Interstitial Irradiation Research Articles

Abstract ES4-1: Partial breast irradiation: Efficacy and patient selection

Abstract Partial breast irradiation is an attractive option for patients and clinicians as a smaller region of the breast is irradiated in (usually) a shorter time period compared with whole breast radiation therapy (RT). The hypothesis for this approach is that a smaller irradiated volume is likely to translate into decreased toxicity, whilst maintaining good local control and survival (efficacy). This educational lecture will examine in detail the efficacy of the four “modern” large, randomised partial breast RT trials that have been published in the last 5 years. These include the ELIOT, Targit-A, GEC-ESTRO and IMPORT LOW studies1-4. In addition, the eligibility criteria and baseline characteristics of recruited patients will be considered for each trial in the context of ipsilateral breast tumour relapse rates. Current national and international guidelines regarding patient selection for partial breast RT will also be discussed.

Primary Vaginal Small-Cell Carcinoma Treated with Concurrent Chemoradiotherapy and Interstitial Irradiation: A Case Report and Review of the Literature

Abstract Background: Primary vaginal small-cell neuroendocrine carcinoma (VSC) is extremely rare and is associated with a poor prognosis. Treatment of VSC differs by institute, and optimal treatmen...

High-Dose-Rate Brachytherapy Monotherapy versus Image-Guided Intensity-Modulated Radiotherapy with Helical Tomotherapy for Patients with Localized Prostate Cancer.

The aim of this paper is to compare outcomes between high-dose-rate interstitial brachytherapy (HDR-BT) monotherapy and image-guided intensity-modulated radiotherapy (IG-IMRT) for localized prostate cancer. We examined 353 HDR-BT and 270 IG-IMRT patients. To reduce background selection bias, we used the method of inverse probability treatment weighting (IPTW) with propensity scores. The actuarial five-year biochemical failure-free survival rates were 92.9% and 96.7% (p = 0.1847; p = 0.077 in IPTW) for HDR-BT and IG-IMRT, respectively; they were 100% and 95.8% (p = 0.286) for the low-risk group, 95.6% and 92% (p = 0.42) for the intermediate-risk group, 90.4% and 84.9% (p = 0.1059; p = 0.04 in IPTW) for the high-risk group, and 87.1% and 89.2% (p = 0.3816) for the very-high-risk group. In the assessment of accumulated incidences of grade ≥ 2 toxicity (Common Terminology Criteria for Adverse Events version 4.0) at five years, HDR-BT monotherapy showed higher genitourinary toxicity (11.9%) than IG-IMRT (3.3%) (p < 0.0001). The gastrointestinal toxicity was equivalent for HDR-BT (2.3%) and IG-IMRT (5.5%) (p = 0.063). No Grade 4 or 5 toxicity was detected in either modality. HDR-BT showed higher genitourinary toxicity than IG-IMRT. HDR-BT and IG-IMRT showed equivalent outcomes in low-, intermediate-, and very-high-risk groups. For high-risk patients, HDR-BT showed potential to improve prostate-specific antigen (PSA) control rate compared to IG-IMRT.

Phosphorus-32 interstitial radiotherapy for recurrent craniopharyngioma: Expressions of vascular endothelial growth factor and its receptor-2 and imaging features of tumors are associated with tumor radiosensitivity.

