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Journal articles on the topic 'HDR brachytherapy'

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Published: 4 June 2021

Last updated: 2 February 2022

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1

Kanaev, Sergey, Ye Bykova, I. Akulova, Nadezhda Popova, Pavel Krzhivitskiy, Petr Krivorotko, Olga Ponomareva, Zhanna Bryantseva, Sergey Novikov, and Yu Melnik. "RADIATION BOOST AFTER WHOLE-BREAST IRRADIATION: DOSIMETRIC COMPARISON OF HIGH DOSE RATE INTERSTITIAL BRACHYTHERAPY AND IRRADIATION WITH ELECTRONS." Problems in oncology 64, no. 3 (March 1, 2018): 303–9. http://dx.doi.org/10.37469/0507-3758-2018-64-3-303-309.

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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.

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Mitra, Devarati, Yaguang Pei, Ivan Buzurovic, Phillip M. Devlin, Katherine Thornton, Chandrajit P. Raut, Elizabeth H. Baldini, and Miranda B. Lam. "Angiosarcoma of the Scalp and Face: A Dosimetric Comparison of HDR Surface Applicator Brachytherapy and VMAT." Sarcoma 2020 (August 25, 2020): 1–6. http://dx.doi.org/10.1155/2020/7615248.

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Purpose. Angiosarcoma of the face and scalp is a rare disease with high rates of recurrence. The optimal treatment approach is not well defined. This study presents a dosimetric comparison of high-dose-rate surface applicator (HDR-SA) brachytherapy to volumetric-modulated arc therapy (VMAT). Methods. Between 2011 and 2018, 12 patients with primary or recurrent angiosarcoma of the face or scalp were treated with HDR-SA brachytherapy using CT-based planning at our institution. For comparison, deliverable VMAT plans for each patient were generated, and dose distribution was compared to the delivered HDR-SA brachytherapy plans. Results. Both VMAT and HDR-SA brachytherapy plans delivered good coverage of the clinical target. However, the dose distribution of VMAT was significantly different from HDR-SA brachytherapy across a variety of parameters. Mean doses to the lacrimal gland, orbit, lens, and cochlea were significantly higher with HDR-SA brachytherapy vs. VMAT. Brain Dmax, V80%, and V50% were also significantly higher with HDR-SA brachytherapy. Conclusions. There may be dosimetric advantages to VMAT over HDR-SA brachytherapy for many patients. However, individual tumor location, patient anatomy, and treatment reproducibility may result in HDR-SA brachytherapy being the preferred technique in a subset of patients. Ultimately, a personalized approach is likely to be the optimal treatment plan.

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Crook, Juanita, Marina Marbán, and Deidre Batchelar. "HDR Prostate Brachytherapy." Seminars in Radiation Oncology 30, no. 1 (January 2020): 49–60. http://dx.doi.org/10.1016/j.semradonc.2019.08.003.

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4

Strom, Tobin Joel Crill, Alex Cruz, Nicholas Figura, Kushagra Shrinath, Kevin Nethers, Eric Albert Mellon, Daniel Celestino Fernandez, et al. "Health-related quality of life changes due to high-dose rate brachytherapy, low-dose rate brachytherapy, or intensity-modulated radiation therapy for prostate cancer." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 72. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.72.

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72 Background: To compare urinary, bowel, and sexual health-related quality of life (HRQOL) changes due to high-dose rate (HDR) brachytherapy, low-dose rate (LDR) brachytherapy, or intensity modulated radiation therapy (IMRT) monotherapy for prostate cancer. Methods: Between January 2002 and September 2013, 413 low-risk or favorable intermediate-risk prostate cancer patients were treated with HDR brachytherapy monotherapy to 2,700-2,800 cGy in two fractions (n=85), iodine-125 LDR brachytherapy monotherapy to 14,500 cGy in one fraction (n=249), or IMRT monotherapy to 7,400-8,100 cGy in 37-45 fractions (n=79) without pelvic lymph node irradiation. No androgen deprivation therapy was given. Patients used an International Prostate Symptoms Score questionnaire, an Expanded Prostate cancer Index Composite-26 bowel questionnaire, and a Sexual Health Inventory for Men questionnaire to assess their urinary, bowel, and sexual HRQOL, respectively, pre-treatment and at 1, 3, 6, 9, 12, and 18 months post-treatment. Results: Median follow-up was 32 months. HDR brachytherapy and IMRT patients had significantly less deterioration in their urinary HRQOL than LDR brachytherapy patients at 1 and 3 months post-irradiation. The only significant decrease in bowel HRQOL between the groups was seen 18 months following treatment, at which point IMRT patients had a slight, but significant, deterioration in their bowel HRQOL compared with HDR and LDR brachytherapy patients. HDR brachytherapy patients had worse sexual HRQOL than both LDR brachytherapy and IMRT patients following treatment. Conclusions: IMRT and HDR brachytherapy cause less severe acute worsening of urinary HRQOL than LDR brachytherapy. However, IMRT causes a slight, but significant, worsening of bowel HRQOL compared with HDR and LDR brachytherapy.

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Tyree, W. C., H. Cardenes, M. Randall, and L. Papiez. "High-dose-rate brachytherapy for vaginal cancer: Learning from treatment complications." International Journal of Gynecologic Cancer 12, no. 1 (January 2002): 27–31. http://dx.doi.org/10.1136/ijgc-00009577-200201000-00005.

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Abstract.Tyree WC, Cardenes H, Randall M, Papiez L. High-dose-rate brachytherapy for vaginal cancer: learning from treatment complications.Historically, early stage vaginal cancer has been treated with low-dose-rate (LDR) brachytherapy with or without external beam radiation therapy (EBRT). Complication rates have been low and treatment efficacious. Although high-dose-rate (HDR) brachytherapy has been used for cervical cancer in many countries for over a decade, only more recently has it been integrated into treatment plans for vaginal cancer. This paper describes three patients treated with HDR brachytherapy who experienced significant late effects. Given the very limited amount of literature regarding the use of HDR brachytherapy in vaginal cancer, this analysis potentially contributes to an understanding of treatment-related risk factors for complications among patients treated with this modality.A focused review of hospital and departmental treatment records was done on three patients treated with HDR brachytherapy. Abstracted information included clinical data, treatment parameters (technique, doses, volume, combinations with other treatments) and outcomes (local control, survival, early and late effects). A review of the available literature was also undertaken.All patients had significant complications. Although statistical correlations between treatment parameters and complications are impossible given the limited number of patients, this descriptive analysis suggests that vaginal length treated with HDR brachytherapy is a risk factor for early and late effects, that the distal vagina has a lower radiation tolerance than the upper vagina with HDR as in LDR, and that combining HDR with LDR as done in our experience carries a high risk of late toxicity.Integration of HDR brachytherapy techniques into treatment plans for early stage vaginal cancers must be done cautiously. The etiology of the significant side effects seen here is likely to be multifactorial. For users of HDR brachytherapy in vaginal cancer, there is a need to further refine and standardize treatment concepts and treatment delivery. Ideally this will be based on continued careful observation and reporting of both favorable and unfavorable outcomes and experiences.

