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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

The image-guided high-dose-rate (IG-HDR) plan for patient 4 (shown on the left) is compared to a twomonth follow-up scan on the right, demonstrating growth of a lesion on the lateral surface of the ischium and eroding through the bone into the pelvic sidewall. At the time of presentation for IG-HDR, disease was only visible medial to the ischium, and hence the bone itself was not targeted. The color code for the isodose colorwash is as follows: magenta, 200%; orange, 150%; yellow, 110%; dark blue, 100%; green, 90%, light blue, 85%
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Figure 0003: The image-guided high-dose-rate (IG-HDR) plan for patient 4 (shown on the left) is compared to a twomonth follow-up scan on the right, demonstrating growth of a lesion on the lateral surface of the ischium and eroding through the bone into the pelvic sidewall. At the time of presentation for IG-HDR, disease was only visible medial to the ischium, and hence the bone itself was not targeted. The color code for the isodose colorwash is as follows: magenta, 200%; orange, 150%; yellow, 110%; dark blue, 100%; green, 90%, light blue, 85%

Mentions: Among patients who had LC, eight had stable disease and four had partial responses. Three of the patients who had local failures appear to have had “marginal misses”, wherein disease progressed towards the edge of the 100% isodose line (an example is shown in Figure 3). Times to local failure were 1.03 and 2.87 months, respectively; two of these patients had repeat IG-HDR. One patient had a local failure (third recurrence overall) in 2.57 months and was treated with systemic therapy; she remains alive. The second had a local failure (third recurrence overall) in 8.37 months and passed away 2.47 months later.


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)

The image-guided high-dose-rate (IG-HDR) plan for patient 4 (shown on the left) is compared to a twomonth follow-up scan on the right, demonstrating growth of a lesion on the lateral surface of the ischium and eroding through the bone into the pelvic sidewall. At the time of presentation for IG-HDR, disease was only visible medial to the ischium, and hence the bone itself was not targeted. The color code for the isodose colorwash is as follows: magenta, 200%; orange, 150%; yellow, 110%; dark blue, 100%; green, 90%, light blue, 85%
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: The image-guided high-dose-rate (IG-HDR) plan for patient 4 (shown on the left) is compared to a twomonth follow-up scan on the right, demonstrating growth of a lesion on the lateral surface of the ischium and eroding through the bone into the pelvic sidewall. At the time of presentation for IG-HDR, disease was only visible medial to the ischium, and hence the bone itself was not targeted. The color code for the isodose colorwash is as follows: magenta, 200%; orange, 150%; yellow, 110%; dark blue, 100%; green, 90%, light blue, 85%
Mentions: Among patients who had LC, eight had stable disease and four had partial responses. Three of the patients who had local failures appear to have had “marginal misses”, wherein disease progressed towards the edge of the 100% isodose line (an example is shown in Figure 3). Times to local failure were 1.03 and 2.87 months, respectively; two of these patients had repeat IG-HDR. One patient had a local failure (third recurrence overall) in 2.57 months and was treated with systemic therapy; she remains alive. The second had a local failure (third recurrence overall) in 8.37 months and passed away 2.47 months later.

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