To investigate the relationship of the expression of vascular endothelial growth factor (VEGF)/vascular endothelial growth factor receptor-2 (VEGFR-2) and imaging features with the therapeutic efficacy of Phosphorus-32 colloid interstitial radiotherapy in recurrent craniopharyngioma.Thirty-two patients with recurrent craniopharyngioma underwent phosphorus-32 colloid interstitial radiotherapy. The tumor imaging features were classified into 4 types according to the thickness of the cyst wall and signals of the cyst contents as shown by computed tomography (CT) and magnetic resonance imaging (MRI) images. Protein expressions of VEGF and VEGFR-2 in craniopharyngioma tissues were evaluated with immunohistochemistry before radiotherapy. The tumor radiosensitivity was determined at 12 months after the interstitial radiotherapy.VEGF mainly expressed in the tumor cytoplasm, and VEGFR-2 expressed either in vascular endothelial cells or in tumor endothelial cells. VEGF/VEGFR-2 expressions varied significantly in cases sensitive or insensitive to the radiotherapy (VEGF: P = .028; VEGFR-2: P = .017). Tumor imaging features were associated with the therapeutic efficacy of interstitial radiotherapy (P = .000). VEGF expression had no association with the imaging features of tumors (P = .226), but VEGFR-2 expression was associated with the imaging features of tumors (P = .008).Our results confirmed the association among imaging features, VEGFR-2 expressions, and tumor radiosensitivity in craniopharyngiomas. Imaging features and VEGFR-2 expressions may add useful data to the radiosensitive assessment of craniopharyngiomas.

Interstitial Lung Disease and Curative Lung Radiotherapy; Increased Risk of Mortality

Interstitial Lung Disease and Curative Lung Radiotherapy; Increased Risk of Mortality

RADIATION BOOST AFTER WHOLE-BREAST IRRADIATION: DOSIMETRIC COMPARISON OF HIGH DOSE RATE INTERSTITIAL BRACHYTHERAPY AND IRRADIATION WITH ELECTRONS

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.

Second breast conserving surgery and interstitial radiotherapy for the treatment of breast tumor local recurrences. Five-year results

To report the clinical outcomes of second breast-conserving therapy with perioperative interstitial radiotherapy for the treatment of ipsilateral breast tumor recurrences. Between 1999 and 2015, 33 patients, presenting with an ipsilateral breast tumor recurrence after previous breast conserving therapy, were salvaged by re-excision and perioperative high-dose-rate interstitial brachytherapy. A median of 8 (range: 4-24) catheters were implanted into the tumor bed intraoperatively. A total dose of 22 Gy in 5 fractions of 4.4 Gy was delivered to the tumor bed with a margin of 1-2 cm, on 3 consecutive days. The adjuvant systemic treatments consisted of hormonal therapy for 24 patients (73%) and chemotherapy for 6 patients (18%). The survival results were estimated by the Kaplan-Meier method. Late side effects and cosmetic results were also registered. The median follow-up time following the second breast conserving therapy was 61 months (range: 26-189 months). During the follow-up, 4 patients (12.1%) developed second local recurrence. The five-year actuarial rates of the second local, regional and distant recurrence were 6.3%, 6.1%, and 14.9%, respectively. The five-year probabilities of disease-free, cancer-specific and overall survival were 76.2%, 92.4%, and 89.2%, respectively. Four (12%), 19 (58%), 4 (12%) and 6 (18%) patients had excellent, good, fair and poor cosmetic results, respectively. Grade 2 and 3 fibrosis developed in 9 (27%) and 1 (3%) patients. Asymptomatic fat necrosis was detected in 7 (21%) women. Second breast conserving therapy with perioperative high-dose-rate interstitial brachytherapy is a safe and feasible option for the management of ipsilateral breast tumor recurrences. Interstitial brachytherapy may decrease the risk of second local relapse with acceptable cosmetic results and low rate of late side effects. Hence, in selected cases it can provide a feasible alternative to salvage mastectomy. Orv Hetil. 2018; 159(11): 430-438.

