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1.
A.M. Kukiełka M.D. M. Hetnał M.D. P. Brandys M.D. T. Walasek M.D. T. Dąbrowski M.D. E. Pluta M.D. D. Nahajowski R. Kudzia 《Strahlentherapie und Onkologie》2013,189(6):467-475
Objective
A retrospective study to evaluate the feasibility and toxicity of interstitial hyperthermia (IHT) combined with high-dose-rate (HDR) brachytherapy as the initial treatment for low- and intermediate-risk prostate cancer, and as a salvage therapy in previously irradiated patients with local recurrence.Patients and methods
Between 18 December 2008 and 5 September 2012, 73 prostate cancer patients were treated with interstitial HDR brachytherapy of the prostate combined with IHT. In 54 patients this was the initial therapy for prostate cancer, while the other 19 were treated for local recurrence after previously undergoing external beam radiotherapy (EBRT). Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v. 4.03 within 3 months after treatment.Results
Median follow-up was 15 months (range 3–46). The combination of HDR brachytherapy and IHT was well tolerated. The toxicity profile was similar to that of HDR brachytherapy when not combined with hyperthermia. The most common minor complications were urinary frequency (grade 1: 37?%; grade 2: 22?%), nocturia (three times per night: 29?%; four- or more times per night: 20?%) and transient weakening of the urine stream (grade 1: 36?%; grade 2: 11?%). No early rectal complications were observed in the patient group and the severity of genitourinary toxicity was only grade 1–2.Conclusion
Early tolerance of IHT in combination with HDR brachytherapy is good. Further prospective clinical studies should focus on the effects of combining IHT with HDR brachytherapy and the influence of this adjuvant therapy on biochemical disease-free survival, local control and overall survival. 相似文献2.
Nikolaos Tselis Georgios Chatzikonstantinou Christos Kolotas Natasa Milickovic Dimos Baltas Nikolaos Zamboglou 《European radiology》2013,23(8):2264-2270
Objectives
To evaluate the clinical outcome of computed tomography (CT)-guided interstitial (IRT) high-dose-rate (HDR) brachytherapy (BRT) in the treatment of unresectable primary and secondary liver malignancies. This report updates and expands our previously described experience with this treatment technique.Methods
Forty-one patients with 50 tumours adjacent to the liver hilum and bile duct bifurcation were treated in 59 interventions of CT-guided IRT HDR BRT. The tumours were larger than 4 cm with a median volume of 84 cm3 (38–1,348 cm3). The IRT HDR BRT delivered a median total physical dose of 20.0 Gy (7.0–32.0 Gy) in twice daily fractions of median 7.0 Gy (4.0–10.0 Gy) in 19 patients and in once daily fractions of median 8.0 Gy (7.0–14.0 Gy) in 22 patients.Results
With a median follow-up of 12.4 months, the local control for metastatic hepatic tumours was 89 %, 73 % and 63 % at 6, 12 and 18 months respectively. The local control for primary hepatic tumours was 90 %, 81 % and 50 % at 6, 12 and 18 months respectively. Severe side effects occurred in 5.0 % of interventions with no treatment-related deaths.Conclusions
CT-guided IRT HDR BRT is a promising procedure for the radiation treatment of centrally located liver malignancies.Key points
? Interstitial high-dose-rate brachytherapy (IRT HDR BRT) is a promising treatment for central liver tumours ? CT-guided IRT HDR BRT is safe for treating extensive tumours ? CT-guided IRT HDR BRT could play a role in managing unresectable hepatic malignancies 相似文献3.
