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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 clinical course for patient 1 is shown pictorially. On the left is the gross disease present at the time of IG-HDR treatment. Tumor burden 4.5 months after treatment is shown in the middle. Unfortunately, the patient had subsequent progression, resulting in bulky local recurrence, shown on the right at one year following IG-HDR
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Figure 0004: The clinical course for patient 1 is shown pictorially. On the left is the gross disease present at the time of IG-HDR treatment. Tumor burden 4.5 months after treatment is shown in the middle. Unfortunately, the patient had subsequent progression, resulting in bulky local recurrence, shown on the right at one year following IG-HDR

Mentions: With regards to chronic toxicity, one patient developed pelvic-cutaneous and vesico-perineal fistulas. Before IG-HDR was performed, the patient had prior chemoradiation and an abdominoperineal resection procedure, followed by adjuvant chemotherapy; at the time of IG-HDR, he had a bulky, painful local recurrence (Figure 4A). Subsequent to IG-HDR, he had a significant clinical response, with improvement in pain and significant reduction in tumor burden (Figure 4B). Unfortunately, he subsequently developed a bulky, painful local recurrence after his initial response, and it was at this point that the fistulization manifested (Figure 4C). The patient also began to receive bevacizumab infusions as a component of systemic therapy one month after IG-HDR, which may have also contributed to his fistula formation [34]. Another patient developed chronic grade 1 lower extremity weakness as well as bone necrosis. She had a history of EBRT to the pelvis and due to progressive disease after IG-HDR, she underwent a second course 2.93 months later. Both patients had bulky local recurrences that likely contributed to these sequelae.


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 clinical course for patient 1 is shown pictorially. On the left is the gross disease present at the time of IG-HDR treatment. Tumor burden 4.5 months after treatment is shown in the middle. Unfortunately, the patient had subsequent progression, resulting in bulky local recurrence, shown on the right at one year following IG-HDR
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0004: The clinical course for patient 1 is shown pictorially. On the left is the gross disease present at the time of IG-HDR treatment. Tumor burden 4.5 months after treatment is shown in the middle. Unfortunately, the patient had subsequent progression, resulting in bulky local recurrence, shown on the right at one year following IG-HDR
Mentions: With regards to chronic toxicity, one patient developed pelvic-cutaneous and vesico-perineal fistulas. Before IG-HDR was performed, the patient had prior chemoradiation and an abdominoperineal resection procedure, followed by adjuvant chemotherapy; at the time of IG-HDR, he had a bulky, painful local recurrence (Figure 4A). Subsequent to IG-HDR, he had a significant clinical response, with improvement in pain and significant reduction in tumor burden (Figure 4B). Unfortunately, he subsequently developed a bulky, painful local recurrence after his initial response, and it was at this point that the fistulization manifested (Figure 4C). The patient also began to receive bevacizumab infusions as a component of systemic therapy one month after IG-HDR, which may have also contributed to his fistula formation [34]. Another patient developed chronic grade 1 lower extremity weakness as well as bone necrosis. She had a history of EBRT to the pelvis and due to progressive disease after IG-HDR, she underwent a second course 2.93 months later. Both patients had bulky local recurrences that likely contributed to these sequelae.

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