OBJECTIVE: According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines, adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective, multicenter study was to assess the impact of VB in these groups on local recurrence rate, local recurrence-free survival (RFS) and overall survival (OS). METHODS: Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. RESULTS: The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups. CONCLUSIONS: VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.
Brachytherapy ; Endometrial Neoplasms ; Female ; Follow-Up Studies ; Humans ; Medical Oncology ; Methods ; Neoplasm Recurrence, Local ; Radiotherapy ; Recurrence ; Retrospective Studies

OBJECTIVE: To determine and compare treatment outcomes between cobalt-60 (Co-60) and iridium-192 (Ir-192) high dose rate (HDR) brachytherapy in stage IB2–IIIB cervical cancer patients at Department of Radiology, Faculty of Medicine Vajira Hospital, Navamindrahiraj University. METHODS: A retrospective cohort study of patients diagnosed with cervical cancer and treated with radiotherapy at the Department of Radiation Oncology, Faculty of Medicine Vajira Hospital between 2004 and 2014. Survival rate was analyzed by Kaplan-Meier method and were compared between groups with log-rank test. Multivariate analysis was performed using Cox proportional hazards model. RESULTS: A total of 480 patients with cervical cancer and treated with radiotherapy were included, 274 patients for Ir-192 group and 206 patients for Co-60 group. The 2- and 5-year disease-free survival rate in Ir-192 group were 80.4% and 73.1% and in Co-60 group were 82.5% and 74.7%, respectively (p = 0.365). Overall survival rates at 2 and 5 years were 89.4% and 77% of the Ir-192 group, and 91.6% and 81.9% in the Co-60 group, respectively (p = 0.238). The complications were primarily grade 1 or 2. Grade 3 and 4 complications were found in 13 of 274 and 7 of 206 in Ir-192 and Co-60 groups, respectively (p = 0.232). Grade and clinical stage of cancer significantly affected the survival outcome. CONCLUSION: Cervical cancer patients who were treated with HDR Co-60 brachytherapy were comparable in survival and toxicity outcomes of those with HDR Ir-192 brachytherapy. Co-60 source has lots of economic advantages over Ir-192 and hence suitable for low resource radiotherapy setting.
Brachytherapy* ; Cohort Studies ; Disease-Free Survival ; Humans ; Methods ; Multivariate Analysis ; Proportional Hazards Models ; Radiation Oncology ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms*

OBJECTIVE: To compare the accuracy of different methods for image registration in image-guided adaptive brachytherapy (IGABT) for cervical cancer. METHODS: The last treatment planning CT images (CT1) and the first treatment planning CT images (CT2) were acquired from 15 patients with cervical cancer and registered with different match image qualities (retained/removed catheter source in images) and different match regions [target only (S Group)/ interested organ structure (M Group)/body (L Group)] in Velocity3.2 software. The dice similarity coefficient (DSC) between the clinical target volumes (CTV) of the CT1 and CT2 images (CTVCT1 and CTVCT2, respectively) and between the organs-at-risk (OAR) of the two imaging datasets (OARCT1 and OARCT2, respectively) were used to evaluate the image registration accuracy. RESULTS: The auto-segmentation volume of the catheter source using Velocity software based on the CT threshold was the closest to the actual volume within the CT value range of 1700-1800 HU. In the retained group, the DSC for the OARs of was better than or equal to that of the removed group, and the DSC value of the rectum was significantly improved ( < 0.05). For comparison of different match regions, the high-risk target volume (HRCTV) and the low-risk target volume (IRCTV) had the best precision for registration of the target area, which was significantly greater than that of M group and L group ( < 0.05). The M group had better registration accuracy of the target area and the best accuracy for the OARs. The DSC values of the bladder and rectum were significantly better than those of the other two groups ( < 0.05). CONCLUSIONS The CT value range of 1700-1800 HU is optimal for automatic image segmentation using Velocity software. Automatic segmentation and shielding the volume of the catheter source can improve the image quality. We recommend the use of interested organ structures regions for image registration in image-guided adaptive brachytherapy for cervical cancer.
Brachytherapy ; methods ; standards ; Female ; Humans ; Organs at Risk ; diagnostic imaging ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; standards ; Radiotherapy, Image-Guided ; methods ; standards ; Software ; Tomography, X-Ray Computed ; methods ; standards ; Uterine Cervical Neoplasms ; diagnostic imaging ; radiotherapy