Dr. N. Tselis U. Maurer W. Popp H. Sack N. Zamboglou 《Strahlentherapie und Onkologie》2014,190(4):358-363
Introduction
The German Society of Radiation Oncology initiated a multicenter trial to evaluate core processes and subprocesses of radiotherapy by prospective evaluation of all important procedures in the most frequent malignancies treated by radiation therapy. The aim of this analysis was to assess the required resources for interstitial high-dose-rate (HDR) and low-dose-rate (LDR) prostate brachytherapy (BRT) based on actual time measurements regarding allocation of personnel and room occupation needed for specific procedures.Patients and methods
Two radiotherapy centers (community hospital of Offenbach am Main and community hospital of Eschweiler) participated in this prospective study. Working time of the different occupational groups and room occupancies for the workflow of prostate BRT were recorded and methodically assessed during a 3-month period.Results
For HDR and LDR BRT, a total of 560 and 92 measurements, respectively, were documented. The time needed for treatment preplanning was median 24 min for HDR (n?=?112 measurements) and 6 min for LDR BRT (n?=?21). Catheter implantation with intraoperative HDR real-time planning (n?=?112), postimplantation HDR treatment planning (n?=?112), and remotely controlled HDR afterloading irradiation (n?=?112) required median 25, 39, and 50 min, respectively. For LDR real-time planning (n?=?39) and LDR treatment postplanning (n?=?32), the assessed median duration was 91 and 11 min, respectively. Room occupancy and overall mean medical staff times were 194 and 910 min respectively, for HDR, and 113 and 371 min, respectively, for LDR BRT.Conclusion
In this prospective analysis, the resource requirements for the application of HDR and LDR BRT of prostate cancer were assessed methodically and are presented for first time. 相似文献4.
Peter Kneschaurek 《Strahlentherapie und Onkologie》1998,174(9):468-472
Background
In HDR brachytherapy activity distributions can be achieved which were unknown in LDR brachytherapy. For this reason the classical dosage systems can only be used with caution in HDR brachytherapy.Methods
Different simple applications are used to investigate the effect of various activity distributions on dose and integrated reference air kerma.Results
Within the classical LDR dosage systems dose and integrated reference air kerma were equivalent. Due to the possibility to “opotimize” the activity distribution in HDR brachytherapy this is not longer the case. Different optimization algorithms and different optimization goals may lead to quite different activity distributions and different integrated reference air kerma values even if the source positions are the same. For target volume oriented optimization schemes a dosage system is described which is based on dose-volume-histograms.Conclusions
A widely accepted dosage system in HDR brachytherapy is missing. The dosage system described in this paper may be useful in solving this problem. 相似文献5.
A.M. Kukiełka M. Hetnał T. Dąbrowski T. Walasek P. Brandys D. Nahajowski R. Kudzia D. Dybek M. Reinfuss 《Strahlentherapie und Onkologie》2014,190(2):165-170
Purpose
The aim of the present retrospective study is to evaluate toxicity and early clinical outcomes of interstitial hyperthermia (IHT) combined with high-dose rate (HDR) brachytherapy as a salvage treatment in patients with biopsy-confirmed local recurrence of prostate cancer after previous external beam radiotherapy.Patients and methods
Between September 2008 and March 2013, 25 patients with local recurrence of previously irradiated prostate cancer were treated. The main eligibility criteria for salvage prostate HDR brachytherapy combined with interstitial hyperthermia were biopsy confirmed local recurrence and absence of nodal and distant metastases. All patients were treated with a dose of 30 Gy in 3 fractions at 21-day intervals. We performed 62 hyperthermia procedures out of 75 planned (83?%). The aim of the hyperthermia treatment was to heat the prostate to 41–43?°C for 60 min. Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, v. 4.03). Determination of subsequent biochemical failure was based on the Phoenix definition (nadir +?2 ng/ml).Results
The median age was 71 years (range 62–83 years), the median initial PSA level was 16.3 ng/ml (range 6.37–64 ng/ml), and the median salvage PSA level was 2.8 ng/ml (1.044–25.346 ng/ml). The median follow-up was 13 months (range 4–48 months). The combination of HDR brachytherapy and IHT was well tolerated. The most frequent complications were nocturia, weak urine stream, urinary frequency, hematuria, and urgency. Grade 2 rectal hemorrhage was observed in 1 patient. No grade 3 or higher complications were observed. The 2-year Kaplan–Meier estimate of biochemical control after salvage treatment was 74?%. The PSA in 20 patients decreased below the presalvage level, while 11 patients achieved a PSA nadir <?0.5 ng/ml. All patients are still alive. Of the 7 patients who experienced biochemical failure, bone metastases were found in 2 patients.Conclusion
IHT in combination with salvage HDR brachytherapy is a well tolerated and effective treatment. 相似文献6.
