| 1. |
- Beskow, Catharina, et al.
(författare)
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Biological effective dose evaluation and assessment of rectal and bladder complications for cervical cancer treated with radiotherapy and surgery
- 2012
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia Sp. z.o.o.. - 1689-832X .- 2081-2841. ; 4:4, s. 205-212
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aims to retrospectively evaluate dosimetric parameters calculated as biological effective dose in relation to outcome in patients with cervical cancer treated with various treatment approaches including radiotherapy, with and without surgery.Methods and Materials: Calculations of biological effective dose (BED) were performed on data from a retrospective analysis of 171 patients with cervical carcinoma stages IB-IIB treated with curative intent between January 1989 and December 1991. 43 patients were treated only with radiotherapy and 128 patients were treated with a combination of radiotherapy and surgery. External beam radiotherapy was delivered with 6-21 MV photons from linear accelerators. Brachytherapy was delivered either with a manual radium technique or with a remote afterloading technique. The treatment outcome was evaluated at 5 years.Results: The disease-specific survival rate was 87% for stage IB, 75% for stage IIA and 54% for stage IIB, while the overall survival rates were 84% for stage IB, 68% for stage IIA and 43% for stage IIB. Patients treated only with radiotherapy had a local control rate of 77% which was comparable to that for radiotherapy and surgery patients (78%). Late complications were recorded in 25 patients (15%). Among patients treated with radiotherapy and surgery, differences in radiation dose calculated as BED10 did not seem to influence survival. For patients treated with radiotherapy only, a higher BED10 was correlated to a higher overall survival (p=0.0075). The dose response parameters found based on biological effective dose calculations were D50=85.2 Gy10 and γ=1.62 for survival and D50=61.6 Gy10 and γ=0.92 for local control.Conclusions: The outcome correlates with biological effective dose for patients treated with radiation therapy alone, but not for patients treated with radiotherapy and surgery. No correlations were found between BED and late toxicity from bladder and rectum.
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| 2. |
- Dohlmar, Frida, et al.
(författare)
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An audit of high dose-rate prostate brachytherapy treatment planning at six Swedish clinics
- 2021
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Ingår i: Journal of Contemporary Brachytherapy. - : TERMEDIA PUBLISHING HOUSE LTD. - 1689-832X .- 2081-2841. ; 13:1, s. 59-71
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: High dose-rate prostate brachytherapy has been implemented in Sweden in the late 1980s and early 1990s in six clinics using the same schedule: 20 Gy in two fractions combined with 50 Gy in 25 fractions with external beam radiation therapy. Thirty years have passed and during these years, various aspects of the treatment process have developed, such as ultrasound-guided imaging and treatment planning system. An audit was conducted, including a questionnaire and treatment planning, which aimed to gather knowledge about treatment planning methods in Swedish clinics. Material and methods: A questionnaire and a treatment planning case (non-anatomical images) were sent to six Swedish clinics, in which high-dose-rate prostate brachytherapy is performed. Treatment plans were compared using dosimetric indices and equivalent 2 Gy doses (EQD(2)). Treatment planning system report was used to compare dwell positions and dwell times. Results: For all the clinics, the planning aim for the target was 10.0 Gy, but the volume to receive the dose differed from 95% to 100%. Dose constraints for organs at risk varied with up to 2 Gy. The dose to 90% of target volume ranged from 10.0 Gy to 11.1 Gy, equivalent to 26.0 Gy EQD(2) and 31.3 Gy EQD(2), respectively. Dose non-homogeneity ratio differed from 0.18 to 0.32 for clinical target volume (CTV) in treatment plans and conformity index ranged from 0.52 to 0.59 for CTV. Conclusions: Dose constraints for the organs at risk are showing a larger variation than that reflected in compared treatments plans. In all treatment plans in our audit, at least 10 Gy was administered giving a total treatment of 102 Gy EQD(2), which is in the upper part of the prescription doses published in the GEC/ESTRO recommendations.
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| 3. |
- Johansson, Bengt, 1958-, et al.