PURPOSE: We compared how doses delivered via two-dimensional (2D) intracavitary brachytherapy (ICBT) and three-dimensional (3D) ICBT varied anatomically. MATERIALS AND METHODS: A total of 50 patients who received 30 Gy of 3D ICBT after external radiotherapy (RT) were enrolled. We compared the doses of the actual 3D and 2D ICBT plans among patients grouped according to six anatomical variations: differences in a small-bowel V2Gy, small bowel circumference, the direction of bladder distension, bladder volume, sigmoid V3.5Gy, and sigmoid circumference. Seven dose parameters were measured in line with the EMBRACE recommendations. RESULTS: In terms of bladder volume, the bladder and small-bowel D2cc values were lower in the 150–250 mL bladder volume subgroup; and the rectum, sigmoid, and bladder D2mL values were all lower in the >250 mL subgroup, for 3D vs. 2D ICBT. In the sigmoid V3.5Gy >2 mL subgroup, the sigmoid and bladder D2mL values were significantly lower for 3D than 2D ICBT. The bladder D2mL value was also significantly lower for 3D ICBT, as reflected by the sigmoid circumference. In patients with a small bowel V2.0Gy >10 mL or small bowel circumference >15%, most dose parameters were significantly lower for 3D than 2D ICBT. The bladder distension direction did not significantly affect the doses. CONCLUSION: Compared to 2D ICBT, a greater bladder volume can reduce the internal 3D ICBT organ dose without affecting the target dose.
Brachytherapy ; Colon, Sigmoid ; Humans ; Methods ; Prescriptions ; Radiation Dosage ; Radiotherapy ; Rectum ; Urinary Bladder ; Uterine Cervical Neoplasms

BACKGROUNDA novel radioactive 125I seed-loaded biliary stent has been used for patients with malignant biliary obstruction. However, the dosimetric characteristics of the stents remain unclear. Therefore, we aimed to describe the dosimetry of the stents of different lengths - with different number as well as activities of 125I seeds.

METHODSThe radiation dosimetry of three representative radioactive stent models was evaluated using a treatment planning system (TPS), thermoluminescent dosimeter (TLD) measurements, and Monte Carlo (MC) simulations. In the process of TPS calculation and TLD measurement, two different water-equivalent phantoms were designed to obtain cumulative radial dose distribution. Calibration procedures using TLD in the designed phantom were also conducted. MC simulations were performed using the Monte Carlo N-Particle eXtended version 2.5 general purpose code to calculate the radioactive stent's three-dimensional dose rate distribution in liquid water. Analysis of covariance was used to examine the factors influencing radial dose distribution of the radioactive stent.

RESULTSThe maximum reduction in cumulative radial dose was 26% when the seed activity changed from 0.5 mCi to 0.4 mCi for the same length of radioactive stents. The TLD's dose response in the range of 0-10 mGy irradiation by 137Cs γ-ray was linear: y = 182225x - 6651.9 (R2=0.99152; y is the irradiation dose in mGy, x is the TLDs' reading in nC). When TLDs were irradiated by different energy radiation sources to a dose of 1 mGy, reading of TLDs was different. Doses at a distance of 0.1 cm from the three stents' surface simulated by MC were 79, 93, and 97 Gy.

CONCLUSIONSTPS calculation, TLD measurement, and MC simulation were performed and were found to be in good agreement. Although the whole experiment was conducted in water-equivalent phantom, data in our evaluation may provide a theoretical basis for dosimetry for the clinical application.

Brachytherapy ; methods ; Computer Simulation ; Humans ; Monte Carlo Method ; Radiometry ; methods ; Thermoluminescent Dosimetry ; methods

BACKGROUNDPercutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model (group of 12 pigs) to assess the safety and feasibility of computed tomography (CT)-guided vena cava puncture.

METHODSUnder CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava (AVC) in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair.

RESULTSFollowing postoperative enhanced CT, two animals were found to have a small pneumothorax (one being hemopneumothorax). The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93-100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer.

CONCLUSIONSCT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava.