R. E. Friedrich A. Krüll R. Schwarz H. Thurmann K. Plambeck R. Schmelzle 《Strahlentherapie und Onkologie》1997,173(10):507-512
Purpose
The clinical effect of high-dose-rate (HDR) interstitial brachytherapy combined with tumor resection was investigated in this retrospective study on patients with recurrent oral and oropharyngeal squamous cell carcinoma.Patients and Methods
Oral and oropharyngeal squamous cell carcinoma in 38 patients were treated over a period of 7 years (1988–1994) by HDR interstitial brachytherapy using Gammamed 12i® equipment. Pretreatment of patients in terms of irradiation and surgery differed (33 irradiated with a total dose between 60.0 and 75.6 Gy, including 8 patients with additional surgery; 1 patient with surgery alone, and 4 patients without any pretreatment). Indications for interstitial brachytherapy differed according to individual responses to treatment and medical histories.Results
Interstitial brachytherapy was successful in the majority of patients, i. e. complete remission: 12, partial remission: 19, no change: 2, progression: 5. Local control and overall survival including patients with surgical treatment was 59% and 81% at 6 months and 47% and 49% after 12 months, respectively.Conclusion
Interstitial HDR brachytherapy with Iridium 192 is recommended in patients with local recurrences or second primary carcinomas after previous external radiotherapy in the head and neck region. Combination of interstitial brachytherapy and surgery is preferable for these patients. 相似文献7.
8.
Purpose
To assess the efficacy, safety, and outcome of image-guided high-dose-rate (HDR) brachytherapy in patients with adrenal gland metastases (AGM).Materials and methods
From January 2007 to April 2014, 37 patients (7 female, 30 male; mean age 66.8 years, range 41.5–82.5 years) with AGM from different primary tumors were treated with CT-guided HDR interstitial brachytherapy (iBT). Primary endpoint was local tumor control (LTC). Secondary endpoints were time to untreatable progression (TTUP), time to progression (TTP), overall survival (OS), and safety. In a secondary analysis, risk factors with an influence on survival were identified.Results
The median biological equivalent dose (BED) was 37.4?Gy. Mean LTC after 12 months was 88%; after 24 months this was 74%. According to CTCAE criteria, one grade 3 adverse event occurred. Median OS after first diagnosis of AGM was 18.3 months. Median OS, TTUP, and TTP after iBT treatment were 11.4, 6.6, and 3.5 months, respectively. Uni- and multivariate Cox regression analyses revealed significant influences of synchronous disease, tumor diameter, and the total number of lesions on OS or TTUP or both.Conclusion
Image-guided HDR-iBT is safe and effective. Treatment- and primary tumor-independent features influenced survival of patients with AGM after HDR-iBR treatment.9.
M.-W. Huang PhD L. Zheng PhD S.-M. Liu PhD Y. Shi PhD J. Zhang PhD G.-Y. Yu PhD Prof. Dr. J.-G. Zhang B.S.Med 《Strahlentherapie und Onkologie》2013,189(6):502-507
Background and purpose
This retrospective study was to evaluate the local control and survival of 125I brachytherapy for recurrent and/or locally advanced adenoid cystic carcinoma (ACC) of the oral and maxillofacial region.Patients and methods
A total of 38 patients with recurrent and/or locally advanced ACC of the oral and maxillofacial region received 125I brachytherapy alone from 2001–2010. Twenty-nine were recurrent cases following previous surgery and radiation therapy. The other 9 cases involved primary tumors. Overall, 12 tumors were located in the major salivary glands, 12 in the minor salivary glands, and 14 in the paranasal region, the nasal cavity or the skull base. The prescribed dose was 100–160 Gy.Results
Patients were followed for 12–122 months (median 51 months). The 2-, 5-, and 10-year local tumor control rates were 86.3, 59, and 31.5?%, respectively. The 2-, 5-, and 10-year overall survival rates were 92.1, 65 and 34.1?%, respectively. Tumors >?6 cm had significantly lower local control and survival rates. No severe complications were observed during follow-up.Conclusion
125I brachytherapy is a feasible and effective modality for the treatment of locally advanced unresectable or recurrent ACC. 相似文献10.