(författare)
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High-dose-rate brachytherapy as monotherapy for low- and intermediate-risk prostate cancer : long-term experience of Swedish single-center
- 2021
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia Publishing. - 1689-832X .- 2081-2841. ; 13:3, s. 245-253
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Until now, most long-term results for brachytherapy only has been published for low-dose-rate (LDR) seeds. Due to radiobiology reasons, high-dose-rate (HDR) mono-brachytherapy is of growing interest. The aim of the study was to report long-term biochemical control rate and toxicities with HDR monotherapy.Material and methods: This was a retrospective single-institution experience, including 229 men, clinically staged T1c-T2b, Gleason 3 + 3 (prostate specific antigen (PSA) <= 15), or Gleason 3 + 4 (PSA <= 10), consecutively treated between 2004 and 2012 with HDR brachytherapy alone, using three different fractionation schedules of 92-95 Gy (EQD(2), alpha/beta = 3). Group 4F (n = 19) had a single implant of 9.5 Gy in four fractions over 2 days. Group 3F (n = 107) had three separate implants of 11 Gy over 4 weeks. Group 2F (n = 103) had two implants of 14 Gy over 2 weeks. No adjuvant hormonal therapy was allowed.Results: For 4F, 3F, and 2F study groups, median follow-up was 10.2, 7.1, and 6.1 years, respectively, and biochemical failure rate was 10.5%, 4.7%, and 14.6%, respectively. Early and late side effects were followed with common terminology criteria version 2.0 and patient-reported questionnaires. There were a temporary acute urethral toxicity increase, 1-2 grades over baseline lower urinary tract symptoms (LUTS), which usually recovered. About 1/3 of the patients had a remaining one grade over baseline LUTS. Severe grade 3-4 toxicity were only found in 3.5% of patients. No rectal toxicity was observed. Erectile dysfunction (ED) was depending on age and erectile function before treatment. In patients without ED before the treatment, we found a complete ED in 21% of men at the last follow-up.Conclusions: In the present study, HDR mono-brachytherapy was found to be an effective treatment, with mild long-term side effects difficult to differentiate from aging effects. There were no significant differences in PSA regression, PSA failure rate, and toxicity between the different fraction schedules.
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| 4. |
- Johansson, Bengt, 1958-, et al.
(författare)
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Long term results of PDR brachytherapy for lip cancer
- 2011
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia Publishing House. - 1689-832X .- 2081-2841. ; 3:2, s. 65-69
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the long time outcome with regard to local tumour control and side effects of a pulsed dose rate (PDR) monobrachytherapy of primary or recurrent cancer of the lip.Material and methods: Between 1995 and 2007 we treated 43 patients with primary or recurrent clinical T1-T3N0 lip cancers. There were 22 T1 patients (51%), 16 T2 (37%) and 5 T3 cases (12%). A median dose of 60 (55-66) Gy was given, depending on the tumour volume. The PDR treatment was delivered with 0.83 Gy/pulse every second hour for 5.5-6.5 days. The patients were followed for a median of 55 (1-158) months.Results: The 2-, 5- and 10-year rates of actuarial local control were 97.6%, 94.5% and 94.5%, overall survival 88.0%, 58.9% and 39.1%, disease free survival 92.7%, 86.4% and 86.4% respectively. The regional control rate was 93%. One patient (2%) developed distant metastases. A dosimetrical analysis showed a mean treated volume of 14.9 (3.0-56.2) cm(3). Long-term side effects were mild and the cosmetic outcome excellent, except for 1 case (2%) of soft tissue necrosis and 1 case (2%) of osteoradionecrosis.Conclusions: Local outcome is excellent and similar to other published studies of continuous low dose rate (cLDR) brachytherapy.
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| 5. |
- Johansson, Bengt, 1958-, et al.
(författare)
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Pulsed dose rate brachytherapy as the boost in combination with external beam irradiation in base of tongue cancer : Long-term results from a uniform clinical series
- 2011
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Ingår i: Journal of Contemporary Brachytherapy. - Poznan, Poland : Termedia Publishing House. - 1689-832X .- 2081-2841. ; 3:1, s. 11-17
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate long time outcome with regard to local tumour control, side effects and quality of life of combined pulsed dose rate (PDR) boost and hyperfractionated accelerated external beam radiotherapy (EBRT) for primary base of tongue (BOT) cancers.Material and methods: Between 1994 and 2007, the number of 83 patients were treated with primary T1-T4 BOT cancers. Seven patients (8%) were T1-2N0 (AJCC stage I-II) and 76 (92%) patients were T1-2N+ or T3-4N0-2 (AJCC stage III-IV). The mean estimated primary tumour volume was 15.4 (1-75) cm(3). EBRT was given with 1.7 Gy bid to 40.8 Gy to primary tumour and bilateral neck lymph nodes in 2.5 weeks. PDR boost of 35 Gy and a neck dissection in clinical node positive case was performed 2-3 weeks later. The patients were followed for a median of 54 (2-168) months.Results: The 2-, 5- and 10-years rates of actuarial local control were 91%, 89% and 85%, overall survival 85%, 65% and 44%, disease free survival 86%, 80% and 76%, respectively. The regional control rate was 95%. Six patients (7%) developed distant metastases. A dosimetric analysis showed a mean of 100% isodose volume of 58.2 (16.7-134) cm(3). In a review of late complications 11 cases of minor (13%) and 5 of major soft tissue necroses (6%), as well as 6 cases of osteoradionecroses (7%) were found. The patients median subjective SOMA/LENT scoring at last follow up was as follow: grade 0 for pain and trismus, grade 1 for dysphagia and taste alteration, and grade 2 for xerostomia. Global visual-analogue-scale (VAS) scoring of quality of life was 8.Conclusion: Local and regional tumour control rate was excellent in this treatment protocol. The data shows the PDR boost as at least as effective as published continuous low dose rate (CLDR) results.