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Hatcher, Jeremy, Adam Shulman, Claire Dempsey, Betty Chang, Sameeksha Malhotra, Oluwadamilola Oladeru, Michael Tassoto, Peter Sandwall, Sonja Dieterich, and Benjamin Li. "Collaborative Model for International Telehealth: High Dose Rate Brachytherapy Training for Emerging Radiation Oncology Centers in Lower- and Middle-Income Countries." JCO Global Oncology 6, Supplement_1 (July 2020): 51–52. http://dx.doi.org/10.1200/go.20.47000.

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PURPOSE High dose rate (HDR) brachytherapy is a critical treatment modality—both palliative and curative—for gynecologic malignancies that significantly burden low- and middle-income countries (LMICs). Many of these countries currently have limited capacity to provide necessary brachytherapy treatment. To bridge this gap in LMICs in North Africa and the Middle East, nonprofits Rayos Contra Cancer and Radiating Hope evaluated the efficacy, cost, and feasibility of a pilot HDR brachytherapy continuing medical education curriculum to selected regional cancer centers via videoconferencing. METHODS Rayos Contra Cancer and Radiating Hope recruited a global team of HDR brachytherapy content experts. They developed a 16-week curriculum and recruited 10 regional cancer center partners in LMICs throughout the Middle East, Africa, and Nepal. The curriculum included 17 sessions shared via live Zoom videoconferences. A lead correspondent was assigned for communication at each center. Attendance was taken during each call, and pre- and postsession Likert-scale (1 to 5 points) surveys were collected from participants that assessed their confidence in 15 practical competencies in HDR brachytherapy and overall confidence in their ability to provide services and teach others. RESULTS A total of 326 attendance hours was recorded during the curriculum. Among 46 participants, the average paired confidence scores increased pre- versus postcurriculum in all 15 practical competencies, with an average improvement of 1.2 out of 5 and significant P values in all 15 topics. Absolute improvements were largest for confidence in applicator commissioning (2.3 to 3.8, P = .0015), TPS commissioning (2.2 to 3.7, P = .0010), and commissioning an HDR machine (2.2 to 4.0, P = .00096). Participant confidence significantly increased in ability to provide services (3.5 to 4.2, P = .0023) and teach others (3.4 to 3.9, P = .013). There was no cost to provide this training, and more than 4,300 patients are treated annually with HDR brachytherapy at participating centers. CONCLUSION This novel low-cost telehealth model for HDR brachytherapy training is a promising vehicle for advancing cancer care in LMICs. Postcourse surveys demonstrated increased confidence in both providing care and teaching in HDR brachytherapy, and sessions were well attended. A video-based telehealth teaching platform enabled expert HDR brachytherapy providers and physicists to reach growing cancer centers worldwide.

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Kabacińska, R., J. Jastrzembski, R. Makarewicz, and B. Drzewiecka. "Optimisation in HDR brachytherapy." Reports of Practical Oncology 2, no. 2 (January 1997): 44. http://dx.doi.org/10.1016/s1428-2267(97)70122-4.

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de la Torre, Marcela, Isabel Rodriguez, and Victor J. Bourel. "117 HDR endobronchial brachytherapy." Radiotherapy and Oncology 39 (May 1996): S30. http://dx.doi.org/10.1016/0167-8140(96)87922-9.

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Scott, Aba Anoa, Joel Yarney, Verna Vanderpuye, Charles Akoto Aidoo, Mervin Agyeman, Samuel Ntiamoah Boateng, Evans Sasu, Kwabena Anarfi, and Tony Obeng-Mensah. "Outcomes of patients with cervical cancer treated with low- or high-dose rate brachytherapy after concurrent chemoradiation." International Journal of Gynecologic Cancer 31, no. 5 (February 8, 2021): 670–78. http://dx.doi.org/10.1136/ijgc-2020-002120.

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ObjectiveThe majority of patients with cervical cancer in Ghana present with locally advanced disease. In October 2014, high-dose rate (HDR) brachytherapy was introduced at the National Center for Radiotherapy, Accra after years of using low-dose rate (LDR) brachytherapy. The aim of this study was to compare the treatment outcomes of patients treated with LDR versus HDR brachytherapy.MethodsPatients with cervical cancer treated from January 2008 to December 2017 were reviewed. Those with stage IB–IIIB who received chemoradiation plus brachytherapy were included in the study. Post-operative patients and those with stage IV were excluded. The study end points were local control, disease-free survival, and overall survival at 2 years. Endpoints were estimated using the Kaplan–Meier method. Comparisons between treatment groups were performed using the log-rank test and Cox proportional hazards model.ResultsWe included 284 LDR and 136 HDR brachytherapy patients. For stages IB, IIA, IIB, IIIA and IIIB disease, the 2-year local control for LDR versus HDR brachytherapy was 63% and 61% (p=0.35), 86% and 90% (p=0.68), 86% and 88% (p=0.83), 66% and 60% (p=0.56), and 77% and 40% (p=0.005), respectively. The 2-year disease-free survival for LDR versus HDR brachytherapy was 64% and 61% (p=0.50), 81% and 69% (p=0.18), 81% and 80% (p=0.54), 62% and 33% (p=0.82), and 71% and 30% (p=0.001) for stages IB, IIA, IIB, IIIA, and IIIB, respectively. The 2-year overall survival for LDR versus HDR brachytherapy was 94% and 93% (p=0.92), 98% and 68% (p=0.21), 89% and 88% (p=0.60), and 88% and 82% (p=0.34) for stages IB, IIA, IIB, and IIIB disease, respectively.ConclusionThere was no difference between LDR and HDR brachytherapy in local control and disease-free survival for all stages of disease, except in stage IIIB. These findings highlight the need to refine this brachytherapy technique for this group of patients.

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Adhikari, Kanchan P., Aarati Shah, Bibek Achraya, Ambuj Karn, and Sandhya Chapagain. "ACCEPTANCE TESTING, COMMISSIONING AND QUALITY ASSURANCE FOR A NUCLETRON 192IR HDR BRACHYTHERAPY AFTERLOADER AT NAMS, BIR HOSPITAL." Scientific World 12, no. 12 (October 6, 2015): 85–88. http://dx.doi.org/10.3126/sw.v12i12.13604.

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To evaluate the accuracy of radiation dose delivered to the cancer patients by using HDR Brachytherapy and to know proposed methods for the initial source installation tests, acceptance testing and a quality assurance program are done on Nucletron MicroSelectron 192Ir HDR Brachytherapy Afterloader at NAMS, Bir Hospital. The observation of sweet spots (maximum dose distribution) by using well chamber (SI HDR 1000) and electrometer (SI CDX 2000). On the basis of the observed sweet spot, Air Kerma Strength of the source is determined. Beside this includes the conformation of step size, radioactivity of the nuclides and safety measures of the machine. A careful radiation survey has been undertaken around the brachytherapy by using well calibrated TBM-IC Mark V is a small ion chamber radiation monitor. Acceptance testing and commissioning of the HDR brachytherapy unit has been completed. Air Kerma strength in newly installed source exhibit small variation but within the limit. The step size has standard deviation 0.05 with the planned step size. The measurement of radiation level around brachytherapy shows the level is within the criteria. Nucletron MicroSelectron 192Ir HDR brachytherapy system has been implemented in our unit. The acceptance test shows that status of brachytherapy and its components are functioning well. Radiation dose which will be delivered to the cancer patients are within planned dose.Scientific World, Vol. 12, No. 12, September 2014, page 85-88

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Sharman, E. C. "A critical evaluation of the clinical value of high-dose rate brachytherapy in the treatment of prostate cancer." Journal of Radiotherapy in Practice 5, no. 4 (November 30, 2006): 227–32. http://dx.doi.org/10.1017/s146039690600032x.

