDR) as a salvage re-irradiation technique in managing pelvic relapse. We reviewed procedures and outcomes from patients with previously irradiated uterine corpus or cervix neoplasms, who subsequently relapsed and then underwent cesium-131 LDR implants between January 2016 and December 2022. Patient demographics, treatment planning variables, and disease response were reviewed. Acute toxicities, late toxicities, and local control rate were compiled for this study. A total of 12 eligible patients (6 cervical and 6 uterine cancer) with 16 cesium-131 LDR implants were included in this study. The majority (75%) of pelvic relapses occurred at the exocervix (cervix-intact) or vaginal cuff (post-hysterectomy). Median time from disease relapse to cesium implant was 32 days. The average area of implementation was 9 cm2 and average number of seeds implanted was 16. The mean prescription dose was 50 Gy. Six patients also received high-dose rate vaginal intracavitary brachytherapy in addition to cesium-131 LDR. Median follow up was 12 months. 81% of cesium implants achieved complete response at first post-treatment follow-up, while the remaining 19% demonstrated partial response. The 6-months local control rate was 79%. After cesium implant, 25% patients had local recurrence and 33% with distal metastasis. The most reported acute toxicities included vaginal mucositis (63%), dysuria (50%) and pain (19%). All patients had various degrees of vaginal stenosis and strictures long-term. Only 1 (8%) out of 12 patients, with 4 repeated cesium-131 LDR implants, developed a rectovaginal fistula and chronic pain. Cesium-131 LDR interstitial brachytherapy is a safe and feasible salvage re-irradiation technique in treating pelvic relapse among uterine corpus or cervix cancer patients with prior history of pelvic radiation. Local control rate at 6-months was acceptable with minimum toxicity. Long-term follow up is warranted to validate the efficacy of cesium-131 LDR. We conclude that cesium-131 LDR interstitial brachytherapy is a promising alternative to pelvic exenteration in selective patient population. Future prospective study is warranted.

Brachytherapy in the adjuvant management of keloid scars: literature review.

Introduction:Radiation therapy is a well-recognised modality for the adjuvant treatment of keloid scars. It can be conventionally delivered as external beam using a large apparatus at a distance from the lesion or as brachytherapy with specialised equipment to enable the delivery of treatment in the immediate vicinity of the keloidal tissue.Methods:An English literature review was performed with keywords ‘brachytherapy’ and ‘keloid’ using the databases PubMed, Embase and Web of Science from their individual dates of inception until June 2017. Studies pertinent to the field are presented in a chronological manner to depict the evolution of different brachytherapy strategies over the last decades. We also discuss considerations relating to the risk of secondary carcinogenesis, which are relevant to shared decision-making in the clinical setting.Discussion:Low dose rate interstitial brachytherapy was first introduced in the English literature in 1976 and currently appears to have been superseded by more modern approaches, including high dose rate interstitial brachytherapy. This modality compares favourably to more traditional modes of radiotherapy in terms of recurrence as well as rates of symptomatic relief from keloidal symptoms. Superficial brachytherapy was introduced more recently in the relevant literature and appears to be associated with favourable therapeutic outcomes compared to external beam radiation therapy.Conclusion:Brachytherapy is a valid modality of radiotherapy for the adjuvant treatment of keloid scars, with high dose rate interstitial and surface regimens gaining in popularity over recent years. Further research needs to focus on randomised controlled trials to further establish the role of different radiotherapy modalities in keloid scar management.

Quality of life and functional outcome of male patients with bladder–prostate rhabdomyosarcoma treated with conservative surgery and brachytherapy during childhood

