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Image-guided high-dose-rate brachytherapy: preliminary outcomes and toxicity of a joint interventional radiology and radiation oncology technique for achieving local control in challenging cases.

Kishan AU, Lee EW, McWilliams J, Lu D, Genshaft S, Motamedi K, Demanes DJ, Park SJ, Hagio MA, Wang PC, Kamrava M - J Contemp Brachytherapy (2015)

Bottom Line: Six patients died from their disease at a median interval of 6.85 months from the end of treatment.There were no grade ≥ 3 acute toxicities but two patients had serious long term toxicities.These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To determine the ability of image-guided high-dose-rate brachytherapy (IG-HDR) to provide local control (LC) of lesions in non-traditional locations for patients with heavily pre-treated malignancies.

Material and methods: This retrospective series included 18 patients treated between 2012 and 2014 with IG-HDR, either in combination with external beam radiotherapy (EBRT; n = 9) or as monotherapy (n = 9). Lesions were located in the pelvis (n = 5), extremity (n = 2), abdomen/retroperitoneum (n = 9), and head/neck (n = 2). All cases were performed in conjunction between interventional radiology and radiation oncology. Toxicity was graded based on CTCAE v4.0 and local failure was determined by RECIST criteria. Kaplan-Meier analysis was performed for LC and overall survival.

Results: The median follow-up was 11.9 months. Two patients had localized disease at presentation; the remainder had recurrent and/or metastatic disease. Seven patients had prior EBRT, with a median equivalent dose in 2 Gy fractions (EQD2) of 47.0 Gy. The median total EQD2s were 34 Gy and 60.9 Gy for patients treated with monotherapy or combination therapy, respectively. Image-guided high-dose rate brachytherapy was delivered in one to six fractions. Six patients had local failures at a median interval of 5.27 months with a one-year LC rate of 59.3% and a one-year overall survival of 40.7%. Six patients died from their disease at a median interval of 6.85 months from the end of treatment. There were no grade ≥ 3 acute toxicities but two patients had serious long term toxicities.

Conclusions: We demonstrate a good one year LC rate of nearly 60%, and a favorable toxicity profile when utilizing IG-HDR to deliver high doses of radiation with high precision into targets not readily accessible by other forms of local therapy. These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves for local control and overall survival. The numbers at risk are shown at the bottom of the plot
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Figure 0002: Kaplan-Meier curves for local control and overall survival. The numbers at risk are shown at the bottom of the plot

Mentions: Six patients had local failures. The median time to local failure was 4.07 months (range: 1.0-23.2); among patients without local failure, the median imaging follow-up was 6.92 months (range: 3.47-28.47). Five patients had distant progression or developed new metastases after IG-HDR, at a median interval of 2.17 months (range: 1.03-11.67). Six patients died from their disease, with a median interval of 6.85 months (range: 4.50-23.17). Two of these patients had no metastases at the time of death, while three had metastatic disease at presentation and one developed metastatic disease after IG-HDR, Kaplan-Meier curves of LC and overall survival are shown in Figure 2, demonstrating a one-year LC rate of 59.3% and a one-year overall survival of 40.7%.


Image-guided high-dose-rate brachytherapy: preliminary outcomes and toxicity of a joint interventional radiology and radiation oncology technique for achieving local control in challenging cases.

Kishan AU, Lee EW, McWilliams J, Lu D, Genshaft S, Motamedi K, Demanes DJ, Park SJ, Hagio MA, Wang PC, Kamrava M - J Contemp Brachytherapy (2015)

Kaplan-Meier curves for local control and overall survival. The numbers at risk are shown at the bottom of the plot
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663208&req=5

Figure 0002: Kaplan-Meier curves for local control and overall survival. The numbers at risk are shown at the bottom of the plot
Mentions: Six patients had local failures. The median time to local failure was 4.07 months (range: 1.0-23.2); among patients without local failure, the median imaging follow-up was 6.92 months (range: 3.47-28.47). Five patients had distant progression or developed new metastases after IG-HDR, at a median interval of 2.17 months (range: 1.03-11.67). Six patients died from their disease, with a median interval of 6.85 months (range: 4.50-23.17). Two of these patients had no metastases at the time of death, while three had metastatic disease at presentation and one developed metastatic disease after IG-HDR, Kaplan-Meier curves of LC and overall survival are shown in Figure 2, demonstrating a one-year LC rate of 59.3% and a one-year overall survival of 40.7%.

Bottom Line: Six patients died from their disease at a median interval of 6.85 months from the end of treatment.There were no grade ≥ 3 acute toxicities but two patients had serious long term toxicities.These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: To determine the ability of image-guided high-dose-rate brachytherapy (IG-HDR) to provide local control (LC) of lesions in non-traditional locations for patients with heavily pre-treated malignancies.

Material and methods: This retrospective series included 18 patients treated between 2012 and 2014 with IG-HDR, either in combination with external beam radiotherapy (EBRT; n = 9) or as monotherapy (n = 9). Lesions were located in the pelvis (n = 5), extremity (n = 2), abdomen/retroperitoneum (n = 9), and head/neck (n = 2). All cases were performed in conjunction between interventional radiology and radiation oncology. Toxicity was graded based on CTCAE v4.0 and local failure was determined by RECIST criteria. Kaplan-Meier analysis was performed for LC and overall survival.

Results: The median follow-up was 11.9 months. Two patients had localized disease at presentation; the remainder had recurrent and/or metastatic disease. Seven patients had prior EBRT, with a median equivalent dose in 2 Gy fractions (EQD2) of 47.0 Gy. The median total EQD2s were 34 Gy and 60.9 Gy for patients treated with monotherapy or combination therapy, respectively. Image-guided high-dose rate brachytherapy was delivered in one to six fractions. Six patients had local failures at a median interval of 5.27 months with a one-year LC rate of 59.3% and a one-year overall survival of 40.7%. Six patients died from their disease at a median interval of 6.85 months from the end of treatment. There were no grade ≥ 3 acute toxicities but two patients had serious long term toxicities.

Conclusions: We demonstrate a good one year LC rate of nearly 60%, and a favorable toxicity profile when utilizing IG-HDR to deliver high doses of radiation with high precision into targets not readily accessible by other forms of local therapy. These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC.

No MeSH data available.


Related in: MedlinePlus