Purpose
To report our results of computed tomography-guided interstitial high-dose-rate (HDR) brachytherapy (BRT) in the treatment of patients with recurrent inoperable glioblastoma multiforme (GBM).Patients and methods
Between 1995 and 2014, 135 patients were treated with interstitial HDR BRT for inoperable recurrent GBM located within previously irradiated volumes. Patient’s median age was 57.1 years (14–82 years). All patients were pretreated with surgery, postoperative external beam radiation therapy (EBRT) and systemic chemotherapy (ChT). The median recurrent tumor volume was 42?cm3 (2–207?cm3). The prescribed HDR dose was median 40?Gy (30–50?Gy) delivered in twice-daily fractions of 5.0?Gy over consecutive days. No repeat surgery or ChT was administered in conjunction with BRT. Survival from BRT, progression-free survival (PFS), toxicity as well as the impact of several prognostic factors were evaluated.Results
At a median follow-up of 9.2 months, the median overall survival following BRT and the median PFS were 9.2 and 4.6 months, respectively. Of the prognostic variables evaluated in univariate analysis, extent of surgery at initial diagnosis, tumor volume at recurrence, as well as time from EBRT to BRT reached statistical significance, retained also in multivariate analysis. Eight patients (5.9%) developed treatment-associated complications including intracerebral bleeding in 4 patients (2.9%), symptomatic focal radionecrosis in 3 patients (2.2%), and severe convulsion in 1 patient (0.7%).Conclusions
For patients with recurrent GBM, interstitial HDR BRT is an effective re-irradiation method for even larger tumors providing palliation without excessive toxicity.11.
L. Zheng MD DDS J. Zhang MD DDS T. Song MD DDS Prof. J. Zhang MD DDS G. Yu MD DDS Y. Zhang MD DDS 《Strahlentherapie und Onkologie》2013,189(5):401-406
Background and purpose
There is a lack of optimal treatment strategies for managing salivary gland cancers in children and adolescents. This study is aimed at assessing the effect of 125I seed implantation for the treatment of parotid cancers in children and adolescents.Patients and methods
A total of 12 patients younger than 16 years with parotid gland malignant tumors underwent 125I seed implant brachytherapy between October 2003 and November 2008. All patients were assessed after treatment and at the local tumor control appointments. Facial nerve function, maxillofacial development, and radioactive side-effects were assessed.Results
The follow-up period ranged from 41–104 months. One patient with T4b died of pulmonary metastasis. The other patients were alive during the follow-up period. There were no serious radiation-related complications. The treatment did not affect facial nerve function and dentofacial growth in any of the children.Conclusion
For parotid gland cancers in children, 125I seed implant brachytherapy may be an acceptable treatment without serious complications and with satisfactory short-term effects. 相似文献12.
Dechao Jiao Kewei Ren Zongming Li Shaofeng Shui Xinwei Han 《La Radiologia medica》2017,122(11):829-836
Purpose
To evaluate the clinical value of C-arm CT (CACT)-guided interstitial iodine-125 (125I) brachytherapy on pulmonary tumors.Materials and methods
30 patients with 40 solid pulmonary tumors were enrolled to undergo CACT-guided interstitial 125I brachytherapy between November 2011 and November 2014. The needle path was planned on a CACT virtual navigation and real-time fluoroscopy system. Technical success, puncture score, procedure time, local control rate (LCR), radiation exposure, complications and survival were investigated.Results
The technical success of interstitial 125I brachytherapy under CACT guidance was 40/40 (100%). The performance score was 4.7 ± 0.5 with a mean total procedure time of 17.7 ± 5.6 min. LCR in small (≤2.0 cm), intermediate (2.1–4.9 cm) and large (≥5.0 cm) pulmonary tumors was 100, 89.5 and 72.7% at the 4-month follow-up, respectively. The mean effective dose was 10.1 ± 2.8 mSv. Major complications occurred in four patients (13.3%). The mean survival time was 28.4 ± 2.3 months.Conclusion
CACT can provide virtual navigation and real-time fluoroscopy synchronously for interstitial 125I seed implantation on pulmonary tumors.13.