PurposeThe aim of this study was to report the long-term results of a conservative local treatment of male patients with bladder–prostate rhabdomyosarcoma (BPRMS) focusing on their outcome and quality of life (QoL). Methods and MaterialsFrom 1991 to 2007, 27 male patients were treated by a single team, according to the ongoing European protocols. Surgical procedure was partial cystectomy or partial prostatectomy or both, followed by low-dose–rate interstitial brachytherapy. Three patients died of metastases and two were excluded; 22 patients, who were long-term survivors with their bladder, received a QoL questionnaire derived from the International Workshop on BPRMS. Urodynamic studies were performed when patients had abnormal continence. ResultsMedian age at surgery was 24 months (14 months–11 years). Median followup after surgery was 10 years (5–21 years); 18 male patients (77%) completed the questionnaire at a median age of 13 years (7–25 years); 13 considered themselves as having a normal QoL, with normal urinary continence (9 of 13) or very rare diurnal dribbling (4 of 13). Four male patients had frequent diurnal dribbling requiring protection for three of them and one was submitted to intermittent catheterism for a postoperative neurogenic bladder. Urodynamic studies were performed in 11 patients with urinary disturbance, often revealing detrusor sphincter dyssynergia. All pubertal patients considered themselves as having normal erections. Three sexually active patients reported having satisfying sex and orgasms. Two patients had normal ejaculations. ConclusionsThe majority of long-term male survivors (76%) within this cohort considered themselves as having a normal QoL after the combined conservative local treatment of their BPRMS.

Innovative technique for pulsed dose rate brachytherpy in mobile and base of tongue carcinomas

Purpose Continuous low-dose rate interstitial brachytherapy using Pernot's plastic tubes afterloading with loop technique was a well-established treatment modality for localized tongue carcinomas. With the stop sale of iridium wires we must use pulse-dose rate brachytherapy, and replace each loop is by two straight catheters, leading to underdosage at the top of the clinical target volume. To obtain a correct clinical target volume coverage, dwell time of distal dwell positions must be increased creating a risk of mucosa necrosis by overdose. We evaluated the use of a bolus in pulsed-dose rate brachytherapy to mimic the continuous low-dose rate iridium wire loop technique. Materials and methods Three consecutive patients with base of tongue carcinomas referred for interstitial brachytherapy were included. We used pulsed-dose rate brachytherapy with interstitial plastic straight. We replaced the loop technique with catheters protruding above the tongue to ensure that the distal dwell position was above the tongue surface. Catheters were protruding through plastic buttons placed at the top end of the catheter for the control patient and plastic button more one bolus (5 mm-thickness) for two experimental patients. The Paris system for dosimetry was applied. Dose distribution was optimized by increased dwell time for the three distal dwell positions. Dosimetric comparison was performed between control patient and the two experimental patients. Results Six catheters were implanted for the control patient and the first experimental patient and 4 for the second. Ratio between dwell time for the distal dwell positions and the other positions was 2,6 for the control patient, 1,9 and 1,4 for the first and second experimental patients respectively, as to cover at least 98% of the clinical target volume. All patients could receive the whole pulsed-dose rate treatment and the bolus was well tolerated. Conclusion Pulsed-dose rate brachytherapy with bolus application could be an effective and safe alternative to continuous low dose rate iridium wire technique for localized tongue carcinomas treatment.

Failure to address potential bias in non-randomised controlled clinical trials may cause lack of evidence on patient-reported outcomes: a method study

ObjectivesWe conducted a workup of a previously published systematic review and aimed to analyse why most of the identified non-randomised controlled clinical trials with patient-reported outcomes did not match a...

Cancer du sein traité exclusivement par l’association d’une irradiation externe et d’une curiethérapie exclusive : résultats à long terme

PurposeTo report retrospective long-term results of historical experience of breast radiotherapy (RT) including external beam radiotherapy (EBRT) followed by low dose rate (LDR) brachytherapy. Patients and methodsBetween 1971 and 1983, at our service 474 breast cancer patients underwent exclusive conserving radiotherapy treatment. The RT included an initial external irradiation followed by interstitial LDR brachytherapy (37Gy) to the residual tumour. The local regional nodes received 47.5Gy followed by a 15Gy boost delivered to the mammary nodes internal (IMN) and 25Gy axilla. ResultsMedian follow-up was 139months (8–342). There were 40 T1, 356 T2, and 78 T3. Local recurrences (LR) were observed in 20% of cases. The rate of recurrences free at 5, 10, 15 and 20years were 86%, 77%, 73% and 67% respectively. At 5, 10, 15 and 20-year, the disease-free survival rates were 63%, 42%, 32% and 24%. Overall survival rates at 5, 10, 15 and 20-years were 75%, 53%, 34% and 25% respectively. ConclusionAlthough the historical retrospective character of these series, it is interesting to have this experience and to analyse it according to our new knowledge and advances. The described technique was a standard for many years and could be still used in some cases.

