CT-gesteuerte Brachytherapie

Ricke, Jens; Wust, Peter; Stohlmann, Anna; Beck, Alexander; Cho, Chie Hee; Pech, Maciej; Wieners, Gero; Spors, Birgit; Werk, Michael; Rosner, Christian; Hänninen, Enrique Lopez; Félix, R.

doi:10.1007/s00066-004-1179-4

Cited by 38 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(1) safety for the patient, clinicians, and the operating room (OR) staff and equipment, (2) ease of cleaning and decontamination, (3) compatibility with sterilization of components, (4) methods for the clinician to review and approve the planned dose distribution and planned robot motions before needle placement, (5) visual (mandatory) and force (optional) feedback during needle insertion, (6) visual confirmation by the chosen imaging technique of each needle-tip placement and seed deposition, (7) provision for reverting to conventional manual brachytherapy at any time, (8) quick and easy disengagement in case of emergency, (9) robust and reliable operation, and (10) ease of operation in the procedure environment.…”

Section: Robotic Systems For Brachytherapymentioning

confidence: 99%

“…For example, one of the brachytherapy robots described in this report has been used for lung cancer, and clinical investigations are under consideration for other sites such as liver. [5][6][7][8] In the last decade, there have been significant increases in the use of robotic systems and automation tools in brachytherapy. Several groups have adapted and integrated such systems and tools into conventional brachytherapy procedures, with the shared goals of achieving higher precision and accuracy in seed placement, improving dose distributions, minimizing surgical trauma, and further reducing radiation exposure to staffs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

AAPM and GEC‐ESTRO guidelines for image‐guided robotic brachytherapy: Report of Task Group 192

et al. 2014

View full text Add to dashboard Cite

In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy & Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3-6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests should mimic the real operating procedure as closely as possible. Additional recommendations on robotic brachytherapy systems include display of the operational state; capability of manual override; documented policies for independent check and data verification; intuitive interface displaying the implantation plan and visualization of needle positions and seed locations relative to the target anatomy; needle insertion in a sequential order; robot-clinician and robot-patient interactions robustness, reliability, and safety while delivering the correct dose at the correct site for the correct patient; avoidance of excessive force on radioactive sources; delivery confirmation of the required number or position of seeds; incorporation of a collision avoidance system; system cleaning, decontamination, and sterilization procedures. These recommendations are applicable to end users and manufacturers of robotic brachytherapy systems. C 2014 American Association of Physicists in Medicine.[http://dx

show abstract

Section: Robotic Systems For Brachytherapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

AAPM and GEC‐ESTRO guidelines for image‐guided robotic brachytherapy: Report of Task Group 192

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Stratification in micrometastases at a distance of < 9 mm, 9-15 mm and > 15 mm revealed significance for the threshold dose only for nearby lesions compared to the very distanced lesions, a phenomenon which we attribute to the decreasing cell density of remote micrometastases as has been proven by histopathology [13,16]. In contrast to this, in CT-guided brachytherapy the dose gradient outside the CTV typically shows a strong decline to approximately 25% of the dose at a distance of 2 cm [32]. We conclude that our results gained by employing the negative proof are statistically very consistent and thus demonstrated their validity for the determination of the threshold dose to prevent recurrent micrometastasis growth.…”

Section: Discussionmentioning

confidence: 98%

Safety margin in irradiation of colorectal liver metastases: assessment of the control dose of micrometastases

et al. 2010

Self Cite

View full text Add to dashboard Cite

BackroundMicrometastases of colorectal liver metastases are present in up to 50% of lesions. In this study we sought to determine the threshold dose for local control of occult micrometastases in patients undergoing CT (computed tomography)-guided brachytherapy of colorectal liver metastases.Materials and methodsNineteen patients demonstrated 34 local tumor recurrences originating from micrometastases after CT-guided brachytherapy of 27 colorectal liver metastases. We considered a local tumor recurrence as originating from a micrometastasis if tumor regrowth occurred adjacent to a formerly irradiated lesion and the distance of the 3D isocenter of the new lesion was ≤ 23.5 mm from the previous tumor margin. Follow-up MRI was fused with the planning-CT and dosimetry data. Two reviewers independently indicated the dose exposure at the isocenter of the micrometastases. Statistical analysis included an analysis of variance (ANOVA) using backward selection. 95% tolerance intervals with coverage of 87.5 and 75% of the data of the normal distribution were calculated.ResultsThe median distance of the micrometastases to the margin of the originating colorectal metastases was 8.75 mm (1-21 mm). Dose exposure at the isocenter was 12.25 Gy (7-19.8) in median. We stratified according to the distance from the isocenter to the initial tumor margin: ≤ 9 mm, > 9-15 mm and > 15 mm. The median dose in the according isocenters was 13.18, 11.6 and 11.85 Gy. The threshold dose failing to prevent micrometastasis growth was sigificantly higher in a subgroup of lesions with ≤ 9 mm distance as compared to > 15 mm (13.18 vs 11.85 Gy). Adjuvant chemotherapy correlated with greater distance of micrometastasis growth to the tumor but not with the threshold dose.ConclusionTo prevent loss of local tumor control by continuous growth of micrometastases a threshold dose of 15,4 Gy (single fraction) should be delivered at a distance of 21 mm to the gross tumor margin.