Purpose
The aim of this study was to investigate the dose rate distribution around 192Ir wires used as radioactive sources in low-dose-rate brachytherapy applications.Materials and methods
Monte Carlo modeling of a 0.3-mm diameter source and its surrounding water medium was performed for five different wire lengths (1–5 cm) using the MCNP software package.Results
The computed dose rates per unit of air kerma at distances from 0.1 up to 10 cm away from the source were first verified with literature data sets. Then, the simulation results were compared with the calculations from the XiO CMS commercial treatment planning system.Conclusion
The study results were found to be in concordance with the treatment planning system calculations except for the shorter wires at close distances. 相似文献14.
Schnapauff D Denecke T Grieser C Collettini F Colletini F Seehofer D Sinn M Banzer J Lopez-Hänninen E Hamm B Wust P Gebauer B 《Cardiovascular and interventional radiology》2012,35(3):581-587
Purpose
This study was designed to investigate the clinical outcome of patients with irresectable, intrahepatic cholangiocarcinoma (IHC) treated with computed tomography (CT)-guided HDR-brachytherapy (CT-HDRBT) for local tumor ablation.Method
Fifteen consecutive patients with histologically proven cholangiocarcinoma were selected for this retrospective study. Patients were treated by high-dose-rate internal brachytherapy (HDRBT) using an Iridium-192 source in afterloading technique through CT-guided percutaneous placed catheters. A total of 27 brachytherapy treatments were performed in these patients between 2006 and 2009. Median tumor enclosing target dose was 20?Gy, and mean target volume of the radiated tumors was 131 (±?90) ml (range, 10?C257?ml). Follow-up consisted of clinical visits and magnetic resonance imaging of the liver every third month. Statistical evaluation included survival analysis using the Kaplan?CMeier method.Results
After a median follow-up of 18 (range, 1?C27) months after local ablation, 6 of the 15 patients are still alive; 4 of them did not get further chemotherapy and are regarded as disease-free. The reached median local tumor control was 10?months; median local tumor control, including repetitive local ablation, was 11?months. Median survival after local ablation was 14?months and after primary diagnosis 21?months.Conclusion
In view of current clinical data on the clinical outcome of cholangiocarcinoma, locally ablative treatment with CT-HDRBT represents a promising and safe technique for patients who are not eligible for tumor resection. 相似文献15.
Mahmoud Allahverdi Ramin Jaberi Mehdi Aghili Fatemeh Ghahremani Ghazale Geraily 《Japanese journal of radiology》2013,31(3):160-165
Purpose
This study was performed to evaluate the role of in vivo dosimetry with semiconductor detectors in gynaecological medium dose rate brachytherapy, and to compare the actual doses delivered to organs at risk (as measured using in vivo dosimetry) with those calculated during treatment planning.Materials and methods
Doses to the rectum and bladder were measured in a group of patients with cervical carcinoma using semiconductor detectors and compared to the doses calculated using a treatment planning system. 36 applications of brachytherapy at dose rates of 1.8–2.3 Gy/h were performed in the patients.Results
The mean differences between the measured and calculated doses were 3 % for the rectum and 11 % for the bladder.Conclusions
The main reason for the differences between the measured and calculated doses was patient movement. To reduce the risk of large errors in the dose delivered, in vivo dosimetry should be performed in addition to treatment planning system computations. 相似文献16.
17.
Jens Ricke Markus Thormann Matthias Ludewig Kerstin Jungnickel Oliver Grosser Christian Wybranski Nils Peters Peter Hass Jürgen Bunke Frank Fischbach 《European radiology》2010,20(8):1985-1993
Objective
To determine the feasibility and safety of image-guided brachytherapy employing a modified open high-field MR system.Methods
This is a follow-up study of a development project enabling technologies for interventional use of 1.0T open MRI. Modifications included coils and in-bore visualization, fluoroscopic sequences and user interfaces. We recruited 104 patients with 224 liver malignancies to receive MR-guided brachytherapy. Interventions were performed >20 min after Gd-EOB-DTPA. We recorded interventional parameters including the intervention time (from acquisition of the first scout until the final sequence for brachytherapy treatment planning). Two reviewers assessed MR-fluoroscopic images in comparison to plain CT as used in CT intervention, applying a rating scale of 1–10. Statistical analysis included Friedman and Kendall’s W tests.Results
We employed freehand puncture with interactive dynamic imaging for navigation. Technical success rate was 218 complete ablations in 224 tumours (97%). The median intervention time was 61 min. We recorded no adverse events related to the use of MRI. No major complications occurred. The rate of minor complications was 4%. Local control at 3 months was 96%. Superiority of MR-fluoroscopic, Gd-EOB-DTPA-enhanced images over plain CT was highly significant (P?<?0.001).Conclusion
MR-guided brachytherapy employing open high-field MRI is feasible and safe. 相似文献18.