Gleason score 7 prostate cancer treated with interstitial brachytherapy with or without supplemental external beam radiation and androgen deprivation therapy: Is the primary pattern on needle biopsy prognostic?

To evaluate the effect of primary Gleason pattern on biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) in Gleason 7 prostate cancer patients treated with low-dose-rate (LDR) interstitial brachytherapy with or without supplemental external beam radiation therapy and androgen deprivation therapy. We retrospectively reviewed the medical records of 932 consecutive patients with biopsy-confirmed Gleason 7 prostate cancer who received LDR interstitial brachytherapy as a component of their definitive treatment regimen. Treatment outcomes were compared between patients with primary Gleason pattern 3 and4. With a median followup of 7.4 years, the 10- and 14-year bPFS, CSS, and OS for the entire Gleason 7 study group were 95.7/95.7%, 98.6/98.6% and 77.2/64.3%, respectively. When biochemical control was evaluated as a function of primary Gleason pattern, the primary pattern 3 had a statistically higher 10- and 14-year bPFS (97.8/97.8% vs. 93.1/93.1%, p=0.006). The Gleason pattern 3 patients also trended toward a higher 10- and 14-year CSS (99.3/99.3% vs. 96.9/96.9%, p=0.058). OS was not statistically different between the two Gleason 7 cohorts. Gleason 7 prostate cancer patients treated with LDR interstitial brachytherapy have an excellent long-term outcome. There was a small but statistically significant advantage in bPFS and a trend toward improved CSS in patients with a primary Gleason pattern of3.

Successful Treatment of an Adolescent With Locally Advanced Cervicovaginal Clear Cell Adenocarcinoma Using Definitive Chemotherapy and Radiotherapy

Pediatric cervicovaginal clear cell adenocarcinoma (CCA) is rare but continues to occur in the postdiethylstilbestrol era. Ideal management is unclear. We report a case of locally advanced, node-negative CCA in a 14-year-old girl without a history of diethylstilbestrol exposure. The patient's disease was FIGO stage IIIA, involving the cervix, vagina, and parametrium. She was treated with concurrent cisplatin and external beam radiation, followed by interstitial low-dose rate brachytherapy. The patient has no evidence of disease after 2 years of follow-up. These findings support the use of definitive chemoradiation as a treatment option for adolescents with locally advanced CCA.

Interstitial brachytherapy for lower lip carcinoma: Global assessment in a retrospective study of 89 cases

Infiltrating squamous cell carcinoma (SCC) of the lower lip is a highly curable cancer. We retrospectively analyzed oncologic, functional, and cosmetic outcomes after interstitial low-dose rate brachytherapy at 58 Gy (50-62) of lower lip SCC treated in our institution. There were 89 patients (44 T1, 33 T2, 2 T3, and 10 after wedge-excision). All tumors were N0 at the time of treatment. We calculated survival rates and assessed functional and cosmetic results de visu. After a median follow-up of 36 months (range, 9-127), 5-year local control rate was 95% and 5-year disease-free survival was 82%. Only 6 patients (5 T2 and 1 T3) developed secondary cervical nodal involvement. Sixty-one patients were reassessed and 11 patients presented mild functional troubles. Cosmetic results were good (77%) or fair (21%). Brachytherapy provided a high local disease control rate, excellent functional results, and good cosmetic outcomes for SCCs of the lip. Risk of cervical node involvement was low with small tumors.