Animals ; Brachytherapy ; methods ; Lung Neoplasms ; radiotherapy ; Lymphatic Metastasis ; radiotherapy ; Swine ; Tomography, X-Ray Computed

OBJECTIVE: Concurrent chemoradiotherapy (CCRT) is the primary treatment for locally advanced cervical cancer. We studied prognostic factors for patients treated with CCRT. METHODS: We retrospectively reviewed records of 85 consecutive patients with cervical cancer who were treated with CCRT between 2002 and 2011, with external beam radiation therapy, intracavitary brachytherapy, and platinum-based chemotherapy. Survival data were analyzed with Kaplan-Meier methods and Cox proportional hazard models. RESULTS: Of the 85 patients, 69 patients (81%) had International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease; 25 patients (29%) had pelvic lymph node enlargement (based on magnetic resonance imaging), and 64 patients (75%) achieved clinical remission following treatment. Median maximum tumor diameter was 5.5 cm. The 3- and 5-year overall survival rates were 60.3% and 55.5%, respectively. Cox regression analysis showed tumor diameter >6 cm (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.2 to 4.6), pelvic lymph node enlargement (HR, 2.2; 95% CI, 1.1 to 4.5), and distant metastasis (HR, 10.0; 95% CI, 3.7 to 27.0) were significantly and independently related to poor outcomes. CONCLUSION: New treatment strategies should be considered for locally advanced cervical cancers with tumors >6 cm and radiologically enlarged pelvic lymph nodes.
Adult ; Aged ; Aged, 80 and over ; Brachytherapy/adverse effects/methods ; Chemoradiotherapy/adverse effects/*methods ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms/diagnosis/pathology/*therapy

OBJECTIVE: To assess actual rates of late vaginal stenosis and identify predisposing factors for complications among patients with previously untreated cervical cancer following high-dose-rate brachytherapy. METHODS: We performed longitudinal analyses of 57 patients using the modified Dische score at 6, 12, 18, 24, 36, and 60 months after treatment, which consisted of 15 interstitial brachytherapys and 42 conventional intracavitary brachytherapys, with a median follow-up time of 36 months (range, 6 to 144 months). RESULTS: More than half of the patients developed grade 1 (mild) vaginal stenosis within the first year of follow-up, and grade 2 (97.5%, moderate) to grade 3 (severe) stenosis gradually increased with time. Actual stenosis rates for grade 1, 2, and 3 were 97.5% (95% confidence interval [CI], 92.7 to 97.5), 60.7% (95% CI, 42.2 to 79.3), and 7.4% (95% CI, 0 to 18.4) at 3 years after treatment. Pallor reaction grade 2-3 at 6 months was only a statistically significant predisposing factor for grade 2-3 late vaginal stenosis 3 years or later with a hazard ratio of 3.48 (95% CI, 1.32 to 9.19; p=0.018) by a multivariate Cox proportional hazard model. Patients with grade 0-1 pallor reaction at 6 months showed a grade > or =2 vaginal stenosis rate of 53%, whereas the grade 2-3 pallor reaction group achieved a grade > or =2 vaginal stenosis rate at 3 years at 100% (p=0.001). CONCLUSION: High-dose-rate brachytherapy was associated with high incidence of late vaginal stenosis. Pallor reaction grade 2-3 at 6 months was predictive of late grade 2-3 vaginal stenosis at 3 years after treatment. These findings should prove helpful for patient counseling and preventive intervention.
Adult ; Aged ; Aged, 80 and over ; Brachytherapy/*adverse effects/methods ; Constriction, Pathologic/etiology/pathology ; Female ; Humans ; Iridium Radioisotopes/therapeutic use ; Middle Aged ; *Pallor ; Prognosis ; Prospective Studies ; Radiopharmaceuticals/therapeutic use ; Retrospective Studies ; Uterine Cervical Neoplasms/*radiotherapy ; Vaginal Diseases/*etiology/pathology

OBJECTIVETo explore the value of percutaneous vertebroplasty combined with interstitial implantation of ¹²⁵I seeds in the treatment of metastatic thoracolumbar tumors.