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Prostate cancer has been treated with low-dose rate (LDR) brachytherapy for early localised disease in the form of permanent seed implants, with all its inherent problems in terms of dosimetry and seed migration. High-dose rate (HDR) brachytherapy has mainly been utilised as a boost to external beam radiotherapy (EBRT) in patients with locally advanced disease. However, limited studies investigating HDR as a monotherapy for early local disease are yielding promising results in terms of biochemical control and reduced toxicity. With the ability to optimise the plan and conform the dose, dose escalation can be achieved whilst sparing normal tissue. Recent studies to assess the α/β ratio of prostate cancer have shown this to be low, making this tumour sensitive to large fractions or hypofractionation. The HDR delivery and large fraction sizes may be advantageous in tumours sensitive to radiation fraction size making HDR brachytherapy the treatment of choice over LDR brachytherapy and EBRT.

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Annamalai, Manikandan, Laviraj MA, Haresh Kunhiparambath, Dayanand Sharma, Subhash Gupta, Supriya Mallick, Pramod Kumar Julka, and Goura Kishor Rath. "Combined HDR brachytherapy boost plus external beam radiotherapy by IMRT versus external beam radiotherapy alone IMRT in intermediate- and high-risk prostate cancer: Dosimetric analysis from a randomized control trial." Journal of Clinical Oncology 33, no. 7_suppl (March 1, 2015): 134. http://dx.doi.org/10.1200/jco.2015.33.7_suppl.134.

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134 Background: Dose escalation by IMRT or brachytherapy significantly improves biochemical control in localized prostate cancer. In this prospective randomized study we compared dose conformity between two modalities HDR brachytherapy and IMRT to deliver a boost to the prostate after External beam Radiotherapy (EBRT). Methods: 20 patients with localized prostate cancer were randomized to receive IMRT alone or IMRT plus brachytherapy. After randomization, all patients received EBRT 45Gy/25#/5 weeks by IMRT in phase I. In phase II patients received either HDR brachytherapy 19Gy/2# (Arm A) or EBRT 29Gy/15#/3weeks (Arm B) and EQD2–DVH parameters were calculated for comparison. EQD2 was calculated with α/β ratio of 1.5Gy and 3Gy for prostate & 3Gy for rectum and bladder. Results: The median age, stage distribution, Gleason score, PSA and prostate volume of the cohort were 69.5 years, T2b–T3b, 7, 38.5ng/ml and 47.4cc respectively.The HDR BT delivered higher mean doses to PTV. In phase II, HDR BT vs IMRT the mean EQD2 for 95% of prostate volume, 33% of rectal volume was 45.7Gy vs 28.4Gy, 6.8Gy vs 17.4 Gy respectively; Dmean of rectum and bladder was 7.4 Gy vs 13.5Gy and 5.4Gy vs 12.7Gy respectively. Conclusions: HDR BT produced more conformal plan and lower OAR doses than IMRT. Dose escalation for prostate tumors by HDR BT may be preferred as easily achievable. [Table: see text]

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Kolotas, Christos, D. Baltas, B. Rome, T. Martin, and N. Zarnboolou. "118CT based interstitial HDR brachytherapy." Radiotherapy and Oncology 47 (May 1998): S30. http://dx.doi.org/10.1016/s0167-8140(98)80123-0.

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Kolotas, Christos, Dimos Baltas, and Nikolaos Zamboglou. "CT-Based Interstitial HDR Brachytherapy." Strahlentherapie und Onkologie 175, no. 9 (September 1999): 419–27. http://dx.doi.org/10.1007/s000660050031.

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Piro, Fabrizio. "HDR brachytherapy for skin cancers." Brachytherapy 7, no. 2 (April 2008): 128. http://dx.doi.org/10.1016/j.brachy.2008.02.111.

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Feuillade, J., M. Gautier, C. Dejean, A. Mana, J. M. Hannoun–Levi, and S. Marcie. "New radioisotopes HDR brachytherapy dose." Physica Medica 30 (December 2014): e138-e139. http://dx.doi.org/10.1016/j.ejmp.2014.10.057.

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Keyes, Mira, Juanita Crook, W. James Morris, Gerard Morton, Tom Pickles, Nawaid Usmani, and Eric Vigneault. "Canadian Prostate Brachytherapy in 2012." Canadian Urological Association Journal 7, no. 1-2 (February 20, 2013): 51. http://dx.doi.org/10.5489/cuaj.218.

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Prostate brachytherapy can be used as a monotherapy for low- and intermediate-risk patients or in combination with external beam radiation therapy (EBRT) as a form of dose escalation for selected intermediate- and high-risk patients. Prostate brachytherapy with either permanent implants (low dose rate [LDR]) or temporary implants (high dose rate [HDR]) is emerging as the most effective radiation treatment for prostate cancer. Several large Canadian brachytherapy programs were established in the mid- to late-1990s. Prostate brachytherapy is offered in British Columbia, Alberta, Manitoba, Ontario, Quebec and New Brunswick. We anticipate the need for brachytherapy services in Canada will significantly increase in the near future. In this review, we summarize brachytherapy programs across Canada, contemporary eligibility criteria for the procedure, toxicity and prostate-specific antigen recurrence free survival (PRFS), as published from Canadian institutions for both LDR and HDR brachytherapy.

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Goyal, Manish K., T. S. Kehwar, Jayanand Manjhi, Jerry L. Barker, Bret H. Heintz, Kathleen L. Shide, and D. V. Rai. "Dosimetric evaluation of tandem-based cervical high-dose-rate brachytherapy treatment planning using American Brachytherapy Society 2011 recommendations." Journal of Radiotherapy in Practice 15, no. 3 (April 15, 2016): 283–89. http://dx.doi.org/10.1017/s1460396916000133.

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AbstractPurposeThis study evaluated dosimetric parameters for cervical high-dose-rate (HDR) brachytherapy treatment using varying dose prescription methods.MethodsThis study includes 125 tandem-based cervical HDR brachytherapy treatment plans of 25 patients who received HDR brachytherapy. Delineation of high-risk clinical target volumes (HR-CTVs) and organ at risk were done on original computed tomographic images. The dose prescription point was defined as per International Commission in Radiation Units and Measurements Report Number 38 (ICRU-38), also redefined using American Brachytherapy Society (ABS) 2011 criteria. The coverage index (V100) for each HR-CTV was calculated using dose volume histogram parameters. A plot between HR-CTV and V100was plotted using the best-fit linear regression line (least-square fit analysis).ResultsMean prescribed dose to ICRU-38 Point A was 590·47±28·65 cGy, and to ABS Point A was 593·35±30·42 cGy. There was no statistically significant difference between planned ICRU-38 and calculated ABS Point A doses (p=0·23). The plot between HR-CTV and V100is well defined by the best-fit linear regression line with a correlation coefficient of 0·9519.ConclusionFor cervical HDR brachytherapy, dose prescription to an arbitrarily defined point (e.g., Point A) does not provide consistent coverage of HR-CTV. The difference in coverage between two dose prescription approaches increases with increasing CTV. Our ongoing work evaluates the dosimetric consequences of volumetric dose prescription approaches for these patients.