Mature follow-up of Low-dose rate interstitial brachytherapy following ipsilateral breast tumor recurrence in patients initially treated with breast conservation therapy

Objective: To evaluate our mature follow-up data in women who have developed IBTR following conservation surgeryand post-operative external radiotherapy retreated by lumpectomy followed by interstitial brachytherapy in lieu of salvagemastectomy.Methods: Between 1/1998 and 10/2006, twenty-two patients with TIS or T1 IBTR were offered interstitial low-dose ratebrachytherapy following tumor re-excision as an alternative to salvage mastectomy. All patients had failed lumpectomyfollowed by standard postoperative external beam radiotherapy (range 5000-6480cGy). The recurrent tumors were excisedwith final margins of resection free of residual disease. Tumor bed implantation was then carried out with an interstitialtechnique utilizing 192Iridium with the target volume consisting of the tumor bed plus a minimum 1.0 centimeter margin(minimum standard dose 4500cGy).Results: With a mean follow up of 67.5 months (range 17-115 months) Twenty-one of 22 patients maintained localcontrol at the time of last follow-up or at the time of their death. The single patient who developed a second localrecurrence was treated successfully with mastectomy. Three patients succumbed to systemic disease. Two patientsdeveloped localized skin breakdown. One patient developed a contralateral breast cancer. Long-term cosmetic results asdefined by the Harvard cosmesis scale and the Allegheny General modification were acceptable.Conclusions: These long-term data suggest that lumpectomy followed by brachytherapy is feasible and may be anacceptable alternative to salvage mastectomy in patients who locally fail conservation breast therapy. The upcomingRTOG retreatment trial (RTOG 1014) should help define the role of repeat conservation therapy in IBTR.

413 Permanent interstitial low-dose rate brachytherapy for patients with localized prostate cancer – a systematic review of randomized and non-randomized controlled clinical trials

413 Permanent interstitial low-dose rate brachytherapy for patients with localized prostate cancer – a systematic review of randomized and non-randomized controlled clinical trials

Mature Follow-up Low-dose Rate Interstitial Brachytherapy (LDR) following Ipsilateral Breast Tumor Recurrence (IBTR) In Patients Initially Treated with Breast Conservation Therapy: The Allegheny General Hospital Experience

Mature Follow-up Low-dose Rate Interstitial Brachytherapy (LDR) following Ipsilateral Breast Tumor Recurrence (IBTR) In Patients Initially Treated with Breast Conservation Therapy: The Allegheny General Hospital Experience

Retrospective Analysis of Local Control and Cosmetic Outcome of 147 Periorificial Carcinomas of the Face Treated With Low–Dose Rate Interstitial Brachytherapy

Skin cancer is the most common malignancy in white populations. We evaluated the local cure rate and cosmetic outcome of patients with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the face treated with low-dose rate brachytherapy. Between February 1990 and May 2000, 147 facial carcinomas in 132 patients were treated by (192)Ir wire implantation. Side effects of brachytherapy were noted. Follow-up was 2 years or more. Locoregional recurrence-free survival (LRFS) and overall survival were recorded. Group A included patients treated by primary brachytherapy, and Group B included those treated after recurrence. A total of 121 carcinomas were BCCs (82.3%) and 26 were SCCs (17.7%); the median tumor size was 10 mm. Of the tumors, 86 (58.5%) were in men and 61 (41.5%) were in women; the median age was 71 years. Group A comprised 116 lesions (78.9%), and Group B, 31 (21.1%). There were 17 relapses (11.6%) after a median follow-up of 72 months: 12 local, 4 nodal, and 1 local and nodal. Locoregional-free survival was 96.6% at 2 years and 87.3% at 5 years. Five-year LRFS was 82.6% in men and 93.3% in women (p = 0.027). After adjustment for gender, LRFS was better after primary treatment than after recurrence (hasard ratio HR, 2.91; 95% confidence interval, 1.06-8.03; p= 0.039). Five-year LRFS was 90.4% for BCC and 70.8% for SCC (p = 0.03). There were no Grade 3 complications. Low-dose rate brachytherapy offers good local control and cosmetic outcome in patients with periorificial skin carcinomas, with no Grade 3 complications. Brchytherapy is more efficient when used as primary treatment.