PHOTODYNAMIC THERAPY FOR HEAD AND NECK BASAL CELL SKIN CANCER WITH ADDITIONAL INTERSTITIAL LASER IRRADIATION

The article is devoted to the development and evaluation of the effi ciency of photodynamic therapy (PDT) with photosensitizer photolon with additional interstitial laser irradiation in patients with head and neck basal cell skin cancer (BCSC). Treatment was performed in 55 patients. On the fi rst stage, all patients underwent photodynamic therapy with interstitial irradiation using fl exible optical fi bers with cylindrical diffuser, on the second stage PDT with distant delivery of laser at a dose of 50-300 J/cm2 was carried out. During the follow- up period of 6 months to 4 years in 13 (23.6%) of the 55 patients a recurrence of the disease was diagnosed. A higher rate of recurrence was in the group of patients who underwent PDT for recurrent neoplasms compared with patients with primary disease (37.5% and 4.3%, respectively), in patients with endophytic growth of the tumor compared to patients with exophytic component (30.0% and 16.0%, respectively) and in patients with large tumors (up to 2.0 cm – 14.3%, from 2.0 to 5.0 cm – 16.7% and more than 5.0 cm – 54.4%).

Advances in colorectal cancer research from 2017 annual meeting of the American Society of Clinical Oncology

It is plentiful about the 289 abstracts for the colorectal cancer (CRC) in the 2017 annual meeting of the American Society of Clinical Oncology (ASCO), which include: (1) comparison between long and short courses of postoperative adjuvant chemotherapy for stage Ⅲ CRC in the early diseases, applications of the full course of neoadjuvant therapy for locally advanced rectal cancer and laparoscopic total mesorectal excision for rectal cancer. (2) The use of Vitamin D3 and selective interstitial radiotherapy for metastatic CRC in the advanced diseases showed an encouraging efficacy. Patients with BRAF mutation and poor prognosis underwent a combination therapy of BRAF inhibitor and epidermal growth factor receptor (EGFR), which has created a new situation for precision therapy. And China′s domestically designed Fruquintinib (small-molecule kinase inhi-bitor) and EGFR CMAB009 have showed better clinical efficacies in the second-line therapy. (3) On the precision medicine and translational researches, clinical value of consensus of molecular subtypes is being revealed and liquid biopsy is advantageous to predict postoperative tumor recurrence. These new therapies and researches would impact the clinical practices, promote clinical development and benefit the patients. Key words: Colorectal neoplasms; Therapy; Progress; American Society of Clinical Oncology

Photoacoustic-based sO2 estimation through excised bovine prostate tissue with interstitial light delivery

Photoacoustic (PA) imaging is capable of probing blood oxygen saturation (sO2), which has been shown to correlate with tissue hypoxia, a promising cancer biomarker. However, wavelength-dependent local fluence changes can compromise sO2 estimation accuracy in tissue. This work investigates using PA imaging with interstitial irradiation and local fluence correction to assess precision and accuracy of sO2 estimation of blood samples through ex vivo bovine prostate tissue ranging from 14% to 100% sO2. Study results for bovine blood samples at distances up to 20mm from the irradiation source show that local fluence correction improved average sO2 estimation error from 16.8% to 3.2% and maintained an average precision of 2.3% when compared to matched CO-oximeter sO2 measurements. This work demonstrates the potential for future clinical translation of using fluence-corrected and interstitially driven PA imaging to accurately and precisely assess sO2 at depth in tissue with high resolution.

Wann ist bei metastasiertem Primärtumor und Lymphknotenmetastasen von Harnblase und Prostata eine nicht-operative Behandlung möglich?

For metastatic carcinomas of the urinary bladder and prostate, systemic therapy is of primary importance. Due to technological advances in radiation oncology such as stereotactic radiotherapy, intensity-modulated radiotherapy, interstitial radiotherapy, and the combination of radiotherapy and chemotherapy, pelvic irradiation can nowadays be carried out effectively and without the risk of major side effects. New data from other tumor entities and retrospective analyses suggest that the use of these technologies can lead to aclinical benefit in terms of improvement in quality of life, local control, and overall survival. For the time being, the decision to administer radiotherapy to the pelvic region should be made on an individual basis. Retrospective analyses of data from prostate carcinomas in particular are currently being planned. This review article introduces potential indications which are supported with real patient examples and discusses future developments giving an overview of the literature and referring to data from prospective randomized trials.