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Nag, S., R. Martínez-Monge, F. Ruymann, A. Jamil, and C. Bauer. "Innovation in the management of soft tissue sarcomas in infants and young children: high-dose-rate brachytherapy." Journal of Clinical Oncology 15, no. 9 (September 1997): 3075–84. http://dx.doi.org/10.1200/jco.1997.15.9.3075.

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PURPOSE Conventional low-dose-rate (LDR) brachytherapy is effective in treating childhood sarcomas, but often not practical (due to the associated radiation hazards) in the young children who require continuous observation and sedation. Fractionated high-dose-rate brachytherapy (HDR) was used to deliver adequate tumoricidal radiation while preserving bone and organ growth in children. MATERIALS AND METHODS Twelve children with diverse sarcomas were treated with fractionated HDR. The median age at diagnosis was 18 months (range, 1 to 42). Nine patients had rhabdomyosarcoma and three had other soft tissue sarcoma (STS) variants. Ten patients had microscopic residual disease at the time of brachytherapy. All patients were treated with appropriate chemotherapy and surgery. HDR was delivered in 3-Gy fractions twice a day to a total dose of 36 Gy in 8 days. External-beam radiation therapy (EBRT) was avoided. Patients were monitored for a median of 61 months (range, 30 to 78). RESULTS One patient developed local recurrence and distant metastases to the lungs. The 6-year actuarial local control and overall survival rates were 91% and 81%, respectively. Brachytherapy-related morbidity occurred in 50% of patients. The morbidity was mild to moderate in 42% of patients and consisted primarily of acute skin and mucosal reaction. One patient experienced severe (grade III to IV) toxicity. Another child, treated to the tongue, had delayed dentition only in the teeth adjacent to the brachytherapy site. The other children have exhibited only minimal or none of the bone growth retardation expected with EBRT. CONCLUSION The combination of conservative surgery, chemotherapy, and exclusive HDR to postchemotherapy tumor volume with a modest margin, avoiding EBRT, provided disease control in carefully selected young children, while preserving bone growth and organ function. The short duration of therapy and small volume irradiated allowed chemotherapy to be resumed shortly after brachytherapy. The use of HDR challenges the present philosophy of radiotherapy treatment volume, which holds that the prechemotherapy tumor volume should be treated with an acceptable margin. Brachytherapy should be included in multicentric clinical trials in young children.

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Chin, Joseph, R. Bryan Rumble, Marisa Kollmeier, Elisabeth Heath, Jason Efstathiou, Tanya Dorff, Barry Berman, Andrew Feifer, Arthur Jacques, and D. Andrew Loblaw. "Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update." Journal of Clinical Oncology 35, no. 15 (May 20, 2017): 1737–43. http://dx.doi.org/10.1200/jco.2016.72.0466.

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Purpose To jointly update the Cancer Care Ontario guideline on brachytherapy for patients with prostate cancer to account for new evidence. Methods An Update Panel conducted a targeted systematic literature review and identified more recent randomized controlled trials comparing dose-escalated external beam radiation therapy (EBRT) with brachytherapy in men with prostate cancer. Results Five randomized controlled trials provided the evidence for this update. Recommendations For patients with low-risk prostate cancer who require or choose active treatment, low–dose rate brachytherapy (LDR) alone, EBRT alone, and/or radical prostatectomy (RP) should be offered to eligible patients. For patients with intermediate-risk prostate cancer choosing EBRT with or without androgen-deprivation therapy, brachytherapy boost (LDR or high–dose rate [HDR]) should be offered to eligible patients. For low-intermediate risk prostate cancer (Gleason 7, prostate-specific antigen < 10 ng/mL or Gleason 6, prostate-specific antigen, 10 to 20 ng/mL), LDR brachytherapy alone may be offered as monotherapy. For patients with high-risk prostate cancer receiving EBRT and androgen-deprivation therapy, brachytherapy boost (LDR or HDR) should be offered to eligible patients. Iodine-125 and palladium-103 are each reasonable isotope options for patients receiving LDR brachytherapy; no recommendation can be made for or against using cesium-131 or HDR monotherapy. Patients should be encouraged to participate in clinical trials to test novel or targeted approaches to this disease. Additional information is available at www.asco.org/Brachytherapy-guideline and www.asco.org/guidelineswiki .

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Li, Hualei, Mindi J. TenNapel, Amina Ahmed, Lilie Lin, Sudershan K. Bhatia, and Geraldine Jacobson. "Uterine Carcinosarcoma Confined to the Pelvis: A Retrospective Review and Outcome Analysis." Journal of Radiotherapy 2014 (March 11, 2014): 1–8. http://dx.doi.org/10.1155/2014/124149.

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Objective. We compared the treatments of uterine carcinosarcoma at our institution and evaluated their impact on survival. Methods. A retrospective analysis was performed on 60 eligible patients with carcinosarcoma limited to the pelvis. Subjects were divided into four categories: surgery, surgery plus chemotherapy, surgery plus radiation therapy, and a combination of surgery, chemotherapy, and RT. The most commonly used chemotherapy was cisplatin and/or carboplatin and taxol. Radiotherapy included external beam radiation therapy (EBRT) alone or with high dose rate (HDR) brachytherapy or HDR brachytherapy alone. Survival probability data were computed using the Kaplan-Meier method. The differences between groups were compared using the log-rank test. Results. The combination of surgery and radiation therapy with or without chemotherapy is seen to improve overall survival (OS) compared to surgery alone (P=0.044 and P=0.028, resp.). Brachytherapy involving three HDR vaginal cylinder fractions shows an equally effective reduction in local recurrence compared to EBRT. Conclusion. Our study of a relatively large number of carcinosarcoma patients suggests that adjuvant radiation therapy improves OS compared to surgery alone. Brachytherapy with 3 HDR vaginal cylinder fractions is preferred because of its time-saving, better tolerance, low toxicity and equivalent OS, and local control compared to EBRT.

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Kandasamy, Saravanan, K. S. Reddy, Vivekanandan Nagarajan, Parthasarathy Vedasoundaram, and Gunaseelan Karunanidhi. "Inter-fraction variation in interstitial high-dose-rate brachytherapy." Journal of Radiotherapy in Practice 14, no. 2 (February 4, 2015): 143–51. http://dx.doi.org/10.1017/s1460396915000047.