Brachytherapy with permanent gold grain seeds for squamous cell carcinoma of the lip

PurposeTo describe the use of radioactive gold grain implantation for squamous cell carcinoma of the lip. MethodsRetrospective review of 51 patients treated with permanent gold (198Au) grain implant brachytherapy. The seed arrangement delivered a dose of 5500cGy at 0.5cm from a single plane. Primary endpoints were local recurrence and cosmetic outcome. ResultsMedian follow-up was 27months. Median age was 69years. The majority (90%) were T1 lesions. None of the patients had evidence of regional lymph node or distant metastasis. Twelve patients had recurrent disease with prior surgery and five patients had previous head and neck radiation. Local control was achieved in 49 patients. Good cosmesis was achieved in 48 patients. Two-year actuarial estimates for local failure-free survival, disease-free survival and overall survival were 97.9%, 94.1% and 87.9%, respectively; no deaths were attributable to lip cancer. ConclusionsGold grain interstitial low-dose rate brachytherapy provides excellent local control and cosmesis in patients with squamous cell carcinoma of the lip. This technique provides an excellent option for patients that are elder or live remotely. It is particularly useful for lesions that are small, in previously radiated areas, or treated with prior surgery.

Second traitement conservateur radiochirurgical dans les récidives locales du cancer du sein

Purpose Currently, radical mastectomy represents the gold standard for ipsilateral breast cancer recurrence. However, we already showed that a second conservative treatment was feasible combining lumpectomy plus low-dose rate interstitial brachytherapy. In this study, we reported the preliminary results of a second conservative treatment using a high-dose rate brachytherapy. Patients and methods From June 2005 to July 2009, 42 patients presenting with an ipsilateral breast cancer recurrence underwent a second conservative treatment. Plastic tubes were implanted intra-operatively at the time of the lumpectomy. After a post-implant CT scan, a total dose of 34 Gy in 10 fractions over 5 consecutive days was delivered through an ambulatory procedure. The toxicity evaluation used the Common Terminology Criteria for Adverse Events v3 .0. Results The median follow-up was 21 months (6–50 months), median age at the time of the local recurrence was 65 years (30–85 years). The median delay between the primary and the recurrence was 11 years (1–35 years). The location of the recurrence was in the tumor bed for 22 patients (52.4%), in the same quadrant for 14 patients (33.3%) and unknown for six patients (14.3%). The median tumor size of the recurrence was 12 mm (2–30 mm). The median number of plastic tubes and plans were nine (5–12) and two (1–3) respectively. The median CTV was 68 cm 3 (31.2–146 cm 3). The rate of second local control was 97%. Twenty-two patients (60%) experienced complications. The most frequent side effect consisted in cutaneous and sub-cutaneous fibrosis (72% of all the observed complications). Conclusion A second conservative treatment for ipsilateral breast cancer recurrence using high-dose rate brachytherapy appears feasible leading to encouraging results in terms of second local control with an acceptable toxicity. Considering that a non-inferiority randomized trial comparing mastectomy versus second conservative treatment could be difficult to perform, what proof level will be necessary to achieve in order to change the medical procedures?

Interstitial Low Dose Rate Brachytherapy for Gynecologic Malignancies: Balancing Control and Toxicity

Interstitial Low Dose Rate Brachytherapy for Gynecologic Malignancies: Balancing Control and Toxicity

Interstitial vs. Intracavitary Brachytherapy and Repeat Lumpectomy for In-breast Tumor Recurrence following Breast Conserving Therapy and Whole Breast Irradiation: A Comparison of Techniques