Use of Nonprostate Ultrasound in Urology Practice

IntroductionUltrasound imaging is necessary for the care of urology patients, and urology residents are encouraged to learn ultrasound technique and interpretation. However, there is limited mandated education in this field. Currently the only ultrasound procedure considered an index case is transrectal ultrasound for prostate biopsy. We investigated the current use of nonprostate ultrasound in urological practice. MethodsWe reviewed ABU (American Board of Urology) certification and recertification logs of practicing urologists from 2012 to 2014. We obtained data for the codes 76700-76776 (kidney), 76870 (scrotal), 76999 (unlisted) and 93975-93981 (Doppler including penile). Codes 51798 (post-void residual) and 76950 (ultrasound for interstitial radiotherapy) were excluded from the study. We analyzed the results based on self-identified demographic information provided by the urologists. ResultsThe practices of 2,427 urologists were reviewed and of these, 43% billed for at least 1 renal, scrotal or penile ultrasound. General and subspecialist urologists perform similar percentages of ultrasound studies, except for pediatrics (0% penile) and andrology (40% penile). Of those who reported on practice type (2,067) 82% self-identify as in private practice and performed more ultrasound studies than academic urologists, including renal 42% vs 23%, scrotal 33% vs 15% and penile 8% vs 6%, respectively. Men performed more nonprostate ultrasounds than women (44% vs 36%, p <0.001). ConclusionsIn addition to prostate ultrasound, renal and scrotal ultrasound is relevant to all urologists regardless of practice model or subspecialty. Graduating residents can expect to perform ultrasound examinations in their practices and, therefore, in addition to prostate ultrasound we should train residents in renal and scrotal ultrasound.

Brachytherapy in thetreatment of the oral and oropharyngeal cancer

Background. One of the methods of radiotherapy of malignant tumors of oral cavity and oropharyngeal region today is interstitial radiation therapy – brachytherapy, allowing you to create the optimum dose of irradiation to the tumor, necessary for its destruction, without severe radiation reactions in the surrounding tissues unchanged. Brachytherapy has the following advantages: high precision – the ability of the local summarization of high single doses in a limited volume of tissue; good tolerability; a short time of treatment. At this time, brachytherapy is the method of choice used as palliative therapy and as a component of radical treatment. Objective: The purpose of this article is a literature review about the latest achievements of interstitial brachytherapy in malignant tumors of the oral cavity and oropharynx.

Combined stereotactic biopsy and stepping-source interstitial irradiation of glioblastoma multiforme.

Patients diagnosed with glioblastoma multiforme receiving stereotactic biopsy only either due to tumor localization or impaired clinical status face a devastating prognosis with very short survival times. One strategy to provide an initial cytoreductive and palliative therapy at the time of the stereotactic biopsy is interstitial irradiation through the pre-defined trajectory of the biopsy channel. We designed a novel treatment planning system and evaluated the treatment potential of a fixed-source and a stepping-source algorithm for interstitial radiosurgery on non-spherical glioblastoma in direct adjacency to risk structures. Using both setups, we show that radiation doses delivered to 100% of the gross tumor volume shifts from sub-therapeutic (10-12 Gy) to sterilizing single doses (25-30 Gy) when using the stepping source algorithm due to improved sparing of organs-at-risk. Specifically, the maximum doses at the brain stem were 100% of the PTV dose when a fixed central source and 38% when a stepping-source algorithm was used. We also demonstrated precision of intracranial target points and stability of superficial and deep trajectories using both a phantom and a body donor study. Our setup now for the first time provides a basis for a clinical proof-of-concept trial and may widen palliation options for patients with limited life expectancy that should not undergo time-consuming therapies.