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AbstractAimTo evaluate the inter-fraction variation in interstitial high-dose-rate (HDR) brachytherapy. To assess the positional displacement of catheters during the fractions and the resultant impact on dosimetry.BackgroundAlthough brachytherapy continues to be a key cornerstone of cancer care, it is clear that treatment innovations are needed to build on this success and ensure that brachytherapy continues to provide quality care for patients. The dosimetric advantages offered by HDR brachytherapy to the tumour volume rely on catheter positions being accurately reproduced for all fractions of treatment.Materials and methodsA total of 66 patients treated over a period of 22 months were considered for this study. All the patients underwent computer tomography (CT) scan and three-dimensional treatment planning was carried out. Brachytherapy treatment was delivered by the HDR afterloading system. On completing the last fraction, CT scan was repeated and treatment re-planning was done. The variation in position of the implanted applicators and their impact on dosimetric parameters were analysed using both the plans.ResultsFor all breast-implant patients, the catheter displacement and D90dose to clinical target volume were <3 mm and 3%, respectively. The displacement for carcinoma of the tongue, carcinoma of the buccal mucosa, carcinoma of the floor of mouth, carcinoma of the cervix, soft-tissue sarcoma and carcinoma of the lip were comparatively high.ConclusionInter-fraction errors occur frequently in interstitial HDR brachytherapy. If no action is taken, it will result in a significant risk of geometrical miss and overdose to the organs at risk. It is not recommended to use a single plan to deliver all the fractions. Imaging is recommended before each fraction and decision on re-planning must be taken.

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Gogia, Pooja, Anil Dhull, and Vivek Kaushal. "Weekly versus biweekly high-dose rate brachytherapy schedules in carcinoma cervix following concomitant chemoradiation with paclitaxel and carboplatin." Asian Journal of Oncology 03, no. 01 (January 2017): 012–16. http://dx.doi.org/10.4103/asjo.asjo_111_16.

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Abstract Context: In the management of cervical cancer, though a number of chemotherapeutic drugs have been used for concomitant chemoradiation, paclitaxel and carboplatin have shown improved overall response rates with acceptable side effects. The use of intracavitary irradiation significantly improves survival and reduces local failures. However, the ideal time-dose-fraction schedule remains controversial with high-dose rate (HDR) brachytherapy. Aims: The aim of this study was to determine the efficacy and safety of paclitaxel and carboplatin for concomitant chemoradiation therapy and to compare the local control, toxicity, and tolerability of the two HDR brachytherapy schedules in patients of carcinoma cervix. Subjects and Methods: The patients were divided randomly into two groups of thirty patients each. Both the groups were treated with a combination of external beam radiotherapy with 50 Gy/5 weeks/25 fractions to whole pelvis along with concomitant chemotherapy. The concomitant chemotherapy schedule was injection paclitaxel (135 mg/m2) and injection carboplatin (area under the curve - 4.5 mg min/ml) at 4-week interval followed by HDR brachytherapy. Following which, patients received HDR-intracranial brachytherapy on the basis of random allocation, Group I: 6 Gy × 3 fractions (weekly) and Group II: 5 Gy × 4 fractions (biweekly). Results and Conclusion: The survival difference between the two groups (weekly and biweekly) was not statistically significant. However, Grade 2–3 rectal reactions in Group I were significantly higher than Group II (P = 0.038). The twice-weekly schedule of brachytherapy was a significant factor influencing the late complication rate but not the local pelvic control rate or overall survival rate.

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De Cicco, Luigi, Andrea Vavassori, Federica Cattani, Barbara A. Jereczek-Fossa, and Roberto Orecchia. "Salvage High Dose Rate Brachytherapy after Primary External Beam Irradiation in Localized Prostate Cancer: A Case Report." Tumori Journal 95, no. 4 (July 2009): 553–56. http://dx.doi.org/10.1177/030089160909500429.

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No standard treatment exists for locally relapsed prostate cancer after primary external beam radiotherapy with no evidence of distant metastases. Radical prostatectomy, brachytherapy, cryotherapy and high-intensity focused ultrasound are currently used as local salvage treatments. Data on the safety and effectiveness of high dose rate (HDR) brachytherapy in this scenario are limited. We report on a patient who has no evidence of disease and no late urinary or gastrointestinal toxicity 33 months after receiving HDR treatment for recurrent prostate cancer.

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Schuck, A., Ch Rűbe, A. Hillmann, M. Paulussen, H. Jűrgens, and N. Willich. "Intraoperative HDR brachytherapy of Ewing's sarcoma." European Journal of Cancer 33 (September 1997): S103. http://dx.doi.org/10.1016/s0959-8049(97)84924-6.

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Prévost, B., E. Dansin, C. Verkindre, T. Sarrazin, S. Hacène, R. Decool, M. Tokarski, A. Joveniaux, B. Castelain, and JJ Lafitte. "HDR endoluminal brachytherapy in lung cancer." Lung Cancer 21 (September 1998): S56. http://dx.doi.org/10.1016/s0169-5002(98)90144-1.

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Das, KR. "Prostate brachytherapy: HDR or seed implant." Journal of Medical Physics 31, no. 4 (2006): 239. http://dx.doi.org/10.4103/0971-6203.29193.

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Lo, T., I. Iftimia, and P. Cronin. "P056 HDR brachytherapy for prostate cancer." European Urology Supplements 13, no. 5 (November 2014): 129–30. http://dx.doi.org/10.1016/s1569-9056(14)61279-3.

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Rübe, Ch, A. Schuck, A. Hillmann, M. Paulussen, H. Jürgens, and N. Willich. "710Intraoperative HDR brachytherapy of Ewing's sarcoma." Radiotherapy and Oncology 40 (January 1996): S181. http://dx.doi.org/10.1016/s0167-8140(96)80719-5.

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Scalliet, P., A. Gerbaulet, and B. Dubray. "HDR Versus LDR Gynecological Brachytherapy Revisited." Medical Dosimetry 19, no. 1 (1994): 52. http://dx.doi.org/10.1016/0958-3947(94)90038-8.

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Scalliet, P., A. Gerbaulet, and B. Dubray. "HDR versus LDR gynecological brachytherapy revisited." Radiotherapy and Oncology 28, no. 2 (August 1993): 118–26. http://dx.doi.org/10.1016/0167-8140(93)90003-q.

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Jones, Bleddyn, Li Tee Tan, and Robert Kingston. "HDR versus LDR gynaecological brachytherapy revisited." Radiotherapy and Oncology 30, no. 2 (February 1994): 186. http://dx.doi.org/10.1016/0167-8140(94)90057-4.

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Vande Woestyne, M., G. Madelis, H. Potet, S. Servagi, and N. Gaillot. "34. Optimization in HDR gynecological brachytherapy." Physica Medica 44 (December 2017): 42. http://dx.doi.org/10.1016/j.ejmp.2017.10.114.

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Slessinger, Eric D. "Practical considerations for prostate HDR brachytherapy." Brachytherapy 9, no. 3 (July 2010): 282–87. http://dx.doi.org/10.1016/j.brachy.2009.05.003.

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Guerif, Stephane Gilles, Ossama Didas, Jean Pierre Tasu, Odile Boissonnade, Catherine Cheze-Le Reste, Bertrand Debaene, and Antoine Berger. "Multimodal image and mapping guided focal salvage high-dose-rate brachytherapy for local recurrent prostate cancer." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 122. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.122.