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| 6. |
- Karlsson, Leif, et al.
(författare)
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3D image-based adapted high-dose-rate brachytherapy in cervical cancer with and without interstitial needles : measurement of applicator shift between imaging and dose delivery
- 2017
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia Publishing House. - 1689-832X .- 2081-2841. ; 9:1, s. 52-58
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Using 3D image-guided adaptive brachytherapy for cervical cancer treatment, it often means that patients are transported and moved during the treatment procedure. The purpose of this study was to determine the intra-fractional longitudinal applicator shift in relation to the high risk clinical target volume (HR-CTV) by comparing geometries at imaging and dose delivery for patients with and without needles.Material and methods: Measurements were performed in 33 patients (71 fractions), where 25 fractions were without and 46 were with interstitial needles. Gold markers were placed in the lower part of the cervix as a surrogate for HR-CTV, enabling distance measurements between HR-CTV and the ring applicator. Shifts of the applicator relative to the markers were determined using planning computed tomography (CT) images used for planning, and the radiographs obtained at dose delivery. Differences in the physical D-90 for HR-CTV due to applicator shifts were simulated individually in the treatment planning system to provide the relative dose variation.Results: The maximum distances of the applicator shifts, in relation to the markers, were 3.6 mm (caudal), and-2.5 mm (cranial). There was a significant displacement of-0.7 mm (SD = 0.9 mm) without needles, while with needles there was no significant shift. The relative dose variation showed a significant increase in D-90 HR-CTV of 1.6% (SD = 2.6%) when not using needles, and no significant dose variation was found when using needles.Conclusions: The results from this study showed that there was a small longitudinal displacement of the ring applicator and a significant difference in displacement between using interstitial needles or not.
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| 7. |
- Karlsson, Leif, 1954-, et al.
(författare)
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The impact of activating source dwell positions outside the CTV on the dose to treated normal tissue volumes in TRUS guided 3D conformal interstitial HDR brachytherapy of prostate cancer
- 2014
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia Publishing House. - 1689-832X .- 2081-2841. ; 6:3, s. 282-288
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Dose coverage is crucial for successful treatment in mono-brachytherapy. Since few and very high dose fractions are used, there is an important balance between dwell positioning outside the clinical target volume (CTV) and possible damage on adjacent normal tissue. The purpose of this study was to evaluate the possibility of having dwell positions close to the CTV surface, while maintaining an acceptable dose distribution, and to investigate the robustness in terms of known geometrical uncertainties of the implant.Material and methods: This study included 37 patients who had received brachytherapy for prostate cancer as a monotherapy with the following schedules: 2 x 14 Gy or 3 x 11 Gy, each fraction separated by two weeks. The source dwell positions were activated 5 mm outside CTV. New optimizations were simulated for dwell positions at 3, 2, 1, and 0 mm. Inverse and graphical optimization were applied according to the relative dose constraints: V-100 CTV >= 97%, D-max,D- urethra <= 110%, and D-10 rectal mucosa <= 65%. The V-100 normal tissue outside CTV was used to evaluate dose variations caused by different dwell positions. Prostate geometries and dose distributions for the different dwell positions outside the CTV were used to investigate the impact on the CTV dose distribution due to geometrical uncertainties.Results: Both V-100,V- CTV, and V-100,V- normal tissue decreased, 98.6% to 92.2%, and 17 cm(3) to 9.0 cm(3), for dwell activation from 5 rum to 0 mm. The evaluation of both simulated longitudinal geometrical uncertainties and different source dwell activations implied that V-100,V- CTV ranged from 98.6% to 86.3%.Conclusions: It is possible to reduce the V-100,V- normal tissue by decreasing the source dwell positions outside the CTV from 5 to 3 mm, while maintaining dose constraints. In combination with the estimated geometrical uncertainties, however, the source dwell positions need to be 5 mm from the surface in order to maintain a robust implant.
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| 8. |
- Olsén, Johan Staby, et al.