To compare low dose rate interstitial brachytherapy to high dose rate intracavitary brachytherapy for IBTR re-treated by lumpectomy. Between 1/1998 and 11/2008, 32 patients with TIS to T2 (< 3 cm) breast carcinoma were offered brachytherapy following failed BCT and WBI (range 4500 - 6600 cGy) as an alternative to salvage mastectomy. One additional patient developed an in-field breast cancer following full mantle irradiation (4500 cGy) for Hodgkin's Lymphoma 27 years prior. All tumors were re-excised with negative margins per National Surgical Adjuvant Breast and Bowel Project (NSABP) definition. Following repeat lumpectomy, tumor bed implantation was carried out utilizing a low dose rate (LDR) interstitial technique (4500 -5530 cGy at 35 - 50 cGy per hour to the tumor bed plus a 1.0 cm margin) in 23 patients. Five patients were treated with high dose rate (HDR) brachytherapy (3400 cGy twice daily at 340 cGy/fx according to NSABP B-39/ RTOG 0413 protocol) using the MammoSite system and five were treated using the Contura multi-lumen system. Maximum skin and rib dosages in the patients treated with the Contura system were additionally compared using the central lumen of the catheter in a multi-dwell idealized delivery against a multi-lumen delivery. Two patients (LDR group) developed grade III acute complications by the Common Terminology Criteria for Adverse Events (v. 3.0). Four patients (HDR group) developed grade I acute complications. With the Contura® system, the mean reduction in maximum skin and rib doses was 12.2% and 13.9% respectively (range: 0- 43.7%) compared to MammoSite. With skin and rib distances of less than 1 cm, the mean dose reductions were 18% and 33.6% respectively. NSABP cosmesis grading scores were: Grade I in 25 patients (including the 10 MammoSite and Contura patients), Grade II in 2 patients, Grade III in 3 patients, and was unavailable for 3 patients. 32 of 33 patients remain free of local failure with a mean follow-up of 24.9 months (range 1 - 90.6 months). Repeat BCT and brachytherapy radiation for IBTR is a feasible process. HDR intracavitary brachytherapy has decreased acute toxicities compared to LDR interstitial brachytherapy. The Contura device provides noticeable skin and rib dose reductions. The long term cosmetic effect of HDR intracavitary compared to LDR interstitial brachytherapy following repeat lumpectomy for IBTR is superior. HDR intracavitary brachytherapy and repeat lumpectomy is a reasonable alternative for the treatment of IBTR.

Is Low-dose Rate Interstitial Brachytherapy for Patients with Large Prostates (&gt;60cc) Safe and Effective?

Is Low-dose Rate Interstitial Brachytherapy for Patients with Large Prostates (&gt;60cc) Safe and Effective?

The Role of Isotope Selection and use of Hormonal Therapy in Long Term Outcomes in Patients with Intermediate Risk Prostate Cancer Treated with Combination of External Beam Radiotherapy and Low-dose Rate Interstitial Brachytherapy

The Role of Isotope Selection and use of Hormonal Therapy in Long Term Outcomes in Patients with Intermediate Risk Prostate Cancer Treated with Combination of External Beam Radiotherapy and Low-dose Rate Interstitial Brachytherapy

Quality of Life of Oral Cancer Patients After Low-Dose-Rate Interstitial Brachytherapy

To assess the quality of life (QOL) of oral cancer patients treated with low-dose-rate interstitial brachytherapy (LDR-BT) alone. Between June 2005 and July 2006, a total of 56 patients with oral cancer were enrolled in this prospective study. QOL was assessed by means of the core questionnaire and head and neck questionnaire module of the European Organization for Research and Treatment of Cancer (EORTC Quality of Life Questionnaire-Core 30 [QLQ-C30] and QLQ Head and Neck 35 [H&N35]). The questionnaires were distributed to the patients before the start of treatment and 3 months, 6 months, and 12 months after the start of LDR-BT. It was possible to analyze the results for 20 of the initial 56 patients because they did not experience metastasis or recurrence during this study. No functions or symptoms asked about in the QLQ-C30 deteriorated during the first year. The emotional function score steadily and significantly increased. No symptoms in the QLQ-H&N35 significantly deteriorated. The scores for pain, trouble with social eating, and weight loss on the QLQ-H&N35 steadily and significantly decreased. Age, gender, and LDR-BT source had no effect on the change in QOL during the first year, but T-stage significantly affected the change in global health status, tumor site affected the changes in swallowing, sensory problems, sticky saliva, and complications affected the changes in pain, swallowing, and mouth opening. QOL of oral cancer patients treated with LDR-BT is high. However, tumor stage, tumor site, and complications affected the changes in a few functions and symptoms during the first year.