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122 Background: Image guided brachytherapy and mapping biopsy could reduce the toxicity of the total salvage brachytherapy. This study evaluate the tumor control and the tolerance of a focal real time salvage high-dose-rate (HDR) brachytherapy to treat the local relapse as defined on transperineal mapping biopsy, multipara-metric MRI and Choline PETSCAN on the same treatment planning. Methods: Between October 2013 and June 2016, Twenty-nine patients with local relapse on Choline PET Scan after a primary irradiation had a salvage HDR Brachytherapy (2 fractions of 10 Gy within 4-6 hours in one implant) without hormone. One month before brachytherapy All patients had real time transperineal randomized European regions standardised magnetic resonance imaging (MRI) prostate biopsies and targeted biopsies with a fusion of T2 MRI sequence /CholinePETscan (50 % SUV) to intraoperative transrectal ultrasound one month before brachytherapy. We used Flex Focus 400 ultrasound machine BK, Vitesse 3.0 and 3 D navigation with EXII Stepper in order to use the result of mapping biopsy for real time HDR brachytherapy treatment planning study. Tumor control was measure with phoenix definition and Kaplan-Meier. The GU and GI toxicity were measure with CTCAE V 3. Results: 13 Low risk, 10 Intermediate risk, 8 High risk, initially treated with 3 Iodine brachytherapy ( 160 GY), 15 EBRT ≥ 78 Gy and 7 EBRT ≤ 70 gy were include. The number of biopsy (mean volume, 21 cm3; SD, 6.7). Prostate Volume (mean volume, 29.7 cm3; SD, 12.5). CTV Volume (mean volume, 13.3 cm3; SD, 6.7). Mean dose to 90% of the prostate was 11.4 Gy (SD, 1.45). Mean dose to 90% of the CTV was 21.1 Gy (SD, 1.45). Mean dose to 90% of the CTVmri was 27.6 Gy (SD, 3.4). The biologic disease free survival at 2 years is 65 % (Kaplan-Meier). Disease without hormone survival at 2 years is 86,5%. The chronic toxicity ( > 6 mois) was 6 Gu and 4 GI for grade ≤ 2 and 1 GU grade 3 (total incontinence). Conclusions: Focal, mapping and multimodal image guided salvage HDR brachytherapy for recurrent prostate cancer is a feasible therapy. This approach has to be evaluated in multicenter cohort.

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Akimoto, T., K. Hiroyuki, K. Shirai, K. Harada, T. Ebara, K. Ito, T. Yamamoto, and T. Nakano. "HDR brachytherapy combined with hypofractionated EBRT for intermediate-high risk prostate cancer." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 14655. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.14655.

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14655 Background: To report on biochemical outcome and late complication in pts with localized prostate cancer (LPC) treated with HDR-brachytherapy (HDR-BT) combined with hypofractionated EBRT. Methods: From 06/2000 to 12/2004, 108 pts with intermediate (37 pts.) or high-risk (63 pts.) LPC were treated with hypofractionated EBRT (3 Gy × 17 fr., thrice a week) followed by HDR-BT (5 Gy × 5; 9 pts, 7 Gy × 3; 15 pts, 9 Gy × 2; 76 pts). HDR-BT was administered a week after the completion of the hypofractionated EBRT. The planning target volume was defined as the prostate gland with a 5-mm margin all around, and the planning was conducted based on CT images. Biologically effective doses (BED) to the prostate was between 83–84 Gy. All patient received androgen ablation. Acute and late toxicities were scored according to the EORTC/RTOG morbidity grading scales. Median follow-up duration was 27 months from HDR-BT and 39 months from initiation of androgen ablation. Results: All pts completed treatment. The 5-year actuarial PSA relapse-free survival rates for intermediate and high-risk pts were 100% and 93% respectively. Acute genitourinary (GU) toxicity was 64% in grade 0–1, 31% in grade 2 and 6% in grade 3. Urethral stricture developed in 3%, with a median time from the completion of HDR brachytherapy to the occurrence of 22 months (19–26 months). Ten pts had grade 2 rectal bleeding, with a median time from the completion of HDR brachytherapy to the occurrence of 11 months (7–14 months). No pts developed grade 3 or more severe rectal complication. The incidence of acute and late toxicity did not differ according to the fractionation schema of HDR-BT. Conclusion: Our data demonstrate the successful feasibility of HDR-BT combined with hypofractionated EBRT as a safe method for escalating the total dose to the prostate without significant increasing risk of acute and late GU and rectal toxicities. No significant financial relationships to disclose.

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Yamamoto, Toshihiro, Masahito Kido, Hiroshi Sasaki, Jun Miki, Takahiro Kimura, Kenta Miki, Hiroki Yamada, Manabu Aoki, and Shin Egawa. "High-dose-rate (HDR) brachytherapy with external beam radiotherapy for localized high-risk prostate cancer: Five-year results in 122 patients." Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 91. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.91.

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91 Background: To present outcome and morbidity of high-dose-rate (HDR) brachytherapy with external beam radiotherapy (EBRT) for localized high risk prostate cancer. Methods: Between May 2005 and April 2009, 122 patients underwent Ir-192 HDR brachytherapy with EBRT and passed after HDR bachytherapy more than one year. The median follow-up was 46 months (range 2-76 months). All patients were high risk and localized prostate cancer. Median PSA was 40.2ng/ml (range 4.1-366ng/ml). Median Gleason Score was 8 (range 6-10). All patients were treated over six months neo-adjuvant hormonal therapy and over twenty-four months adjuvant hormonal therapy. Results: Only one patient had died of lung small cell carcinoma. 14 patients had revealed biochemical failure(BCF) by Phoenix definition. 5-year biochemical free rate was 78%. Clinical T3 group is significant worse than clinical T1-T2 group(5-y BCF 73% vs 81%, p<0.05). Of the 122 patients, only one patient displayed Grade 3 late GI toxicity. There were no other acute nor late severe toxicity. Conclusions: HDR brachytherapy for localized high risk prostate cancer resulted in good outcomes and had comparatively minor toxicity. Clinical T3 patients was poor outcome than clinical T1-2.

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Craciunescu, O., D. Todor, and A. de Leeuw. "WE-F-BRD-01: HDR Brachytherapy II: Integrating Imaging with HDR." Medical Physics 41, no. 6Part30 (May 29, 2014): 513–14. http://dx.doi.org/10.1118/1.4889467.

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Contreras, Jessika, Richard Wilder, Eric Albert Mellon, Tobin Joel Crill Strom, Daniel Celestino Fernandez, and Matthew C. Biagioli. "Quality of life after high-dose rate brachytherapy monotherapy for prostate cancer." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 278. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.278.