METHODSBased on the CT images before ¹²⁵I seed implantation, a computer-based treatment planning system (TPS) was used to determine the optimal seed distribution. Under CT guidance and local anaesthesia, ¹²⁵I seeds were implanted into 22 osseous metastatic lesions in 18 patients. Based on the CT images after the implantation, quality check was carried out with TPS. DSA (digital subtraction angiography)-guided vertebroplasty was performed under local anaesthesia, and bone cement was injected into the vertebrae through pedicle of vertebral arch.

RESULTSAll the 18 patients received percutaneous vertebroplasty combined with interstitial implantation of ¹²⁵I seeds. Every vertebra was injected with 2-6 ml bone cement, average 3.5 ml, and was injected with ¹²⁵I seeds 16-34 pills, average 26 pills. At 2-months follow-up, their numerical rating scale (NRS) pain scores were 7.12 ± 1.48 before and 2.26 ± 1.07 after treatment, with a significant difference (P < 0.05).

CONCLUSIONSPercutaneous vertebroplasty combined with interstitial implantation of ¹²⁵I seeds is a minimally invasive procedure with small wound and minor complications, and no need of external radiation therapy. It is effective in the alleviation of pain in metastatic thoracolumbar tumor patients, restrains the tumor growth, and improves the quality of life. It is a promising minimally invasive method in the treatment of metastatic thoracolumbar tumors.

Aged ; Angiography, Digital Subtraction ; Bone Cements ; therapeutic use ; Brachytherapy ; Breast Neoplasms ; pathology ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Iodine Radioisotopes ; therapeutic use ; Lumbar Vertebrae ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Pain Measurement ; Prostatic Neoplasms ; pathology ; Quality of Life ; Radiotherapy Planning, Computer-Assisted ; Spinal Neoplasms ; secondary ; therapy ; Thoracic Vertebrae ; Vertebroplasty ; methods

OBJECTIVETo evaluate the outcomes of T3a prostate cancer treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy, and analyse the influence of preoperative factors on prognosis.

METHODSFrom January 2003 to December 2008, 38 pactients with T3a prostate cancer aged from 48 to 81 years (mean: 71 years) were enrolled, with serum prostate specific antigen (PSA) levels ranged from 10.000 to 99.800 µg/L (mean: 56.300 µg/L), Gleason score from 5 to 9 (mean: 7.6) and percentage of positive biopsy cores from 10.0% to 100% (mean: 65.3%). All patients were treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy. Survival curves were calculated using the Kaplan-Meier method. The predictive factors including patient's age, prostate volume, serum pre-treatment PSA, Gleason score and percentage of positive biopsy cores were used for univariate analysis on biochemical failure-free, distant metastasis-free and overall survival.

RESULTSThe mean follow-up was 69 months (range: 9-109 months).Nineteen patients experienced biochemical failure. The average biochemical failure time was 13.4 months (range: 1-40 months). There were 13 patients developed as distant metastatic prostate cancer since average 19.7 months (range: 1-70 months) after brachytherapy. Of all patients, 9 died of prostate cancer recurrence, while 6 passed away because of other reasons, with an average of 52.2 months (range: 9.0- 98.5 months). The 5-year biochemical failure-free survival (BFFS), distant metastasis free survival (DMFS), cancer specific survival (CSS) and overall survival (OS) rate were 44.1%, 68.6%, 82.4 and 75.8%, respectively. Twenty-nine patients experienced grade 1-2 gastrointestinal toxicity and 18 patients experienced grade 1-2 genitourinary toxicity. In univariate analysis, the percentage of positive biopsy cores was significantly correlated with BFFS (χ(2) = 17.240, P = 0.000), DMFS (χ(2) = 18.641, P = 0.000) and OS (χ(2) = 8.970, P = 0.003); the Gleason score was significantly correlated with DMFS (χ(2) = 12.484, P = 0.000) and OS (χ(2) = 6.575, P = 0.010); and patient's age was significantly correlated with OS (χ(2) = 5.179, P = 0.023).

CONCLUSIONSPermanent interstitial brachytherapy combined with external radiotherapy and hormone therapy is alternative for T3a prostate cancer. The percentage of positive biopsy cores is correlated with BFFS, DMFS and OS.

Aged ; Aged, 80 and over ; Brachytherapy ; methods ; Combined Modality Therapy ; Hormones ; therapeutic use ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; drug therapy ; mortality ; radiotherapy ; Radiotherapy ; methods ; Survival Rate ; Treatment Outcome