Safety and effectiveness of modified radioactive iodine-125 seed implantation in treatment of lung cancer patients with poor lung function

Objective To study the safety and effectiveness of modified radioactive 125I seed implantation in treatment of lung cancer patients with poor lung function. Methods Thirty one lung cancer patients with poor lung function were enrolled into this study. All of them were implanted 125I seed with technology of fan-shaped distribution and coaxial puncture. Brachytherapy planning system(TPS) was used to draw up a preoperative implantation plan. Fan-shaped seed distribution system was used to simulate surgical program, and implantation pitch was 0.5 to 1.0 cm. Real-time adjustment is necessary during surgery. Dose distributions were checked by TPS immediately after implantation. Match peripheral dose(MPD),the dose of 90% tumor volume (D90) and the tumor volume covered by 90% prescription dose (D90) were calculated. Intraoperative and postoperative surgery-related complications were analyzed. All patients were followed up to 6 months, at month 2, 4 and 6 post-procedure, CT scan was performed to evaluate the local control rate of tumors. Results The technical success rate was 100% for placement of the 125I seed. MPD of the tumors was 90 to 140 Gy. D90 was 95 to 146 Gy,median dose was 118 Gy.V90 was 92% to 97%,median dose was 94%. Surgery-related complications included pulmonary hemorrhage(1 patient), pleural cavity hemorrhage (2 patients), pneumothorax(2 patients). The 2-month, 4-month and 6-monthlocal control rates were 31% (10/32), 78%(25/32) and 90% (29/32)respectively. The overall complete remission(CR) rate was 18%(6/32), partial response(PR) rate was 72% (23/32), stable disease(SD)rate was6% (2/32), progression disease(PD) rate was 3% (1/32).Acute radiation pneumonitis Grade 0 in 29 patients, Grade Ⅰ in 4 patients; advanced radiation pneumonitis: grade 0 in 30 patients and grade Ⅰ in 3 patients. Conclusions The technology of fan-shaped distribution and coaxial puncture for radioactive 125I seed implantation was safe and effective to treat lung cancer patients with poor lung function. Key words: Lung neoplasms; Radiology,interventional; Brachy therapy; Interstitial irradiation

Accelerated Partial Breast Irradiation Using Sole Interstitial Multicatheter Brachytherapy Versus Whole Breast Irradiation for Early Breast Cancer: Five-Year Results of a Randomized Phase 3 Trial – Part I: Local Control and Survival Results

time of analysis there were 185 DFS events; 99 in the C arm and 86 in the H arm. The estimated 7-year DFS is 75.6% (95% confidence interval [CI] 70.3-80.1) in the C arm and 81.8% (95% CI 77.5-85.3) in the H arm. The DFS HR (C/H) is 0.85 (95% CI 0.64-1.14). Comparison of biochemical recurrence (HR Z 0.77, 95% CI 0.51-1.17) and overall survival (HR Z 0.95, 95% CI 0.65-1.41) also met protocol noninferiority criteria. Grade 3 gastrointestinal toxicity is 3.0% (C) versus 4.6% (H), relative risk (RR) for H versus C 1.53, (95% CI 0.86-2.83); grade 3 genitourinary toxicity is 4.5% (C) versus 6.4% (H), RR Z 1.43 (95% CI 0.86-2.37). Conclusion: In men with low-risk prostate cancer, 70 Gy in 28 fractions over 5.6 weeks is noninferior to 73.8 Gy in 41 fractions over 8.2 weeks. (ClinicalTrials.gov identifier: NCT00331773.) Acknowledgment(s): This project was supported by grants U10CA21661 (RTOG-Ops-Stat), U10CA37422 (CCOP), CA81647 (ATC), U10CA 180868 (NRG Oncology Operations), and U10CA180822 (NRG Oncology SDMC) from the National Cancer Institute (NCI).

Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radical radiotherapy

Studies salvage interstitial radiation therapy for recurrent prostate cancer, launched at the end of the XX century. In recent years, more and more attention is paid to high-dose-rate brachytherapy (HDR-BT) as a method of treating local recurrence. The purpose of research – preliminary clinical results of salvage high-dose-rate brachytherapy applied in cases of suspected local recurrence or of residual tumour after radiotherapy. Preliminary findings indicate the possibility of using HDR-BT, achieving local tumor control with low genitourinary toxicity.

Irradiation of localized squamous cell carcinoma of the nasal vestibule.