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278 Background: There is little information in the literature on health-related quality-of-life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy monotherapy for prostate cancer. Methods: We conducted a prospective study of HRQOL changes due to HDR brachytherapy monotherapy for low risk or favorable intermediate risk prostate cancer. Forty-nine of 84 (58%) patients who were treated between February 2011 and April 2013 completed 50 questions comprising the Expanded Prostate Cancer Index Composite (EPIC) before treatment and 6 and/or 12 months after treatment. Results: Six months after treatment, there was a significant decrease (p<0.05) in EPIC urinary, bowel, and sexual scores, including urinary overall, urinary function, urinary bother, urinary irritative, bowel overall, bowel bother, sexual overall, and sexual bother scores. By one year after treatment, all EPIC scores had increased and were not significantly different from baseline values. Conclusions: HDR brachytherapy monotherapy is well-tolerated in patients with low and favorable intermediate risk prostate cancer. Urinary, bowel, and sexual domain scores returned to close to baseline 12 months after treatment.

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Villella, Jeannine A., Thomas Palaia, Eva Chalas, Patricia Patrick, and Jonathan A. Haas. "Endometrial cancer recurrence: Adjuvant high-dose rate vaginal brachytherapy (HDR) versus HDR with whole pelvic radiation." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e15504-e15504. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e15504.

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e15504 Background: Investigators hypothesize that patients with endometrioid carcinoma of the endometrium treated with adjuvant high-dose-rate vaginal brachytherapy (HDR) alone vs. HDR with whole pelvic radiation (WPXRT) have similar recurrence patterns. Methods: Patients reated with any adjuvant HDR between March 2005 and January 2011 were included retrospectively. Demographic, pathologic and treatment data was extracted from the medical record. These clinical data were compared among subjects receiving HDR only vs. HDR with 4500 cGy whole pelvic radiation using t-tests, Mann-Whitney tests, and chi-square analyses as appropriate. Results: One hundred eighty-six patients received adjuvant HDR. Fifty eight were excluded from analyses (46 based on non-endometrioid histology; 12 lost to follow-up). Among the sample of 128 subjects, 56 were treated with HDR only vs. 72 with HDR and WPXRT (43.8% vs. 56.2%, respectively). Subjects were similar in age, body mass index, and the existence of medical co morbidities. Of the 72 patients receiving HDR and WPXRT, 28 (38.9) were staged IA-IC, 28 (38.9) were staged as IIA-IIB, 11 (15.4%) were staged as IIIA-IIIC, 1 was staged as IVA-IVB (1.4%) and 4 (5.5%) was unstaged at diagnosis. Complications were similar between the groups. A total of 5 subjects experienced a recurrence, 1 who received HDR only vs. 4 who received HDR and WPXRT (1.8% vs. 5.6%, respectively, p=0.27). The subject treated with HDR was diagnosed with a grade 1 endometrioid carcinoma and had recurrence in the lung. Of the 4 subjects treated with HDR and WPXRT, 3 had recurrence in the vaginal cuff and 1 had recurrence in the peri-aortic lymph nodes. Conclusions: Recurrence was low among all subjects and did not differ among those who received HDR therapy only compared to HDR therapy with whole pelvic radiation. Investigators plan to conduct additional studies with a larger sample size to determine whether a difference in recurrence exists while adjusting for disease stage and total treatment dosage. If such confirmatory evidence is found, HDR brachytherapy alone may be a viable alternative to the additional radiation exposure of WPXRT in treating patients with endometrioid carcinoma of the endometrium.

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Dhillon, Sneha, Saurabh Bansal, Girish Sindhwani, Meenu Gupta, Vipul Nautiyal, Sunil Saini, and Mushtaq Ahmad. "Clinical and endoscopic response to high dose rate endobronchial brachytherapy in malignant lung tumors: A single centre experience." South Asian Journal of Cancer 07, no. 04 (October 2018): 267–69. http://dx.doi.org/10.4103/sajc.sajc_29_18.

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Abstract Purpose: The aim of the study was to evaluate the short-term clinical, endoscopic response, and acute toxicities in endobronchial cancer treated with high-dose-rate endobronchial brachytherapy (HDR-EB). Materials and Methods: Thirty patients of advanced endobronchial cancers were treated with HDR-EB. Brachytherapy was delivered at a depth of 1 cm from the source axis at weeks 1, 2, and 3 with 7 Gy per fraction. All patients were evaluated before treatment and at 1 month after completion of therapy. Using Speiser's scoring criteria, the severity of symptoms (dyspnea, cough, hemoptysis, and postobstructive pneumonia) and degree of obstruction were graded. Results: Symptomatic response for cough, dyspnea, and hemoptysis was seen in 88%, 75%, and 96%, respectively, with a significant P value (<0.05). Obstructive pneumonia was resolved in 94% of patients. Endoscopic response in terms of degree of obstruction was seen in 84% of patients. Acute toxicities in the form of radiation bronchitis were seen in 32% of patients, whereas 8% of patients experienced esophagitis. Bronchospasm was seen in one patient during treatment. Conclusion: HDR brachytherapy is a highly effective, safe, convenient therapy in alleviating symptoms of endobronchial obstruction with endoscopic response in the majority of cases. Thus, HDR-BT is a promising treatment for palliation of patients presenting with symptoms of endobronchial obstruction with an acceptable rate of complications.

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Tharmalingam, Hannah, Yatman Tsang, Ananya Choudhury, and Peter Hoskin. "External beam radiotherapy (EBRT) and high dose rate (HDR) brachytherapy for intermediate and high-risk prostate cancer: Whole pelvis or prostate-only EBRT?" Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 86. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.86.

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86 Background: In high-risk prostate cancer, the risk of occult lymph node metastases in the pelvic lymph nodes can be as high as 40%. However, the use of whole pelvis radiotherapy (WPRT) in high-risk patients remains controversial with mixed retrospective evidence and two negative prospective trials. Data from a national UK database of patients treated with external-beam radiotherapy (EBRT) and high-dose rate (HDR) brachytherapy was reviewed to evaluate the benefit of pelvic treatment. Methods: From 2009 to 2013, 755 patients with intermediate- and high-risk prostate cancer (clinical stage ≥T2c, Gleason score ≥7 or presenting prostate-specific antigen (pPSA) ≥10) were treated with EBRT and HDR brachytherapy. The pelvic nodes to the level of the common iliac chain were treated in 370 patients with a dose of 46Gy in 23 fractions. The remaining 385 patients received radiotherapy to the prostate only (PORT) at a dose of 37.5Gy in 15 fractions. A single dose of 15Gy was delivered with HDR brachytherapy in each case. Corresponding biologic effective doses to the prostate were 107Gy and 100Gy respectively (α/β = 1.5). 96.5% of patients received ADT with a median duration of 24 months. Biochemical failure was defined as a PSA rise of ≥2ng/ml above nadir. Analysis used log-rank and Cox univariate and multivariate tests. Results: Median follow-up was 4.5 years; 5-year biochemical progression-free survival rates for the WPRT versus the PORT arms were 88% vs 80% (p < 0.05) for all patients and 89% vs 76% (p < 0.05) for high-risk patients. Differences in bPFS remained significant (p < 0.05) after accounting for Gleason score, pPSA, T stage and ADT duration as co-variates. There was no difference in overall survival. Conclusions: Whole pelvis EBRT with HDR brachytherapy appears to significantly improves 5-year biochemical progression-free survival in intermediate- and high-risk prostate cancer compared to prostate-only EBRT and HDR brachytherapy which persists after allowing for covariates including presenting tumour parameters and ADT use. The PIVOTAL boost trial in the UK will assess this further in a prospective randomised study.