Eiichi Tanaka Osamu Suzuki Ryoong-Jin Oh Takashi Takeda Teruki Teshima Toshihiko Inoue Takehiro Inoue 《Japanese journal of radiology》2006,24(1):50-57
Purpose
To compare the results of high dose rate (HDR) (Ir-192) and medium dose rate (MDR) (Cs-137) intracavitary brachytherapy (ICRT) for carcinoma of the uterine cervix.Materials and Methods
Between May 1991 and March 2001, a total of 206 patients with Stage I-IVA previously untreated cervical cancer were treated with ICRT combined with external beam radiotherapy (EBRT). HDR was administered to a total of 135 patients: 22 patients in Stage I, 49 in Stage II, 56 in Stage III, and eight in Stage IVA. MDR was administered to a total of 71 patients: six patients in Stage I, 27 in Stage II, 33 in Stage III, and five in Stage IVA. The MDR at point A was 30 Gy/hour for HDR and 1.7 Gy/hour for MDR treatment, and the corresponding median follow-up periods for survivors were 55 and 68 months.Results
For the HDR group, 5-year cause-specific survival rates were 90%, 78%, 53% and 33% for Stages I, II, III, and IVA, respectively. For the MDR group, the corresponding rates were 100%, 76%, 51%, and 40%. In the HDR group, 19 patients (14%) developed Grade 2 or higher late complications, and, in the MDR group, four patients (6%) did.Conclusions
There was no statistically significant difference in cause-specific survivals between the results of HDR and MDR brachytherapy for cervical cancer. The incidence of late complications tended to be higher for the HDR group than for the MDR group, but did not show a statistically significant difference (p=0.07). 相似文献19.
Shudong Hu Wei Huang Yerong Chen Qi Song Xiaozhu Lin Zhongmin Wang Kemin Chen 《European radiology》2014,24(9):2167-2173
Objectives
We sought to evaluate the capability of spectral CT to detect the therapeutic response to 125I interstitial brachytherapy in a pancreatic carcinoma xenograft nude mouse model.Methods
Twenty mice bearing SWl990 human pancreatic cancer cell xenografts were randomly separated into two groups: experimental (n?=?10; 1.0 mCi) and control (n?=?10; 0 mCi). After a two-week treatment, spectral CT was performed. Contrast-to-noise ratio (CNR) and iodine concentration (IC) in the lesions were measured and normalized to the muscle tissue, and nIC CD31 immunohistochemistry was used to measure microvessel density (MVD). The relationships between the nIC and MVD of the tumours were analysed.Results
The nIC of the experimental group was significantly lower than that of the control group during the multiphase examination. A significant difference in the MVD was observed between the two groups (P <0.001). The nIC values of the three-phase scans have a certain positive correlation with MVD (r?=?0.57, p?0.0001; r?=?0.48, p?=?0.002; r?=?0.63, p?=?0.0017 in the 10, 25, and 60 s phase, respectively).Conclusions
Spectral CT can be a useful non-invasive imaging modality in evaluating the therapeutic effect of 125I interstitial brachytherapy to a pancreatic carcinoma.Key Points
? Spectral CT offers opportunities to assess therapeutic response in pancreatic cancer cases. ? Spectral CT findings correlated with vascular changes associated with 125I seed implantation. ? Spectral CT with monochromatic imaging removed most 125I seed artefacts. 相似文献20.
M. Havez N. Lippa S. Al-Ammari M. Kind E. Stoeckle A. Italiano A. Gangi O. Hauger F. Cornelis 《Cardiovascular and interventional radiology》2014,37(6):1500-1506