The purpose of this study was to evaluate the long-term results of primary radiotherapy treatment for squamous cell carcinoma (SCC) of the nasal vestibule. Eighty-one patients were treated with external beam radiotherapy (EBRT) and/or interstitial radiotherapy (IRT) for a primary, localized, Wang classified SCC of the nasal vestibule. Median follow-up was 38 months. T1 tumors were treated with IRT: we observed 1 local failure (at 13 months) among 48 patients (5-year local control rate of 97%). Most T2 tumors (20 of 26) were treated with EBRT. There were 8 local recurrences among 26 patients (5-year local control rate of 68%). For the T3 tumors (n = 7; all treated with EBRT), we observed local recurrence in 2 patients (5-year local control rate of 53%). The late-term side effects were relatively mild. Local primary radiotherapy (either IRT for T1 or EBRT for T2/3) is an adequate treatment for SCC of the nasal vestibule with little late sequelae. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1870-E1875, 2016.

Long-term Treatment Outcome of Local Recurrences After Bladder Preservation With Brachytherapy for Bladder Carcinoma

Bladder preservation-combining surgery and interstitial radiation therapy (IRT) could maintain quality of life without compromising tumor control in selected patients with bladder carcinoma. Several reports confirm good results. The prognosis of patients who experience a bladder recurrence after IRT is not well known. We report the long-term results of patients who were treated for a local recurrence after bladder preservation treatment with IRT Between 1989 and 2011, 244 selected patients with bladder cancer (nonmuscle and muscle invasive) were treated with a combined regimen of preoperative external radiation therapy, subsequent surgical exploration with or without partial cystectomy, and IRT. Data of patients presented with local recurrence after this regimen were retrospectively collected. The primary endpoints were local recurrence-free survival (LRFS) and overall survival (OS) after the treatment of recurrence. The complications of the secondary treatment were reported Local recurrence was developed in 62 of 244 (25.4%) patients. Two patients were excluded because of lack of data. The local recurrence was muscle invasive in 27 (45%) patients, nonmuscle invasive in 31 (51.6%) patients, and in 2 patients the stage of the recurrence was not conclusive. Fifty patients (83.3%) were treated for a local recurrence: 26 patients underwent a salvage cystectomy and 24 patients underwent transurethral resection, which was followed by intravesical therapy in the majority of the cases. In 5 (8%) patients, cystectomy was preoperatively terminated because of tumor extent or positive lymph nodes. Five patients (8%) did not receive any treatment for their recurrences. With a median follow-up of 74 months (6-223 months), the 2- and 5-year LRFS after the treatment of recurrence was 71% and 60%, respectively, and the 2- and 5-year OS was 74% and 48%. The LRFS of the 26 patients treated with salvage cystectomy was 76% and 67% after 2 and 5 years, respectively, and the 2- and 5-year OS was 69% and 45%. In 14 patients (54%) treated with cystectomy, postoperative complications were reported, 7 patients having a Clavien-Dindo complication grade ≥3. Treatment of patients for a local recurrence after a bladder-sparing regimen with IRT offers a good long-term oncological outcome. Salvage cystectomy gave the best long-term local control, although it was at the cost of a high complication rate.

Brachytherapy for prostate cancer: Comparative characteristics of procedures

The introduction of interstitial radiation sources is the «youngest» of the radical method of treatment of patients with prostate cancer (PC). The high level of efficiency comparable to prostatectomy at a significantly lower rate of complications causes rapid growth of clinical use of brachytherapy (BT). Depending on the radiation source and the mode of administration into the prostate gland are two types BT – high-dose rate (temporary) (HDR-BT) and low-dose rate (permanent) (LDR-BT) brachytherapy. At the heart of these two methods are based on a single principle of direct effect of the quantum gamma radiation on the area of interest. However, the differences between the characteristics of isotopes used and technical aspects of the techniques cause the difference in performance and complication rates for expression HDR-BT and LDR-BT.