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Ahmed, Imtiaz, Sharon Shibu Thomas, Alexander Cain, Jufen Zhang, Sreekanth Palvai, Dabden Dawam, Rakesh Kizhakke Veetil, Lavinia Romero, Karen Hayden, and Mahbuba Choudhury. "Timing of high-dose rate brachytherapy with external beam radiotherapy in intermediate and high-risk localized prostate cancer (THEPCA) patients and its effects on toxicity and quality of life: Results of a randomized feasibility trial." Journal of Clinical Oncology 39, no. 6_suppl (February 20, 2021): 236. http://dx.doi.org/10.1200/jco.2021.39.6_suppl.236.

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236 Background: Advances in brachytherapy, external beam radiotherapy (EBRT) and image-guided radiotherapy have revolutionized radiotherapy delivery. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities remain a significant issue. Currently there is no European consensus on the timing of high-dose rate (HDR) brachytherapy in relation to EBRT. Schedules of HDR boost before or after EBRT vary significantly between institutions.The incidence of GI and GU toxicities was assessed in patients receiving HDR brachytherapy before and after EBRT. Methods: Men with Intermediate/high risk localized prostate cancer were randomized to Arm A (HDR brachytherapy before EBRT) or Arm B (HDR brachytherapy after EBRT). Both arms received a HDR boost of 15Gy and 46Gy in 23 fractions of EBRT. All patients received neoadjuvant and adjuvant hormone therapy for up to 2 years. Patients were followed quarterly up to a year. CTCAE scores for GU and GI toxicities were taken. IPSS, IEFL and FACT-P scores were collected. Fisher’s exact test was used to analyze the association between GU and GI toxicities. The T-test compared the mean differences in IPSS total scores at each follow-up. Analysis of variance evaluated the difference at follow up. Post-hoc testing and Bonferroni correction was applied. Results: 100 patients were randomized between 2015 and 2017. Data for 88 patients was available at cutoff. Mean age was 69 years (SD: 4.6). Age, Gleason score, TNM and clinical staging were similar in each arm. Mean IPSS Score was similar between both arms at baseline Arm A (6.52) & Arm B (6.57). 12 months follow up showed mild worsening of symptoms in both arms, but no significant difference noticed between Arm A (8.02) & Arm B (8.14) p=0.55. At 12 months, Grade 1 and 2 GU toxicities were more frequent in Arm A (22.88% & 5.28%, p=0.669) compared to Arm B (19.36% and 2.64%, p=0.485). Grade 1 GI toxicity was more common in Arm B (23.76%) than Arm A (21.2%), p=0.396. Grade 2 GI toxicities were more common in Arm A 5.28% vs 3.52%, p=0.739. Baseline mean IIEF scores were 10.9 and 10.53 in Arm A and B respectively. At 12 months this was 6.6 in Arm A and 7.11 in Arm B, but not statistically significant. FACT-P scores were not different in either arm, with good QOL scores maintained throughout. Mean score at baseline (125.18) was observed to be similar at 12 months follow up at (126.10). The PTV, CTV & OAR dose were compared and no significant differences were found. Conclusions: There were no significant differences in GI and GU related toxicities up to a year between patients receiving HDR brachytherapy before or after EBRT. There were no grade 3 or 4 toxicities. Treatment was well tolerated in both arms with good QOL scores. Longer follow up and a phase III multicenter RCT would be needed to validate findings. Clinical trial information: NCT02618161.

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Marosevic, Goran, Dzenita Ljuca, Hasan Osmic, Semir Fazlic, Oliver Arsovski, and Dusan Mileusnic. "Inter-application displacement of brachytherapy dose received by the bladder and rectum of the patients with inoperable cervical cancer." Radiology and Oncology 48, no. 2 (June 1, 2014): 203–9. http://dx.doi.org/10.2478/raon-2013-0082.

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AbstractBackground. The aim of the study was to examine on the CT basis the inter-application displacement of the positions D0.1cc, D1ccand D2ccof the brachytherapy dose applied to the bladder and rectum of the patients with inoperable cervical cancer.Patients and methods. This prospective study included 30 patients with cervical cancer who were treated by concomitant chemo-radiotherapy. HDR intracavitary brachytherapy was made by the applicators type Fletcher tandem and ovoids. For each brachytherapy application the position D0.1ccwas determined of the bladder and rectum that receive a brachytherapty dose. Then, based on the X, Y, and Z axis displacement, inter-application mean X, Y, and Z axis displacements were calculated as well as their displacement vectors (R). It has been analyzed whether there is statistically significant difference in inter-application displacement of the position of the brachytherapy dose D0.1cc, D1ccand D2ccof the bladder and rectum. The ANOVA test and post-hoc analysis by Tukey method were used for testing statistical importance of differences among the groups analyzed. The difference among the groups analyzed was considered significant if p < 0.05. Results. There are significant inter-application displacements of the position of the brachytherapy dose D0,1cc, D1ccand D2ccof the bladder and rectum. Conclusions. When we calculate the cumulative brachytherapy dose by summing up D0,1cc, D1ccand D2ccof the organs at risk for all the applications, we must bear in mind their inter-application displacement, and the fact that it is less likely that the worst scenario would indeed happen

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Pouliot, J., C. Charra-Brunaud, Y. Kim, E. Lessard, J. Speight, P. Xia, and I. Hsu. "Inverse planning for HDR brachytherapy: clinical implementation." International Journal of Radiation Oncology*Biology*Physics 54, no. 2 (October 2002): 333. http://dx.doi.org/10.1016/s0360-3016(02)03631-3.

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Kolkman-Deurloo, Inger-Karine K., Wilhelmus J. M. de Kruijf, and Peter C. Levendag. "On-line implant reconstruction in HDR brachytherapy." Radiotherapy and Oncology 78, no. 1 (January 2006): 53–59. http://dx.doi.org/10.1016/j.radonc.2005.12.003.

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Fonseca Siles, A., C. Jimenez Crespo, E. Montero Garcia, E. Gonzalez Moral, M. Blazquez, and R. Molina Cruz. "HDR-brachytherapy for partial breast irradiation (PBI)." Reports of Practical Oncology & Radiotherapy 18 (June 2013): S148. http://dx.doi.org/10.1016/j.rpor.2013.03.028.

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Hoskin, P. J., P. Bownes, L. Bryant, and P. Ostler. "HDR Monotherapy Brachytherapy for Localised Prostate Cancer." Clinical Oncology 19, no. 3 (April 2007): S7. http://dx.doi.org/10.1016/j.clon.2007.01.288.

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Nechushkin, M., L. Maryina, M. Suschchikhina, and N. Zinoviev. "47 Intraoperative HDR-Brachytherapy for gynaecological cancer." Radiotherapy and Oncology 31 (April 1994): S33. http://dx.doi.org/10.1016/0167-8140(94)91145-2.

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Cunha, J. Adam M., I. Chow Hsu, and Jean Pouliot. "Novel catheter patterns for HDR prostate brachytherapy." Brachytherapy 7, no. 2 (April 2008): 177. http://dx.doi.org/10.1016/j.brachy.2008.02.443.

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