show abstract

“…The best prescription dosage of radioactive 125 I seed interstitial implantation for HCC and the best radioactivity of seed are still controversial. Ricke J, et al [9-11] thought that the mean minimal dose inside the liver tumor margin amounted to 17-18Gy (range, 10-25Gy); Zhang FJ, et al [12] described that 125 I seeds of the radioactivity of 30 MBq, MPD was 100 approximately 150 Gy. These reports strongly support the importance of reasonable MPD in inducing tumor regression.…”

Section: Discussionmentioning

confidence: 99%

125I Radioactive Seeds Implantation Therapy for Hepatocellular Carcinoma

Cao

Zhu

2009

Gastroenterol Res

View full text Add to dashboard Cite

BackgroundThis study was to evaluate the outcome and the prognostic factors of unresectable hepatocellular carcinoma (HCC) patients with 125I radioactive seeds implantation, who had failed transcatheter arterial chemoembolization (TACE).MethodsFrom September 2002 to March 2006, 48 patients with unresectable HCC underwent 125I permanent implantation brachytherapy. Thirty-eight patients were male and 10 were female. Mean age was 59 years, ranginging from 32 to 86. Karnofsky performance status(KPS) was 100 in 10 patients, 80 in 21 patients, and 60 in 17 patients. According to Child-Pugh classification of liver, 34 patients were in class A and 14 patients in class B. Twenty-two patients had alpha-fetoprotein (AFP) level > 400 ng/ml. Tumor size was < 5cm in 17 patients, 5-10 cm in 18 patients, and > 10cm in 13 patients. Thirty-four patients had confluent tumors, 14 patients presented single hepatic tumor. Serum hepatitis antigen markers were positive for type B in 38 patients and type C in 10 patients. Twenty-two patients had Okuda Stage I, 24 patients Stage II, and 2 patients Stage III. According to the AJCC staging system (6th edition), 10 patients were in Stage II (T2N0M0), 20 in Stage IIIa (T3N0M0) and 18 in Stage IIIb (T4N0M0).ResultsAn objective response was observed in 34 of 48 patients, giving a response rate of 70.8%. The survival rates at 1, 2 and 3 years were75%, 45.8% and 27.1%, respectively. In the analysis of prognostic factors, tumor type, tumor size, Okuda stage, AJCC stage, Liver Child-Pugh, pretreatment AFP level, and matched peripheral dose (MPD) all had significant impact on survival.ConclusionsThe 125I permanent implantation brachytherapy induced a substantial tumor response rate of 70.8% with survival rates at 1, 2 and 3 years of 75%, 45.8% and 27.1%, respectively, and a median survival time of 15.5 months in patients with unresectable HCC who had failed TACE. The complications are acceptable and can be managed with conservative treatment. Although we do not know whether there is a survival benefit through the use of this treatment, 125I permanent implantation brachytherapy seems to be a practical method of salvage for this subset of patients. Further study is warranted to evaluate the survival of such patients with controlled trial.

show abstract

CT-gesteuerte Brachytherapie

Abstract: CT-guided brachytherapy is safe and effective. This technique displays broader indications compared to image-guided thermal ablation by radiofrequency or LITT with respect to tumor size or localization.

Cited by 38 publications

References 23 publications

AAPM and GEC‐ESTRO guidelines for image‐guided robotic brachytherapy: Report of Task Group 192

AAPM and GEC‐ESTRO guidelines for image‐guided robotic brachytherapy: Report of Task Group 192

Safety margin in irradiation of colorectal liver metastases: assessment of the control dose of micrometastases

125I Radioactive Seeds Implantation Therapy for Hepatocellular Carcinoma

Contact Info

Product

Resources

About