(författare)
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Predicting toxicity caused by high-dose-rate brachytherapy single boost for prostate cancer
- 2022
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia sp. z o.o.,Termedia Publishing House. - 1689-832X .- 2081-2841. ; 14:1, s. 7-14
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Treating localized prostate cancer (PC) with combination radiotherapy consisting of external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) has been proven to result in better disease outcome than EBRT only. We aimed to evaluate the incidence of toxicities due to combination therapy and identify parameters correlated to acute or late urinary, rectal, and erectile toxicities.Material and methods: Data on symptoms and tumor/treatment parameters were collected from 359 patients treated between 2008 and 2018 with EBRT (42 Gy in 14 fractions) and HDR-BT (14.5 Gy in one fraction) for localized PC, at the Örebro University Hospital. Urinary, rectal, and erectile symptoms were presented descriptively, and bivariate analyses for correlation between grade ≥ 2 toxicity and potential predictors were performed. To evaluate prognostic models, multivariable analyses were applied.Results: Urinary toxicity grade ≥ 2 was observed in 154 patients (47% of patients without pre-existing symptoms grade ≥ 2), of which 15 were grade 3. Rectal toxicity grade 2 was observed in 22 (6%) patients. Any grade erectile dysfunction was evident in all patients without pre-existing dysfunction (n = 103), whereas only 7 recovered completely. In bivariate analyses age was correlated with higher risk of acute urinary toxicity, and irradiated volume was associated with both urinary and rectal toxicities. However, we found no multivariable model of clinical and statistical significance to predict the risk of urinary or rectal toxicities.Conclusions: In our study cohort, the severity of toxicities was in general mild or moderate and temporary, whereas the incidence of severe toxicity was considerably low. Although we found no predictive models for toxicities, our findings are reassuring that this treatment approach as curative therapy for localized PC is well-tolerated.
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| 9. |
- Padjas, Anna, et al.
(författare)
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Comparative analysis of three functional predictive assays in lymphocytes of patients with breast and gynaecological cancer treated by radiotherapy
- 2012
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia Sp. z.o.o.. - 1689-832X .- 2081-2841. ; 4:4, s. 219-226
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: There is a need to develop predictive tests that would allow identifying cancer patients with a high risk of developing side effects to radiotherapy. We compared the predictive value of three functional assays: the G(0) aberration assay, the G(2) aberration assay and the alkaline comet assay in lymphocytes of breast cancer and gynaecological cancer patients.Material and methods: Peripheral blood was collected from 35 patients with breast cancer and 34 patients with gynaecological cancer before the onset of therapy. Chromosomal aberrations were scored in lymphocytes irradiated in the G(0) or G(2) phase of the cell cycle. DNA repair kinetics was performed with the alkaline comet assay following irradiation of unstimulated lymphocytes. The results were compared with the severity of early and late side effects to radiotherapy.Results: No correlation was observed between the results of the assays and the severity of side effects. Moreover, each assay identified different patients as radiosensitive.Conclusions: There is no simple correlation between the in vitro sensitivity of lymphocytes and the risk of developing early and late side effects.
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| 10. |
- Tagliaferri, Luca, et al.
(författare)
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ENT COBRA (Consortium for Brachytherapy Data Analysis) : interdisciplinary standardized data collection system for head and neck patients treated with interventional radiotherapy (brachytherapy)
- 2016
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Ingår i: Journal of Contemporary Brachytherapy. - : Termedia Publishing House Ltd.. - 1689-832X .- 2081-2841. ; 8:4, s. 336-343
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Forskningsöversikt (refereegranskat)abstract
- Purpose: Aim of the COBRA (Consortium for Brachytherapy Data Analysis) project is to create a multicenter group (consortium) and a web-based system for standardized data collection.Material and methods: GEC-ESTRO (Groupe Europeen de Curietherapie - European Society for Radiotherapy & Oncology) Head and Neck (H&N) Working Group participated in the project and in the implementation of the consortium agreement, the ontology (data-set) and the necessary COBRA software services as well as the peer reviewing of the general anatomic site-specific COBRA protocol. The ontology was defined by a multicenter task-group.Results: Eleven centers from 6 countries signed an agreement and the consortium approved the ontology. We identified 3 tiers for the data set: Registry (epidemiology analysis), Procedures (prediction models and DSS), and Research (radiomics). The COBRA-Storage System (C-SS) is not time-consuming as, thanks to the use of "brokers", data can be extracted directly from the single center's storage systems through a connection with "structured query language database" (SQL-DB), Microsoft Access, FileMaker Pro, or Microsoft Excel. The system is also structured to perform automatic archiving directly from the treatment planning system or afterloading machine. The architecture is based on the concept of "on-purpose data projection". The C-SS architecture is privacy protecting because it will never make visible data that could identify an individual patient. This C-SS can also benefit from the so called "distributed learning" approaches, in which data never leave the collecting institution, while learning algorithms and proposed predictive models are commonly shared.Conclusions: Setting up a consortium is a feasible and practicable tool in the creation of an international and multi-system data sharing system. COBRA C-SS seems to be well accepted by all involved parties, primarily because it does not influence the center's own data storing technologies, procedures, and habits. Furthermore, the method preserves the privacy of all patients.
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